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Dr. Jean Deveze During the 1793 Epidemic

Deveze's history of the 1793 epidemic is not difficult to find in good microfilm collections, but I will copy generous excerpts of it here since a better understanding of what Deveze did is crucial to understanding Rush's performance during the decade of epidemics. Most historians paint Deveze as by far the doctor who by modern standards treated his patients with the greater humanity and knowledge. Yet Deveze did not by any means eclipse Rush in the eyes of contemporaries. Being French and a refugee from Haiti, of course, made it difficult for Deveze to influence opinion in Philadelphia, but he had native American doctors in his corner, as well as influential laymen.

His memoir of the epidemic was written in French and printed with an English translation on the facing page. The most interesting part of it is a section in which he gives case histories. So to begin, I will copy his introductory passages and then go right to the case histories. As time permits I fill in the rest, emphasizing those parts that both contrast with Rush and contradict the historical view of Deveze. Also to make it easier to skim through this (I have no index or search function,) I will print his remedies in red. Since Rush is also faulted for his dogmatism and shameless bragging, I will highlight in green sentences in Deveze's memoir that show the same weakness. (For my brief discussion of Deveze's work, see Chapter Six, beginning at footnote 16.)

An

Enquiry

into, and

Observations

Upon the Causes and Effects of the the

Epidemic Disease

Which raged in Philadelphia from the month of August till towards the middle of December 1793

A few days after my arrival at Philadelphia, the seventh of August, 1793, it was reported many persons had lost their lives in consequence of a sore throat.

The rapid progress of the disease gave reason to suppose, it had some contagious property annexed to it; the death of many persons in the same quarter, and nearly at the same time, so far gave sanction to this opinion, that it was proved to a certainty to be very dangerous to approach those who were attacked with it.

The month of August had nearly elapsed before I had an opportunity of inspecting into the nature of this complaint, when I attended a girl about six or eight and twenty years of age, servent to Mr. Bohlen, merchant in North Water-street. She was very robust and of a sanguine habit; the family physician, a respectable and well-informed practitioner, judging the case unfavourable, and supposing she would probably share the fate that had attended many of his patients, called in and engaged me, in case she sunk under it, to open the body, and endeavour to find out the case of so fatal a malady.

I went with him to Mr. Bohlen's. We found the patient in extreme agitation, face red, eyes sparkling, skin dry and hot, tongue and lips also dry and red, the amygdale glands swelled, the uvula, palate, and inside of the throat inflamed; she swallowed with great difficulty and spoke with pain; respiration was strong, head and throat painful, pulse hard and frequent.

From these indication I proposed bleeding - the physician consented, and I immediately performed the operation, and prescribed lemonade and a gargle made with water and oxymel, or one of honey and spirit of vitriol. It was also agreed the patient should make use of the bath. On our return the next day she was infinitely better; the pulse had unfolded, and she spoke with more ease. As the fever continued, the heat was considerable, and the blood taken the preceding day indicated great inflammation. I proposed a second bleeding, which was performed by the consent of the physician. She was desired to continue the gargle and lemonade, to take creamed of barley or rice, a light mucilaginious diet, such as sago, tapioca, and the like. The next day we found she had quitted her bad, was in good spirits, without fever, and had no farther occason for medical assistance. We advised her to take a common cathartic. I saw her no more, but heard her health was perfectly re-established, and she has not since felt the slightest indisposition.

I could cite many other cases of a similar nature, having seen and visited an infinite number of persons attacked with the same disease, and had the happiness not to lose any, except a child that was placed under my care at the last extremity.

Let it not be supposed, these observations are made as an apology for bleeding. I acknowledge having cured many without that help; although it was generally requisite, have often observed symptoms which forbid its use. I then substituted glysters, gargles, baths, lemonade, chicken water, skimmed milk, emulent, simples, and sedatives, and even sometimes used them in conjunction with the lancet.

If in the beginning of this unfortunate malady, recourse had been had to a similar treatment, I am convinced it would seldom have proved mortal.

But an ill-directed public often acted contrary to what was efficacious. The diseased were carefully shut up in close rooms, and covered with three or four blankets; their beverage was infusions of camomile, Madeira wine, and other inflammatory liquors, which increasing the disease brought the patients to extremity, having produced mortification and over-charged the brain. After death, the victim of this fatal practice had a livid appearance, and the vessels of the head and brain were in the same state as those who with with a fit of the apoplexy.

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Page 75

First Observation

A man between thirty-six and thirty-eight years of age, middle sized, bilious temperament, hair and beard black, was admitted into Bush-hil hospital on the 29th of September 1793. He could not say how many days he had been ill, but was informed the first or second day of the fever he had taken a drastic medicine, composed of jalap and calomel. The tongue and lips were very black and dry, respiration painful, and extremities cold; he threw up with violence all he took, his belly was hard and painful, the abdominal muscles were is such a state of contraction as to flatten the belly in a manner that it almost touched the backbone; the faeces were black, of an ill smell, and mixed with blood; the urine in small quantity, also black and foetid; in short, the pulse was concentrated, and the tendons convulsed. I had blisters applied, and hot bricks to the extremities. I endeavoured to get some remedy down his throat, but in vain; nature was so weakened art could not re-animate him. He died in the night of the 1st of October. The second I opened his body and found:

The membranes of the brain in their natural state; the sinews of the duramater contained a very little black blood; the brain firm, the curtical substance less red than it should have been, the medulla substance too white, the ? artery and plexus choroides discoloured and almost white, the ventricle scarcely containy any serosity.

The lungs in their natural state, the pericardium containing very little serosity, the heart withered and wrinkles, absolutely not containing any thing, pale, appearing as if it had been washed and of a flabby consistency.

The stomach a little contracted in thickness double what it ought to be, the internal membrane partly destroyed, what remained was red and inflamed. the duodenum and almost all the whole intestinal canal in the same situation, what remained of the internal membranes appeared blocked in proportion as I apporached the larger intestines, the passages were lined with a black, glairous, bloody matter of a faetid smell; the liver, gall bladder, pancreas, and kidneys in a natural state. In opening the liver I found a small quantity of black blood, the spleen black, withered, and of a consistence less firm than its natural state; the mesentery black towards the spine, its membranes having opened formed a bag, that was filled with blood extremely black; that, contained in the largest abdominal veins was of the same color; in short, the bladder was contracted , and contained but a small quantity of black faetid urine, and the internal membrane was spotted with a brown color.

Second Observation

The first of October, a man about thirty-three years of age was admitted into the hospital. He was insensible, cold, and almost without pulse; his mouth half open, and full of black blood; his respiration low, quick, and interrupted; his body deep yellow. Those who accompanied him told me, in answer to my questions, that he had been ill some days, but did not say how many, and that he had taken many medical powders similar to the preceding patient.

Every method I made use of to re-animate the vital powers, were useless; the patient died during the night. The second I opened him; the head shewed nothing different from the preceding body.

The lungs even appeared in their natural state, except some adhesions, but they were old and were found between the pleura and the right lobes.

The pericardium contained a little serous matter of a deep yellow; the heart withered, empty, and the right auricle full of very black blood.

The stomach, which I found more than double its natural thickness, contained also, as well as the intestinal canal, black blood, and bile also black, sometimes mixed together, and sometimes separate, the internal membrane of these parts almost entirely destroyed, the little that remained was mortified, detached, and floating in matter; the mesentary, towards the intestines, was inflamed; the glands very much swelled and black; it contained yellow pus between its two membranes near the spine; the gall bladder was empty, the liver, spleen, and veins in their natural state; the pancreas, hard and inflamed, was about twice as large as it ought to be; the urine was black and faetid; the internal membrane of the bladder mortified.

Third Observation

A man, thirty-four years of age, of a sanguine and robust habit, accustomed to drinking, fell sick the 11th of October, after a debauch in which he had drank brandy to excess. I saw him at the hospital the first day of the disease; he had a burning heat, his skin was hot and dry, his face the colour of crimson, his eyes sparkling, he was extremely thirsty, his tongue very dry and covered with a fir that was pale yellow, his respiration high and difficult, he vomited with violent straining green and yellow bile, his pulse was hard and tight, he complained of pains in the epigastric region, and in the head.

I had him bled in the arm, and ordered clysters made with a decoction of flax seed, a bath, and lemonade with nitre. In the afternoon, find the symptoms not diminished, I had him bled again.

The day after, being the Second, I had him twice bled, and prescribed the same remedy, but he threw up every liquid.

The third day he experienced lassitude, his pulse became intermittent, his eyes and skin yellow, his stools were glastrous, mixed with blood, the abdomen was neither extended nor painful, the little urine that came up from him was bloody. In short, he vomited green and yellow matter, mixed with blood.

In this melancholy situation I gave him water acidulated with dulcified spirits of nitre, and gave order at the same time to change the drink according to his fancy; they gave that he wished, but he vomited every thing immediately, and nothing could remain on his stomach.

The fourth he experienced weakness, and the whole body was of a deep yellow, the extremities became cold, the pulse little and intermittent, his respiration more difficult, the faeces continued to be marked with a glaucous bloody matter, and strength wore away by degress; in short he died on the 15th of October, the beginning of the fifth day. He preserved his senses to the last.

By the opening of his body I found that the serocity contained in the ventricle of the brain was very yellow; the rest of the head offered nothing remarkable.

The lungs on the outward part were covered with black spots; in dividing them I found they were gorged with a black frothy blood; the humour of the pericardium was yellow, the heart absolutely empty, its right auricle contained black blood.

The stomach was extended by the air it contained, it was almost double the thickness it ought to be, and contained clots of black blood; the internal membrane was inflammed but unequally, the red was in some places brighter than others, that of the duodenum and other intestines were in the same situation; clots of black blood and glairous matter of the same colour lined the intestinal canal; the vessels of the mesentery were choaked and also contained black blood.

The bladder contained a little bloody urine, and the internal membrane was very much inflamed.

Fourth Observation

The 15th of October I saw a young man at the hospital, about twenty-six years of age. He was brought the evening before, and had been sick five days, druing which he had taken three doses of drastic powders, composed of jalap and calomel. He was of a bilious temperament, small made and had chestnut coloured hair.

He had a great deal of fever, his skin was burning hot, breathing difficult, tongue dry and very red, he was very thirsty, and made many efforts to vomit; he had violent pains in the abdomen, instead of faeces pure blood came from him, his pulse was strong and frequent, he made some few drops of urine, with great pain, and of a deep colour.

I ordered him lemonade with nirtre, a simple ? emolient clysters, cataplasms on the lower belly, and had him bled three times in the course of the day.

The 16th I saw no other change than the weakness he felt on going to stool; every thing he swallowed instantly came up again with most violent and painful efforts; his beverage returned from his stomach mixed with blood. I tried many methods to stop the vomiting, but in vain, he was in continual agitation till death, wished to lie on the ground, and said he had a fire burning within him; these agitations terminated in weakness, which carried him off the 18th, at the end of the seventh day.

On opening his body I made the following observations: the corridal plexus was not as high coloured as in its natural state, the brain was firm, and the ventricles without serosity, the sinuses of the duramater contained very little blood, but of a brown-red colour; the right lobes of the lungs were much inflamed, the left in a natural state, no serosity in the pericardium, the heart was empty, its right auricle contained a clot of blood that did not stick to it; when I took it out I saw another that followed and came from the vena cava inferior; it was three inches long, and of two colours; the part that answered to the exterior of the auricle white and resembled the blood of those who have the pleurisy; the rest, as well as what came out of the vena cava, was a red brown;... the stomach contained blood, as well as the intestines, the internal membrane was much inflamed, the pylorus mortified, and the intestines had inflammatory and gangrenous spots; the liver white on the outside was gorged with very black blood, the spleen appeared in its natural state, the pancreas hard and inflamed, the bladder which I found in its natural state contained a very little red blood.

Fifth Observation

A woman, about thirty-four years of age, robust, of a sanguine habit, and that had been sick about six days, entered the hospital the 4th of October. She told me the first day she was ill she had taken two doses of drastic powders, which took no effect; she was very red and violently oppressed; her pulse intermittent, hard, and tight; her tongue red and dry, she was peculiarly thirsty, her skin hot, she felt a pain and tightness in the left hypochondria, she was uneasy and could not remain long in the same place. I had her bled in the arm and gave her lemonade acidulated with dulcified spirits of nitre; also prescribed emollient glysters and a bath.

In the afternoon, the same symptoms remained; the blood that had been taken from her was absolutely without serosity. I ordered a second bleeding, which could not take place on account of an extreme faintness, that seized her at the moment the surgeon was about to open the vain; he had even much difficulty in bringing her to again; it seized her every time she ? to dring. The 16th I found her insensible, and she died shortly after. The 17th I opened her body and found: [I'll copy this later.]

Sixth Observation

A man about fifty years of age, of a bilious temperament, hair and beard grey, came into the hospital the 21st of October. He told me he had felt great weakness for some time, and had been very ill about six weeks previous. He was very weak, his pulse slow, and almost in its natural state; said he had occasion for food, and asked for something to eat. I gave him soup, and for drink Bordeaux wine with water. He reamined in the same state three days, and except the weakness seemed well, and said he felt no pain.

The 31st he was oppressed, his eyes became yellow, and pulse weak. I prescribed him as a remedy, a lincus of water, honey, and styllitic oxymel; and for his common drink, water and honey. The 1st of November the whole body became yellow, his nose bled, his tongue was covered with blood, he spit a great deal in the afternoon, respiration became painful, and the extremities cold; his urine was black, as also the bile he vomited, his pulse became intermittent, he had a palpitation which very much incommoded him. I prescribed a decoction of bark, acidulated with spirits of vitriol, a camphorated cordial draught, and wine with sugar was given in table spoonfuls. The second he was worse; to the symptoms of the preceding day were joined black and bloody faeces; he vomited often, his strength insensibly decreased, and he died on the morning of the third. In the afternoon I opened his body....

Seventh Observation

The 27th of October a man about thirty-eight was brought to the hospital. He was insensible almost without pulse, cold, mouth half open, eyes yellow, open, and fixed.

I had large blisters applied to the legs, and hot bricks to the extremities; I ordred a cordial draught in case he should be able to swallow it; all these means ? operated insensibly; the 30th he recovered his senses and speech, told me he had been ill eight days when brought to the hospital. I found him so well as to give hope of curing him, consequently had him carried from the chamber of the dying into another room. The second, he refused the decoction of the bark which I had ordered, he took creamed rice and diet drinks, he continued tolerably well till the 5th day on which day his pulse became litte and concentrated, the blisters dried up, the extremeties became cold and livid.

I again ordered the decoction of the bark, and a draught, antiputrescent and cordial. I had the blisters dressed with the ungent of storax, his extremities were fomented, but all was useless - the progress of the mortification increased every day, the slough fell from the blisters; the 8th supperation was re-established, the patient took all they gave him, every function was perfect, and he said he felt no pain; he preserved his senses till the 11th, on which day he again became insensible, his pulse intermittent and scarcely perceptible, he had an infectious smell, the breath from his lungs was cold and stinking, he was at length in such a state as to be unable to swallow, he had convulsed motions in the tendons. He died the 12th in the morning; in the afternoon I opened him, and found:....

Eighth Observation

The 17th of November I saw a young man about twenty-five years of age. He had been brought to the hospital the evening before, and told me he had been ill five days; he had a high fever, his skin was burning about the body, though his extremeties had only their usual heat; he complained of a seeming fire in the inside; was thirsty, his tongue and lips black and dry, his respiration laborious and frequent, the breath from the lungs considerably hot, his eyes were very yellow, his person livid and very thin, instead of faeces glairous yellow frothy matter came from him, his urine was red, he threw up all he drank, became worse and died the 19th, the seventh day of his disease. The 20th, I opened his body: the lungs were spotted with red and black, the pericardium contained a little yellow serosity, in the heart was found blood of a pale red colour.

The liver was of an olive green colour, in the interior as well as exterior parts; the gall bladder of an extraordinary size, it floated in the abdomen, extended to the inferior part of the illiac region, and was marbled with black; I took it out with care, and weighed it with the bile it contained; I found it twelve ounces three drachms; the bile when put in a vase was of a green black colour, and of the consistence of white of egg.

The spleen was hard on the outside, the inside resembled conserve of red roses by its consistency and red colour; the stomack was contracted, and did not contain any thing, the internal membrane was slightly inflamed, that of the duodenum in the same state; the intestines contained glairous yellow frothy matter, the internal membrane had spots slightly inflamed; the pancreas hard, red, and rather larger than in it natural state; the internal membrane of the bladder inflamed, the urine extremely red, the mesentery and pyplon contained no fat.

Ninth Observation

A woman, about twenty-eight years of age, robust, and of a sanguine habit, entered the hospital the 30th of September. She was attacked with the fever two days before; her respiration was short, quick, and hot; pulse hard and tight, face red, eyes watery and bright, skin hot and dry; she had pains in the head and epigastrick region, her urine was in small quantity and very red, she vomited white glairous matter of so strong an acid as to set her teeth on edge, her tongue was dry and red, accompanied by excessive thirst.

I prescribed bathing, and bleeding in the arm, which I had repeated in the afternoon, and gave her as a beverage, water mixed with volatile concreted alkali, in each bottle I put ten grains and two ounces of simple syrup.

The next day, being the third, she was affected with the same symptoms, and felt such extreme uneasiness, as to be continually wishing to change her place; the remedies were continued as before, with the addition of ten grains of fat of tartar, and lemon juice, to be taken at the moment of effervescence, and repeated twice a day, also every half hour a grain of camphire, with three grains of nitre in form of a bolus.

In the afternoon she was less agitated; her pulse a little dilated, the vomiting and pain in the epigastrick region ceased about noon; her tongue was moist, and a little white; she complained of pain in the reins [in French "d'une fore douleur aux lombes."] The bolus and alkalised water were continued as before.

The fourth day in the morning, her tongue was ash coloured, and mouth clammy; she had two evacuation of green, bilious, frothy, yellow matter. I prescribed half an ounce of cream of tartar, and two grains of emetic tartar, to be dissolved in a pint of water, and taken in three doses, at the distance of an hour each, observing not to repeat them, if either produced vomiting two or three times. In the afternoon she was without fever, with a moisture on the skin, had taken the whole of the remedy, and vomited five times white glair, mixed with green bile; she had also eight motions.

I ordered strong broth, creamed rice, and for the evening (as she had been deprived of sleep from the time she fell sick) a jalap, composed of fifteen drops of liquid laudanum, four ounces of common water, and an ounce of simple syrup.

The fifth day passed without fever; she took creamed rice, and the usual drink. The following day I gave her a cathartic. The seventh passed without fever. The eighth she again took an opening medicine, and was then sent among the convalescent, where she recovered, and left the hospital in perfect health.

Tenth Observation

The 30th of September I saw a young man, about twenty years of age, of a sanguine habit, who had been ill two days, and was bled at home. His respiration was high, pulse quick and short, face inflamed, eyes sparkling, skin dry and hot; he had pains about the heart and in the head, his tongue was red and dry, he was thirsty, and vomited yellow matter with violence; for some days he had been costive, his urine was red and in small quantity.

I prescribed bathing, emollient clysters, water acidulated with fixed air for common drink, and bolusses of camphire and nitre. The following day, the third of the disease, the symptoms were the same, as was the remedy. The fourth, the symptoms had diminished; his tongue was incrusted but moist, he had a disagreeable taste, and had not vomited since the night; his abdomen was swelled, but not painful. I prescribed an ounce of cream of tartar in water and syrup, which remedy produced five or six evacuations of white gairous matter; in the afternoon he took broth several times. The fifth day he was much agitated, changing his place continually; the symptoms of the third returned with equal violence, and the same remedies were continued.

The sixth day he was much fatigued, had neither slept nor vomited; he had a pain in the loins, that of the head and epigastrick region had left him; the abdomen was swelled but not painful.

The seventh day he was very uneasy, vomited green and yellow bile, and almost all he drank; with the abdomen painful, the head-ache returned, his breath was short and quick, pulse weaker, shewing an approaching state of debility.

In the afternoon he had an evacuation of white and glairous matter, the head ache and vomiting ceased, respiration became easier, which determined me not to apply blisters; but I ordered creamed rice, and wine with sugar to support his strength.

On the eighth he was oppressed; I gave him wine and water, creamed rice, and wine with sugar. The ninth he was much agitated, with the abdomen swelled and painful, he threw up all he drank, his respiration was much confined; about two in the afternoon a bloody flux appeared; it was glairous and of a foetid smell, then the vomiting ceased, respiration became free, and thought he had several evacuations, was not so weak in the morning. The tenth the flux continued.

The eleventh it was more considerable, swelling of the abdomen continued, the pulse and waving and the skin moist.

The twelth and thirteenth passed tolerably well, the flux being less; his tongue was covered with a fir of a dirty white colour.

The fourteenth day passed without fever, I administered three drachms of rhubarb, and two ounces of manna. This medicine had a good effect; the blood totally disappeared after the two first evacuation, the fever also gave way, and did not return.

On the sixteenth he took a similar dose; and on the seventeenth was sent among the convalescent, from whence he went out in perfect health.

Eleventh Observation

The seventeenth of October a man was brought to the hospital, about forty-five years of age. He was insensible, with his mouth open, tongue and teeth black, the body cold, and almost without pulse, respiration was short and slow: he was placed on his arrival in the chamber with the dying. I prescribed an antiputrescent, and cordial draught, ordered hot bricks to his extremities, and wine with sugar to be given him. He remained in the same state till the 19th, when I found the pulse raised, his senses returned, and tongue was moist. He complained of a pain in the genitals, which were much enlarged; the testicles, spermatic cords, and scrotum were much swelled, the latter was covered with blisters and gangrenous spots; the penis was four times as large as it ought to be, and covered with spots like the scrotum; the prepuce formed a phimoses.

I ordered a strong decoction of bark, acidulated with spirits of nitre, a quarter of a glass was taken every hour, and a table spoonful of a camphorated draught taken every half hour; his usual drink was water acidulated with fixed air; his food creamed rice. An emollient cataplasm was put on the genitals.

The 20th I found him much better, but the moritifaction had fixed on the penis. I made an incision as deep as the part would admit, and had the poultices composed with spirits of turpentine, and camphorated spirits of wine; the internal remedies were the same.

The 21st I took away the skin that was loose from the incision of the preceding evening; the part was dressed with the unguent of storax, and cataplasms appled as before upon the testicles. The 22nd the suppuration began; as it gradually augmented the other parts decreased, and assumed their natural size. This patient left the hospital perfectly re-established, after having taken the decoction of bark, and water acidulated with fixed air for a length of time; when he ceased their use the suppuration became bad, and fever returned. His cure was compleated by cathartics, administered in proportion as the suppuration dried up, and the cicatrice formed.

Twelvth Observation

The third of November a young girl between twelve and thirteen was brought to the hospital. She told me she had been ill several days; her eyes and skin were very yellow, the latter dry and of a burning heat; she was thirsty, with a quick pulse, and interrupted perspiration; she had an hemorrage from both mouth and nostrils, the blood from the latter was very red, the drops that fell on the sides of the bason appeared composed of little globules which were not adhesive.

I prescribed a camphorated draught, and for ? drink, water acidulated with fixed air. The following day the heat of the skin diminished, but the other symptoms remained; to the remedies already given, I added a decoction of bark, acidulated with spirits of vitriol; and as the patient was very weak, she had during the day four cups of veal broth, in each of which was ? half a drachm of gum dragant in powder; she also took some spoonfuls of sweetened red wine.

The 9th, she complained of a sore throat. I made her a gargle with a mixture of water, styllitic oxymel, and honey, acidulated with spirits of vitriol. The hemorrage continued with the same force till the 13th, on which day it was more considerable; the 14th it entirely disappeared, as did the other symptoms; the remedies were then laid aside, and she continued to recover. I gave her a cathartic some days after, and sent her to the convalescent from whom she went out perfectly recovered.

Thirteenth Observation

The 27th of September, a young woman, about twenty-six years of age, was brought to the hospital. She was of a phlegmatic constitution, and had a fit of sickness a short time before. She was attacked with the fever in the morning; her skin was dry, tongue and lips in the same state; she felt a lassitude and pain in the epigastick region, she had a difficulty in breathing, and was thirsty; her urine was excor? and small quantity.

I prescribed a cooling antiputrescent draught, and water acidulated with dulcified spirit of nitre, sweetened with simple syrup.

The second she became yellow, and vomited bile of different colours. The third the yellow was deeper, all the symptoms of the second day had increased with violence, the vomiting fatigued her very much; to avoid the pain she refused to drink; at night her tongue was covered with blood. The fourth a quantity came from both mouth and nostrils; she was excessively weak.

The fifth her pusle was low and intermittent, she lost much blood, and was greatly oppressed; her tendons were much convulsed. I ordered blisters to her leg and prescribed decoction of bark acidulated with spirits of vitriol, wine with sugar, and broth with gum dragant, as in the preceding case. In the evening she was senseless, and almost without pulse; she mechanically applied her fingers to her nose, which she pinched, and covered her face with the black blood that came from both mouth and nostrils; her face was entirely yellow, mouth and eyes half open, which gave her a most hideous appearance. I had hot bricks applied to her extremities, which were cold, as also upon the blisters; and ordered a cordial draught to be given in spoonsfuls, when she should be able to swallow.

The sixth I found her better, but her senses were imperfect and ideas confused; she swallowed mechanically all that was put in her mouth; the blisters rose well, and discharged thick pus. I supported her with cordialified tincture of bark, wine, and broth.

The seventh she relapsed, and was as on the fifth; the blisters were covered with a dry gangrenous slough and the hemorrage continued. I found her in a desperate situation, and had her warmed with hot bricks as before.

The eighth, ninth and tenth she was the same, and did not recover her senses till the eleventh; then the mortified slough fell from the blisters, and suppuration was great. She continued the acidulated bark till the twentieth, when the hemorrage ceased; she also used a detergent gargle, to brace and cleanse the inside of the mouth, which was excoriated and covered with little ulcers, her lips were in the same state and swelled. I made use of means to support her strength, gave her cathartics when the blisters dried up, and sent her among the convalscent, where she entirely recovered.

Fourteenth Observation

The third of December, a woman acbout thirty-eight years of age, robust, and of a sanguine habit, had been taken ill the evening before. She had pains in the head and back, her face was red, respiration short and quick, skin dry and of a burning heat, tongue also dry and red; she was thirsty, with a hard and tight pulse, her abdomen painful, but not swelled; she was bled twice that day, had emollient clysters, and chicken water with nitre.

The third day she felt great uneasiness and gastrical pain, she changed her position continually; the fever was very strong, her urine red and in small quantity; she continued the chicken water, to which I added water acidulated with dulcified spirits of nitre.

I found her better on the fourth; her tongue was covered with a white fir, her mouth clammy and bitter; the irritable symptoms appeared calmed. I prescribed half an ounce of cream of tartar, and two gains ot emetic tartar, to be dissolved in two glasses of water, and taken in three doses at the distance of n hour each. She took only two-thirds of this remedy, as she vomited a quantity of green and yellow bile with glairous matter, and had three motions; she took some light broth, and in the afternoon continued the chicken and acidulated water; and in the evening had a clyster.

There was a sensible change on the fifth. On the sixth she was much oppressed; could not lie but sat on the side of the bed; and was much weakened by frequent evacuations of liquid matter. In the afternoon the pulse became low and convulsive. I had blisters applied to her legs, and prescribed draughts composed of four ounces of common water, an equal quantity of rose water, thirty grains of prepared cachoe, an ounce and a half of spiritious cinnamon water, and two ounces of simple syrup. A table spoonful to be taken every half hour.

The seventh she was fatigued and agitated, changing her situation every moment, had pains in her bones, and an oppression so great as to be obliged to sit up in bed; she had a burning skin, and great thirst, took whatever was offered her; her urine was red and in small quantity; she had convulsive motions in the tendons, and the solids were in a state of irritation.

I prescribed a draught of eight ounces of common water, twenty grains of Homberg's sedative salts, thirty-six drops of Hoffman's mineral liquor, and two ounces of simple syrup to be taken by the table spoonful every half hour; the blisters were taken off about four in the afternoon, there was a great deal of pus; the pain in the loins and evacuations ceased, her face was red, she had a violent head-ache and oppression, her nose began to bleed about six in the morning, and her pulse became concentrated. I gave her wine with sugar. At nine o'clock she became cold; hot napkins were applied to her extremities, and she swallowed some spoonfuls of a cordial draught, which was occasionally repeated till morning.

The next day, being the eighth, the patient was so bad as to be almost without pulse, was forced to press very close to feel it, it was intermittent; she had convulsive motions in the tendons, and had not recovered any warmth; her respiration was difficult, and the hemorrage violent; her tongue was moist, and she was extremely weak.

I prescribed a decoction of four ounces of red bark in a pint of water, and added to it twenty drops of spirits of nitre, She took two table spoonfuls of this remedy every hour, and in the intervals red wine with sugar, broth, and creamed rice, or barley.

Towards elelven o'clock her pulse raised, respiration was easier; the hemorrage continued as before. At four in the afternoon she became weak as in the morning, lost a great deal of blood, and breathed with difficulty; her urine was thick and of the colour of strong beer, it was put in glasses but did not settle; her pulse was scarcely to be felt; her senses continued perfect, though her weakness was so great. When the blisters were drest, they were dry, and covered with gangrenous slough. I had unguent storax applied. She continued the decoction of bark, wine broth and creamed barley.

The morning of the ninth I found her better, the oppression had ceased; but she fainted at four o'clock; the hemorrage was considerable all night, but entirely disappeared in the morning; she had two foetid evacuations in substance; her urine was abundant, and had a cloud in it that did not settle; her skin was humid and of an equal natural heat; she felt easy.

The regimen and remedy of the preceding day were continued. The tenth she was rather stronger, and ? easy in bed, had slept during the night; her pulse was expanded, and fever ceased, a natural heat only ? , the urine was in quantity and thick, as was a white sedimentary deposited; the slough began to detach itself from the blisters; the remedies were continued the same. The eleventh her tongue was firred, and had a disagreeable taste. She had no evacuation from the ninth. I gave her three drachms of glauber's salts, and two ounces of manna, dissolved in two glasses of water, which she took in three doses; the evacuation was great, and consisted of bilious glairous matter of an infectious smell. At night she was without fever, and stronger notwithstanding the great evacuation.

The twelvth passed without accident. She took her food the thirteenth. On the fourteenth the slough was entirely detached; suppuration was abundant, and completed the cure. The patient took an opening medicine after the blisters had dried up. She had no relapse, and was perfectly re-established.

Fifteenth Observation

A man of about fifty years of age, entered the hospital the 29th of September, with a tetanus; his jaw was so very fast locked, it was difficult to put a small spoon between his teeth to give him drink. The disease became worse, he was stiff in every part, and bent backward. He refused every remedy. I had him carried into the chamber of the dying. As he saw numbers expire on all sides, victims to the epidemic, and their beds immediately re-occupied by others, the terrifying spectacle no doubt suggested to him some very serious reflections; and he immediately asked for some drink. As my visits were as frequent in this room as in the others, I perceived the change, and having some hope from it, prescribed remedies suitable to the case. He found himself very soon relieved, the action of swallowing became free, and by degrees the disease gave way. At the end of twenty-five days he was well enough to sit upright, when he went into another apartment. His cure was not retarded though he was continually with those that had the epidemic; he was perfectly re-established, and went out of the hospital the 19th of November, in a better state of health than he had previous to the disease.