Medical facts and inquiries

Front matter

Class. toil

Book h^C^

I

Chapter II

Of the Nature, Origin, and Contagion of Endemic Fevers,

Section I. Of the Nature and Origin of Endemic Fevers, - - 76 Section II. Inquiry into the Doctrine of Contagion, Importation and Exotic Origin of the Yellow Fever, ..... 127

j* CHAPTER ITT.

Of the Predisposing and Exciting Causes of Endemic Fever, 148

Section 3. Cure of Remitting Fever, - - - - - 298 Of Blood-letting, - - - - - - 298

Of Emetics, 310

Of Cathartics, 312

Of Calomel, 319

Of the Cold Bath, 324

Of Cold Applications and Sponging the Body, - 332

Of the Warm Bath, 334

Of Febrifuge and Sudorific Medicines, - 336

Of Blistering, 341

Of Peruvian Bark, - 343

Of Wine, - 344

Of the Sulphate of Quinine, - - - - 347'

Of Stimulating Drinks, - 347

Of Mineral and Vegetable Acids, - - - - 348

Of Opium, 361

"Directions concerning Convalescents, - 364

An account of the Bilious Remitting orEndemic Fever of Alabama, as it appeared in Cahawba and its vicinity in the summer and autumn of 1821, 371

An account of the Endemic Fever of 1822, « .- = . . 418

Preface

JT EVER is a disease of such common occurrence, that accordins: to Gorter one third, and according to Sydenham two thirds, of all the disorders to which mankind are liable, are of this description ; and it has been a received opinion among physicians, that more than one half of the human race are destroyed by fever alone.*'

What an idea must we not have of the malignancy and fatality of the yellow or bilious fever of the West Indies, when we are informed by Dr. Home, that three out of four of his patients in Jamaica were destroyed by the disease ? This, however, is by no means equal to the mortality caused by the bilious fever in Natchez, in the summer of 1823 ; in which, out of four hundred persons that were tak*m sirk between the 15th of August and the 20th of September, only twenty survived.

The inhabitants of Europe, and of large manufacturing establishments in our own country, are subject to a description of fevers called typhus, from the Sow nervous symptoms which- attend them ; these, as being of a local and more limited extent, are not the subject of the present inquiry. Those who wish to become acquainted with the typhus fever of England, may consult with advantage the ingenious work of Dr. Armstrong. Nor is it my d°sign to enter minutely into the discussion of the various forms and characters of febrile affections ; but my object is more especially the consideration of those fevers which are obviously connected with and originate from heat of climate and noxious exhalations: or in other words, the endemic bilious and remittent fevers incidental to the wide extent of the United States, but especially to its southern section. Asa knowledge of these fevers, from the malignancy which they frequently assume, is of the greatest importance to the physician, so every attempt instituted to investigate the laws by which they are governed, their nature, prevention and cure, must thence derive an importance, proportionate to the ability with which it is conducted. The

* Burserius' Practice of Physic, p. 104.

IV PREFACE.

merits of this performance I leave for others to determine. — ■ Having, from careful and mature consideration of facts, drawn the most obvious and practical conclusions, I have at least satisfied myself with respect to many particulars on the subject of fever which have been hitherto neglected, or but slightly and imperfectly remarked and understood.

The outlines of these observations were drawn up during my residence in the southern portion of the United State?. Upon my return to the north, I consulted every writer within my reach who had treated on fever, and the relative branches connected with the subject.

In thus presenting myself as an author before the public, I have maturely weighed the responsibility and importance of the step which I have taken. It is now nearly ten years *ince I first turned my attention to this inquiry, during which time I have carefully examined and considered the subject matter of investigation, so that it cannot be viewed in the light of a hasty, indigested essay, without maturity or experience, but as the result of labor, study and observation. Such as it is, 1 now offer it to the public. In several instances I have found it necessary to prune, correct and enlarge the crude performance of my more juvenile years ; and although I have not the vanity to think that the present work is entirely free from errors and defects, yet I flatter myself that in every point of view these observations will be found of practical utility.

No disease has been the theme of so much discussion as fever, and there is probably none upon which so much has been advanced to so little purpose : but as every subject of scientific investigation must be progressive in its course to perfection, so by improving upon the experience and researches of our predecessors we may hope ultimately to arrive at the summit of human perfection. I might here take up an investigation of the various hypotheses that have prevailed in the medical world on the subject of fev^r, from the time of Hippocrates to that of Dr. Rush. But a labor of this description would prove as unprofitable in its result as it would be painful and tedious in its performance.

The reader will perceive that I have taken a new view offerer, at least one quite different from any that has lately appeared. I have, indeed, endeavored to trace this disease through all its intricacies and meanderings of its causes and operations to its complete and final developement. And as the feveis which form the subject of the present work are known to be connected with, and to depend upon morbid changes and vitiations existing in the atmosphere, I have, as a leading inquiry, directed my attention to the chemical composition of this element, and have further attempted to show what it is that destroys the salubrity of the atmosphere in certain seasons and situations, and to point out the manner in which this state oi the air may be guarded against and prevented.

PREFACE. V

On the subject of contagion and importation, I have also dwelt at considerable length, and as I conceive hsve given it a fair and candid investigation. The practical purposes to which this branch of the inquiry more expressly applies, are the police of cities, the enforcement of quarantine regulations, and the intercourse of physicians, nurses and friends, with those laboring under disease The establishment of just principles, therefore, in relation to this subject, is of the first importance ; not only in a medical, but also in a civil and national point of view.

In conducting this inquiry, facts were necessary to establish principles. Of these, therefore, I have availed myself to as great an extent as my time and opportunity would permit, or as the subject might seem to require. I may, perhaps, in the opinion of some, have adduced more examples in proof of the pernicious effects of putrid exhalations, than the general admission of the fact might seem to demand : yet in an investigation of this nature, it is highly necessary and proper that every individual should knotv the foundation and reason of his opinion and belief; and as the chief object in the prevention of diseases is the knowledge of their causes, it is evident that these cannot be too clearly defined and ascertained.

The present is but a part of a more extended performance, the publication of which is for the present postponed ; and I find that in my delay in appearing before the public, I have lost much of the credit that I might otherwise have acquired. Thus the theory of ricke's advanced by Mr. Bonhomme, of France, and which has been successfully applied to practice, was entertained and advocated by the author of this work long before the publication of the performance of Mr. Bonhomme. But in the present inquiry 1 believe I have not been anticipated.

Some, perhaps, will dispute my claims to originality, both as it respects the theory of scurvy and fever. This, however, I must do myself the justice to say, that at the time this work was undertaken my mind was perfectly unshackled by prejudice or preconceived opinion ; and that the ideas that suggested themselves were for the most part original and unborrowed ; and it was not till I had embarked in a general course of medical reading, with the view of qualifying myself as an author, that I discovered several coincidences of opinion between myself and some former physicians. But these coincidences which I occasionally observed on the part of others, were like random steps taken in total darkness ; where one by chance and possibility may be right, and where a hundred in probability will be wrong. They were detached and disconnected, in scattered fragments without order or design ; and clouded and beset with so many absurdities, that it appeared clearly the writer had no distinct and definite ideas upon the subject. One kind of scurvy, or fever, for instance, depended on an acid, another on an alkali, another on phlegm, another on salt or an unknown acrimony, and finally on

VI PREFACE.

all the elements, either singly or combined, earth, air, fire and water. These, by fermenting; and working, and mixing and straining, and beating and cooling, and boiling; and foaming, produced all the various fbrrn^ and phenomena of frver

" Fevers,'' says Hippocrates, " are caused by the bile and phlegm growing hot ; these mixing with the blood at first condense and cool it, and occasion the coldness and rigor ; afterwards they heat the blood and produce the hot stage."* No better founded a«*e the opinions of many of bis successors, who have attempted to account for the nature, of disease^ upon the supposition of certain qualities and mixtures of the different fluids of the body ; for as the properties of these were unknown, of course all reasoning upon their mixtures, changes and chemical action, could have been nothing more than the erroneous ' vagaries of mere speculation. "Experiments," says Dr. Fordyce, "can only determine the condition of the fluids of the body. Every thing, therefore, that is said with regard to the fluids before the time their properties were investigated by experiments, excepting some of the externa! appeal ances of some ot the secreted fluids, is to be entirely passed over as not at all relevant to the explanation of the causes of this disoase, (fever,) or the history of it in any manner. The first part of the blood which was distinctly marked was the serum. Some person about a century and a half ago discovered the red particles. Even Boerhaave was unacquainted with the coagulable lymph ; and the properties and varieties which take place in these three essential parts of the blood, are even not well known to the majority of practitioners in Europe. It would appear, therefore, that there is very little ground for resting the cause of disease, whether it be fever or any other, on what has been affirmed of the properties of the fluids by rmmjr, even practical authors, for they knew them not, and did not examine them."| " From Willis to Fothergill," says Dr. Beddoes, " and from Fothergill downwards, scarce any real observation occurs upon the state of the blood. One tells us that it is polluted, another that it is contaminated, a third that it is acrid, a fourth that it is putrescent, without recollecting that to employ terms expressive of phenomena, such as the senses may recognize, and to reason upon such phenomena alone, are indispensable conditions in philosophizing.":}:

In taking the view of the subject here presented to the public, practical conclusions are established, founded on the latest discoveries and improvements in medical philosophy. As in the time of Dr. Cullen, an investigation of the nature of diseases on the principles of the humoral pathology would have

* Hippoc. De Morb. Lib. 1.

t Geo Fordyce on Fever, Sec. p. 158.

t Beddoes' Observations on Sea Scurvy, &c. p. 152.

PREFACE. VU

been in a great decree Unsuccessful and abortive from the imperfect knowledge of animal chemistry at the time, in like manner '.he nature and phenomena of many diseases remained unexplained. Many of these difficulties mo longer exist, and in the present work I have called to my aid the latest improvements in medical srience.

In my attempt to contribute to the cause of my profession. I have aimed at some fundamental pathological conclusions, and have endeavored to establish a practical theory, founded upon the sure h.isis of fiets and demonstration. It is the custom of many to decry theory in physic as vain and unprofitable speculation, and to insist upon the superior advantages of experience, as the only and essential qualification for successful practice. — But it was well observed by Dr. Beddoes, and the same idea is expressed by Dr. *. T -.>ore, thai there are few diseases in which we have any fixed rules q£ practice, and our"specjfics are so few, and so easily applied, that this part of medicine may be acquired without difficulty or loss of time. In some instances a theoretical deliberation of some sort must precede prescription, and here the discrimination' of persons habituated to speculation will have the superiority of skill over chance, and their facility of resources wiJ) appear to peculiar advantage. For, a,s observed by Dr. ftioo're^? some diseases appear in such a questionable shape, that the most knowing are puzzled to decide to what class the* belong, and the combined powers of experience and sagacity have sufficient employment in treating them. " He who draws medical knowledge from books alone," says Dr. Moore, 41 and whose exalted notions have not been moderated by experience, will practise medicine as the philosopher who declaimed on the art 6f war to Hannibal would have commanded an army ; but he who has seen much practice without reasoning, as one of Cannibal's pioneers , and he who to extensive experience join* the greatest natural acuteness and all the powers of ieasonrng, as Hapnibal himself." And it is well observed by Dr. Rush, that " a single principle in our science will lead to more truth in one year, than whole volumes of uncombined facts will do in a century."

As this work consists more in demonstration than in theoretical speculation, the facts and illustrations, to whatever purpose they m; \y * >e applied by others or myself, must be considered of essential practical importance.

My original desigu was, at first, merely to embrace an historical account and medical illustration of the epidemics of the years 1821 and 1822; but with the view of rendering the work the more generally useful and interesting to the medical reader and to the public at large, I have thought proper to embrace a general history of the causes and treatment of endemic fevers as they

* Medical Sketches.

Vlll PREFACE.

occur in various places and seasons in the United States ; adapting the practice more especially to the fevers of the southern section of our country. And with the design of rendering this treatise the more profitable, I have enlarged upon the practical part considerably more than if I had intended it exclusively for the experienced physician. In this, however, the inexperienced will find an advantage ; for it often happens that the young practitioner, who has been more familiar with theory than the bed-side ofthe sick, finds himself materially at a loss on approaching his patients, at the diversified character of diseases : and upon consulting his best authorities, he is still left in doubt and uncertainty. The general treatment of diseases is described, but so many particulars are omitted, that he finds himself, in a great measure, thrown upon the resources of his own judgment and discretion. To obviate these inconveniences, and to render the work useful to the general community, I have extended the subject of the prevention and cure of fever considerably beyond ray original design. As it respects the treatment of fever of 1821 and 1822, I have spoken almost entirely from my own experience : and what has been omiited under these heads may be found discussed at large under the general treatment of fever in the previous part ofthe treatise. Accounts of the fever of 1821 and 1822, will be found in the latter part ofthe present work.

In the execution of this performance some inaccuracies have, perhaps, escaped me, as the authorities referred to were principally taken in manuscript during my residence in New- York, in the years 1815, '16, and '17 ; and the impossibility of again consulting them on the present occasion, must be my apology for the few orthographical errors that may be detected.

As the sense in which the words epidemic and endemic should be received, has not hitherto been accurately defined by medical writers, it may be thought necessary for me to explain the acceptation in which I employ them. An endemic may be defined, a disease incidental to a country or tract of country, and such as from local peculiarity of climate and situation, or similarity of constitution, frequently occurs : thus the bilious remitting or yellow fever is an endemic of the East and West Indies, and of various parts ofthe United States. As in each place it has some symptoms which are not observable elsewhere, each district and section of country may be said to be liable to an endemic peculiar to itself. The itch is an endemic in Scotland, and the plica Polonica in Poland. Now as the season and situation may be more or less unhealthy, the endemic may be epidemic or sporadic ; epidemic, when it attacks a large proportion of the people ; sporadic, when it affects only a few scattering individuals. This is the construction which I give the words epidemic and endemic ; making endemic the class, and epidemic and sporadic the orders. But there may exist an epidemic w ithout an endemic disease ; as is the case with most contagious disorders, as the

PREFACE. IX

small pox, meazles, chicken pox, &c. as likewise influenza and the spotted fever. As these are incidental to every country, and confined to no one in particular, they cannot, with propriety, be called endemics.

By designating the summer and autumnal bilious fevers of the United States, whether appearing in large cities and sea-ports, or in inland situations, the endemic fever of the country, I have endeavored to simplify the subject, and to disrobe it of that mystery and terror with which some physicians have endeavored to invest it. A fever originating from offensive docks and filthy streets has received the frightful appellation of the yellow fever ; but to designate by that name a disease arising under similar circumstances of heat and putrefaction in the interior of the country, would by the advocates of imported contagion be con* demned as heterodox in the extreme. In the view which I have taken, I have considered all the modifications of summer and autumnal fevers as the same disease, diversified, however, in different seasons and situations, in form, violence and degree ; but in every instance originating from similar causes.

OF THE CAUSES. NATURE, PREVEN- TION AND CURE OF FEVER.

Chapter I

Of the causes of Summer and Autumnal Fevers in hot anitrop* ical climates — Chemical and philosophical investigation of the preliminary circumstances of Endemic Fevers — Chemical analysis of the process of putrefaction and decomposition*

SECTION 1. Introductory Remarks

FROM a consideration of the circumstances which are generally connected with the origin of fever, there can be little doubt that the most frequent cause of it consists in that vitiated condition of the atmosphere occasioned by animal and vegetable decomposition; so that whatever favors and promotes this process must equally favor the production of fever.

It must be obvious to every person, of even the most limited observation, that the salubrity, or unhealthiness of climates is essentially modified by the temperature and condition of the atmosphere, and by the physical processes which are constantly taking place on the surface of the earth. Thus we find that a high degree and long continuance of heat during the summer and autumnal months, give rise, in various situations, to bilious diseases. We as regularly observe, on the other hand, that the cold of approaching winter puts a stop to the prevalence of these diseases ; hence we infer with as much certainty, as from the alternate vicissitudes of light and darkness, which take place upon the rising and setting of the sun, that this luminary is the source of light; with the same certainty we infer that the prevalence and declension oi bilious diseases are owing to the successive vicissitudes of heat and cold, in connexion with other physical circumstances, which is the object of this history to point out and ascertain.

One of the most striking effects of a high temperature is the decomposition or destruction which it occasions in dead animal and vegetable substances. The immediate consequence of this decomposition is the escape of elastic gases, and the corruption or vitiation of the surrounding atmosphere. The effect of this contamination of the atmosphere, as determined by extensive observation, is the production ©f endemic and epidemic diseases.

Thus we find that the same sun which warms and cherishes the seasons, affording life, support, activity, and beauty to the animal and vegetable world, is also, to the human race, the prolific parent of diseases and death.

Previously to entering into an investigation of the more immediate causes of fever, I shall, therefore, premise a short account of some preliminary circumstances ; as the process of putrefaction and decomposition ; a chemical consideration of the atmosphere; the vitiations and changes to which it is liable ; together with the theory of vegetation.

SECTION 2. Of the processes of putrefaction and decomposition

The circumstances required for the putrefaction of dead animal and vegetable substances, are heat, moisture, and exposure to the atmospheric air. The temperature most favorable to the process, seems to range between 15 and 95 degrees of Fahrenheit. A higher degree of heat, by dissipating humidity, impedes or suspends the process. The degree of heat necessary to putrefaction, is much inferior to what is required for spirituous and acetous fermentations, for putrefaction take place at the temperature of 45°; but a higher temperature is still more favorable, at least if the heat be not so violent as to volatilize and dissipate all the moisture of the putrescent substance, and render it entirely dry. Access of air is another circumstance especially favorable and necessary for putrefaction, for it is found that vegetable substances are preserved in vacuo.

A certain degree of moisture is indispensably necessary for decomposition. When animal bodies are suddenly deprived of their humidity and aqueous juices, they become hard, dense, and incorruptible, like petrifactions. This is exemplified in the arid and sandy deserts of Egypt and Arabia, and also in some parts of South Americp. ; where, notwithstanding the heat of climate, the dryness of the atmosphere and soil prevents putrefaction by the rapid exsiccation of the animal juices which it occasions. By an increase of caloric, the quantity of water which the atmosphere is capable of holding in solution, is also increased. Now the air in passing over these parched and sandy deserts, where there are no trees, herbage, nor aqueous exhalations to refresh it, becomes intensely heated by the scorching sun, so that its capacity for water is greatly augmented ; from which circumstance it happens that every thing is robbed of its humidity which is capable of affording it, and animal bodies are converted into mummies. We are informed by the learned Dr. Shaw, in his travels from Egypt to the Holy Land, that he saw in the deserts, the bodies of some dead camels, which had belonged to a former caravan, and remaining in a state of preservation, entirely free from putrefaction.*

*The destruction of caravans and travellers in the deserts of Asia and Africa, is frequently caused by the fatal breeze called Samid wind, a blast of which, in those parched deserts, proves instantly fatal to the unfortunate traveller or beast, that may be exposed to it These winds seem to produce death by suffocation, in consequence of their depriving the lungs of the ability to perform their function, and not by any pestilential poison »n the air itself It appears from the experiments of Dr. Priestley, that oxygen gas will not act upon the blood through dry membrane, and that a moist state is necessary for this purpose. This dry and parched air of these sandy deserts instantly absorbs the moisture from the delicate membrane forming the air cells of the lungs, and thereby prevents the oxygen of the atmospheric from performing its purifying operation upon the blood. The effects of this air upon the surface of the body, are similar to those upon the lungs ; it shuts up the pores of the skin, and puts an entire stop to perspiration. These reflections were made previous to my seeing- those of Mr. Volney upon the same subject ; who says> in his description of the Kamsyn, (which may be considered the same as the Samiel) that the lungs are irritated by the presence of this air, are contracted and rendered crisp. " Thi6 wind,'" continues he, " crisps the skin, evaporates animal moisture, closes the pores, and produces febrile heat which always accompanies suppression of the perspiration." The effect of this hot suffocating blast or vapour, (the Samiel) says Dr. Lind, on the human body, even when mitigated by passing through a moist atmosphere, is the same as that of intense cold ; it shuts up every pore of the skin, and entirely stops the perspiration of such as are exposed to it. They come on only in the day time, and always from the deserts. Water is the only known antidote or corrector of this vapour. {Lind on H&t Climates, p. 144.) It appears from the experiments of Saussure, that a cubic foot of atmospheric air will hold eleven grains of water in solution ; from five to ten grains, however, is the usual quantity contained in every cubic foot. A certain degree of humidity is necessary to preserve substances upon the surface of the earth in a proper state of moisture and pliability. During a season of the year the wind called the Harmatan prevails in the interior of Africa, which is so extremely dry, from passing over the sandy deserts, that furniture of houses is destroyed by it, the floors and joints of

It is owing fo a want of access of air to favor decomposition, that the accumulation of soil constituting peat and morass is so inert and unproductive. Ihe cultivators of cotton about Eaton Rouge, and the iower parts of the Mississippi, as they find the top of the soil which is alluvial, impoverished by repeated crops, remedy the evil hv ploughing deep with a strong team of cattle, thereby exposing the mould, which has been hitherto excluded from the air, and again rendering the earth fertile and productive.

buildings are laid open, and the scarfskin on the human body is rendered crisp and peels off.

We are informed by Wafer, an English surgeon, that he and *-ome others landed at Virmejo, in South America, in I6b7, and marched about four miles up a sandy bay. " All whic h," he says, "we found covered with the bodies of men, women and children ; which lay so thick, that a man might, if he would, have walked half a mile, and never trod a step off a human body. These bodies to appearance seemed as if they had not been above a week dead ; but if you handled them, they proved as dry and light as a sponge, or a piece of cork. After we had been some time ashore, we espied a smoke, and making up to it. found an old man, a Spanish Indian, who was ranging along the sea-side, to find some dry sea-weeds, to d;e?s some fish, which his company had caught ; for he belonged to a Spanish boat hard by. We asked him many questions in Spanish about the place, and how the dead bodies came there. i'o which he returned for answer, that in his Father's time, the soil there, which now yielded nothing, was greeu, well cultivated, and fruitful. 1 hat the city of Wormia had been well inhabited by Indians, that they were so numerous, that they could have handed a fish from hand to hand twenty leagues from the sea, until it had come to Inca's hands ; and that the reason of these dead bodies was, that when the Spaniards blocked up and laid siege to the city, the Indians, rather than be at the Spaniards' mercy, dug holes in the sand and buried themselves alive, — The men as they now lie, have with them their broken bows, and the women their spinning wheels and distaffs with cotton yarn upon them." Voyage and Description of the Isthmus of Atncrica.

Fuzier, a French voyager, who was also in Peru in 1712, confirms the same account. He says, lt . The vale of Hi'o, in which there are not at present more than three or four families maintained an Indian town, the remains of which are still to be seen, two leagues from the sea ; a dismal effect of the ravages the Spaniards have made among the Indians. There are still more moving marks of the misfortunes of that poor nation, near Aric'a, above the church of Jlilo, and all along the shore as far as the point of Colos, being ?u infinite number of tombs, that when they dig up at this very time, they find bodies almost entire, with their clothes, and very often gold and silver vessels. Those 1 have seen are dug up in the sand, the depth of a man, enclosed with a wall of dry stone ; they are covered with v.ai* els and canes, on which there is a layer of earth, and sand laid over, that the place where they were might not be observed They were so terrified that they thought they must die, when they were informed that the Spaniards had not spared their beloved Atalahalpa, who among them was looked upon as the offspring of the sun, which they worshipped. Therefore to escape out of their hands, they lied as far as they could eastward, to implore the mercy of the sun ; but being stopped by the sea, they buried themselves alive on the edge of it." Relation die Voyages de la Mer du Sud. The preservation of these bodies appears to have been the effect of dryness and exclusion from atmospheric air.