Epidemics as they appeared in Dutchess county from 1809 to 1825 by Bill Jeffway

S553r 1626

***

Surgeon General's Office

>^HLki —^ y

-f

wc S553r

At it

a Meeting of the

Dutchess Medical Society,

was resolved, that Dr. Sherrill be desired

to pre-

pare for the press, and take measures to have printed, the Papers on the Diseases of our County, which he

has formerly read before

Members the

this

Society

;

and that the

of the Society be requested to subscribe for

Book when

offered for publication.

A true

copy from the Minutes.

CALVERT CANFIELD, Secretary. April 9th, 1826.

THE MEMBERS OF THE

DUTCHESS MEDICAL SOCIETY: AS

A TESTIMONY OF REGARD AND ESTEEM FOR

YOUR ACQUIREMENTS AND JUDICIOUS EXERCISE OP THE

Profession, AND

AS A GRATEFUL

ACKNOWLEDGMENT

FOR THE ATTENTIONS CONFERRED,

THESE PAGES ARE

MOST RESPECTFULLY INSCRIBED, BY

THE AUTHOR, Hvde-Park,

May

1826-

PREFAC E.

In attempting to

comply with the regulations

of our County Medical Society, while official station in

its

it,

filling

a short historical account

prominent diseases was drawn up

occasion, compiled from notes and

dums, collected scripts having

at various times.

for the

memoran-

The manu-

answered the purpose

for

which

they were written, were laid aside, with an expectation that they would remain in private obscurity.

number of

solicited their publication

friends have latterly :

compliance with

which, and the resolution of the Medical Society, they

have been corrected, and

fitted for

that purpose.

The

general and cursory manner in which

the several subjects noticed must be touched

PKEFACE.

Vlii

an Essay of

this kind, will necessarily

frequently lose the advantage of detail and elucidation

but

it is

cursory history, a collection

of some facts, and general principles only, that is

attempted

;

with a hope, and leaving oppor-

tunity for

some one better

upon the

hints

qualified, to

improve

and elucidate the subjects.

In addition to the original manuscripts, with

some

slight corrections,

such remarks as

fur-

ther observation and experience has suggested,

are added in notes.

ADDRESS, DELIVERED BEFORE

THE DUTCHESS MEDICAL SOCIETY THEIR ANNUAL MEETING IN

NOVEMBER

1810. /

^5SLG@^Ss.

ADDRESS. GENTLEMEN, Connected as agreeably to

with this Society,

becomes my duty, deliver before them an

by-laws

its

this anniversary, to

address.

In turning the attention to the nu-

merous branches of medical science, some of which naturally present themselves as a subject for this discourse, one finally has been selected, which,

more than

teresting to this audience

others,

and

may be

in-

this generation;

one with which we are all somewhat acquainted and the facts connected with which, the community at large have had an opportunity, ;

in a greater or less degree, of witnessing.

The rected,

subject to which your attention is

di-

a retrospective view of the diseases

of our county for ten years past.

beg you

would forget the abilities necessary to execute this task

dour

with propriety, and listen with can-

to the efforts of a

for this Society

that entitled

was

him

member, whose regard

his principal qualification

your choice.

12 not to In progressing with this review, it is notice be expected we should detain you to

and investigate the occasional and incidental day diseases that are the occurrence of every and every year, under almost

all

circumstan-

ces; but will aim, with impartial faithfulness, to trace the progress of the train of

epidemical

and endemial excitement, and notice the prominent features of diseases as they have arisen and affected the human system, and point out a general outline of the method that proved most successful claim ject,

much

which

in the cure.

Permit

indulgence for selecting this sub-

approached with diffidence

;

for,

independent of the want of qualification to do justice in so extensive and important a field of inquiry, the nature of it

something near a

it is

fair

and

such, that, to give full

consideration,

more upon your time than the Society probably had expected, and more than But when it is recolI could have wished. lected, that it is an investigation of health and will trespass

disease

—that the theme before us

deration of the preservation of

mination in death,

—

it is

life,

a consi-

its ter-

trusted this respected

audience will yield indulgence patiently to

hear us through. I

proceed now

when

commenced

in this county, I

observe, that in 1809,

the practice of medicine

found

very subject to fevers

13 of the intermittent and remittent type, and in the autumn assuming symptoms of high bilious

grades of disease.

learned that the district

of country in the town of Clinton (now HydePark), along the east bank of

Hudson

River,

and also along Crum Elbow Creek, which empties itself into the river at Hyde-Park, had for several years been very subject to those types

of disease

;

much

so, that the

creek fever

and the Hyde-Park fever had become proverbial in this part of the county. The same types of disease spread more or less through the county,

particularly along the banks of

Wappinger's Creek, which traverses

this

coun-

ty nearly from north-east to south-west, espe-

you approach and North Stanford of town its source in the East (since Pine Plains), where the disease obtained various local and popular names;

cially near the alluvial lands as

was all remittent bilious fever, and governed by the same general laws. The vernal season opened with intermittent fevers of a mild character, and occasional remittents. As the season advanced, and the weather became warm, the intermittents became more severe

still it

and obstinate, and the remittents increased in proportion to number as well as in severity. To-

ward autumn and in the fall, real bilious remittents became very prevalent. These frequently were attended with symptoms of great sevemany of the cases were ushered in with rity :

Fevers of

14 rigors, restlessness, nausea,

and sometimes vo-

miting; violent pain in the head, back, limbs, generally

;

and

many

and

cases during

autumn, such was the severity of the pains, that the suffering patient, in describing his

case, would give vent to his feelings by a flood

of tears. larity

In a

number of

was discovered

cases, a great simi-

to that disease noticed

by Dr. Rush, called the break-bone fever, in and about Philadelphia, as

which appeared

connected with or influenced by the yellow fever of 1780.

The skin, tongue, and eyes, often showed a yellow bilious tinge in the incipient stage, and never failed

symptoms during the progress: the skin often became of an to exhibit these

orange yellow. In the progress of the disease,

where the remedies had not been well symptoms.

direct-

e(j n t ne ear i v stage, the tongue became covered with a dry brown or black scurf; the skin dry and husky, attended in some cases j

with delirium, though this was not a very com-

mon symptom

cases sometimes ran into a pro-

tracted state, and continued twelve or thirteen

days, and then terminated favourably.

the

more general character of the

when

But

disease,

the patient had early and proper attend-

ance, was to intermit on the

fifth,

seventh, or

ninth day, and form a salutary crisis.

ease sometimes

fell

with

its

The

dis-

principal force on

the bowels, producing a dysenteric affection.

)

This was the constitutional character of the diseases during the summer and fall of 1809, 1810, and 1811, though there was less sickness in 181

than in the preceding years, and those

The remainder

cases were of a milder grade.

of those years were generally healthy,

al-

though there were more or less cases of phlegmasial disease, as catarrh, pneumonia, enteritis,

This period of 1811 was also attended with a peculiarly obstinate cutaneous eruption, which frequently extended into

croup, &c.

blotches and sores

know

but

not,

merino

itch.

for

name of

common cutaneous

effect a cure,

and

often resisted the This eruption 1

have recourse

nally,

from what circumstance

obtained the popular

USUal remedies tion.

;

was

affec-

often necessary

to active mercurials exter-

May

alteratives internally.

not this

disease have been a precursor of one of

winter

epi-

that

violence

demic ?

(

followed

—the

The method which proved most in the

cure of those fevers, was

—

successful

in the inter-

mittens, effectually to cleanse the alimentary canal; and in the intermission, to administer

bark (cinchona)

bitters,

wine, &c.

;

and during

the febrile stage, diluents and sudorifics.

The

patient was sometimes much benefited, by anticipating the fit, by an anodyne, or an anodyne

combined with

sudorifics.

was sometimes

obstinate eruptioii-

necessary to vary the mode, by anticipating the

with blisters, or substituting mineral

fit,

preparations instead

of,

or combined with the

bark.

From bowlers

the difficulty of getting children to

take bark, Fowler's arsenic solution appeared

solution u

rTin

the

we N adapted

to their cases,

much

was used

was observed that in children, this remedy had

with advantage: but adults, as well as in

and

better effect in the vernal than in the

This may probably be ac-

autumnal cases. counted

for,

from the vernal cases partaking

more of the phlegmasial character; whereas in the autumnal, the system was more saturated with bile, and acted upon by its effects and to effect a cure, evacuations from the stomach and bowels were among the most effectual remedies.

In a

number of cases which proved

and did not yield Biood

let-

linginobsti-

mlttents'""

obstinate,

to ordinary medicines, there

sometimes was a preternatural tension and

ful-

effected tonics,

sy stem -

In such cases, a cure

was by suspending the use of the bark and and making use of blood-letting, with

ness in * ne

and ankles, as recommended by Dr. Rush after which, tonic? blisters to the wrists

;

effected a cure.

In treating the remittent type of the disease,

evacuating the stomach and bowels, and the usual sudorific course

was pursued, with

frequent repetition of cathartics.

When

in-

termission supervened, tonics were adminis-

tered; and as the fever subsided, the strength

was supported and kept up by nourishment and invigorating remedies.

mer cases pline.

The

vernal and sum-

pretty readily yielded to this disci-

But

at the

approach of autumn, when

the disease assumed more of a bilious character

—when

the

system was operated on by

fever, attended with high

tion

— when

grade of bilious affec-

was decidedly the autumnal bisomething more than

lious remittent fever,

—

refrigerants, diluents, sudorifics, &c.

appeared

necessary to overcome the febrile excitement.

From

taking a view of the symptoms, evacua-

seemed most strongly indicated to produce that effect, and they were the remedies mostly relied on. The method of evacuating selected, was generally from the bowels. This practice was founded on such authority as Dr. Rush, who used cathartics as a leading remedy Townsend, in his in curing bilious fevers. Guide, repeatedly recommends cathartics as the most useful remedy in fevers of this type, and in other diseases. Dr. Hosack and Dr. Miller, in their Lectures, strongly recommend

tions

alvine evacuations in fevers of this type.

But

the usefulness of purgatives in fevers, as well as in out,

many other diseases,

and their

fully

effects detailed, by Dr.

pointed

Hamilton,

18 id his

Remittent of 1810Tjreatment.

Treatise on Purgative Medicine, whose

method was more particularly followed. When there was actual puking in the commencement of the disease, an emetic was administered c

wnere this was not the case, a course ol cathartics was commenced, or those followed the emetic when that was given. They were given in small divided

doses, so as to administer

about a quarter of an ordinary dose at a time, and that repeated every three or four hours, till

six,

duced.

eight, or ten evacuations

were pro-

This generally pretty well evacuated

and crudities of the intestinal canal; relieved the depression, and much of the pain and fever and was generally followed by easy the bile

;

Gentle sudorifics were then

perspiration.

troduced, with diluents

much

pain, as

;

in-

and where there was

was frequently the case, opiates

were given in sufficient quantity to allay that. As a diluent, simple cold water (2) was always most palatable to the patient, and perhaps as salutary as any. Cathartics were again repeated, either alone, or

combined with

sudorifics,

so as to procure six or eight stools as often as

Much

every alternate day. the immediate

on the system to notice

them more

when an

remedies

but as there will be occasion at large in the

the winter epidemics, that

might be said on

salutary effect of those

account of

pass on to observe,

intermission in the fever occur-

19 red, nourishment, bitters, bark, wine, &c.

The

exhibited, according to circumstances. articles of medicine generally

used

were

for cathar-

were sulphate of potash, rhubarb, jalap, and calomel, differently combined, or all well ground together the quantities of each admi-

tics,

nistered could exactly be determined, having

always practised accurately weighing

all ac-

tive medicine. It

was stated

on the

fifth,

that the disease formed a crisis

seventh, or ninth day.

may,

however, be remarked, that an intermission

was frequently had on the third day but the greater number of critical days were the fifth and seventh. Sometimes the disease assumed :

an irregular intermittent or remittent type, and

became somewhat protracted; but generally the patient convalesced pretty readily after

the

crisis.

the cases treated in this way,

there was seldom a black scurfed tongue or

much

delirium, or those

symptoms supervening

would warrant our calling it a typhoid case. From some memoranda which were kept of the disease, it seems there were more than that

one hundred cases, of the remittent type of fever, came under my prescription in 1810.

There was but one case

that

assumed symp-

toms strictly of a typhoid state of disease. This

had a turn of the fever on the thirteenth day, and recovered. This was the most patient

20 protracted and most typhoid case that occur-

As an external

red during those three years. application, blisters

good

effect.

We mild

were used with apparent

have remarked, that the fever was more

the autumn of 1811, than

during the preceding years. force in Termina tion of mitteot

type

its

The

merous.

in 1811

fall

finally

had been

and the cases were

action,

exerted less

less nu~

disease declined early in the

seemed

suspended

have spent

its

force,

operation on the

and

human

system, not only for this year, but nearly so for

every year since

;

so that

that here terminated the

may be considered train of summer and

autumnal bilious disease; and our county has been subject to very little of that character of disorder since. In the latter part of 181

and the commence-

ment of 1812, an unusual degree of health existed. We had no fevers of any particular description, and few other diseases, until about February.

Cases of disease began to occur,

somewhat novel in their appearance and prowhich operated with unusual force on

gress,

the

human

nated winter 1°mic

e P i-

system, and in

fatally

many

and unexpectedly.

cases termi-

was no

less

than the

commencement of a disease, that called forth an exertion of the medical faculty; that excited much anxiety and solicitude in the

community; and called upon

its

members

fre-

quently to witness frequently to

draw

its

melancholy

effects,

and

forth their sympathies or

mingle their tears with bereaved friends or relatives,

from bereavements of those who had

fallen victims to the winter epidemic. (3)

In describing the epidemic it

will

now commenced,

be necessary to take into view the symp-

toms as they more generally occurred, as there

was no

particular set of

symptoms

that cha-

racterised each case, and perhaps no one that

was present

in every case.

racter of the disease

The

general cha-

was a pneumonic

affec-

combined with a fever of a remittent and bilious type; or a remittent and bilious type tion,

of fever, without pneumonic symptoms. Sometimes one type of disease predominated, sometimes the other

;

at other times they

were very

equally combined.

Whether to a

the bilious

redundant secretion of bile, or a diminish-

ed quantity of that tity

fluid

;

or whether the quan-

was a cause of the symptoms, or the state and secretion of

or quality of the bile

bilious it

symptoms were owing

a consequence of disease, although worthy

of notice,

not a subject for present investi-

gation.

The

case was generally ushered in with

agues, or chills, which frequently continued an

unusual period. (4) Generally, the longer time they continued, the more obstinate was the

22 case. tion symptoms,

Sometimes there was a sudden prostraof strength, and great want of action of Frequently at the commencement,

the skin.

the patient was affected with violent pain in the chest, difficulty of breathing, pain in the

head, back, and some one or

all

the limbs, and

Sometimes they were attacked with the usual symp-

nausea, and puking of bilious matter.

toms of autumnal bilious fever, attended with a yellowness of the skin, yellow eyes, a yellowish tinge

on the tongue, &c.

Sometimes the

was attacked with dysenteric affection, together with pain, and some of the other symptoms noticed. Appearances showing an patient

accumulation of bile

in the

system, or an error

was an almost uniform symptom in some stage of the case though some of the pneumonic cases differed very little from a loci of

it,

;

common peripneumonia. When affected, at times the pain

others, they

the chest was

was very acute

complained of very

pain, but rather of a stricture

and obstruction

to respiration,

inability to dilate the chest.

little

the edges

though

acute

and heaviness, from apparent

The

tongue, at

the beginning, generally exhibited scurf, or that tinged in the

;

a white

middle with yellow were generally of a lively red; some cases it retained its natural

appearance.

;;

At the

attack,

there was

when

the chest was affected,

some cough, more or

less expecto-

and that frequently tinged or mixed with

ration,

When

blood.

the chest

was not

affected, there

was no cough or expectoration, and perhaps all

The

the other train of symptoms.

showed great apparent

often

sometimes a disposition fainting.

The

patient

debility,

and

to syncope, or

even

heat of the skin frequently was

not increased, and sometimes diminished.

pulse in

many

sometimes in

general

it it

cases was very

pressed pulse.

much

six different

heads:

intermitting pulse.

de-

frequent pulse, without

tension, feeling like an elastic tube, par-

tially filled

and,

The

altered:

was in a morbid, healthy state was considerably varied. It may

be arranged under ° slow pulse.

little

with

fluid.

(5)

tense, full pulse.

A hobbling pulse

The

fourth variety

was the most common. Although the bowels were sometimes loose, and operated on in a dysenteric manner, they were generally costive, and frequently required active and repeated purgative medicine to move them. The patient was apt to be restless there was a good :

deal of disposition to pain

in the

head

;

false

perception, and delirium or stupor: sickness at the stomach,

and puking, were very

blesome symptoms

in the cure.

trou-

state of the pulse.

u I

did not perceive that any class was particu-

larly subject to

it,

or exempt from

of intemperate habits; and

acute diseases, Typhoid disposition.

it,

but those

with those, like all

was most apt

prove

fatal.

in the disease to There was a disposition * assume a malignant or typhoid type, particularly where evacuations were not early used. This, I am informed, was also the case in several instances in the city of New-York, where

The system

the disorder appeared sporadic.

often laboured under great depression

pulse almost uniformly rose, and natural or

full after

;

the

became more

early evacuations.

This description applies principally to the incipient stage of the disease.

which succeeded

The symptoms were much

in the progress,

influenced by the method of treatment.

some of the violent cases the powers of were suspended, somewhat similar to

In life

as-

phyxia, or a deprivation of a supply of oxy-

gene

to the lungs,

by the inhalation of carbonic

showed the lungs, and the blood-vessels of the lungs, and the heart, to be distended, and engorged with

gas.

Dissections after death,

blood, and in such a situation as to be unable to

admit the

air into the bronchial cells

of course the blood was deprived of

its

;

and

neces-

sary supply of oxygene.

Whether ances in

all

the disease put on those appearparts of the county,

do not under-

;;

25 take to say

but in some parts

;

be attended with more

The

nature of

fatality

appeared

than others.

business happened to be

saw cases of it in several towns of which there appeared no material

such, that in all

The

difference.

Rev. L. Birch of Stanford,

The Rev. I,.

who devoted

the most of his time, in his pious

and sacerdotal

among

office,

the sick, the dy-

ing and the dead, kept an accurate

number of deaths

list

of the

town

that occurred in that

of the epidemic of 1812, and politely furnished the result, which

February, 4 June, 2

;

March, 1 8

total, 63.

as follows ;

—January,

April, 24

The town

;

May,

4 1

;

contains about

50 square miles, and 2350 inhabitants.

in many cases were many they were not diseased.

observed that the lungs ,

and

affected,

yellowness of the skin and eyes was very

common ter.

From

many

raised blood, or bloody mat-

did not observe any spots on the skin.

the best observations he could make, he

thought that out of the whole number that sick-

ened, one-third died. ease, a it

good deal

in the

visited in the dis-

adjacent towns, where

exhibited about the same character, and

was attended with the same

result.

physi-

cian of extensive business in that part of the

county, gave

a very similar account of the

disease, except he thought, in about one half r>

Birch's

scatemet

•26

>>l

all

that

minated

The

were actively seized, the case

ter-

fatally.

great business of a practitioner of

me-

dicine, at the appearance of numerous and violent cases of disease, which he is called upon

conduct the suffering patient

to alleviate, or

through,

to investigate the nature of

it,

some general laws of morbid excitement, to observe the manner in which it produces its effects on the system, and to adopt some rational, and if possible, a successful merefer

\ccounts of lie Eastern

thod of cure.

Some

to the aptime previous * *

pearance of this disease among

us,

we had had

numerous and various accounts of a complaint that

had prevailed

in several parts

of the East-

ern States with a good deal of violence and

Those accounts of the disease in the East, together with the method of treating it, were frequently contradictory, as they were mortality.

brought to us by

common

bal communication,

intercourse and ver-

by newspaper

intelligence,

and by some professed medical publications.

The

opinion respecting the nature of the dis-

ease to the Eastward, which was more generally held in this county,

which was the most

popular and generally received, was, that

was a spotted (6) fever from debility, or that it was a disease of a direct typhoid character, and that

all

evacuating remedies were injuri-

ous in the cure of

it.

Prepossessed as we were

we were

ready to believe that

disease, which so that which

in this doctrine,

we had

the same

much had been heard

had prevailed

of,

the Eastward;

same remedies were thought to be the only proper ones in the cure. Whether there was a similarity or dissimilarity in the two diseases, is not a subject for present inquiry. Perhaps it ought to be remarked, when therefore the

the disease

first

appeared, that with others

did passively receive the doctrine that

we had

an epidemic of a direct typhoid character; and this was so much in accordance with popular opinion, that

required very considera-

ble firmness to resist the current that set in

from every direction against every species of depletion

hence nurses, old women, and un-

informed individuals soon appeared with hemlocks, essences, cordials,

and a vast host of

heating sudorifics, the use of which was com-

menced with

the

ready

off*

to lop

commencement

of the case,

the heads of the hydra epi-

demic.^) To show on what grounds the treatment which proved most successful was founded, and by which it was confirmed, I beg leave to introduce the opinions of some of the most eminent authorities in our profession. Perhaps there is no epidemic, or other general disease which attacks the

human frame

at the

28 present day, which

not nearly allied

to,

corresponds with, some disease which has pre-

ceded

Having adopted the alexipharmic

it.

(heating, sweating means, to drive the disease

out through the skin) method

of the

first

when

inclination

cases, the result

in treating

a tew

was unsatisfactory;

and duty urged

an investi-

was exhibited, and to endeavour to ascertain what disease it might be associated with, and adopt a course gation of the nature of

it,

of treatment accordingly. Autbori-

appeared that epidemics were treated of

ties.

by Sydenham,

under three general heads.

First, stationary fevers, or those

produced by

a peculiar constitution of the air

they exist

for a certain time as the standing disease, pre-

side over

by them.

all

others, or all others are affected

this

plague, yellow

&c.

kind

may be enumerated

fever, bilious

The second

autumnal

rent fevers, or those that take place less in

fever,

he calls stationary intercur-

more or

every year, and at particular seasons of

the year; such as pleurisies, peripneumonies, quinsies, &c.

Under

the third head, he ar-

ranges symptomatic intermittents, by which he

means those diseases

that partake of the sta-

tionary and intermittent diseases

When

was taken

into consideration that the

intermittent, remittent,

prevailed in the

combined.

and bilious fevers had

summer seasons

for several

29 years

;

when

also

was recollected,

that the

diseases which generally are met with in the

winter and vernal seasons, were those of the

phlegmasial (inflammatory) type, or the tionary intercurrents of pretty readily perceived

Sydenham;

sta-

was

the epidemic

that

partook of hoth of those sets of diseases, and

was

be referred to the

last

groupe, or that

of symptomatic intercurrent fevers, exhibiting

mingled symptoms of peripneumonic or phlegmasial, and remittent or bilious morbid excite-

ment.

Therefore we met with cases putting on nearly the character of usual phlegmasial

ver

;

and we saw

receding from

that,

fe-

through

the varied grades of excitement, to the typhoid state of disease.

why by

may now

readily appear

were called and described names of peripneumonia, pe-

the diseases

the different

ripneumonia notha, peripneumonia typhoides, bilious pleurisy, bilious fever, typhus fever, spotted

fever,

and many others,

either of

which was probably more correct than the delusive ones of typhus fever, or spotted fever. (8)

Among

other sources of information on the

subject of the Eastern

fever,

we had

North's book, in which that disease

Dr.

describ-

ed with much accuracy and candour, and the treatment detailed, of a liberal, high, mustilating nature, which, however, proved very

Dr.

watt.

30 ur

aiott.

Dr. Mana.

Dr. Mott

unsuccessful with us. that ours

was a

of opinion

different disease as

he saw

Dr. Mann, Hospital Surgeon

on Long-Island.

during the late war,

who perhaps saw

his full

share of the Eastern disease, being an Eastern

man, and no doubt, as Hospital Surgeon during the war, saw more than most others of the disease under consideration, as

spread along

the Northern frontier, extending from Green-

bush

and from Plattsburgh

to Burlington,

Niagara, thinks they are diseases of different

grades of action. (See Med. Repository, also Dr.

Mann's bookJ) Mixed

Mixed

dis-

diseases, with similar symptoms,

oases.

appeared had often been described, and some Syden-

of the leading remedies pointed out.

ham describes

a peripneumonic affection com-

bined with a preceding fever, which occurred in

England

1675: the symptoms

respects agreed with those of ours. serves,

many

ob-

always began with pain in the

head, back, and limbs." cure, he proceeds

With respect

to the

—" The symptoms were best

relieved by moderate bleeding, applying blisters, giving clysters

compares with

every day," &c. Dr. Rush

this,

bilious

pleurisy of the

United States. Hilious in-

u££E2?

This author also describes a disease which in 685, which he calls a new fever,

appeared

or winter fever. s

was of the peripneumonic

The symptoms correspond

class of fevers.

so well with those which have been ascribed to

take the liberty to transcribe

this, that I will

some of them. head and limbs

Heat and cold

pulse

not

of a healthy person.

;

much

pain in the unlike that

cough mostly, with

other concomitants of a mild peripneumonia: lying always in

bed

Pe-

often dangerous.

techia (spots) or eruptions frequently appear,

occasioned by an unseasonable use of cordials

and hot regimen.

Though

these eruptions do

sometimes come out spontaneously, yet they are frequently driven out by the

bed-clothes and cordials."

warmth of

effect a cure,

he used moderate bleeding and purging, &c. Boerhaave describes a peripneumony, which

was not very unlike the pneumonic type of ours. He observes " It is cured by this most prudential method: let the patient be blooded;

—

let

a clyster be injected daily,

by proper diluting

till it

signs, that the lungs are

appears,

eased

;

use

and opening aposems; lay on large

blisters," &c.

Dr. Cleghorn, in his Treatise on the Diseases of Minorca, informs us, that pleurisies and bilious diseases are often island.

combined

that

cure them, they require evacua-

tions.

Dr.

Rush notices a

fever which appeared in

Philadelphia in the winter of 1793, which he

;

The same

inflammatory fever.

calls a bilious

author gives an account of bilious pleurisies

and peripneumonies, which appeared

and some of the following years.

in 1794,

They were

cured by bleeding, purges, &c.

John

Bell, in his

failing the

System of Anatomy,

de-

causes which prevent a due oxyda-

tion of the blood in the

human

system,

among

mentions peripneumonia notha.

others,

says —"There

not merely an inflammation

of the pleura, as the

name expresses, but of

the lungs themselves

and

;

it is

not from inflam-

mation, pain, fever, and acute suffering, that Lungs obslructed,

produces ghastly ap

they die, but because the lungs O are entirely J J

crammed with blood, the heart can no longer move. They (the patients) are not sensible of their

dangerous

state,

but are suffocated in a

When

moment, and die without a groan. disease comes upon a place, the frequency disease.

The

;

pulse

weak, the cough

sallow.

all

slight

more anxious than

the face shrunk in the features, and

flushed, or rather of a

wjien

comes with

and destruction of an epidemic

the difficulty of breathing painful

this

lurid

colour, except

was cadaverous (deathly),

pale,

The

the lungs

suffocation

sudden

;

and

have no longer the cellular appearance of lungs their bronchia (air cells) are crammed ;

with blood tion,

that

the heart

so curbed in

its

gives but a small, feeble,

ac-

and

33 trembling pulse."

appears Mr. Bell gives a

very accurate description of many cases of the winter epidemic, and an explanation of the

cause of the irregular, small, and yielding states of the pulse.

The remedy

for

state of disease, naturally indicated,

such a

was

excite the circulation and action of the cuta-

neous and capillary vessels, and

some of the blood,

to relieve the

to abstract

engorgement

of the large vessels; so that there might be a less quantity of

blood to oxydate, that the

celerity of the blood through the lungs might

be increased, while the inflammatory action was subdued, and the system enabled to receive the oxygene with greater ease.

The Sydenham

of our country, Dr. Rush.

suggests such a remedy, that where such an

engorgement of stagnating blood has taken place, the best

remedy

bleeding, in small

and often repeated. By this mode, we give the viscera an opportunity of emptyin<* their superfluous blood into the vessels,

quantity,

and thereby prevent their collapsing from a sudden abstraction of the stimulus which they contained. In the History of North Carolina, written

Dr. Williamson, he remarks, that bilious pleurisies are frequent in that climate in the winter;

and upon the approach of

febrile

symp-

toms, some are apt, as they express themselves,

;

34 In this case, by taking

brave the fever.

exercise,

and not unfrequently by the use

ardent spirits, or other stimulant drinks, bring

on a

typhus.

In the Medical and Philosophical Register,

Dr.

Hosack describes the epidemic of 1812

and

813 as a mixed disease, partaking of an

inflammatory type, and requiring the lancet in

many

cases: typhoid in others, requiring ca-

thartics, sudorifics, followed

The

editors of the

and Francis, make Epidemic penpneu-

same

cordials, &c.

journal, Drs.

Hosack

a very similar remark.

in his Lectures, that Dr. E. Miller taught ~

Biding

peripneumonia notha sometimes became epi-

"hecur"

demic, when blood-letting

often required,

with other depleting remedies

;

mulants increased the debility,

and that

sti-

given before

evacuations were made. Bowels

Observing the torpid state of the bowels in

their state

and remedies.

many

instances,

toms, in

many

and the

similarity of

cases, to those

symp-

which occurred 1, the mind

in the fevers of 1809, 1810,

and 181

was naturally directed

applying remedies

to them.

In passing

by many authors through succes-

sion of time,

some of whom are mentioned, we

remark that Wilson,

in his Treatise

on Fevers,

observes, "if the bowels are constipated, find the skin

bowels are restored

comes

soft

dry and shrunk: as soon as the to action, the skin be-

and moist."

35 in his justly admired Treatise on Purgatives,

Dr. James Hamilton states,

when he had

given purgatives, the tongue, which had been

dry and furred, hecame moister, cleaner, and a feeble, creeping pulse acquired a firmer beat,

and the skin became moist; and ally

encouraged and

in typhus,

Edward

1 was graduemploy purgative medicines

to repeat them."

Miller, in

The

late Dr.

Lectures in 1807-8.

his

while on the subject of bilious fever and yel

low

fever, informed the class that cathartics

should be given, so as to keep up a kind of artificial diarrhoea.

Dr. Hosack, in his Lec-

same

years, taught very similar

tures for the

In a manuscript

doctrines.

paper among the

collections of Dr. Franklin, as stated by Dr.

Rush, giving some account of the yellow fever as

prevailed in Virginia in 1741,

it is

observ-

were the most valuable and remedy, and one which effected a

ed, that purges efficacious

cure.

goes on to say

trid fevers

art,

" All those acute pu-

require some such evacuations to

bring them to a perfect that

crisis

and

solution,

and

which must be promoted by

by stools, where nature does not do the business

herself.

this account,

an ill-timed scrupu-

lousness about the weakness of the body, is of bad consequence, for it is that which seem chiefly to

can

make evacuations necessary; and

affirm, that

have given a purge

in tbii

r, a

3(j

case,

the pulse lias been so low that

when

could not be

felt,

the debility extreme;

and

yet both one and the other have been restored

by skiu; state awl seating.

it."

seemed Sweating O (9) \ J

Of,

mucn

be an evacuation

and no doubt with propriety, under certain circumstances: it appeared to re hed on,

require some precautionary steps to use.

Among

the

free

its

many admonitions on

the

injury of forcing sweats in fevers, the follow-

ing from Sydenham, will be

place here.

•'Sweating depends upon the regimen; for that be over-heating,

and though it

in a

flows plentifully

affords little relief.

manner

viscous,

and universally,

raise a

sweat by

medicine in the beginning of the distemper, ordinarily translated

the morbific matter, if

not to the head, at least to the limbs."

remark of a learned modern divine,

worthy of notice.

The

Rev. Dr. Miller,

in his

Retrospect of the Eighteenth Century, says M

To oppose

the

cardiac and alexipharmic

doctrines of the Sylvian school, the illustrious

Sydenham was eminently

suited.

city of this physician led him,

seeming

intuition, to discover

The

saga-

by an almost

and obey the

dictates of nature, and to afford every proper assistance, without urging her to useless

hazardous

efforts.

The

and

effects of this revolu-

tion were immediately seen

in the

improved

treatment of acute diseases of every description

;

when, instead of the fashionable alex-

ipharmics,

intended

promote

imaginary

depurations, by additional heat and increased

stimulus, a safer antiphlogistic or cooling plan & r was adopted, with a view to unload the

oppressed habit, to reduce excessive action,

and

to preserve the strength of the

Revolution

from the h e ati t

par

system for

the subsequent conflict." (10)

Wilson observes, that when a patient wan confined to a hot room, and loaded with bed-

was produced

clothes, if a sweat

almost

al-

ways did harm. Although the theory of fever adopted by the immortal Dr. Cullen, leads to place reliance on sweating as a

remedy

much

overcome

the atony and spasm of the superficial and

cutaneous vessels, he has important cautionary observations, that " sweating has been generally hurtful,

when

excited by stimulating,

and inflammatory medicines; that it has been hurtful when excited by much external heat that it has been hurtful when it does heating,

;

not soon relieve, but rather increases the fre-

quency and hardness of the

pulse, the anxiety

and difficulty of breathing, the head-ache, and delirium

when

;

it is

that

it is

always hurtful

not fluid and

when

if it

it is

be urged,

partial."

I inferred the disease to require evacuations,

from observing that the pulse did not readily

lfni

38 raise

by the use of alexipharmic remedies;

remained obstinately dry under their use; and that the delirium and stupor were apt to be increased by omitting evacuathat the skin

tions.

also inferred

from observing

to require evacuations,

nearly allied in

to the bilious remittent fever

ceded

it,

many cases

which had pre*

and from those diseases being pro-

and rendered obstinate, if not fatal, by omitting them in which respect the epitracted,

;

demic under consideration agreed. I inferred those remedies to be indicated, by observing spontaneous hemorrhages being attended with salutary effects. It often happened, that a favourable

was formed

crisis

immediately after a considerable discharge of blood.

one instance.

will select

woman in who had a

young

the family of William Bard, Esq.,

severe pneumonic case, had bleed-

ing from the nose nearly all night on the sixth

was formed the next day, and she recovered. From what had day of the disease

a crisis

been learnt respecting epidemics, it

perceived

was the general opinion, that when they

prevailed, ter,

all

diseases partook of their charac-

or " were compelled to

and when the disease ing to popular report, all

first I

wear

their livery :"

appeared, accord-

was expecting

1o find

diseases exhibit a typhoid character. This

position soon proved

incorrect,

that all dis-

39 eases were typhoid.

the contrary,

ap-

peared that we had a disease of an inflammamatory type, either uncombincd or mixed with that said to be of a different character; for,

soon after

appearance,

its

in the night to visit Dr. S. o

his

chamber,

was called upon

Bard.

entering o

found him labouring under a

I)r

case

Ba r<i * ,

violent attack of disease, attended with difficulty of breathing, restlessness, barking hoarse-

and symptoms of croup. The prevailingdisease had been described as violently seizing local parts at first, before it produced its

ness,

general, or prostrating effects on the system. I

hesitated as to the remedies.

pressions were, that

demic, disguised in

The

this

im-

form of disease, and

that bleeding might prove fatal.

been many

first

might be a case of epi-

There had

fatal cases of it in the county

;

and

the disease was what popular opinion repre-

sented

it,

that

remedy might prove

fatal here.

Bleeding, however, was thought advisable: and the symptoms were such, that in about ten

hours

was repeated, by which, with other

remedies, he recovered.

was inferred that evacuations would be proper, by observing difficulty of respiration, in the chest, and suppressed cough and pain * It

expectoration in the latter stage of the disease, and until death (11); and from noticing a

white scurf on the tongue, with a lively red-

Distress . thG dies', tbe C rlGS .

till deatl-

40 ness of

its

edgc^, in the early periods of the

which Dr. Rush says

case,

an invariable

sign of an inflammatory diathesis. Tact

taught by Dr. Hosack, in his Lectures.

was inferred

similar

would be

that evacuations

proper, by noticing a suffocated state of the lungs and ghastly appearance of the counte-

nance, and sudden loss of the animal functions,

which,

the

commencement

of disease,

could not perceive could be produced by debility from abstraction, but might be bility

by de-

from action.

by the lanby observing the small and irregular states of the pulse in which Dr. Rush recommends its use in the commencement of disease. The blood was usually of a dark appearI

inferred the use of evacuations

cet to be indicated,

;

liloodi

ai>

pehrancefe <r.

ance, showing signs of not being properly oxy-

dated; and at the

first,

bleeding did not always

show the sizy coat, when it afterwards did. It often had the colour and consistence of molasses.

Blood of those appearances,

placed

in a scale of inflammatory action or depression,

above that which has a

buflfy coat.

With this view of the subject, we now comr to the method of treatment which has, in some measure, been anticipated. lancet (12) was cularly

commenced

was used

The

use of the

cautiously, parti-

in those cases

where there

was a pneumonic attack. After bleeding, an emetic was given, which was followed by a course of cathartic medicines, according to

Treats

cir-

cumstances, so as to produce repeated and

thorough alvine evacuations

;

or, as

sometimes

was the case, an emetico-cathartic of calomel and tartarised antimony was exhibited. The emetic seldom failed

discharge quantities of

bile, which was frequently very viscid and glairy. In some cases friction, with moderate warmth, was applied to the skin. Sudorifics and

expectorants, with a pretty liberal quantity of

calomel, were given in the progress.

mel was generally given so

The

calo-

as to operate

the bowels, connected with an extensive use of blisters

;

and as the disease yielded or shaped,

those were followed by nourishment, cordials, tonics, stimulants, &c.

many

of the cases,

was of service to begin with the latter remedies pretty early after the evacuations; and at this or the latter stage, it was frequently it

necessary to use stimulants freely gress.

The

in the pro-

case sometimes assumed that

situ-

ation in which Dr. Currie advises the external

use of cold water ;

when

was used

in affusion

and ablution with great advantage. After having lost five patients in 1812,

be conceived on may " patient, Mr.

gratification

the recovery of the

first

First case

C[)

Vandusen, (13) by the use of ™ eedd r

those remedies.

He had

a very violent attack

"Dlir

42 of pneumonic bilious disease.

His skin was

yellow, and his tongue covered with a

Within twenty-four hours from the

scurf.

tack, he

The

brown

was bled twice, 12 ounces each

at-

time.

emetics given brought off large quantities

of bilious matter: after which the skin softer In

became

and moister, and the pulse more regular. the operation of the

cathartics,

was generally a copious discharge of feculent matter.

there

bilious,

After the bleeding, the pulse

commonly became more full and fair, which was particularly the case after the other evacuations; and then the patient was pretty readily got into an easy moisture, by diluting

drinks and gentle sudorifics.

The

case occasionally so far partook of the

phlegmasial type, as to require a repetition of the bleeding, and that sometimes on the sixth

or seventh day, particularly in the latter part of the spring.

Editor of the Indiana Herald,

much

now who was very

In 1812, R. Nelson, Esq.,

prostrated in the attack, was bled at

symptoms were such as to require two more bleedings to remove the disease. The system appeared to be relieved, and re-acted much better in many cases by

first

biSgs some " !fml 5

after which, the

ta king a small quantity of

repeating

manner

it.

This was

blood at

in imitation

first,

and

of the slow

which nature discharged the blood

in those cases of spontaneous

hemorrhage.

There was much

benefit derived in

many

cases, by occasionally repeating the emetic or

the purgative medicines. As there was a great

determination to the brain, (14) blisters to the

neck and between the shoulders were of much advantage they were also of much benefit to :

other parts, where local pain and

affection

existed, or to translate excitement.

The

dis-

ease frequently had a disposition to assume

a suffocated or typhoid character, particularly

where early evacuations had not been made; so that it was important to watch its progress, importance 1 o ofdeterminand obviate those symptoms by a timely use ^com of tonics and stimulants. There were, how- mXnYf. ever, probably many unfavourable consequences, from anticipating the approach or accession of the typhoid state before it had arrived. Many facts might be adduced corroborating i

1 1116 -

this

remark.

In that type of the disease in J r

which the

lungs were not affected, blood-letting generally

appeared unnecessary. The

first

remedy,

was an emetic, or a course of catharThe purgative medicine was given so as tics. to produce a number of copious evacuations these were followed, intervened, or combined with diluents and sudonfics, and externally therefore,

some other application to parts affected. I was often agreeably disap-

blisters,

locally

Remittent type.

pointed, on making a second or third

visit, to

44 tind the patient, particularly children,

been considered dangerously

ill,

in a playful, or comfortable, or state, after the

convalescent

operation of the evacuating

In this type of the disease, the re-

medicines.

medies varied very

little

been successfully used

from those which had

in the bilious remittent

fever of the preceding years

and more

who had

sitting up,

liberal use of

;

except an earlier

wine appeared

ser-

viceable. It

appeared that by many practitioners much

was placed on calomel as a remedy; and very deservedly so, in the pneumonic type reliance

of the disease,

when

the case did not yield to

the early use of the evacuating remedies. in the bilious .Mercurializing not required.

type only,

was seldom neces-

sary, except as an evacuant rity

But

;

majo-

for in the

of the cases, the patient would begin to

convalesce sooner than the system could be

placed under a mercurial action.

A very important period, which try

often lost the advantage

coun-

was to see and early to

of,

the patient early after the attack,

make

in the

use of vigorous remedies; for such was

the rapidity of the progress of the disease, that the vital functions were soon impaired or de-

where they were not early relieved from the morbid action for, like all acute or stroyed,

;

inflammatory diseases, the more violent the attack, the sooner

changed

its

type,

and

assumed a malignant character when or aggravated by remedies.

left to

itself,

For most diseases with which our systems are subject to be affected, there are popular, and frequently unfounded, remedies in the hands there are

of almost

all sorts

also in the

same hands, remedies and prescrip-

of *prescribers

tions as preventives of those diseases.

«uack

medies.

The

remark was strongly exemplified respecting this disease and in this, as in most cases, they hit upon one of the most pernicious tendency. The most general and popular preventives were heating, stimulant, and spirituous potations. Perhaps there is no remedy rmma* remedies more universally resorted to by patients, and

truth of this

;

friends, at the ap-

urged on them by their

proach of indisposition of any kind, than that of heating sweats and stimulants and perhaps ;

there

none that

universally injurious

in the forming stage, or early periods of all diseases of our climate. Hence those who are

the nearest relatives and best friends, by their officiousness and ill-timed prescriptions, in a

majority of cases,

become

the patient's worst

enemy. (15)

Whatever might have been

the cause, there

be a torpor on the vital and nervous system; and evacuations from the stomach and bowels were more particularly indicated where blood-letting was adopted. appeared

40 Evacualions from

the bowel necessary with bleed

Perhaps blood-letting, without being followed by those evacuations, might in some instances have been attended with unfavourable effects. By emptying the blood-vessels, and leaving the bile and colluvies in the alimentary canal, their effects on the system probably

became

increased, and produced a greater degree of

torpor and malignant tendency than though no

evacuation from the blood-vessels had been

made. The depressed, overloaded state of the system in many cases was such, that by using blood-letting largely at once, no doubt

have been injurious out following

;

or to have used

would

with-

by free evacuations from the

stomach and bowels, re-action would not readily have taken place, and then bad effects might have ensued.

required the steady,

persevering use of all

those remedies to secure

a successful

result.

and heating remedies

relying on sweating

in this state,

increased

down

the pulse

the depression, and carried instead of raising

it.

The whole number

under

of cases which

came

care in 1812, cannot exactly be de-

termined, having kept only some general notes.

They

were, however, more in

number than

the succeeding year: the number of deaths

were

ten, five of

cases.

there

The was

which were among the

disease

little

first

subsided in June, and

or no general febrile excite-

ment

human system during

in the

the remain-

der of the year.

The year

1813

commenced with

epidemic excitement

the train of

about the same form

we had witnessed in the preceding year. With a view of determining the number of that

cases, the

manner of

treatment, &c., for

attack, the result of the

private

satisfaction

kept a register of the cases of epidemic disease for 1813.

made it

commenced with

ment of the

disease,

and daily

By J

as the cases occurred.

Number this register ° cases.

appears that one hundred and twelve cases

came under my I

commenceentries were

the

care, exclusive of those

which

had an opportunity of seeing, which were

attended by other physicians.

were bled,

sixty-three

five

Of this number,

were bled twice,

and one was bled three times. Sixty-one of those were pneumonic cases of course there were fifty-one in which the lungs were not dis;

eased.

Out of the whole number there were Respecting those who died,

seven deaths.

some remarks are proper. Four of them were of intemperate habits one had been in the :

habit of drinking from a pint to a quart of spirits

a day

;

so said his friends

the disease

seized him like a whirlwind, and soon carried

him

off!

recently

The

other three intemperates having

come

into the place,

had

their pre-

judices about them, and obstinately refused

48 being bled, though their situation urgently required

One

it.

of them died in a state of furi-

ous delirium, with

full

symptoms of depression

One

and turgescence of the system.

of the

others took few or none of the medicines directed, and got

little

If those

or no nursing.

four that literally destroyed themselves are

deducted, one hundred and eight cases remain, out of which there were three deaths to

one

The

— equal

in thirty-six.

disease again disappeared in 1813 on

the approach of warm weather.

A very healthy

summer and autumn ensued. The remittent

bilious

train of the

autumnal fever has been

nearly extinct since the appearance of the

winter epidemic. in

The summers and autumns

general have been healthy

vernal seasons have produced

the winter and

some cases of

disease, in addition to the ordinary diseases of

the season, which assumed

more or

character of the epidemic, which

less the

may be

con-

sidered sporadic cases of that disease. Disease or

In the

1811

affected,

autumn of 1814, our citizens were in some instances fatally so, in

and

consequence of a peared

have

its

fehrile disease,

origin with the militia

were doing camp duty lyn, in the vicinity

From

this

which ap-

who

Harlem and Brookof the city of New-York. at

circumstance the disease received

the appellation of the

Harlem or Brooklyn

;;

49 lever. for

There might have been some propriety as a common or popular name. Owing

to a pretty large this

detachment of the

militia of

county being sent there on military duty,

a number sickened there, and some died

some sickened, and came home on others sickened after their return

and

parole,

so that the

cases were among the militia soldiery, who had been serving their country in a military tour. By the influence of fell disease, they

first

were compelled to retrograde from the bustle of war to recline upon a couch of sickness and

some

instances, to part with that vital

spark which, no doubt, their valour and patriotism would have induced them more willingly

have relinquished on the

conflict, in

field

defence of their country and the

principles of liberty.

The

disease, however,

this class of

people

;

was not confined

occasionally attacked

others, though the principal part of the cases

were among those of the family or attendants of those who had been in the army. The symptoms attending the disease, were rigors, pain in the head, back,

stomach was more or

less

and limbs

disordered;

;

the

eyes were red, or blood-shot, tongue slightly furred

;

pulse sometimes

others small or yielding.

and nature of

full

and

firm,

In tracing the cause

this disease, reference

and

might be

symptoms.

had

to the place of its origin.

servation, that ther,

when

It is

an old ob-

troops are collected toge-

and new armies raised, particularly when

they are composed of militia, there are a variety of causes which operate to generate febrile disease. life

and

among

The

general change in the

in the habits

mode

of the individual, are

those which operate powerfully to pre-

dispose the system to morbid excitement. Dr.

had this in view, when, in the commander-in-chief in HI 8,

Mitchill no doubt his report to

observes, —"

In case the militia should

ces arise from the sudden change of life.

must be seasoned by degrees garrison, the

many inconvenien-

called into actual service,

camp, and the

Men

to the fare of

field

;

fresh habits

must be formed the powers of the body must bend to martial impulse. The habits of a military life are at length formed and habit, as ;

;

has been observed of old,

But

modifying causes, it

a second nature.

often suffers severely while

bends, and the old habit gives way.

individuals this it

moulding the frame of man by those

breaks before

pliancy and

some

so rigid and unyielding, that it

elasticity,

and

cracking and snapping of utmost importance."

bends.

—

its

prevent the are of the

its fibres,

To smooth

the citizen to the soldier

preserve

the

to avoid

way from

generating

a predisposition in the body to disease

—

51 palliate the rigours of a

camp

life,

and

to pre-

serve the vigour of the body of the army generally,

—seem

be the leading and humane

views of the Surgeon General. In that early day, the great Jewish lawgiver

seems

have been sensible of the importance

of cleanliness and regularity in a camp, to

avoid disease and pestilence, by his so strongly enjoining

in his

system of laws delivered to

the Israelites in the wilderness.

The

disease did not differ in any essential

degree from those ordinarily produced under where the body is pre-

similar circumstances,

disposed to disease, not only by those causes

enumerated, but by the action of miasma, generated by animal and vegetable substances in a state of decomposition.

was

The

complaint

a fever of a remittent character, some-

times alternating with or combined with dysenteric affection,

action,

and

and attended with much heat,

fulness.

The remedies most

serviceable in this dis-

ease were blood-letting: after that, or

was not used, or when

when

was not thought to it be indicated, the other remedies were vomits, and after repeated followed by cathartics it

;

alvine evacuations, sudorifics, with occasional laxatives,

were used; and

the progress,

nourishment, tonics, wine, &c. In observations

on the diseases of the army during the revolu-

Remedies.

Rush

tionary war, Dr.

checking the

failed of it

was

tient

says, M an emetic fever, if

a forming stage, and before the pa-

was confined

to his bed."

to believe that several cases

the

seldom

exhibited while

have reason

were cut short

same way, or rendered mild by early

evacuations.

Diseases have been losing their complex

character of 18 2 and 1813. 1

The

winter dis-

eases have gradually lost the bilious type, and

appeared more sial

excitement

in the ;

simple form of phlegma-

and the

bilious or remitting

character has been reserved, and

again ap-

more usual autumnal season. While this change has been taking place during two or three years past, there has been a pearing

in the

disease peculiar to each season, though none

very extensively prevailing, and no particular epidemic. uhesse

1819.

Diseases of the throat

About the beginning of the year 1819, although not very sickly, there were produced a variety of disease and grades of morbid excitement. There appeared a complaint of the rr r throat and fauces: many cases were mild, others were severe; and some of them proved tedious, and in some instances very obstinate. The patient was attacked with some febrile affection

;

a general soreness of the throat and

difficulty of

swallowing, which was in some

cases followed by a swelling of the pharynx

53 or tongue, or a thickening of the membrane lining the upper part of the oesophagus. Some patients fancied that a preternatural substance

was growing

the oesophagus.

of cases the swelling

and first,

became

In a

number

large externally,

some instances suppurated. After the or febrile stage was over, a debility and

relaxation

of the parts about the pharynx

(throat) and the ligaments of the voice took place, producing a hoarseness and difficulty

of speech.

This

disease

treatment

required

an antiphlogistic

in the incipient stage; that

followed

by stimulant applications to the throat and adjacent parts. Those cases which became tumified externally, were benefited or cured by continued blistering. Mingled with ately following

this complaint,

it,

we had

cases of pneumonia,

influenza, rheumatism, &c.

well as in

all febrile

and immedi-

;

in all

which, as

diseases of the forepart of

the year, there has been a peculiar disposition to affection

of the head, with pain, stupor,

and sometimes delirium. Those cases of catarrhal pneumonia and affection of the head, with fulness, stupor, and some delirium, came

near proving

fatal in several cases

they were

cured by large bleedings, and other active evacuations.

Disease or the brain.

During the winter and spring seasons of this

among other types and characters of disthere appeared one which we have been

year, ease,

very

accustomed

little

to in this

the period under consideration a r et fev e r

county within :

was the

In the

cynanchae maligna, or scarlet fever. vicinity of

Hyde-Park there were a number of

severe cases, and some of milder attack. Early in the case, the throat

bited a fiery redness,

became sore, and exhiwhich was followed by

an eruption on the fauces (throat), and that by

an aphthous scurf and ulceration of the part. In the progress, the skin exhibited a cadave-

When

rous appearance.

much

the throat

was not

affected, the scarlatina? flush or eruption

appeared more on the dies for

it,

skin.

were an emetic

The

best reme-

in the early stage,

or gentle cathartics, and those followed by cordial sudorifics: in

some

cases, a liberal use

of tonics and wine became proper, as the disease advanced.

do not know of any death

occurring with this disease in the county, and

have not learnt that tricts

of the county.

citizens, the

prevailed in

One

many

dis-

of our distinguished

Hon. James Tallmadge, may long

have occasion with parental affection

lament

the fatal effects of transferring an only son into

an atmosphere predisposed to generate and

produce

this disease in

Connecticut, where

prevailed to a considerable extent.

Nearly

for the first time since the appear-

ance of the winter epidemic, a few mild cases of intermittent fever have appeared.

warm

£;

turned

As the

season advanced, some cases of the cho-

lera morbus have been produced.

Dr. Bard

says, the principal remedies that he has found

laudanum and As the season farther ad vaneed, the bowels became generally affected with mild diarrhoea, though in some cases, and in some parts, it put on pretty severe dysenteric symptoms. As there are so many details on the method of curing dysentery, by systematic and other writers, it may be thought presumpnecessary in

this disease, are

chicken-broth.

tive for

to say

any thing on the subject.

choieraand dyseutery.

may, however, be remarked, that the plan which seems to be attended with the best success,

that

by evacuations

in the early periods,

succeeded by, or combined with, anodyne dorifics.

Sydenham used emetics

as a

remedy to discharge the contents of the mach, which otherwise became acrid, and

sufirst

stoset-

tled on the bowels, producing troublesome or

incurable gripes.

The

surgeons of the army during the late

war, bear testimony to the injurious effects of

a too free use of astringents in this disease. The late Dr. E. Hunting of Fishkill, who, during a long and successful practice, saw

much

of the dysentery epidemically, informed

Dr HuB t sentery.

56 ine, that the

method which proved almost invawas to give an emetic of

riably successful,

ipecacuanha, a cathartic of rhubarb, then small doses of ipecacuanha, rhubarb, and opium. Teiiow

re-

ver of 1819.

While the inhabitants of our metropolis, and the cities along the sea-board, almost from one end of the territory to the other, have been '

excited by fears and anxieties, and shunning the seats of pestilence, and fleeing their in " wild confusion," in

homes

consequence of the

prevalence of malignant disease, (16) which appeared with threatening and alarming devastation,

— our county has

general this sea-

son enjoyed an unusual degree of health.

The

autumn brought with it some cases of remittent fever, attended more or less with bilious symptoms, which in some instances has showed a disposition to protract

its

existence to a very

considerable length. Whether this

some

owing

peculiarity of the season or the type of

the disease, or to

some other cause, remains

for further observation to determine.

In treating the successions

of morbid

and catenations

and epidemical excitement, and

witnessing the effects which disease, in various

ways, produces on the human system, in impairing the regular operations of the functions

of the body,

are in

some measure shown

the numerous avenues which prove outlets to

human

life:

at the

same time

brought

view the multiplicity of to

ills

which man

heir

— which, without the balm conveyed by the

medical lists

art,

would swell the long and gloomy

of painful affection, and premature termi-

nations of our existence It

be perceived, that the practice of

will

medicine cific

—that

not a business of nostrum or spediseases are not to be met with,

simply confined within the lines of nosological

arrangement, nor cured by specific remedies for specific diseases

;

but that the character

of the disease, the stage of the case, and the

grade of excitement, ought scriptions

— that

govern the pre-

a faculty of discrimination in

detecting and applying remedies to them, constitutes the

sician.

most correct and most

In such reflections,

this Society will see the

situation.

the

skilful

phy-

members

importance of their

Organized under the patronage of

an enlightened legislature, they become the guardians of the public health, and may be enabled to overawe empiricism, and promote a rational and systematic method of managing diseases. While we bring to mind, that during the short period reviewed,

brethren have been attacked

many of our

such a manner

them our friends and

as to suspend their labours, and remove

from the scene of action

—

that

acquaintances have sometimes been caught

the rounds of morbid affection, of such a grade

practice or

medicine no nostrum.

58 as to baffle our art and

mock

our

skill;

but

and by a hum-

that our healths and lives are preserved, that the prospect before us

is,

that

ble and judicious exercise of the iEsculapian art,

we may

continue to be useful to our fellow-

citizens; for

which favours, "what

shall

render as a thank-offering unto the Great Fa-

ther and Redeemer of Men? falters

—here language

" Come, then, expressive

Here utterance

fails !"

silence,

muse His

praise !•

ADDRESS, DELIVERED BEFORE

THE DUTCHESS MEDICAL

SOCIETY,

THEIR ANNUAL MEETING IN

NOVEMBER

1825.

ADDRESS. GENTLEMEN,

When I had

the honour, six years ago,

of addressing you from

this station, I

that opportunity in laying before fect review of the diseases of

preceding ten years.

improved

you an imper-

Dutchess

And perhaps

for the

cannot

better discharge the duty which your laws (17)

have

at this time

imposed upon me, than by

taking a brief notice of those that have prevailed since, with a generalized account of

what appears ment.

It is

be the best method of again to be remarked, that it to

treatis

not

the diseases that are occurring every day and

every year, under almost

all

circumstances,

that will here claim our attention

;

but to trace

the most prominent symptoms of those of an

epidemical nature, as they have arisen, and displayed their characteristic effects on the

human

system.

After the termination of the epidemic constitution of

for

our climate, which had prevailed

a number of years, and been more or

less

62 connected with the late military operations, or influenced by them, there

was a period of

very general health.

The year 1820 commenced under very

fa-

vourable circumstances of exemption from general disease.

very few cases of phleg-

masial affections marked the winter and vernal

remittents e otery 82 o

period.

few intermittents

were the principal

and mild

train of diseases

summer months. As the season advanced, the dysentery became epidemic °f tne

fi pst

some sections of the county it was attended with obstinate and alarming symptoms, and in in

many

instances

with

The

fatality.

various

ordinary derangements incident to this dis-

ease of the alimentary canal took place, which

was frequently attended with considerable Bloody discharges arterial action and fever. from the bowels was almost an invariable

symptom.

The

evacuations were sometimes

scanty, attended with tenesmus

;

but frequently

they were copious, particularly after cathar-

were used, and they frequently had the appearance of thick, bloody water.

tics

Treatment.

Treatment

In the early stage, particularly

as the cold season approached, blood-letting

some cases was beneficial. This was best to be succeeded by emetics of ipecacuanha, or cathartics, of which calomel was a leading

article,

with something to aid

its

operation,

when

was very serviceable

to determine to the skin,

of the bowels. ficial to

was

to give remedies

and sheath the

lining

also found highly bene-

give opiates occasionally, and parti-

cularly as an anodyne at night, in sufficient

These

quantity to allay the pain and irritation.

remedies were to be followed by astringents, tonics, &c. as soon as the case

In several instances, as

be the case, time was

lost

would bear

it.

perhaps too apt to

by beginning w ith r

astringents too early, before the vascular ex-

citement had been removed in the early stage. The fatal cases wre about in proportion of

one

to twenty. (18)

very successful method of treating dysen-

...

was communicated to me by Dr. Ford of South Carolina, which is used there with suc-

tery,

to K

Dr. Pord-s plan-

the blacks. It is by giving an of ipecacuanha once in about six

among

infusion

hours, so as to keep up a nausea, and occasionally vomit.

Every year has produced a few

sporadic cases of time (viz. 1820),

this disease its

but since that

occurrence has not been

as frequent as during the past season.

Sue-

Dysentery of 1825.

ceeding the extreme heat, derangements of the alimentary canal

became very common,

exhibiting choleric and dysenteric symptoms.

Among adopted

the for

variety

the

of plans proposed and

cure of dysentery, a very

soothing and successful one

was pursued by a

64 surgeon in General Packenham's army, that was near New-Orleans in 1816. A plan some-

what caiomeiand opium plan.

similar has been used by

some

ers in this county with success.

practition-

consists in ..

giving opiates, in sufficient quantity to allay the

and calomel, either combined or alternated with it, enough to open pain and

irritation,

the bowels, aided by castor

tive mucilages.

adapt

oil,

some

laxa-

this practice to our

be necessary frequently to pre-

climate,

Biood-iettinj in dy-

cede

blood-letting or an emetic, or use by J

semery.

t n#

its

will

<-'

The

success of this course was eminently

exemplified in the case of General Lewis, in a violent attack of this disease on the 12th Sep-

Diseases or

tember last. He lost 24 ounces of blood, took opium enough to quiet the pain, and large doses of calomel, which was aided in its operaThe cure was speedy. tion by castor oil. In 1«2J, nothing, pecuhfcu marked the early

1821

part of this year.

some

sections of the

county, phlegmasial diseases prevailed to a

moderate degree, particularly those of a perip-

neumonic type. Dr Bards

They

was a peripneukind in May, that termi-

antiphlogistic remedies.

death.

monic attack of

this

of the

nated the

life

ciety, Dr.

Samuel Bard.

a short digression,

first

cused, to cherish the friend.

generally yielded to

President of this SoIn passing this event,

presumed,

memory

will

be ex-

of a patron and

As a physician, he had an active,

65 discriminating mind and discerning judgment,

well calculated to detect the intricate and

obscure operations of morbid action, and devise means to effect their removal.

to his

benevolent disposition, and perseverance in laudable undertakings, he perhaps did more for the

advancement and cultivation of medical

science than any of his cotemporary country-

Much is due to him for procuring the passage of the law by our Legislature, under men.

the auspices of which bled, and out of

are this day assem-

which has grown

that ad-

vancing respectability of the medical character which, by the irradiating influence of science, has overawed, and almost obscured

empiricism. (19)

Those who had an oppor-

tunity of meeting

him within these

readily bring to ation, ple,

mind our then

when we were

and edified by

dresses.

Although

walls, will

flourishing situ-

stimulated by his examhis

maxims and

his ad-

for

many years

retired

from the city and from active business, he was not withdrawn from professional usefulness or

benevolent purposes.

constantly,

when

required, gave counsel to those around him;

and among the poor, sought out cases of sickness and want, on which to bestow gratuitous services.

His

wife,

who was

with the same disease, was his

first

attacked

last patient,

and

—

;

he her last physician! He being soon attacked, was obliged to end his medical labours, and withdraw from her the day before she died and in his turn became a patient. During his short illness, he displayed his usual vigour of

mind and promptness of decision. He conversed with me and with his friends, with calmness, on the nature of his disease and the

More than once he

approach of death. pressed

ex-

substance a couplet that he had

used on another occasion "

God

direct

Teach me

to place

erring mind to thing's above

bliss in faith,

and hope, and love

dwelt on the importance of early subduing

and of preventing effusion in the lungs, which he anticipated would with him be the case. All he dreaded, he said, was the suffocating distress that that would give arterial action,

him.

In the former opinion his anticipations

were realised

—

in the latter

they were not. Al-

though effusion took place, he became calm, and died in full assurance of receiving a Christian's

reward

for a life well spent.

Every year,

for several years,

our county

has been more or less visited with intermittent

and remittent

assumed the most subject

fevers,

which

the aulumn have

The

parts

to these diseases, are the

towns

bilious

character.

along the river, and some other sections in

67 the vicinity of ponds,

marshy

creeks, and

exposures.

The

fevers of a remittent character

symptoms,

us, generally, exhibit

among

the early

stage, of increased arterial action or congestion in the system,

symptoms of a

more or

less

attended with

bilious (20) affection;

though

the latter are not so prominent as they have

been

former periods, and those of the pre-

sent year have generally been attended with

more decided symptoms of

fiery,

increased

excitement or depression.

Whether, fevers

some

do occur

diathesis at the

sections of the county,

that partake of the typhoid

commencement

to be a question not wholly far as

or not, appears

settled.

observation has extended,

have taken considerable pains the subject,

—

But as

—and

to investigate

induced to believe they are

very rare. In making

this

remark,

am aware

that in the progress and treatment, a variety of

circumstances tracted form. arterial action

may concur Unless is

to give

in the

them a pro-

commencement

restrained, or congestion

and

the causes of depression removed, or the mor-

bid action transferred to the alimentary canal,

and the feculent matter eliminated from the system, a train of tedious, perplexing, and ty-

phoid symptoms

may

supervene.

™ rie)f

The numerous modes

known

fevers, are too well It

of curing intermittent

may, however, be

fairly

be detailed here.

observed, that those

of this year have required more evacuations less tonics than they did formerly. (2 1)

and

In the treatment of the remittent or bilious

remittent fevers, emetics arc frequently indi-

The

cated. to

best plan in the progress, seems

be that of purging, somewhat on the plan of

Hamilton, by calomel, aided by other laxative articles, gently and perseveringly pursued; and

sudorifics, with, occasionally, opiates, (22)

large enough to quiet

motion raised

all

pain and the com-

the system;

which plan

formerly detailed in the treatment of the remittent

and

bilious fevers of 1810.

This course,

with occasional blood-letting, in the early stage of the case, can be

recommended from long

and successful

By emptying

use.

the blood-

and evacuating the system, we not

vessels

only remove the tension and disposition to in-

creased arterial action, but place the disease

more under the

control of remedies, and often

prevent the occurrence of those obstinate and difficult Typhoid cases.

Treatment,

vene.

symptoms

that otherwise

In those cases that

may

super-

assume the typhoid

•

character, the indications of cure appear to be

best answered by frequently evacuating the

stomach and bowels, particularly

in the early

and arousing them

stage,

to action; then at-

tempting to equalize the circulation, by pro-

moting the action of the

skin,

and

by purgatives, combined

in the pro-

The method

gress to support the strength.

with, or followed

calomel, opium, and sudorifics, appears best to

answer those

indications. This course is essen-

pursued by Dr. Miner,

tially

in his

treatment

of the typhoid diseases of Connecticut. the nature of typhus, or what

But

by Armstrong

called congestive or inflammatory typhus,

by that author ably investigated, and the general use of

evacuant remedies clearly detailed.

In those cases

when

the proper period has

arrived forgiving calomel, with an intention of

having

enter the system,

in sufficient

it is

quantities to

well to exhibit

operate on the

bowels. believe

rials

soonest

may be considered that mercuenter the system when they pro-

duce a laxative

effect,

by which the

lacteal ab-

sorbents are aroused to action, to take them

whereas, when the action of the bowels

not increased, the absorbents act sluggishly,

and the mercurials may tem.

It is

probably on

lie

dormant

in the sys-

this principle, that ca-

thartic remedies, by brushing the mucous crudities

from the mouths of those absorbents,

and stimulating them

to action, to take

up nu-

n owe is

be acted on, e a

mercurial e j.°^a , action.

become

tritious matter, frequently

Hence,

mulants used.

the best

broken up, instead of giving cathartics, or carry off a salivation,

sti-

after the disease is

is it

to stop

not better to cease

giving mercurials and omit cathartics, and let

the bowels

become

ritation of the

inactive;

and allay the

ir-

system by opium, and the use of

cold gargles ?

The

Mercumi treated.

great perplexity in managing a mercu-

r j a | gore

m outh,

in the old

nected with the frequent

common way,

irritability

con-

of the sys-

tem, and often dissatisfied looks of the patient, will, in

a great measure, be obviated by this

course. it,

When

the state of the system will bear

a free exhibition of wine will prove a great

auxiliary to this treatment.

Whether

it is

that,

by taking off excitement,

or removing congestion, in the early stage of disease, or to

some other circumstance not now

be inquired

into,

when

these remittent dis-

eases have been treated upon those principles, I

have not observed an occasion to prescribe

for a typhoid, or a long protracted case. It

may be considered an improvement

art, that

the

the evacuating method of treating fe-

vers in the early stage,

and becoming a substitute

gaining in fashion, for the tedious

and

protracted one of relying upon sudorifics, mercurializing

and alexipharmjcs.

With a very few exceptions, I have not, for a BoRorcnm pressible number of years, until this fall, observed those p^bee of cases of fever that,

in the early stage,

hibited the peculiar, small,

which

have attempted

soft,

have ex-

obscure pulse,

to describe, as taking

place in the epidemic of 1812; since which a

number have occurred. The attack of disease, some cases, is rather mild; perhaps the case is some days in forming; though in others it comes on quickly. Some complain of very in

little

or no pain, others of considerable

head

generally

affected,

producing

the dull

heaviness, and a sleepy dulness of the eyes.

Some have been attended

with

insidious,

others with severe peripneumonic symptoms.

The skin is very much furred, but

dry and husky; tongue not of a fiery red appearance

;

bowels commonly torpid discharges of blood from the nose have occurred in several cases. I believe attempts have been made to relieve this state of disease by relying upon alexiphar;

mic, sweating means, mercurializing, &c. which will

sometimes succeed, but often

this

plan finally succeeds,

it is

fail.

When

generally after

The patient a long, tedious, protracted black scurf is affected with a black tongue, a illness.

on the

teeth, delirium, nervous irritation,

a train of those symptoms called

typhus.

and

Those cases are

by one and these followed by

beneficially treated

or two bleedings early,

remedies that produce evacuations from the

stomach and bowels, and

warm

bath.

Although

some cases the

some instances

have

bled largely, which corresponds with Armstrong's

method of treatment, yet

occasion again to remark, as

here take

stated in the

treatment of the disease of 1812 and 1813,

there are well-founded anticipations of debility ensuing, the

bleedings had better be small,

and repeated, and those followed by a course of cathartics, which gives the vessels an opportunity to remove the congestion, and the Appearan-

system a chance to re-act.

The

blood

in this

ces of the

blood

state of disease

whereas

in the

very dark, thick, and heavy;

advanced

state,

when

there

real typhoid action, or debility from abstrac-

said to be dark, but thin

tion, the

blood

light.

have not observed

coat, in either case.

becomes more

florid,

In the

first,

and

form a sizy as

flows,

and more disposed

exhibit signs of inflammatory action.

After

may

this,

usefully

calomel, opium, and sudorifics

Under this treatand becomes more i'ree,

be exhibited.

ment the pulse rises and by this course, judiciously pursued, the disease generally goes off in a few days.

As this is an important state of disorder, for which we occasionally have to prescribe, it is trusted no excuse will be required for intro-

ducing an abstract account of two cases, to

show

the nature of it

October 20th.

at large.

A. B., aged 10 years, after se-

veral days of slight indisposition, attended with

a want of activity and languor, had chills and rigors for a long time, followed

by mild

fever,

slight pain in the chest, skin dry, very little

heated, followed by great lassitude, fiery redness of the tongue, which was slightly furred,

pulse small, soft and irregular; had a considerable discharge of blood from the nose, during the night previous. She took an emetic, which

was followed by cathartic remedies. 21st.

The medicine

Symptoms very

operated as desired.

relieved.

little

Took

eight,

ounces of blood from the arm, which was dark

and

thick.

Repeated the cathartic remedies.

Directed to take freely of water and other cold drinks, and a large anodyne after the free

operation of the cathartics.

22nd. Medicine produced free and copious evacuations

from

the

sweating succeeded.

bowels.

copious

Pulse more free and

full.

She now commenced the use of calomel, opium, and sudorifics, and continued the drinks.

The

25th.

disease nearly

state considerably debilitated

menced

the

remedies;

left her, ;

but in a

when she com-

use of wine and strengthening

from which

time

she

gradually

recovered.

The in a

following case

of recent occurrence,

gentleman who had experienced conside-

rable fatigue at a meeting of the Alumni of

Columbia College.

May 20th. W.

B.,

aged 4b, after some slight

was attended by moderate

indisposition from a catarrhal affection,

seized with lassitude, rigors,

which continued ten or twelve hours.

These symptoms were succeeded by a

slight

fever.

Pulse

22d.

soft

and small

ed with an inactive

feel

;

skin dry, attend-

tongue fiery red on

the edges, and very slightly furred in the mid-

Countenance dull and heavy.

dle.

Says he

has no pain, but complains of a tired, uneasy, horrid feeling.

lowed

Gave him an

emetic, and

fol-

by 10 grains of calomel, and a dose

of sulphate of magnesia. 23d. little

The emetic operated well. Bowels very The symptoms of yesterday in-

moved.

creased.

He was

bled twelve ounces.

very dark and heavy.

Blood

Directed calomel and

jalap, each five grains, once in four hours, to drink freely of cold water

and whey.

and

Medicine operated very

24th.

Has experienced full

and tense.

dark and

very

little relief.

slightly.

Pulse more

Bled him one pound.

Blood

became more

while

thick, but

florid

Continued the cathartic powders

running.

with an infusion of senna and manna. r

2. >th.

Medicine operated

Symptoms

artic.

Took

all

apparently

relieved.

calomel, opium, and sudorifics.

Some

26th.

fever

arose

which rendered him rather very

freely as a cath-

little

excited.

towards night, restless.

Pulse

Tongue somewhat furred.

Continued the remedies. 28th.

Symptoms

all relieved.

From

this

time he gradually recovered.

an observation long ago made, that diseases perform revolutions by forming groups or peculiar trains of diseased action, which appear, and exist for a length of time, producIt is

ing their devastating effects, and again disappear, and are no more heard of perhaps for years.

This remark

will be, in

some mea-

sure, exemplified by tracing the succession of

diseases of a country for a series of years, but more particularly in that of the small pox. After the introduction of the kine pox, (23) the small pox gradually diminished, and became

almost extinct;

till

July 1808, a pauper was

introduced into the New-York Alms House,

smaii pos.

who soon broke

out with small pox.

rapidly through the house,

spread

where about

se-

venty cases occurred in the natural way, one in nine of

which was

Considering the

fatal.

close confined situation and the heat of sum-

mer

which

prevailed,

was thought

be attended with not very great

Some

mortality.

of the nurses had what was termed nurse

pox, which differed

none, from what

very

little,

now termed

or perhaps

varioloid.

From

the disease spread northerly and exten-

this,

was such,

sively through the state. Its progress

that

prevailed and spread widely in this

county

the winter following of 1808-9, ex-

citing

much

many

cases with mortality.

anxiety,

and being attended

and general use of kine pox, ence was

resisted.

and probably

From

By the prompt much of its influ-

the use of kine pox,

some measure from the sub-

siding or passing by of the atmospheric predisposition to produce small pox, the disease

disappeared period

we hear

small pox, its

in the spring

till

appearance

but

little

1821-22,

From

of 1809.

this

of the existence of

when

again

made

an epidemic form, in Philadel-

phia and some of the southern sequently in New-York.

nied by a disease of

cities,

and sub-

This was accompa-

much more

general and

extended influence, though milder

in degree,

producing very similar the

early

stage:

effects, particularly in

was denominated the

varioloid.

There seemed ric

be very strong atmosphepredisposition to produce those diseases, to

became very numerous, and appeared almost to overcome the influence of kine pox in shielding the system from their so that cases

effects.

their

From thence

appearance

these complaints

made

in this county.

In December 1823, the small pox was introduced from one source, and the varioloid from another. Of the former several cases

occurred, but the latter were much the most numerous, being produced by both diseases.

From no

this introduction of small

fatal case.

Again

May

pox there was 1824, two very

severe cases of small pox occurred

Hyde

Park, both of which terminated favourably.

From

these a

ceeded.

number of cases

Again

in the

of varioloid pro-

autumn, the small pox

Red Hook, and some cases of varioloid in Pleasant Valley. In Red Hook these diseases became epidemic, and several cases of small pox terminated fatally. From this place appeared

those diseases spread east, into Pine Plains; north-east,

around

Stanford, Washington,

Pleasant Valley, and Poughkeepsie, producing

some cases of

fatality in their progress.

1823.

Vari-

oloid and

smaSpoi.

78 smallpox of 1825*

August 1825, the varioloid was again introduced into Hyde-Park, by a young lady who had

been

company with a

city of i\ew-York.

small pox.

had a very

and went through vsrioio.d small

pox

From each

pox. f

From her

a sister, a young

not been vaccinated, took the

who had

child,

varioloid patient in the

all

thick, full eruption,

the regular stages of small

number were produced. These

of these instances a

cases of varioloid

diseases wore the decided inflammatory cha-

and required the antiphlogistic

racter,

treat-

ment, modified by the peculiarity of the disor-

der and state of the case.

abstract from remarks

ease as

show what was the pro-

per course of treatment, as

much

the dis-

prevailed in the Hospital in 1808,

will very conclusively

county.

made on

In the

prevailed in our

cases, the fever partook

first

of the inflammatory type.

The

patient

bore depletion and the antiphlogistic treatment very well, which was attended with evident advantage.

the pustules did not

fill

promoted their

fill-

well, a cathartic generally ing.

The secondary

fever

was inflammatory,

and was relieved by cathartic and refrigerent means.

During

its

prevalence, at about the

twentieth case, the disease in

changed

its

some measure

type, and debility supervened after

the turn of the pock, and the patient required

some of those cases Dr. Hosack directed the warm bath to which was added a decoction of bark and Castile soap, which stimulants.

;

appeared

be an important remedy

in re-

straining the septic tendency, and saving the lives of

some

that used

The appearance of subjects who had had at

first

it.

the varioloid in those the kine pox,

shake the public

faith in favour of

But when

that protecting disease.

seemed

was ol>

served that those who had had the small pox, were equally or more subject to the varioloid than those who had had the kine pox, and that the varioloid was a mild disorder, the reputation of the kine pox again resumed its

former station, and has proved

much importance

protecting

itself of as

the

from the influence of small pox as

merly supposed

Among

system

was

for-

the hundreds

Kine po x

vaccinated in the county, there has been no

preveuts small P° x

to be.

well-attested instance, in which the kine pox

had been genuine, vened.

Among

investigation

that the small pox has super-

the various subjects of medical

which have

tention, none, perhaps,

lately

occupied

intricate

at-

and

mysterious than the various operations and

connexions of small pox, varioloid, and kine pox.

Whether they are

distinct diseases, or

mere modifications of the same

virus,

appear^

80 to

be a question yet

be discussed.

attended with considerable difficulty

some

cases to determine the line of distinction be-

tween small pox and varioloid, though cases varioloid, charac-

its

ter-

it is,

most

however, easily ascertained.

From the writings ° of others, and from my own observation, I can state a fair character of varioloid to be, more or less indisposition,

attended with pain

in different parts,

quently with considerable fever.

and

This

fre-

is fol-

lowed by an eruption, generally scattered, though sometimes very thick, so as to be con-

The

fluent.

pustules are small, and not gene-

rally attended with the circular inflammation

of small pox to

they go on increasing from three

seven days, and have a peculiar horny pro-

minent

top.

matter.

Many

of them

fill

with a watery

Before the ninth day they generally

recede, and entirely return into the skin, or go

commonly followed by secondary fever, nor has it produced any death in the county. Whereas in small

off in

branny scales.

It is

not

pox, the eruptions appear, and continue enlarging beyond the ninth day, even to the sixteenth,

and then

fill

scabs, and

The

with pus. peel

off,

pustules dry into

followed by secondary

fever, &c.

Opinions held at present respecting those diseases, as established

facts

and observa-

81 tion,

appear

sions

warrant the following conclu-

That varioloid will produce varioloid. That in a subject that has not had kine

1st.

2d.

pox or small pox, varioloid

produce small

will

pox.

That vaccination,

3d. is

most or

a preventive of small pox

;

cases,

or so modifies

the access of small pox, as to take

danger of

all

away

all

fatality.

4th. That varioloid will attack after small pox or kine pox; but is most severe after

small pox.

stated in an essay on this

subject by Dr. Bell, that a patient

may have

kine pox four times, and that the virus pro-

duces the

less

fifth

and

time

less effect it

on the system,

produces none

at all;

till

when

the patient becomes saturated, and resists the influence of both small pox and varioloid.

The

small pox character of disease seems to have

run

its

course;

and that and the varioloid

have disappeared, and we hear no more of them.

The

measles have prevailed more or less

every year under consideration, tricts

some

dis-

of our county, to a moderate extent. But

Measles of 1824

in the spring ol

1824 they became a general

epidemic, and spread nearly, or county. In

many

all

over the

instances they were attended L

82 with

The

fatality.

diathesis of the disease

was of a high inflammatory character, although great numbers of cases went safely through But those that required

without medical aid.

medical treatment, succeeded best by anti-

means and frequently the case was by copious bleeding. When the disease terminated fatally, it was commonly by a secession of the eruption, and a peripneumonic attack. The term black measles, which it phlogistic

;

benefited

sometimes obtained, appeared

be a gangre-

nous state consequent upon fullness and inflam-

matory Feripneumoiiia of 1825

The

action. (24)

more general than ° any other among us which terminates more lives than any or all others to which our comwhich

disease,

—

munity

and

subject

— which

prevails every year,

every season of the year, but more gene-

rally in cold weather,

—

the different grades

of inflammation of the chest, arranged by nosologists

under the various terms of bronchitis,

influenza, peripneumonia, pleurisy,

pneumoni-

cula, &c.

When epidemic,

this it

character of disease becomes

produces the most general

influ-

ence on the human system of any variety of

morbid excitement. ioflammatory type.

may

prevail

sthenic or an asthenic diathesis m

few exceptions,

;

under a

but with very

our climate,

the inflammatory character.

partakes of

has been three

83 times epidemic within our time.

In 1807, the

influenza, with peripneumonia, spread through

the county, and extended itself over the United States. all,

was so universal

or nearly

all, felt its

in its

operation, that

The

influence.

late

Dr. Wheeler of

Red Hook, observed that he a person in that town who had escaped it. There are many interesting facts on this disorder, recorded in the New-York did not

know

Medical

Repository,

Museum, by Coxe, and

Philadelphia

Medical

the American Medical

and Philosophical Register, edited by Dr. Hosack and Dr. Francis.

The

peripneumonia, with bilious disease .

under

different

prevailed from

names and modifications, again 1812 to 1814, and continued

sporadically to 1816.

The

influenza and pe-

ripneumonia again prevailed the

last spring.

Besides those wide-extended epidemics, these diseases are every year more or less prevalent,

and have

their annual returns during the ver-

nal season.

There

no class of diseases that exercises

the skill and ingenuity of the physician more

than

this,

and particularly that of the perip-

neumonic type; none

much danger sis,

which there

of mistaking the present diathe-

by taking congestion or suppressed inflam-

mation for a state of debility or incipient

presence of peripneuia &c

^ 1816

18I 2 t0

84 typhoid action

;

or none in which the inexpe-

rienced in the profession would be more likely to attempt to

remove oppression and apparent

debility by stimulant means, Indications of cure.

when remedies

a different kind would be most proper. (25) v * ' rp^

e g enera | indications of cure, are to re-

strain arterial action;

remove congestion

of blood in the pulmonary vessels, with

tendant inflammation

;

the effects of a secretion of sion in the lungs; It will

and

its at-

prevent or obviate

mucus or of

effu-

support the strength.

readily occur, that these indications are

be answered by depletory, antiphlogistic

means.

the disease

not arrested in the

early stage, effusion or suffocation takes place,

or a protracted or typhoid state frequently

For a more particular detail of the plan of managing these diseases, permit supervenes.

me, besides the systematic writers, principles

the

works of

to refer for

Sydenham and

Rush. Bisease of 1825 very

infumma-

The

last spring, disease that prevailed i o was * As is f a very active phlegmasia! type.

observed by John Bell, " the lungs were quently stuffed and

When

blood."

exhibiting a small pulse, prostration of

strength, Treatment,

crammed with

fre-

and a

pallid countenance, there

the most urgent call for bleeding.

And

was

have

not met with a disease where the patient re-

85 quired more bleeding, or better.

in which he bore it Although some cases recovered with-

out the use of the lancet, yet in most cases of

much

activity

frequently

was used with advantage, and

was necessary

be several times

repeated. (26)

has been considered that

ces this disease

many

instan-

connected with a typhoid

diathesis, or that there

a great pronenoss to

that state of the system.

Hence we hear of pneumonia typhoides, of typhus supervening, and that the patient may be run down if depletion

used, &c.

extended,

far as

observation has

have not observed such a

In addition to the testimony of a

medical brethren

state.

number of

favour of the sthenic

nature of those diseases, their inflammatory

character will appear, when that

the

antiphlogistic

observed,

depletory course of

treatment was uniformly pursued, and

that

Result or cases.

out of the numerous cases that passed under

prescription,

(a child),

there

and one case which terminated

consumption. (27)

The

There was no case tongue, or

Whatever as

was but one death in

patient has since died.

that exhibited a black

which a typhoid

state supervened.

the diathesis of disease

leave the banks of the

proach the Connecticut

river,

may

be,

Hudson and apI

have not been

86 But, as

able fully to determine.

our county, to

will

relates to

prove a dangerous delusion

adopt the position of Dr. Miner, that the

inflammatory nature of disease has entirely left

our country, and that "

diseases par-

all

take of a typhoid character." Numerous facts are not wanting to show the generally decided

inflammatory or congestive nature of our diseases. (28)

The

chiid-bed fever.

last disease,

though o

importance not r

the least, (for an account of which you will be

detained,)

one of a peculiar nature.

confined to the female sex, and, more than most others, nearly connected with the procreation

of our species: It

the puerperal fever. (29)

has not fallen to our lot to have this disease

prevail epidemically

among

sionally occurs in all places,

appeared

our county

;

and

much

but

latterly

occait

has

oftener than for-

so much so, that in some districts it has been very frequent; and too true it is to evade,

merly

;

these occurrences have been attended with great

fatality.

For the character and descrip-

tion of this disease, reference it

one, "in this almost

all

be had to

has been observed by

systematic writers, as

practice,

agree."

During

have had a few mild sporadic cases

of this affection, such

occur in the country.

believe as generally

They have yielded

moderate bleeding, purging, sudorifics, anodynes, &c. 1 have been well informed, that in the southern parts of the county it has lately prevailed with a good deal of frequency and

much

What

have been cured or died, or what mode of treatment has been pursued, I have been unable to ascertain. fatality.

proportion

Since the beginning of this year

has appear-

ed, and exhibited almost an epidemic character near

residence, attended with such

violence and pain as

attributed to the most

malignant cases. It is

considered an active inflammatory dis-

ease by Denman, Gordon, Hey,

aftd

Diathesis.

Armstrong,

of Europe; by James, Bard, Hosack, and Francis,

of our

own

Burns and some

country.

others have their doubts on that subject

;

out

of which probably proceeds Burns' vacillat-

mode of treatment, when he says, u I find much easier to say what remedies have

ing it

what have done good." He evidently labours under a mind of typhoid association, and is one of those who furnish the failed, than

disastrous reports of those

who

consider the

disease of a typhoid character. At the present

day, there

believe, is,

and

our climate especially,

or ought to be, but

opinion on that subject.

what may be considered the

little

diversity of

taking a view of true pathology of

Pathology;

88 the disease,

will farther exhibit

The

tory nature.

its

inflamma-

uterus and surrounding ves-

sels after labour, are in a lax, dilated,

table state; and this

termed a

and

irri-

may not be improperly

state of predisposing debility.

This

being the state of the parts, the blood flows

them in inordinate quantities, distending and cramming them, producing an inflamma-

into

tion

somewhat

which

generis,

sui

extends to the surrounding parts. allied in its

its

readily

It is

nearly

nature to violent peripneumonia in

From

suffocating effects on the lungs.

this

may proceed

the great pain and sudden dis-

tension of the

abdomen: and

duces similar

fatal

the disease pro-

gangrenous

results, unless

the vessels are unloaded, and the circulation

equalized It

very onset.

at the

ought not to detract from the reputation

of a practitioner to lose his patient in this disease, after the

avowal of such men as Burns,

what had failed, rather than what had cured of Bard, who declared it to be a most fatal disorder of William Hunter, that he could say ;

;

who

used bleeding and cathartics

man, and she died tions in another,

—sudorifics

and she died

;

one wo-

and fomenta-

who

tried the

stimulant plan in another, and she died: in short, all plans failed

Edinburgh, who, as

or of a Professor in

are informed, lately

89 told his class that

he considered

an incura-

ble disease.

Several valuable treatises have lately ap-

peared on the subject of puerperal fever; but

none of them has so

forcibly

recommended

the

use of the lancet, as that by Mr.

Hey

in this disease,

have employed blood-letting

of Leeds.

(says he,) to a greater extent than any other practitioner with whose writings

;

acquaint-

and have hazarded the opinion, that the

quantity of blood

scarcely to be limited, but

by the removal or considerable diminution of the pain

but let

be recollected, as a neces-

sary appendage to this opinion, that the period for bleeding

confined to an early, though not

a very definite, stage of the disease."

Some writers, more especially those of own country, have warmly recommended liberal use of cathartic medicines;

themselves

fortified in this practice,

and by

our the feel

reflect-

ing on the advantages which so generally arise from an open state of the bowels during the advanced period of pregnancy, and immediately

subsequent to labour.

fatal fever,

the very

puerperal epidemic of Aberdeen,

are told by Dr. Gordon, that of those

were

freely

purged the day

one died of puerperal

fever.

who

after delivery, only

That the puer-

90 peral fever

when

its

may

form

at times

become

that of typhus,

contagious,

a position

countenanced by the recent remarks of several able clinical observers.

The

contagious cha-

racter of the puerperal fever, (says Dr. Fran-

Notes on Denman,) has been denied by some writers, while others have represented cis, in his

an eminent degree. The records of the Lying-in Hospital of Great Britain

be so

visited the

1816, Dr.

confirm this latter opinion. While

Royal Infirmary of Edinburgh

Duncan, jun. informed me

that six cases

at that time occurred, in three of

had

which the

disease was satisfactorily ascribed to attend-

ance on the puerperal women.

was communicated by the

The

nurses."

contagion

These

facts

are confirmatory of the views and illustrations of Dr. Gordon.

Others might be cited from

clinical observers.

Dr. Francis has recently stated to me, that four cases of puerperal fever occurred in the

New-York during the spring of 1825, which were strongly marked by all the characteristics of malignant typhus. Dr. Hosack was

city of

upon very respectable authority, prevailed in Elizabeth Town and its

informed, that

neighbourhood,

the state of New-Jersey,

several years ago, and proved fatal to a

ber of lying-in women.

It is

num-

almost superfluous

91 to add, that these

require different

two forms of the disorder modes of treatment.

Yet, notwithstanding these few special in-

stances of the puerperal fever assuming a ty-

phoid character,

ceive, holds good,

original position,

—that

con-

the complaint

may

be classed among the most matory.

Exceptions

general rule. there

may

can

Moreover,

strikingly inflam-

only

confirm

the

know

that

all

scarcely a disorder of the system that

not,

under certain circumstances, take

on the typhoid aspect. In the treatment,

it is

observed by Bard, that

" all practical

men

free bleeding,

moderate purging, &c. are pro-

are agreed, that early and

Little or nothing

per."

can be done with pro-

bable success after collapse supervenes. It is

observed by Gordon and some others,

that nearly every patient died

bled freely in the beginning

and

who was it

not

appears in

general, that where depletion has been copi-

ously used, the patient recovers most readily. If the

that

semblance of debility and prostration, frequently attendant upon the ushering

in of the disease, should deter from the use of

the lancet,

will

be found a

fatal delusion. In

the language of Dr. Rush on another occasion, the disease should be taken out of the hands

92 of nature, and the system held under medical control.

After bleeding freely,

treatment.

recommended

to give large doses of calomel,

and

to aid its

operation by some other cathartic and nauseating medicines, which are to be repeated, if

This course has frequently suc-

necessary.

ceeded; but

either from not

many

instances

commencing

has failed,

sufficiently early,

or from a want of courage in the

first

stage to

carry the remedies to the extent required

;

But

some a symptom which proves very aggravating, and which it is a great desideratum to overcome, other cause not easily ascertained.

the extreme pain attending the complaint.

With a view of

relieving the pain, restrain-

ing morbid irritation, and equalizing the circulation,

would, with due diffidence, propose

the following plan if practicable, first

Bleed largely

take blood enough within the

twenty-four hours.

govern as to the quantity twenty

to sixty

at once, or

Circumstances must to

be taken.

From

ounces during the time above

mentioned, may be required.

After the

first

bleeding give calomel, ipecacuanha, and opi-

um. (30)

Let there be opium enough given to

quiet

pain; say three grains at

all

one or two till

first,

and

be repeated every three hours

has that effect; and ipecacuanha and

calomel enough to nauseate, and to insure a cathartic operation in due time, with the aid of

some

laxatives.

In the progress, strong sina-

pisms should be applied to the line fomentations to the

and alka-

feet,

abdomen and pubes.

After the operation of the

first

cathartics, a

large blister should be applied to the abdomen. It is

much consequence

to sooth the dis-

tressing anguish and anxiety of the patient,

and friends attending these cases. Pain, it is known, has a direct tendency to irritate the heart and arteries, and thus will increase or prolong inflammation.

enough,

giving

opium

operates as a sedative, and in abdo-

minal disease, aids more than retards the operation of cathartics.

Within twenty-four hours,

have found to occur, the cathartics pro-

duced a copious operation: after which the opium ought to be repeated, so as to allay the pain during the progress of the cure. (31)

the progress of the cure, sometimes heat of skin, fever,

and restlessness come

on,

even

after the operation of the cathartics,

when

most urgent symptoms are relieved

time

much

benefit

;

the

which

derived from exhibiting

small doses of antimonials, at proper intervals. In this disease, as in

some

depends on an exact timing

much of remedies. The others, (32)

...

large quantities of blood drawn, without being

Bleed before giviDj

°P ium

succeeded by opium, might, prove injurious; and tities

many

instances,

quan-

to give very large

of opium before the tension of the sys-

tem (33)

taken

off,

and relaxation produced

by bleeding, would prove equally unfavouraIn this situation the system, if

ble.

the term,

ity allayed,

while the cathartics perform their

the

vicinity, three

which

number of cases prescribed

that

have occurred

have proved one

for,

the others which have

and

use

irritabil-

and the circulation becomes equalized.

office,

may

buoyed up by opium, and

fatal

;

two of

did not.

come under my

All

care,

which the plan of treatment here pro-

posed was pursued, those patients have

all

recovered.

The two terminated

cases which fatally,

largely, cathartics

the

prescribed patients

and sudorifics

for,

that

were bled were freely

given, which produced a free, desirable effect,

and

blisters

were applied.

anodyne procured a good

which

all

one case, a large

night's rest; after

medicines were rejected

the pain

through the small of the back and uterine region was very severe, and continued to the last.

abstract of

some

cases, taken from

case-book, will give a more correct idea of the treatment and the result.

95 Mrs.

after a severe labour, in

about

forty-eight hours from the delivery

was viosaw her about eight hours after, which was after 12 A.M. on the 3d of June. She was immediately bled forty lently attacked.

first

ounces; commenced taking calomel and jalap,

ipecacuanha, and opium, the doses of which

were repeated

proper intervals

;

so that in

less than twenty-four hours she took thirty grs.

of calomel, ten of jalap, and eight grs. each of opium and ipecacuanha. after beginning with the

In a short time

opium the pain abated,

and the tension of the abdomen subsided. In about twenty-four hours, sweating and the purgative effect commenced. Within twelve hours she had fifteen evacuations, which were attended with severe pain.

During

this

time she

took seventy drops of laudanum, twenty grains of Dover's powder, six grains of ipecacuanha,

and

injections with

two drachms of laudanum.

large blister was applied to the abdomen,

which again

entirely relieved the pain, and a

copious sweating continued.

the 4th, the

pulse became sharp and tense, the skin dry,

and the pain increased. She was bled six ounces, and the cathartic repeated during the night. She became easy, and perspired freely.

On the 5th, and during the night, rested The puerperal disease was entirely gone

well. :

she

had only mercurial disease and

debility,

from

which she gradually recovered. Mrs.

aged 28, had a tedious, pro-

tracted labour, which was attended with such violent pain in the right side, and through the

region of the diaphragm, as to require free

bleedings and large anodynes before delivery

took place, which was on the 17th of August.

She was comfortable, and even cheerful, to when she was violently attacked, so much so, that it was thought she could not have lived many hours. The case was ushered in with severe chills, and violent pain in the the 19th,

and small of the

right side, uterine region,

back; the pulse was small and tense, tongue covered with a white fur; extreme anxiety

the countenance, and great difficulty of breathing: there was a universal soreness, and the

system was very again. In

all,

irritable.

She was then bled

she lost fifty-two ounces of blood.

She then began taking calomel, opium, and ipecacuanha.

In less than twenty-four hours

she took ten grains of opium, forty of calomel,

and four of ipecacuanha. infusion of senna,

and had a

She

also took an

blister applied to

the abdomen, which course nearly suspended

the disease.

free perspiration

came

on.

about eighteen hours the purging commenced

numerous again

free evacuations ensued.

came

ates.

on,

The

pain

and was again quieted by opi-

about forty-eight hours from the

at-

seemed entirely removed. She had no mercurial affection of the mouth, and recovered strength rapidly.

tack, the disease

Mrs.

aged 24, after a labour

wise peculiar, was delivered on the 30th of

September.

October 2nd. Forty-eight hours after delivery, she was attacked with severe pain in the head, small of the back, and sacrum, together with general soreness and tension of the abdomen. The pain through the uterine region was The tongue was also particularly severe. middle, and fiery the white in slightly furred, red on the edges the skin was very little :

heated, rather inclining to clamminess. Her breathing was laboured, somewhat resembling that of a lady in tight-laced corsets, seeming to

exert the diaphragm only. (33)

The

secretion

of milk was partially suspended, and the lochia totally suppressed. She was bled at 9 o'clock a.m. twenty ounces, and

commenced

taking

of calomel, one of opium, and two of ipecacuanha, to be repeated every three hours. Warm alkaline fomentations were apfive grains

The

plied to the abdomen.

peated to sixteen ounces

;

in ten hours.

Some nausea, and a little The breathing rather im-

9 o'clock P. M.

vomiting induced.

proved

bleeding was re-

pain considerably abated

rounder and

appeared

softer.

The

;

the pulse

lochial discharge has

she sweats copiously. Omitted the

and applied a

fomentation,

the

blister

abdomen. Oct. 3d.

The medicine began

purge at

10 this morning; before which the pulse be-

came quicker (120

in a

and the tongue more 10 P. M.

The

become more

pulse has fallen to 95, and

natural

siderably abated.

minute) and smaller,

furred.

the heat and fever conShe sweat gently; had ;

some stranguary: very

little

pain, except from

the cathartic effect of the medicine.

The

calomel and ipecacuanha were discontinued,

and two grains of opium given. Oct. 4th.

7 A.

has had several

During the night, she

stools,

attended with some

Sweat freely the whole time, and obtained some easy and natural sleep. The scurf pain.

mostly removed from the tongue.

She took

twenty drops each of laudanum and tincture of kino after each stool. 10 P. M. wine.

After

During the day, took a it

she had a

little

fever,

gill

and the

99 pulse

became more

tense.

The wine was

omitted, and simple nourishment recommended.

At evening,

drops of laudanum were

fifty

given as an anodyne, and the laudanum and

kino mixture continued as before.

Rested well

Oct. 5th.

pears very tranquil self quite well; 6th.

last night,

and ap-

has strength to assist her-

and seems

free of disease.

Convalescent. (34)

These

Remarks.

patients, with

except nourishment, got

and patient had

rid of the disease,

The

gained strength rapidly. a mercurial sore mouth affected in that way.

no stimulant

;

first

the others were not

In the third case, the

small quantity of wine given aggravated the

symptoms. In

this case,

during three days she

ounces of blood took forty grs. of calomel, twelve grs. of ipecacuanha, ten grs. of opium, and three hundred drops of lauda-

lost thirty-six

num.

;

In nineteen hours the purging

ced, and continued

commen-

rather copiously.

The

and pain was allayed by opium, and the too free purging restrained by that

irritability

and kino.

Whether

the excellent plans of treatment,

by bleeding and purging, among others, recommended by Mr. Gordon and Mr. Hey, would

100

have succeeded

those cases, under any mo-

dification, is difficult to

result of

my two

determine: from the

would seem probable there was

cases,

first

somewhat doubtful. It is more pain and irritability attending these cases, than those described by them. But the severe pain and anxiety present in

and particularly

cases,

know

except opium.

teract,

Mr.

Hey

an unpleasant

of no remedy to coun-

This

a symptom that

admits was troublesome, even

successful cases.

the late stage of

those that terminated fatally,

symptom, that

all

Without presuming

in his

draw

between any former recommended plan of treatment, and the one here

comparison

proposed

in favour of this,

may be

said, that

by this the disease is generally cut short in two or three days the patient is secured from pain, and lies easy, and the system preserved ;

from the deranging effects of long-continued

morbid Dr.

action.

Gordon seems

be of opinion that

purging, and a free loss of blood, during, or directly after delivery, prevents the attack of

Mr.

this disease.

Hey

did not find that to be

the case with his patients, for several of them that

had

wards

lost

much

—which

blood, had an attack after-

corresponds with

observa-

101 tions.

first

two, and fatal cases, cathar-

were given soon produce a full effect. tics

ful one,

after delivery, so as to

In the second success-

here reported, the patient lost about

forty ounces of blood

from the arm, before delivery; and after delivery, a copious flooding came on, so as to require very active means

check

notwithstanding which, in about

forty-eight hours the puerperal disease on, as noted in the case.

came

(35)

Before so enlightened an audience, it is presumed no apology will be required to avoid the imputation of temerity in the use of remedies in

some of our

violent diseases

;

when

it is

recollected, that the doses of medicines proper in a state of health, or in a small remove from it,

bear but to

ward

little

proportion to what

requir-

off from the system a violent attack

of disease, and preserve

from the sudden

derangements of excessive morbid medicine, that alone

action.

the proper dose which

answers the indication.

And while we are exercising the all-important duties of our profession,

tain

may our

leading emulation be to sus-

principles in our minds, and

command

remedies

in our hands, ready to control the various and violent grades of diseased action

which our fellow-creatures are subjected.

CARIES OP

THE JAWS OF CHILDREN: READ

BEFORE THE MEDICO-CHIRURGICAL SOCIETY OF THE

In 1808.

BY THE AUTHOR, While Resident Physician of

the

New-York Almshouse.

PREFACE.

Since the following

little

seems the disease treated Hospitals of New-York;

Essay was written,

of, is

not confined to the

but a similar one has

occurred in our county.

The

beneficial tendency of investigations of this

kind, especially of the diseases of our is

own

the only apology that will be offered for

lication.

The

much

its

pub-

cases communicated to the author,

by so worthy a very

county,

practitioner as Dr. Beers, tend

show

class of disease:

the nature and extent of this

and

the whole, taken together,

leads to a successful method of stopping the progress of the disorder, or of curing similar cases,

our labours will be amply compensated.

PREFACE.

CV1

have added this disorder,

to the present discourse,

a letter

by Dr. Francis, Professor

in the

College of Physicians and Surgeons, New-York.

This communication shows this affection is

sufficiently well that

not so rarely to be seen as has

been generally supposed, and adds facts

on the subject.

Several of

to existing

inquiries in

relation to this formidable complaint, have

answered by

this

been

communication from Dr. Francis.

CARIES

THE JAWS OF CHILDREN.

GENTLEMEN, In compliance with the regulations of .._,.. becomes my duty, this Society, rotation, .

to read a

paper on some medical subject.

have undertaken the task of offering some remarks on a disease which has come within my observation within a few months past, a description of which I have not met with in any author, and which I shall term a Caries of the Jaws of Children. This disease seems to the

Almshouse of

this opinion,

be somewhat peculiar

this city.

have formed

from never having been able to

hear of a case out of

it;

and am confirmed

the remark, from the like observations of several respectable

medical characters, who have

Disease ot the jawbones

108 seen the disease

known

in question.

(36)

has been

only to attack children under the age

of twelve years, and generally over the age of three years.

The

symptoms are commonly a slight swelling and pain in some particular part of first

the jaw, and generally in the upper one, as the

under one otherwise

affected.

The

child

good health, and takes its usual One, two, three, or four teeth be-

exercises.

come

seldom

loose, according to the extent of the dis-

ease, and begin to turn black about the cervix:

gums are detached from them, and evidently corroded, so that the jaw-bone becomes the

visible, black,

quite loose and painful, finds

much

breath

and the

teeth are little

which

fetid

the lips

now

sufferer

difficulty in taking its food.

remarkably

rally swell,

The

and dead.

The

now gene-

the case with the face on

the affected side.

The bowels

are

frequently affected with

loose fetid discharges by stool. is

not arrested here, the

If the

disease

jaw continues

denuded, though sometimes the affection and death of the bone proceeds without any other very serious symptoms.

.became affected over the

one case, the bone front teeth, to the

extent of an inch square, so that the teeth and

109

bone were

easily taken out together.

In an-

other case which tion, the

came under our observabone was affected over the molares

of the right side to the extent of three teeth,

and extended up higher than the alveolar sockets; the teeth were taken out, and soon after the mortified part

came away,

extending both inside and

out.

tion took place quite through the

the disease

The

separa-

bone

at once.

These two cases recovered without any other alarming symptoms supervening. But unfortunately the disease so favourable

grows worse

for

;

the

in spite

all

tongue, and fauces

lips, face,

not always

disorder sometimes remedies.

The

become swelled

the tongue covered with a dark-coloured scurf, the patient liquid

unable to swallow, except some

more or

;

attends

;

and extremely debility

less fever of

course always

the bowels are affected with frequent fetid

discharges; languor and

pervade the whole frame; the

charge from the affected bone to corrode the lips

spreads.

dis-

so sharp as

and skin over which

Sulphuretted

hydrogen

gas

can

hardly be more offensive than their breath;

and

in this

the scene.

stage death generally soon closes

very bad

110 In the inquiry into the causes (37) of this affection,

be proper to take into consi-

will

who

deration the situation and diet of those

are subject to

it.

Almshouse, there Probable cause.

In an institution like the is

necessarily a numerous

collection of persons in one room.

In the nur-

series appropriated solely for children, there

are about

apartment,

fifty

same eat, and

or sixty inhabiting the

who consequently

sleep,

Medical

respire within a small compass.

his-

tory informs us, that the diseases of confined

and crowded places have a gangrenous tendency; and experience confirms the remark.

Though

particular attention

paid to clean-

more or less miasma generated and floating in the confined atmospheres, which will assist other causes in

liness in those rooms, there is

producing diseases, or render diseases obstinate which are otherwise produced.

brown bread and molasses, though sometimes they have white Their food

bread; and

principally

stead of molasses.

much

considerable sugar in-

latterly,

Rye bread, we know,

less digestible, particularly in delicate

stomachs, than wheat.

When

does not

di-

gest well, a kind of acetous fermentation takes

place, and a corrosive acid

there

formed

;

and

scarcely no material more susceptible

;

Ill of fermentation than molasses,

and exposed

diluted,

when somewhat

a moderately increas-

ed temperature. Thus we have materials, very susceptible of fermentation, mixed and moistened in the mouth, and conveyed to the stomach, where, if the powers of digestion are not strong, this acetous matter will be formed,

and

by eructations or exhalations from the stomach, it

be passing over the teeth and gums,

will

which in process of time must be much affected by it. Likewise, the particles of food remaining in actual contact with the teeth and gums, and there forming a corrosive matter,

may be

considered as another cause of the dis-

ease in question.

Perhaps no one of these causes would pro-

duce

this

affection alone; but all acting in

concert, are doubtless sufficient, particularly in previously debilitated constitutions,

find are

most subject

which

to this disease.

In the treatment (38) of this disease, a variety of

remedies have been had recourse to

as alkaline gargles, alkalies

combined with

astringents, and tonics exhibited

though with very

little effect.

The

internally,

tincture of

Peruvian bark has been used as a gargle, in a diluted state, with but slight success, except in

moderate cases.

Several other remedies

have been tried without success.

Treatment.

112

find that the only alternative is to ex-

tract the teeth surrounded by disease, as soon

made any considerable progress

has

and

;

as soon as the diseased portion of bone begins

from the sound, that should be re-

to separate

moved

likewise.

The

gargle which

effect, is a solution of

When

vitriol).

is slight,

the

more advanced

the patient

constitutionally

affected,

robust,

and not

means gene-

these

and good nur-

rally cure, with nutritious diet

But when the constitution

sing.

may

this

should be as strong as the parts will

When

bear.

found to have the best

sulphate of copper (blue

the affection

be made weak, but stages

debilitated,

and the bowels become irregular,

it is

neces-

sary to have recourse to antiseptics and tonics internally, together with the aid of local

The bark

dies.

with to

much

take

indicated, but

it is

reme-

attended

difficulty to get children of that

substance; therefore

age

we have

had recourse to the tincture, (>9) which is more palatable, and easily exhibited. In slight cases, three or four drachms of the tincture a day, with a glass or two of wine, might be cient.

But

more alarming

drachms should be given, or stomach

will

suffi-

cases, five or six as

much

as the

conveniently bear, with a free

113 exhibition of wine. At this stage of the disease,

no rule give as take.

necessary for giving wine, but to

much as the patient can be made By thus persevering in this mode

treatment, the gangrenous tendency

ease

may

generally be arrested

;

of the dis-

the strength

of the system will be restored; healthy action will take place at the margins of the mortified

bone the carious portion will be thrown off, and the patient restored to health. Case. In 1816, 1 was desired to see a child, ;

about

six

years old, with a singular affection

was termed. On examinafound the gum detached from two of the which were carious, as was also the ad-

of the mouth, as tion,

teeth,

jacent jaw-bone.

immediately recognised

the disease, in the treatment of which

previously had some experience.

The

had

diseas-

ed teeth were extracted, and remedies used correct the state of the digestive organs.

The

parts were bathed with a lotion of sulphate of

copper, and tonics and stimulants given pretty liberally internally.

In a short time the patient

recovered.

The following cases were communicated me by Dr. Beers, a respectable practitioner the town. of Clinton, in this county.

to in

Ill

Sarah GhTord of Stanford, aged 11

1817.

some time the teeth of the upper The friends opposed a

years, of a scrofulous habit,

complained of pain

jaw of the

right side.

for

have the diseased teeth About this time she was attacked

solicitation I

extracted.

made,

with a pretty severe inflammation of the lungs.

her recovery from

this

attack, the

gums

and parts adjacent became swollen, and the cheek externally very much tumefied: soon after which, a

black gangrenous spot appeared

in the centre of the cheek.

the jaw-bone under

examination,

was found carious, and

One

the

gums

in a

was

easily

pushed through the socket

antrum.

dropped tated.

out.

The

whole of the

came

gangrenous

state.

into the

little moving with the probe, it She was now very much debili-

disease extended rapidly. right portion of the

carious,

tooth

The

upper jaw be-

and a part of the malar bone. All

the molares of that part

came away.

Ulcera-

and extendnearly mouth to the ed from the angle of the ear. From the acrid matter falling upon the tion took place through the cheek,

lower jaw, that also became diseased. Nearly, or

all

the molares, with a considerable portion

of the jaw-bone, ten teeth.

came away.

all,

she lost

115

When

the gangrenous tendency of the sys-

tem was discovered, the patient was treated with vigorous antiseptic and stimulant remedies. The debility and prostration, a part of the time, were so great as to require the most liberal use of these remedies.

The

strength

was supported, and the diseased portions of the bone were separated from the sound. The space was filled with a new growth of parts, after a long and tedious process. The wound closed up, and the patient recovered, and is still

enjoying tolerable health.

Robert Doty, aged 30, of a good constituand temperate habit, in 1819 complained

tion

some time of a

some which

catarrhal affection, with

swelling of the glands about the throat,

was succeeded by some small abscesses, or boils, that

considerably debilitated him. Dur-

ing this period, a double tooth

and was extracted.

Soon

afflicted with general pain

jaw.

On my

nous spot

first

became

after this,

painful,

he was

through the upper

seeing him, he had a gangre-

mouth, together

in the roof of the

with a general tumefaction and gangrenous

appearance of the parts. The whole the upper jaw was diseased so that ;

days,

by taking hold of the

circle of in

a few

front teeth, the

116

whole jaw could be moved, forming a separation about as high as the upper parts of the

The

sockets.

been

teeth might mostly have

taken out with the

fingers.

was put upon

the use of active stimulant remedies. In about

ten days, however, his strength failed, and the disease

made such

progress that he died.

LETTER On Caries

of the Jaws of Children; addressed

Sherrill, by John Obstetrics, fyc.

W. Francis, M.D.

Dr.

New-York.

New- York,

DEAR

Professor of

31st December, 1825.

SIR,

The memoranda which I

possess, con-

cerning the particular subject of your inquiry, are few and imperfect. hesitation in

Yet

can have no

communicating, for your disposal,

such information as

able.

The disorder which you denominate a of

the

Jaws of

Children,

named a Gangrenous

Caries

and which others have

Ulcer of the Face of Children,

though comparatively speaking a complaint

seldom to

be met with,

nevertheless found

occur under different circumstances of age,

117

modes of lieve

and country.

living, climate,

to be, moreover, a disorder

so novel as

be-

by no means

supposed by some.

Pearson, in

his Principles of Surgery, has evident allusion to

;

and long before

Huxham

his time,

states

that he witnessed a mortification of the fauces

and mouth

in infants, besides

a caries of the

cheeks and os vomeris, which occasioned a This followed

very painful kind of death. after measles.

Willan has observed almost the

same occurrence

to take place subsequent to

scarlatina. Hall, of Nottingham, has described

several cases, which he terms a peculiar species of gangrenous ulcer, affecting the face in

children.* Burns, in the last edition of his Midwifery, has a section on the diseases of chil-

dren, entitled Erosion of the Cheek, and Sloughing Ulcer of the

two

Pudendum.^ This

indeed blending

his facts are strikingly applicable.

the cases of Mr. Kinder

scribed under the the

many of And even

affections not wholly alike; yet

title

Wood, which

are de-

of a fatal affection of

pudendum of female

children, enable us

the better to understand the character of the

* Edinburgh Medical and Surgical Journal, f

Burns' Midwifery, sixth edition.

118 peculiar caries of the jaws you have described.* In this last mentioned complaint, the ulceration ensues within a

of the part;

few hours after vesication

becomes deep and

In the treatment

mortification rarely occurs.

bark, and cordials internally, and stimu-

it,

applications externally,

lating

Many

most serviceable.

been

but

foul;

familiar with

have proved

practitioners

have

who have

this disorder,

never seen an instance of caries of the jaws.

frw

The

late distinguished Dr. flicilmi'd

was an ardent advocate

this city,

srth

Cu kj i

)

in these cases

of ulceration of the pudendum, of the treat-

ment by

tonics generally,

and of the local

application of the ungt. basil, nig.

ed that I

his practice

report-

successful.

strongly inclined to think, that if refer-

ence be made

to the continental authors,

shall find the disorder of the to

It is

was eminently

jaws of children

be noticed by several of them.

In his class

Cachexia?, order Anomalae, the father of nosology, Sauvages, enumerates several kinds of

necrosis

;

cornutum

as those

—from

which

arise

from the secale

particular virus

—from

* See Medico-Chirurgical Transactions of London, vol.

scor-

vii.

— 119 butus, &c. Infantilis,

From

quote the following.

Necrosis

the section entitled Necrosis

Infantilis.

Morbus

est novus,

seu nullibi descriptus, frequens tamen apud infantes quinquennes, potissimum in orphano-

trophio;

illis

apud macula rubra

vel in gena, vel in vulva

puellas, supervenit, sine febre,

vel livescens, sine dolore, tumore, calore, quae

acu pertusa non

dolet, post

paucos dies sponte

laceratur a levissimo tactu, sine ulla sanguinis vel alterius humoris effusione: sensim vicina

carnes, gingivae

v. g.

eroduntur, pulsu, fame,

caeteris vix mutatis, et intra

paucos dies

fato

cedunt, omnino absumtis, nigris, siccis, vel

eodem modo

vulva

erosa.

" Pluribus scorbuticis superveniebat ad ge-

nam

ulcus exiguum, album, in ambitu durum,

quod neglectum livescebat, nigredine et accedente, unde tota, gena, perforata, dentes in

faetore

erosa,

conspectum se prodebant; hujus

ulceris indolentis, gangrenosi, sicci, progressus

ries,

Similes casus vidi plu-

spiritus vitrioli.

sistit,

sed gena sine ulcere statim livescebat,

altero die perforata, sine dolore, inappetentia, debilitate,

febre,

letho vidi

intra

interiora oris patefaciebat,

paucos dies subsequente: idem

apud virgunculas

Hist, de

VAcad. R. des

vulva."

(Poupart

Sc. 1699, p. 175.)

120

some of the most promi-

the other hand,

nent clinical observers of the present day have neither seen nor even heard of this disorder. In the Bristol Infirmary, one of the largest and

best organized institutions of Great Britain, neither Dr. Chisholm nor Dr. Pritchard ever

witnessed a case

bracing

and

this topic, Dr.

a letter to me, em-

Chisholm remarks, that

to him the complaint was wholly novel; he had seen no case of it during his long and extensive practice in the Indies. Mr. McGregor,

Report of the principal Diseases that

in his

have prevailed

at the

at Chelsea, from

Royal Military Asylum

establishment in 1804 to

its

1814, gives no instance of such an affection.

Asylum, twelve hundred children are

this

fed, clothed,

tion of five to

suffer

and educated, under the protec-

government

they are admitted from

twelve years of age.

find

them

from measles, scarlet fever, and the

like,

now who has

but from no sequela, like the disorder

under consideration.

Dr. Bateman,

so well described the diseases of London, from

1804 of

to 1816,

allusion to an instance

in his valuable Reports. (London, 1819.)

Still

observe for

makes no

in it.

our country

The

we may

Dyckman, who was the New-York Alms-

late Dr.

some time Surgeon

occasionally

121

house and Penitentiary, saw some cases of

at that institution in the season of 1821-22.

have been well informed

that

has occasion-

occurred there since.

ally

have known caries of the jaws in children to occur in the Almshouse in different years, I

and in

at different seasons, since

your attendance

The accompanying

1809.

were such

circumstances

as for the most part you have de-

In some cases the disorder was preceded by derangement of the digestive organs

scribed.

— by fever of a malignant form—and instances

in a

few

followed diseases of specific con-

tagion, variola

and scarlatina.

have had no

positive proof of a single instance of the

com-

plaint arising from the use or abuse of mer-

cury

and moreover, the

effects of

calomel on

the mouth and salivary glands, are different

from those characteristic of

when

this

proves

fatal.

mineral

this disease,

induces

sloughing,

even

and

This remark coincides with the

observation of Dr. Hall.

Those most vulnerable to an attack of this disorder, were from the age of two to five years, and whose muscular strength was debilitated or it

reduced by

irritation.

At the time

prevailed in 1812-13, several instances were

122 seen affecting patients somewhat older.

saw

one of a female child, aged about seven years.

Cases of the complaint were always more frequent in the winter season than at any other;

and during the periods when a humid atmosphere prevailed.

existed in the apartments

on the ground-floor of the Almshouse little

and the

were generally, upon the apremoved to a higher and better

sufferers

pearance of

;

it,

ventilated situation. Every medical

man knows

the pernicious effects which cold and moisture

produce

in children;

and that those thus ex-

posed, rarely escape disease of some

doubt can

exist that the diet of the

agency

also an

sort.

house had

in creating this disorder.

cannot deny the connexion and influence of local disease with general disorder of the di-

gestive functions.

a vitiated or depraved

state of the chylopoietic organs,

tributed

many

of the cases

must be

we observe

at-

of local

derangement of structure and function, whether of the muscular fibre or of the osseous

The

system.

sceptical

may

consult on this

head, Abernethy on the Constitutional Origin

and Treatment of Local Disease.

The

rapidity of this disorder

nishing,

though

patient lingered out

was

often asto-

particular instances

the

some ten or fourteen days

123

from

commencement; and

its

pened

instances hap-

which the disorder persevered

in its

course, and did not terminate until twenty or

Cases also repeatedly occurred,

thirty days.

which an extensive sphacelus would be formed, and life itself be cut off within the in

first

thirty or forty hours after the complaint

manifested at others

Sometimes the upper jaw,

itself.

the lower, and occasionally both

jaws, would be the immediate seat of

its

inva-

The specimens I have, (presented me by the late Dr. De Puy,) are of the upper jaw sion.

;

and

this

rity

of cases, was

was

in fact the part

specimens there I

have not

first

which,

attacked.

a majo-

these

regret

an entire necrosis.

command the interesting obserman drew up concerning

vations this excellent this disease,

and which he read

a meeting

of the Medico-Chirurgical Society.

The

disease frequently began about the

edge of the gums,

contact with the necks of

the teeth, say the incisors.

The

tumid, with hardness and pain.

parts

became

Sometimes the

larger part of the side of the face, about the seat of disease, assumed, with scarcely any

premonitory

signs,

an erythematic aspect, and

was subsequently marked by spots of a dark purple or brown colour. Sometimes the

this

124

became dark, and sphacelus speedily ensued the flesh became loose and separated,

part

;

and the whole emitted a

fetid exhalation.

The

tongue was loaded with a foul sordes, and the breath was

now

excessively fetid.

seemed

place, and the patient

from

suffering.

Coma

took

to enjoy a truce

Death often suddenly occurred

under these circumstances. In other instances, the teeth at

a very early stage

became loose

in these last cases,

was not uncommon for many of them to drop The out by the slightest effort or motion.

some subjects, involve full of the jaw, and the ulceration affect

necrosis would, in

one side

an equal portion of the soft parts, as also the alee nasi,

the nose

cheek nearly up

itself,

the sphacelated flesh tion of the

and also extend

to the'orbit of the eye. fell in,

the internal por-

mouth was exposed. lip also, in some few

The lower came

tumid,

to the

When

cases, be-

and discoloured, and

painful,

underwent morbid changes similar the upper lip and parts.

to those of

They spread

in like

manner from the gums, affected the teeth sockets, mucous surface, and cheeks. I do not recollect seeing any case in which other parts of the body participated in this peculiar ulceration.

Authors have cited

in-

125 stances where superficial gangrene has taken

place about the nates and genitals. I question, however, whether any such morbid recipro-

was observed

city

in this

disease at any season

by the medical prescribers of the Almshouse. At the different seasons in which caries of the jaws of children occurred in the NewYork charity, the disorders especially noticed as

anywise prevalent

in the city,

were the

measles, the varioloid disorder, pneumonia,

and intermittent and remitting

On little

fevers.

the subject of treatment in this disorder,

need be

state of the

After due attention to the

said.

stomach and

intestinal canal, bark,

in substance or in tincture,

was

freely given,

and the bark and yest poultice applied

The

affected parts.

to the

decoction of the snake-

root and wine were also prescribed as a valu-

able

antiseptic.

available efficacy,

But

the

remedy of most

was the saturated solution

of the sulphate of copper, freely applied several times a

ulcerations.

day

to the excoriated surface

A weak

and

solution of the sulphas

cupri was generally used as a gargle, and at times the ordinary washes of borax, alum, &c. But, as before said, the most general and certain

remedy was the saturated

sulphate of copper.

solution of the

126 If

have written

than you desire, ject will plead

Very

you

at greater length

trust the nature of the sub-

excuse.

truly

your friend,

JOHN W. FRANCIS. Dr. Sherrill.

NOTES ELUCIDATIONS.

NOTES AND ELUCIDATIONS.

(1.)

Page

15.

Similar affections of the skin have been noticed by writers, as preceding great epidemics.

(2.)

The

time has been,

cool air

room

;

Page

were

18.

when cold water and

a measure shut out of a sick-

but modern doctrines and experience

admit a free use of both, particularly

Although

early stage of disease.

have been indulged I

injurious.

in the

patients

in the use of cold water,

do not recollect an instance

proved

It is

taken into the stomach

which

has

the quantity of fluid in

most cases, more

130 than the temperature, or any specific quality of the herb infused in it, that is serviceable in

and furwhen and perspiration:

curing fevers, by diluting the nishing matter for

there

fluids,

increased action in the system, the

cold has a tendency to diminish that and lessen heat. It is often difficult to get patients to

take

drinks in quantity enough to do good, when they will take freely those

warm

much

that are cold.

(3.)

Some

Page

21.

part of the description of this disor-

der, and the principles of treatment here detailed, are

taken from a paper

wrote in

8 1 3,

while the disease was prevailing, which was published under the signature of " Medicus," in the

Republican Herald of Poughkeepsie.

(4.)

Page

21.

some cases the ague lasted ten or twelve A very long ague was commonly athours. In

131

tended with a torpid state of the system, when remedies,

ordinary doses, failed to produce

the desired effect.

This combination of

cir-

cumstances indicated an obstinate or severe >f

disease,

which experience

will

teach

confined to this disorder, but will prove

so in other cases.

an indication for

greater perseverance in the use of remedies.

Page

(5.)

This appears

23.

be the kind of pulse de

scribed by Armstrong, and called a compressible pulse.

It is

particularly noticed by

as taking place in diseases of congestion. similar to

him It is

what Dr. Rush terms a pulse from

depression.

When

stage of disease,

pulse to

become

ations.

This pulse

takes place in the early

have uniformly known the

fuller is

and

fairer after evacu-

increasing in frequency

in the diseases latterly prevailing.

Dr. Rush, in his Observations on Hydrophobia, has described a condition of the system, in

which a pulse denominated the soap-bubble

pulse of the

may

The language is " The bilious fever in

occur.

fact.

expressive the South-

— 132

ern States,

are told (says Dr. Rush), fre-

quently exhibits a feeble

state

this transition

from an

active to

This soap-

the arterial system.

bubble form of disease appears likewise in madness, when it occurs in hard drinkers. After one or two bleedings, which are called by the pulse, the system sinks into a prostrate

for

state;

and unless

be restored by prompt and

liberal doses of opium, volatile alkali, and in

some cases by ardent

spirits,

the disease some-

times terminates in death."

Dr.

"The hydrophobia

this kind."

sack, in the

appears

Rush adds be a fever of

(See Dr. Rush's Letter

Dr. Ho-

American Medical and Philosophical

This pulse Dr.

what or what

essentially different from

Rush terms the depressed

pulse,

others have termed the flaccid pulse of congestion.

There

a striking practical prin-

ciple always to be kept in view on the subject

of the pulse of persons intemperate in the use of ardent or spirituous drinks and nothing on ;

head can militate against what has been advanced in the text. this

;

133

Page

(6.)

The

26.

idea that spots or circular eruptions, or

discolorations occasionally attendant on fevers, are an evidence of a state of real debility,

or of a typhoid state of the system,

be erroneous.

It will

found

be recollected, that

was an argument used in favour of the stimulant practice, and opposed to evacuations that the disease was a spotted fever. Spots may be attendant on violent inflammatory action it

or depression

quence of real they occur

;

or they

may be

the conse-

debility and exhaustion.

When they

in the early stage of disease,

are generally considered of the are red and

[n the

fiery,

first

kind,

and

advanced stage of

the case, they are likely to be connected with

typhoid debility

such cases they are dark,

or of an inky colour.

The

disease appears

to differ

which occurred

in the

character

this

somewhat from

that

Eastern States.

elaborate Essay on this disorder, the

spotted fever, was published by Dr. Strong of

Hartford;

and the

Massachusetts Medical

Society also gave an interesting history of the complaint, in the second volume of their Communications.

It is

evident from these accounts,

that under peculiar circumstances the

com-

134 plaint exhibited a variety of character, both in the several affections,

which they occurred. on the

skin, the

and

in the

order in

Speaking of the spots

Committee of the Boston Me-

dical Society observe

"The

spots on the skin are of various de-

scriptions.

disease

;

They occur

less frequently,

in all stages of the

however, on the

than on the subsequent days.

first

Frequently a

rash, or miliary eruption only appears, or a

few blotches on the inside of the elbow, and other similar parts

and

has been suggested,

may be produced by the mode of treatment usually adopted. The blotches are An appearance like florid, or red and fiery.

that these

measles has also been noticed, and likewise vesicles

pared In

and pustules, which have been comvaccine and variolous eruptions.

to the

some

cases, these spots

appeared

at periods

and eruptions have

two or three times

course of the disease.

The

vesicles

tules are very frequently torn

in the

and pus-

by scratching:

after which, or without being torn, they are

commonly followed by scabs of a brown colour; but occasionally they are followed by ulcerations, which do not heal until after recovery. " These affections of the skin are often at-

tended with itching; and, independent of them, itching very frequently occurs, especially on

135

when

the third day,

more favourable

symptoms become

the

This itching

at that time.

sometimes extremely

violent, so that the pa-

tient will almost tear

ing to alleviate

All these affections arc

it.

his skin in

frequently noticed at the time

endeavour-

when

the

important symptoms abate, or subside. " In a few instances, vesicles containing a

bloody

occurred

fluid

These

cester.

in the

vesicles

county of Wor-

were compared

blood-blisters, and were about the size of a

large pea

they appeared in various parts of

the body and limbs

;

a few days they broke,

and scabbed over. In one case, in which the attack was very violent, blisters resembling those produced by discharged a bloody

fluid,

cantharides, appeared on the second and third

day, on the breast and on one

about

five

breadth.

foot.

They were

inches in length, and nearly one in

the fourth day from the attack,

some of those on the breast and that on the foot became black and dry, and the skin was sphacelated.

ment,

left

difficulty.

The

eschars, with due

clean ulcers, which healed without

The appearance

vibices has been noticed

of petechiae and

they occur in com-

paratively few cases of the disease.

of worse

treat-

They

are

portent in proportion as they are

136

more dark-coloured. always occur

They do

in fatal cases,

not,

however,

nor are they con-

fined to such cases."

In his observations on the epidemic pneu-

monia, Dr.

Low

of Albany states, that in seve-

ral instances the disease

terminated by the

supervention of an anomalous rash, which was

very prevalent in that city during the whole winter.

(See his Letter

Dr. Francis,

American Med. and Philos. Register,

(7.)

Page

in the

vol. iv.)

27.

In the attack from the diminished action of the vessels, of the skin, and the flow of blood to the heart

and lungs, or from the depressing

effects of the crudities of the alimentary canal,

a chilling syncope or torpor was produced,

which required, and was benefited by, cordials and stimulants, to aid the re-action of the system, which generally took place in a few hours, though in some extreme cases it appeared to when it was proper that last a long time ;

those remedies should be omitted, and the reaction

met by the

cuating remedy.

lancet, or

some other eva-

137 In Dr.

Mann's Medical Observations and

Collections on the Diseases of the Army, during the late war, are to be found esting remarks on

stimulant practice, as used as well as

among

some

inter-

the injurious effects of the

among

the soldiers,

the inhabitants, in

stances, in the vicinity of the army.

of treatment, which Dr.

Mann

rally attended with success,

many

The

in-

course

says was gene-

was very

similar

to that detailed in these pages.

(8.)

Names

Page

29.

themselves are harmless, when

they do not exert an improper or controlling influence over the minds or actions of men.

They

are,

however, apt to have too much

in-

fluence in the treatment of diseases, by having

associated with them a certain set of remedies in the cure, instead of taking into

view the

operations of the functions of the body, the

beat of the pulse, the grade of excitement, and the state of the system generally. Thus, with intermittent fever, tonics and stimulants are

associated as remedies; with pleurisy, bloodletting

and other evacuations; with

syphilis,

138 mercurials, &c.

;

dials, stimulants,

and with typhus

But

&c.

in all

fever, cor-

these,

and

other cases, the system frequently requires a

preparatory course of remedies, before com-

mencing with those ordinarily used

in the sim-

ple systematic treatment. If the disorder which

receives the to

name of typhus, does

not happen

be that state of disease, but rather disguised

inflammation or congestion, and early evacuations are omitted or prohibited, through fear

of producing debility, there

great danger of

bringing about that typhoid state of the system that

had been so much feared.

(9.)

From

information

Page

36.

received

sources, respecting the

mode

from various

of treatment pur-

sued, and a comparison of the results,

drawn

from the various essays that have appeared

on the subject,

would seem that the sweat-

ing and stimulating plan, either alone, or com-

bined with mercurials, was frequently unsuccessful in this part of the country.

The

plan

of relying upon mercurials and sudorifics, unless

they were given in sufficient quantities to

139

produce

free operations

on the stomach and

bowels, and bring about an early mercurial action in the system,

was very frequently

tended with unfavourable

at-

results.

what was termed the sweating stimulating plan, the patient was put upon the use of hot stimulating teas and drinks, which were In

rendered more heating by adding dent tities

spirits,

and that frequently

hot fomentations,

and

them

ar-

large quan-

other heating

applications, were applied externally, so as to

get the patient (as

sweat

;

and frequently

was termed) this

into a hot

course was conti-

nued throughout, under various modifications. This course was sometimes successful. Dr. Rush states, that stimulant remedies may, in some cases, be used in such an excess as to over-

power the stimulus of the

disease, by carrying

the excitement of the system over the diseased action.

This, however, he considers a course

much more hazardous

than to let

and take off the diseased

action.

it fall

It is,

back,

how-

ever, to be observed, that the transition from

the active to the passive state of the system, was sometimes quick, and in many cases it

was proper to commence earlier with the use of wine and stimulants, than in many other diseases; and at this stage of the disease,

140 stimulants

were sometimes called

for

very

liberally.

The

heating sweating practice in the cure

of diseases, has but recently been

and introduced with an ostentation of

refined,

patent remedy, by what

Steam or Vapour Bath; which,

it is

vapour

somewhat

termed Thompsons

— by

said the patient

the

process of

subjected to hot

for a length of time, without regard to

the state of the system or grade of excitement. If this course, in

many

instances, does not pro-

duce direct death, by forcing the vital parts,

fluids into

likely at least to convert a

mild disease into one of a more obstinate and

The evil effects of using this way particularly, while

malignant character.

such remedies, in there

fulness

and increased excitement

the system, will appear in various ways.

(10.)

Has there to

sition

Page

37.

not latterly been rather a dispo-

recede

medical doctrines and

practice from the cooling evacuating method,

and

adopt the alexipharmic course, which

Sydenham and many ed

of his successors labour-

oppose and correct

141

(11.)

A in

Page

lasting impression

39.

was made on my mind,

the early part of the prevalence of the dis-

ease, on calling on an acquaintance in a town

some distance off, who was very ill with it. It was about the sixth day of his illness. He had tightness and pain in the chest, bloody expectoration, and a deathly countenance. sat

in a chair,

and showed

he called them, on

was dying,

his legs,

as he really was.

the spots, as

and concluded he

expired in a

few hours afterwards.^ His legs exhibited the striped mottled appearance attendant on cases of depression or inflammatory action in the

where evacuations have not been made. None had been made in this case. The kind of spots, or mottled appearance in

late stage,

this

case,

believe were the principal ones

attendant on the disease

(12.)

among

Page

us.

40.

so happened, that in the treatment of this

disease, a considerable difference of opinion

142

who adopted the evacumet with much opposition and

occurred, and those ating plan,

some obloquy from the prejudice against

But

it.

that existed

after a while, the prejudice so

most cases as

far subsided, (at least in

was concerned,)

that there

was no

difficulty in

carrying the course of evacuants into tion.

far as

full

opera-

How much this prejudice against evacua-

tions has continued to

cal men, will not

sway the minds of medi-

be attempted

be shown.

After the adoption of these principles and re-

medies, and this lapse of time,

serve,

—

" But

notwithstanding the improve-

ments that have taken place of physic, there

is still

in the practice

too general a dread of

The

blood-letting in idiopathic fevers.

ing

mode

times

gratifying

it is

Armstrong ob-

to find so valuable a writer as

of treatment has lessened in

the frequency of the putrid

cool-

modern appear-

ances, and the introduction of the purgative

plan by Dr. Hamilton, has tended the as

number of malignant it

may

cases.

diminish

Remarkable

appear, the fevers accounted the

most malignant, require the most vigorous in the onset. Cut short the inflammatory

means

or congestive

symptoms

in the

beginning, and

nothing putrid or malignant will appear."

143

Page

(13.)

The

nursing of this poor

undertaken by Mr.

41.

man was humanely

Rogers, by whose kind-

ness and constant attention

much was done

toward a successful termination of the case.

Page

(14.)

The

43.

general affection of the brain, attended

with stupor and delirium, particularly

in the

early stage of the case, was an evidence of the

determination of the

;

and

the depressing effects produced by them,

may

be taken as one cause of the diminished

cir-

fluids to that

culation, smallness of the pulse,

the

skin.

The symptoms,

organ

and torpor of

taken together,

seem

bility

from action or depression, by Dr. Rush,

have produced that

state

termed de-

and congestion, by Dr. Armstrong.

(15.)

Such

make

Page

45.

the disposition of

use of ardent

many people

spirits, that

they are ready

Ill

upon any excuse of disease or medical authority to gratify that propensity. As a preto seize

ventive and a remedy for this disease,

became very its full

share in exciting the disease into action, it

did not end here.

faculty

when formed. Its effects

became very perceptible

But the

on the moral ;

operated

as a passport to drunkenness; so that,

in a vicinity, their use

and

often spread

effects

were observ-

ed so that intemperance mingled

(16.)

The yellow

amid

was

the anxiety and gloom that

Page

56.

Page

61.

in the

scene

fever.

(17.)

The

use

This practice had

fashionable.

and of aggravating evil

its

President

to deliver

an address to

the Society, at the end of each year after his election to office. {Extract from the By-Laws of the Dutchess

Medical Society.)

14:

Page

(18.)

Although used

G3.

was occasionally became perplexing,

blood-letting

at times,

the case

connected with a wiry hardened state of the pulse, pain and soreness of the bowels a state ;

that opiates

—

gravate rific

do not relieve, and astringents agis more readily relieved by sudo-

or evacuating means.

remedy

some

late wri-

urged as an important

tings, blood-letting is

in the treatment,

and a recent extensive

opportunity for observing the progress of this disease, and the effect of remedies in

tended

to confirm the

that in our climate

remark made

it,

has

in the text,

advisable, in active

cases, to use blood-letting, or

some other

active

evacuating remedy, either before or soon after the free exhibition of opium.

When

these

remedies are combined, united with calomel

and judiciously managed, a favourable influence is produced on the disin liberal doses,

ease.

many

cases, particularly those of a

mild nature, the method of giving ipecacuanha in infusion, or in small doses, with occasional opiates,

a very pleasant and successful

of effecting a cure.

posed

After

all

for curing this disease,

way

the plans pro-

requires to be

146

somewhat according to the nature of the prevailing epidemic and peculiarity of the ease, which will show the uncertainty of a reliance on a particular plan, and the futility of recommending the various specifics and

treated

nostrums yearly published for the cure of dysentery. Where there is a congestive state of the system, or an active fever attending it, with a fiery red tongue and hot or husky state of the skin,

as,

when

the disease

frequently occurs, blood-letting tial,

and

in that state the use of

early stage without

happy

it,

epidemic

very essen-

opium

in the

attended with un-

results.

(19.)

Page

65.

one thing, perhaps, is better calculated (o correct medical abuses and professional jealousies, than well regulated medical soci-

eties.

effect that object,

it is

advisable to

have judicious laws, and those regularly enforced.

147

Page

(20.)

The

67.

remittents that have prevailed latterly

have not been attended with any prominent external symptoms of bilious affection, such as

were exhibited at some former periods. The skin is seldom very yellow, and the tongue not coated with bilious scurf;

particularly

substance of In

redness.

the

rather partaking of a fiery

many

cases, considerable torpor

of the system and huskiness of the skin has occurred.

The

remittent type of fever in

some parts

has, latterly, partaken of a very inflammatory

character, and been frequently attended with

much depression, which is to be relieved only by the liberal use of remedies adapted to this .state

of disease.

(21.)

Page

68.

Such changes have taken place racter of our intermittents, in

in the

many

cha-

instances,

that they frequently require the liberal use of

W6 remedies to reduce increased excitement, before the case is benefitted

tonics.

The

majority of cases that have occurred recently

have recovered with the very sparing use of the latter remedies.*

Page

(22.)

The

68.

practice of giving opium

beneficial

after the operation of cathartic remedies, par-

and then

ticularly at evening,

to allay the pain

are often required. in the cure,

such doses as

For this 100 drops of laudanum

and insure sleep.

purpose, from 50 to

much

This practice aids very

and

generally agreeable

to the patient.

* In the excellent remarks on intermittent fevers, in the nineteenth number of the observed,

Journal,

action

elevated from the

New- York Medical and

Physical

" sometimes, however-

arterial

commencement,

inflammatory diathesis of authors. if

constituting the

Hence,

such cases,

the excitement be reduced by venesection, an emetic or a

cathartic, according to existing circumstances, a less quantity

of the curative agents will be required."

149

(23.)

Page

73.

very peculiar and interesting dis-

this

ease, the reader might consult, with great ad-

vantage, the interesting work of Mr. Cross, of

Norwich,

entitled,

a History of the Variolous

Epidemic which occurred

year IB 19, and destroyed thirty individuals, with

tection

afforded

Norwich,

five

the

hundred and

an estimate of the pro-

by vaccination, &c.

This

authors remarks on modified small-pox, are Several other able pens highly valuable.

have been recently employed on the same subject.

Page

(24.)

In the

82.

town of Poughkeepsie, where the

measles prevailed to an extensive degree,

informed by Dr. Cooper, that the disease

exhibited such an inflammatory character, as to

be benefited,

many

ral use of the lancet.

that stage

when

there

instances, by a libe-

also observed, in

was a determination

hi)

the lungs, emetics

were used with

beneficial

effects.

Dr. Barnes observed, he found occasion to use blood-letting frequently with great advantage.

Page

(25.)

A number of been observed.

84.

cases of this description have

One

of the nicest points of

discrimination, particularly in ease,

is,

when

withhold them. is,

pneumonic

to give stimulants

dis-

and when to

them

pretty early use of

generally, agreeable to the friends, buf

sometimes

fatal to the patient.

(26.)

some instances

advisable.

85.

four or five bleedings

The necessary quantity had

be drawn early cise rule

Page

after the attack,

can be adopted

for

cularly in congestive cases.

were

better

though no pre-

some

time, parti-

A[stricture across

ir>\

the chest and tension of the pulse take place in the

advanced progress of the case, when a

small bleeding

much

service.

fortunate that diseases are frequently

It is

removed and health restored by different modes of treatment, and perhaps most practihave one

tioners partial is

but

most

likely

which they are somewhat we can arrive at a mode that to

carry the patient safely

an important point gained. That which appears to be among the best, the result through,

it is

much research and

observation, from

proving very successful,

the following.

an acute attack of inflammation of the

its

chest,

bleed from one and a half to two pounds, or until

a disposition

to fainting is

induced.

the pain, stricture, and tension of the pulse continue, or return in twelve or fourteen hours, let the

bleeding be repeated.

direction

to continue

ters

under the

som

salts,

Armstrong's

until the pulse flut-

Give Glauber or Epwith tartarized antimony in small finger.

doses, so as to nauseate or vomit and gently

operate on the bowels. action

After the arterial

pretty well subdued,

continues, though

the disease

frequently terminates here,

give calomel, opium, and sudorifics

;

giving opium the evacuations ought

but before to

be such

152 as to

produce a relaxation

in the system,

The

take off inflammatory tension.

may be doubted

and

propriety

of giving calomel in these

acute inflammations until about this period, as the preceding

may be

considered the stage or

time most appropriate for venesection; after this,

calomel and opium most readily affect the

When it becomes necessary to contnue

system.

the bleedings to three or four times, as

quently the case, a state of

irritability

is fre-

of the

system sometimes takes place, and a pulse of irritability

supervenes, which

better learnt

by observation than by description;* which most readily relieved by opium and calomel. At this period there ought to be a

state

steady free exhibition of those remedies, until the circulation becomes equalised and a mercurial impression

the patient

The

made on

the system,

when

generally safe.

patient ought to be encouraged to drink

which they are generally inclined, and commonly have a preference, for cold water, in the use of which I have often had pleafreely, to

sure in seeing them freely indulge, notwith-

standing the general prejudice against

its

use

* For some useful observations on diseases and states of irritability,

see

New-York Medical and

Physical Journal.

153

when they

are taking mercurials.

of this objection

cover

— on

prove

The

force

have not been able to

dis-

the contrary, facts and experience

be unfounded.

appears to be

one of those errors about remedial means that

have crept along through traditions of the

nurseries, and in the good old women, without be-

ing much noticed. By frequently gargling the mouth with cold water and drinking it, if preferred, we prevent the mouth becoming sore, as

otherwise would.

It is

the application of

cold, either of water or air to the skin, that is

injurious during the use of mercurials

—by

checking the perspiration and determining the

medicine and action glands of the mouth. is,

to the internal parts

and

This view of cold water

aware, in a considerable degree, at

variance with the views of John Pearson of

London, concerning the treatment of the mercurial eczema and excessive salivation.

The

use of opium to relieve a mercurial sore

mouth, as alluded ral to

have the

to in

effect.

page 70, must be

Where

libe-

disease has sud-

denly given way, and the effect of the medicine on the mouth has become excessive,

have given large quantities at intervals of five or six hours, with very beneficial results.

154

Page

(27.)

The cases in

85.

number of consumptive our climate, in some measure grows

increasing

out of the frequent epidemic prevalence of those inflammatory affections of the lungs :

being ill cured from the want of early depleor the tion, or from a want of efficient means :

patient neglecting to take proper advice, a

consumptive predisposition

formed

;

and

fre-

quently not thinking themselves very sick, they are decoyed into the use of some of the nu-

merous coughs,

nostrums colds,

offered

and consumptions

per to observe, that

this

the

for ! !

remark

cure is

pro-

refers only to

that species of consumption succeeding inflam-

matory

affection of the chest, or the

pneumo-

nicula of Dr. Rush.

(28.)

Page

86.

Although there are many valuable practical

maxims

Dr. Miner's book, his positions

against the use of depleting remedies,

ap-

155 plied and carried into operation in the dis-

eases of Dutchess County, as far as

obser-

vation has extended, would be attended with serious arid unfortunate consequences.

Many

his views correspond with those of Armstrong,

but the indications and use of the lancet, con-

nected with the other remedies as recommended by the

latter,

make an important

part of

the treatment.

(29.)

Page

may be somewhat

86.

incorrect to state, that

this disease is confined exclusively to the fe-

male

sex, although true childbed fever

necessarily be so.

analogous

may extend

seems one somewhat to other persons.

Campbell's Treatise on Puerperal Fever, observed, "

we find

must In it

a disease in no respects

dif-

ferent in males and in virgins in the unimpreg-

nated state"

—and " that women who were not and even

in childbed, pregnant, or nursing,

men, while the puerperal fever was epidemic, (in Edinburgh) were seized with symptoms resembling

it,

and died precisely

condition with those

in the

who fell victims

same

to the dis-

156 Since the prevalence

ease of childbearing."

of this disease, more cases of inflammation of the abdominal viscera have occurred than

have observed

in the

They have

period.

same

time at

any other

uniformly yielded to the

same general remedies,

that

is,

blood-letting,

calomel, cathartics, opium, &c.

Under

this class

of abdominal affections,

the disease termed bilious cholic

may

be placed.

number of

This disorder,

in a

properly in-

stances within our knowledge, has recently

proved

fatal.

may be

successlully treated

by liberal blood-letting, succeeded by calomel and opium. These remedies should be followed by gentle cathartics. It is not so important to produce a speedy evacuation from the bowels, as to relieve inflammation, and remove the stricture.

When

this is

By irritating them

are generally easily moved. at

first

with active cathartics, the complaint

may be aggravated, and the

(30.)

The

done, the bowels

object not attained.

Page

92.

plan of treatment here proposed

proper to observe, as

far as

bleeding

it is

used,

157 is in

conformity with the authority of Gordon,

Hoy, and Campbell, only

seems unnecessary

to continue the bleeding as late in the disease

as they, in some instances, recommend.

In-

stead of pursuing their subsequent treatment

of purging with

salts,

&c. the practice

drawn

from the principles of Armstrong, of using calomel and opium

in liberal quantities,

the external treatment

and

for

we have the authority we are using the

of Campbell, " that while

abdomen should be fomented."

lancet the

(31.)

By keeping

Page

93.

the patient under the continued

action of opium, so as to produce what

may

and allay the

irri-

be termed an opium tability.

pulse,

In this stage of the disease,

opium

does not appear to prevent the operation of cathartics,

and perspiration

promoted.

158

(32.)

Page

93.

See note 26, on the use of

blood-letting, ca-

lomel, opium, &c. in cases of inflammation of Also, refer to note 28, on the cure of

chest.

dysentery.

(33.)

In most cases

where

large doses of opium ease,

will

Page it

94.

advisable to give

in the early stage of dis-

be better to precede

by blood-

produce a relaxation of the system, and partially empty the vessels. Otherwise, opium may have a tendency to increase

letting, so as to

the tension and fulness, and produce restlessness and heat. May it not be from a want of

attending to this circumstance, that opium and the remedies used with

it,

often fails in reliev-

ing tetanus and other spasmodic affections ?

159

Page

(33.)

This symptom disease, and

attended

97.

somewhat peculiar to the a very good characteristic. It is

with

difficulty of speaking,

though the patient was out of breath from running.

Page

(34.)

Since reading

this

99.

paper,

several

other

cases of this disease have occurred, that have

come under our

direction.

They have

all

been successfully treated upon the same general

plan.

case

From among

introduced.

these, the following

shows that the

loss of

blood beforehand, does not prevent the ease, as

remarked

Nov. 1825. thoric habit,

the 24th.

The

page 100 and 101.

B. P., aged 25,

was taken

dis-

of a

full

ple-

labour on Thursday

labour was tedious, and the

delivery was not accomplished until Saturday

morning.

She had been bled

six times

during

her pregnancy, and once largely after labour had commenced. She took cathartic medi-

100 cines which operated freely, and seemed very

comfortable until the 29th. 29th.

This morning,

eight o'clock, she

was attacked with severe pain across the abdomen, and in the sacral region, attended by a very burning heat.

The abdomen

tumefied

and extremely tender; skin dry; pulse moderately full, and the tongue white. Respiration and the countenance anxious. At two o'clock, took sixteen ounces of blood and gave three grains of opium, with ten of

difficult,

Applied strong sinapisms

calomel.

and fomentations Eight o'clock

what abated.

Took

to the

to the feet

abdomen.

Pain and tension some-

Skin

still

dry.

sixteen ounces of blood.

Pulse

100.

Directed ten

grains of calomel, two of ipecacuanha, with

the

same quantity of opium

be taken du-

ring the night. 30th.

Six

a. m.

Rested tolerably well

Perspired very

night.

little.

Skin

still

last

dry.

Pain not severe, and tension gradually abating.

Gave um,

fifteen grains of

manna. sion.

calomel and one of opi-

be followed by an infusion of senna and

During the day, continued the

The

infu-

opium was also repeated twice in

two grain doses.

161

Eight o'clock

during the day.

Gave

dry.

Has had several stools Very little pain. Skin still m.

ten grains of Dovers' powder,

two grains of opium

left

and

be taken at twelve

o'clock.

Dec.

1st.

directed.

ded.

Eight

Took

the opium as

Pain and distension entirely subsiSkin not moist, but

Pulse 90.

felt

natu-

Encouraged the evacuations by castor

ral.

and

gruel.

From

this

oil

period she gradually re-

covered.

(35.)

The puerperal

Page

101.

fever, like other diseases, will,

no doubt, be influenced by the nature of what other epidemic may be prevailing at the time,

and have symptoms more or less varied in character, which will have a tendency to render the case more difficult and perplexing, and sometimes may require a variation

in the

mode

of treatment. In further showing the authority for the extent to

which remedies may be used

in this

and some other diseases, the following quota:— " In any tion from Campbell is appropriate

162 case, the condition of the circulation alone to

be our guide during the flow of blood, and

the

arm must be secured when

to flutter.

have often heard men of great

experience say, and tunities of rect, that

the pulse begins

knowing

have had many oppor-

their sentiments to be cor-

we seldom do harm by

bleeding too

much, but very frequently by bleeding too tle.

wish

this to

under consideration

in the disease

persuaded, that

be particularly kept

have very

our assistance

the lancet too freely

some

fied, that in

little :

;

for

lit-

called for,

apprehend from using

and

am no

less satis-

cases, the contracted or ap-

parently enfeebled state of the pulse, so characteristic

abdominal inflammation,

has

often deterred persons from performing vene-

section

when

vantage."

might have been done to ad-

{Campbell on Puerperal Fever.}

(36.)

Drs.

Page

108.

Hosack and Macneven,

at that time visi-

ting physicians of the Alms House, were of

the number.

163

(37.)

may be

Page

stated, that

vered a disposition to

110.

when

there

this disease,

disco-

would be

advisable to pay particular attention to the state of the digestive organs.

The

blue

pill,

combined with some gentle laxative or tonics, would be very appropriate remedies. In this and some other diseases, when the general health needs improving, the best remedies are those that correct the secretions and actions of the bowels, combined with, or followed by, tonics.

Page

111.

sulphate of quinine

now

(38.)

The

doubtless be a useful remedy.

in use,

would

164

CARIES OF THE JAWS OF CHILDREN. Since the observations on

this disorder in

former part of this work have been printed I

have received the following

off,

New- York, November DEAR

1826.

SIR,

Since the date of

you on the subject of

communication

Jaws of Children, Dr. Coates of Philadelphia has pubCaries of the

lished an excellent paper on the disease, in

the third dical

number of

the North American

Me-

pur-

and Surgical Journal, which

suaded

would be serviceable

your contemplated work. voured

Dr.

to insert in

Hosack has

fa-

with an interesting notice of an

analogous disorder, which he has generally noticed in his annual course of lectures on the

practice of medicine.

take the liberty of

enclosing to you his remarks. "

Analogous

to this peculiar disease

the

sphacelus of the cheek, which follows the ulceration so often occurring in the mouths of chil-

dren, as symptomatic of teething and a de-

ranged condition of the digestive organs." "

saw

this disorder

many years

ago.

Se-

165 veral cases

have noticed

of which occurred

lectures,

one

a child, aged about six

Alms House of Alexandria, during my residence there in 1791, and which proved fatal within a few hours from its commencement; sweeping away the soft parts of the cheek and jaw, even to the internal fauces. The nature of this disease of the animal body

years, in the

may

be, in no imperfect manner, illustrated by

reference to that occurring in the vegetable structure, especially in the cactus coccinelli-

denominated by Monsieur Thierry, in his Natural History of the Nopal of the Westfer,

Indies, la dissolution, so called from the rapid

destruction which the disorder produces this plant.

appearance,

In the in

morning the cactus

perfect health;

begins by small spots

;

in the

the

is,

to all

disease

course of a few

hours these diffuse themselves, and terminate in the

decomposition or sphacelus of a great

portion of the plant.

for the

most part

ascribed to an inordinate plethora, occasioned

by excessive rains."

With due regard,

remain yours,

John

Francis.

166

Extracts from Dr. Coates's Essay.

Locality of the Disease.

Children's Asylum street,

—The

situated in South Fifth-

between Prime and Federal

The

the district of Southwark. is

Philadelphia

called alluvial, or rather diluvial

known

be the case with

streets, in

soil ;

what

well

all that district,

lying south of Philadelphia, as well as the

southern part of the city

was

and

built,

for

itself.

The house

many years occupied,

as a

mansion, by the head of a most respectable

and wealthy

family.

some of the choosing the

Its

qualities site

situation possesses

usually

selected

of a country seat.

The

buildings stand on a swell of ground, leaving

an open lawn, now interrupted by several unoccupied streets, and extending, on the right hand, to the banks of the Delaware, and, on the

left,

suburb of is

not far

Navy Yard and Southwark. Towards

to the

the north,

from the edge of a thickly

pendage of the

The

part of the

district

built ap-

city.

immediately south of the Asy-

marshy, and has long been noted for the prevalence of intermittent fevers but the slightly elevated site of the building had been

lum

;

167 generally healthy, and continued so,

till

the

universal and distressing epidemic, which infested all the

outskirts of

1822 and 1823.

Even

Philadelphia, in

at this period, the per-

sons resident at the Asylum, were far from suffering so severely as the adjacent neighbour-

hood and, since those years, it has again become, in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot, situated at a short distance, on which were deposited the con;

tents of a

number of

privies,

proved a source

of great inconvenience, and some disease, at the Asylum.

This focus of

effluvia,

together

with the general and copious use of similar materials in manuring the adjacent

oc-

fields,

casioned an intolerable stench, and generated diarrhoeas, in the early part of the spring.

When

the grass and weeds, however, were

grown

sufficiently

to protect the surface

the soil from the sun and wind, this effect en-

and I know not that any other was experienced from the same inconvenience tirely

ceased

;

source, unless

attribute

to this, as

may

be done, the destruction of the purity of This formerly afforded very good the well. fairly

water; and, since that period, improved.

When

has

much

the corporations of South-

wark and Moyamensing

shall introduce, as

;

168 is to

be hoped they

will, the

Fairmount water

into their streets, one remaining cause of in-

convenience and

health will be removed

ill

from the Children's Asylum.

Description

which we

Disease.

the

of speak,

may begin

—The

ulcer

many

parts of

number commences immediately

In by far the greater

the mouth.

cases, however,

of at

the edges of the gums, in contact with the

necks of the

teeth, and,

most generally, of the

two lower incisors. A separation is found here which exhibits a slight loss of substance ;

extreme edge of the gums, and, as

at the

have observed, a whitishness of the

eased surface.

some

not very frequently, this swelling and

slight

the disease

and

tients

may

have

instances, is

far

dis-

though

preceded by a

redness.

In this state,

continue for a long time

reason

believe,

that

pa-

have remained thus affected, during the

whole period of three months, for which I attended the Asylum. At one time, when the disease ral

was

its

patients with

height, threatening seve-

destruction,

found up-

wards of 70 children, out of a population amounting to about 240, more or less affected with these ulcerations.

No remarkable change

169 is

at this stage observable in the functions of

the

little sufferer,

except a general

air of lan-

guor and weakness. The appetite and the muscular activity continue, but are somewhat reduced not sufficiently, however, to disable ;

the child from attending school, taking the

or continuing his ordinary practices. state, all

no symptoms of

discovered.

day, no pain

The

irritation

skin

air,

In this

have been

cool during the

complained of and no account

has ever been given

;

of any nocturnal pa-

roxysm of fever. It would appear to be purely a state of asthenia. We are, however, by no

means

certain, that there

irritation in the system. sity,

was no concealed

were, of neces-

obliged to depend, in a great measure,

upon the reports of nurses, and other females and these were liable to overlook, or mistake

for

mere weakness, the

signs of an obscure

In this manner,

disease.

commencing cases

were frequently not discovered, and nothing was done till the affection had made further progress and this continued until the ascer;

tained existence of the epidemic in the house,

combined with the recollection of its former had excited an alarm which led to an inspection of all the mouths of the children

ravages,

in the institution.

;

170

The

disease, in this form, must

curative powers of nature

not the case,

;

be within the

should hear of more nume-

rous unfavourable terminations.

dom, however,

if at all,

to witness this

tendency

been within ;

and,

has

sel-

my power

when

not con-

by a particular treatment, the cases

trolled

have almost always either remained or increased in severity.

Its first

most generally, by extending the

were

this

as, if

gums round other

teeth

;

stationary,

progress

to the

edges of

frequently affect-

ing a large portion of the dental arches.

very early progress ed,

down

is,

however, mostly

effect-

the length of the tooth, in the direc-

tion of the socket

;

and, in this way, the dis-

ease commits great and unexpected ravages.

When

reaches the edges of the bony socket,

the tooth begins to be loose, and

when drawn,

exhibits portions of the fang, including parts

which had been contained within the alveolus, entirely denuded of their periosteum. Indeed, from observation,

membrane was

should say, that the latter

the part, which

was the most

peculiarly liable to injury and death from this

disease

;

and

by no means

apprehension, that this

commencement of

clear, to

not frequently the

the complaint.

The

injury

generally proceeds with augmenting rapidity

;

171

when

especially

parts

and

while in the act of rapidly

spreading, that

has affected the deeper

occasions gangrene.

In the production of gangrenous sloughs,

much resembles

the descriptions usually given

of sloughing ulcers.

portion of the parts

immediately subjacent to the ulcer loses life

;

this

rapidly separates

its

and, before or

complete removal, a fresh slough

after a

formed

in the

same manner.

The sloughs

are

generally black, with ash-coloured edges.

have not been able

to discern a

change of co-

lour, the production of vesicles, or any material tumefaction, as antecedent to the gangrene.

There heat

is,

generally, by this time, an increased

the parts

;

" calor mordens."

the

discharge now, for

time,

pain when ;

The

becomes acrimonious; giving comes in contact with cuts in the and excoriations are produced on all

first

finger

with the sensation termed

parts in contact with the sloughing ulcerations; as the lips, the cheeks, the tongue, and the ad-

joining surface of the part where the ulcer

situated.

As soon

as the external gangrene has reach-

ed the level of the edge of the bony socket, and frequently much sooner, the adjacent portion of the latter

found deprived of

its life

172

The death

forming a necrosis.

teum

of the perios-

in the socket, at least that of the fang of

the tooth, precedes, by some interval of time, that of any portion of the

When tion

gangrene

bone

formed, a fever of

generally developed.

time at which

itself.

In regard to the

this takes place, there is

diversity in different constitutions.

peared

to the original disease, and, in

has ap-

secondary

most cases, to

acrimony of the discharge.

aggravated by loss of

a great

depend, principally, upon the

inflammation of the mouth, which

arise from the

irrita-

rest,

want of nourish-

ment, and, probably, by putrid matter finding its

way

into the stomach.

also refer

the latter cause

a diarrhoea, which almost uniformly

comes on, towards the close. There are accounts of a similar disease having begun on the inside of the cheeks. I have, however, never seen a well-marked inthe cases which were sup-

stance of this;

posed

be such, having, in every instance,

been also found

to exhibit ulcerations at the

That the disease spreads the cheek, is a fact which I

edges of the gums.

from the gums

have often seen exemplified.

It is,

indeed, the

most usual termination of bad cases.

After

producing gangrene and necrosis

gums

in the

173

and

alveoli,

and

after the discharge

becomes,

as above stated, acrimonious, a gangrenous

spot

is not unfrequently found about the opening of the Stenonian duct, on the inside of the upper or lower lip, opposite the incisors, in

some other part of the inside of the lip or cheek, or in more than one of these situations at the same time. Whether this be owing to excoriation from the discharge, or to

other cause,

cannot say

every instance which

;

has, however, in

have seen

sufficiently

early to witness

the

some

its rise, been subsequent symptoms previously described.

When

the gangrene reaches the cheek or

however, very active inflammatory symptoms are uniformly developed. In the cellular lip,

substance of these parts, they assume the well known characters which have been attributed to the phlegmonous species.

have a great

thickening, forming, in the cheek, a

large,

rounded, prominent tumour, with great heat

and

pain.

externally;

Sometimes redness but,

perceived

frequently, the great

distension of the skin of the cheek seems to

empty the cutaneous

vessels; giving to the

part a smooth, polished, dense, white appear-

ance, very

much resembling

violent salivation.

the effect of a

have no doubt that

this is

174 the tumour described by Poupart, and alluded to in

an earlier part of

this

Great

paper.

thickness and hardness have always occurred, in the other situations

where

approached the external face; in the

lip,

this

gangrene has

cellular masses of the

however, they are

less

re-

markable, perhaps from the smaller amount of cellular matter.

black spot

After reaching this stage, a frequently seen on the outer

surface of the swelling. This spreads rapidly;

and has always been,

my own

experience,

the immediate harbinger of death.

per

to state,

however, that

It is

have heard

prosaid,

that cases had recovered in this city, in which

the gangrene had produced a hole through the

Under what physician^ care

cheek. curred,

this

oc-

have never learned.

In two cases it commenced in the fauces; and was marked by the same unsuspected progress.

remarked

one of these, the to

little

patient

was

be languid, but had no positive

external marks of disease.

The mouth was

examined, and found healthy; but no suspicion of the real situation of the disease was entertained,

till

after three or four days more,

when he complained

of a slight sore throat.

large gangrene of the tonsils, half-arches

;;

175

and pharynx, was now found

need hardly be

The

;

and the event

told.

markthe gums

closing stage of this affection

ed by large gangrenous patches in deep fissures between these and the teeth; the latter loose, or falling out; large pieces of the alveolar processes, often containing the roots of several teeth, in a state of entire necrosis;

the whole lining

membrane

of the

mouth suffering a violent excoriation; the whole adjacent external cellular substance, hard and swelled

;

large gangrenous spots in

the inside of the cheek or

lips,

occasionally

extending quite through to the outer surface

total incapability to sleep, or to take the least

food

;

rhcea.

fever ; a swelled abdomen, and diar-

AN ACCOUNT or

THE DYSENTERY, AS

PREVAILED AT HYDE PARK,

YORK,

In the Summer and Autumn of 1826.

unavoidable and unexpected delay

ting this

work through the

in get-

press, has furnished

an opportunity of complying with a request of several of my friends, to add a short account of the Dysentery that has prevailed at

Park

this season,

The

Hyde

with unusual severity.

early part of this year and during the

spring months, an inflammatory affection of the

chest prevailed to a considerable degree, and

extended through the whole county. It assumed the different types of pneumonia, peripneumonia, &c.

During the

first

summer

months, the weather became extremely dry, so that from the beginning of May to July the greatest drought occurred, atthisseason, known in this part of the country by the oldest inhabitants.

After

this,

the weather

became

rainy,

178 the temperature variable,

sudden.

The

and the changes

period of the drought was unu-

sually healthy.

After the

damp weather

set

the fevers of the intermittent and remit-

in,

tent kind occurred

They partook

to a

moderate

degree.

of such a character as to exhi-

symptoms of more congestion, or increased excitement, than we usually meet in remittent bit

fever at this season of the year.

About the

first

of August, a disease of a dif-

ferent description

made

its

appearance

at the

bank of the Hudson river. was a severe case of dysentery, combined with a fever of the character that had been

landing, on the east It

moderately prevailing. fatally.

It is

The

case terminated

worthy of remark, that

occurred in a temperate young

this

case

man who had

laboured about the dock and on a farm.

had not been in any way exposed to dysentery, or impure air. The banks of the Hudson here are elevated, dry, and rocky. This and one other were the only cases that occurred in that house, although

contained a large family.

But several of the attendants who had been with him and gone away, took the disease. It spread regularly along the street east from the river about a mile,

and from

this,

moderately

about the country so that the only family in ;

179 the street that escaped having

more or

less

some instances almost every one had an attack) was a French family. Around cases, (and in

place there are four of these families,

this all

escaped the disease.

North or south of

were only

this street, there

who

few cases.

who sickened with it of the place; some of

several instances patients

moved out them some miles into the country, where they

here, were

had

the

disease severely.

The

families to

which those cases were carried, all took the disease, and in most instances they suffered very

much from

minated

;

Except those

fatally.

few cases occurred

But from

all

several of those cases ter-

families, very

those neighbourhoods.

the information

we have been

able to collect, the sporadic cases were,

in pro-

portion to the number, the most severe; as

among them greatest.

the proportion of deaths were the

When

the dysentery

pearance there seemed

made

its

ap-

be a struggle be-

tween that and the fever that preceded it, for the ascendancy in their action on the system, so that the cases frequently ing and obstinate. vation long since

became perplex-

exemplified the obser-

made by Sydenham, and

re-

peated by some of our older practitioners, that every epidemic return of dysentery re-

180 quired a study of

a want of violent

its

character anew, and from

sufficient time

manner

which

quire this knowledge, sure, attributed

two

first

cases.

less

from the sudden and it

may

commenced, to acbe, in some mea-

the fatal termination of the In

making

this confession, I

candid than were Sydenham, Rush,

and Bard, who admitted that they generally lost some of their first cases in an epidemic, before they could have an opportunity of stu-

dying the peculiarities of the disorder.

some cases the dysenteric symptoms commenced with severity and run on several days, when they abated and a fever, more or less In severe, became the principal disease. others, the fever was antecedent, and continued some days, when it would terminate parIn

tially,

and severe dysentery supervene, and

frequently both were united in an active form.

The

termination of the active form of dysen-

was as sudden as it commenced. After the fifth of September new cases rarely octery,

curred, and a fever of an active, inflammatory, remittent type succeeded, and spread more extensively around the country.

The

mildest form of dysentery

with languor, wandering pains

commenced

in the

abdomen,

nausea, and sometimes vomiting, followed by

181

mild diarrhoea, the patient

The

usual occupation

still

attending to his

stool? gradually be-

came more frequent

as the disease advanced,

accompanied with a

dull

The

pain.

heavy bearing down

discharges were of a whitish slimy

appearance, and streaked with blood. skin

was generally

little

ral.

The

dry, but not hot; the pulse

quickened, and rather wller than natu-

The tongue was

of a fleshy red colour

on the edges, and the middle covered with a yellowish white scurf.

Cases of

this description

fully treated

were most success-

by emetics of ipecacuanha, suc-

ceeded by cathartics of senna and manna, with sulphate of magnesia or castor

oil.

The

emetic produced the best effects when given^ in small doses, so as to

produce considerable

These evacuations, if the disease continued, were immediately to be followed by calomel and opium in liberal doses, as recommended by Armstrong. Five grains of calomel with as many of Dovers' powder, were repeated every third hour until the evacuations changed to a yellowish Fifteen or twenty drops of laudanum green.

nausea before

operated.

were frequently required to quiet the griping and tenesmus. With these remedies were also recommended the free use after

each

stool

182 of mild diluents, such as barley water, weak

chicken

gum

mixture

tea, or a

Under

arabic.

with

isinglass

this treatment, the

disease

rarely continued longer than the fourth or

fifth

day.

more violent cases, all the sympThe toms assumed an aspect of severity. contracted skin was hot and dry. The tongue But

the

and thickly coated.

in its substance,

thrust out of the mouth,

being

was very sharp-

pointed, and had a peculiar tremulous motion.

The

pulse

sometimes firm and tense,

was

but generally

soft,

quick, and

compressible.

This kind of pulse, probably attends congestive diseases of the abdomen where there is a partial reaction.

The

dejections were small

in quantity, but frequent ful.

They were

and extremely pain-

principally blood,

accompa-

nied with small quantities of slime and detach-

ed portions of the mucous membrane. The tenesmus was almost constant, and in children, prolapsus ani very troublesome. The abdo-

much distended, but very tender The countenance appeared touch.

men was to

the

not

heavy, and the respiration laboured. In the treatment of this variety, those cases

which reaction had not come on were most benefited, at first, by the warm bath and an

183

emetic.

this course, reaction

nerally brought on ter this

was

was attended by

six

fairly

was most ge-

or eight hours.

Af-

established, blood-letting

The

the most happy effects.

quantity of blood drawn, was governed solely

commencement it was fainting, or some degree of re-

continued laxation

the

its effects.

until

was produced.

rendered moist by

this

much

sive discharges of blood

and copious.

dry hot skin was

remedy, and the excesless

this stage of the disease, if

the urgency of the pain required

given in doses

when

opium was

it,

from one to four grains b ut ;

the pain was not severe,

to withhold

frequent

was better

entirely, until further evacuations

had been made by

cathartics.

While the

tongue retained the peculiar thickened sharp form, and red and fiery edges, opium was sel-

dom

of service, often otherwise, although the

pain sometimes rendered

indispensable.

One

of the best indications of the mitigation of the

when

disease, and for the use of opiates

symptoms

changing of the tongue towards colour and shape.

As a

merly mentioned, seemed, to

this

freely

the

otherwise indicated them, was the

stage.

After

its

natural

cathartic, that foralso, well

adapted

evacuations had been

made, the bowels were

still

kept open

184

by mild cathartics and opium combined with calomel, in doses sufficient to quiet

and

irritation,

was subdued.

was continued

all

pain

until the disease

was not rendered moist, the pulvis antimonialis or. ipecacuanha If

the skin

combined with the above remedies generally answered that indication. It was generally unnecessary

continue

calomel after the

stools

had become of a yellowish green.

mouth

rarely

When

became

The

sore.

the dysenteric

symptoms abated, and

a remittent supervened, the treatment recom-

mended

for that disease, without

the dysenteric affection,

any regard to

was adopted.

gene-

rally required a continuation of sudorifics, ca-

thartics, &c.

Page

for town read towns. 3 from bottom, for that read another. 2 from bottom, for mustilating read stimulating . 8 from bottom,/or treating read tracing

13, line 17,

25,

29, 58,