Medical inquiries and observations: An Account of the Bilious Remitting and Intermitting Yellow Fever as it Appeared in Philadelphia in the Year 1794 Volume 4

PROPERTY OF
.AIIEL llOLTO.

ACCOUNT

ilious remitting and intermitting
YELLOW FEVER,

PHILADELPHIA,

kIEDICAL
Inquiries and Obfervations :
CONTAINING
AN ACCOUNT
OF THE
Bilious remitting and intermitting
YELLOW FEVER
.d8 IT .ffPPE.ffRED IV HILAELPHIA IN 7"t1 I'ER 1794.
OETHEK WITH
INTO TH
PROXIMATE CAUSE OF EVR ;
A Dfnce  Blood-lettig
R E  E D Y
CERTAIN DISEASES.

PKOFESSOR OF THE INSTITUTESj AND OF CLINICAL IIEDICINE$
IN TH UNIVERSITY OF PENNSYLVANIA.

VOLUbIE IV.

PHILADELPHIA;
IRINTED BY THOle|AS DOBSON) A'F THE STONE-HOUSE
o 4i  SOUTH $ECOND-$TKEET.
 796.

THE PREFACE.

nay pupils, added to a fenfe of the precarious
tenure by which I hold a laborious life, have
induced me to publifl, them in their prefent
concife and immature Prate. If they lead the
reader to exercife his reafon in examining
them carefidly, he will readily fupply my de-
ficiency of time and Prudy in preparing them
for the prefs. He will reject what is erro-
neous in them, and apply what is not fo, to
all the difeafes of the human body.

The Account of the Yellow Fever, as it
appeared in Philadelphia in I794, will, I
hope, be utful, by bringing more facCts to
light upon the fubjedt of its origin, and by
exhibiting that variety in the fymptoms and
method of cure, which is produced by the dif-
ference of feafon in all epidemics.

In Rating the condu, and oppofing the
opinions of my medical brethren, I have not
been acCtuated by the lealt unkindnefs to any
one of them. I lament being called to this
painful duty, but it muff be performed by
fomebody, and ;_n this way only can we dif-
charge

THE PREFACE. Vii

charge our obligations to thofe men wIo, at
the expenfe of charaer and fortune, have
put us in the peaceable poffefllon of all our
knowledge in medicine ; for, however Rrange
it may appear, I believe we have not admitted
a ufefid medical principle, or remedy of any
kind, but what has coil: the authors of them
more or lefs confli&s with cotemporary phy-
ficians.

If the principles contained in this volume
flxould be received with candour, they flall be
followed (life and health permitting) by an
application of them to the cure of the gout,
and of the difeafes of tF, e mind.

,796.

BENJAMIN

RUSH.

VOL: v. B

CONT N rS.

A Page
CCOUNT o/" thc x-eather and difeafes which
preceded the yellow fever in 1794,
lames given to it by rome of the phyficlans of the city,
Condu& o'f the Committee of Health, and thcir report
from an examination of rome of the phyficians, t 5
Reafons xvhy the prevalence of the yellow fever in a city"
thould always be made public, - -  3
Its predifpofing and exciting caufes, - -
Its fymptoms, - " " u 7
Its forms or type, - - - 44
Its lxedomlnance over all other difcafes, -
Its corttagious quality, and its peculiar effects upon the
body, where it did not excite fever, -
Methods of obviating the contagion of the yellow fever, 56
Methods of preventing its fpreading in a cty, 58
]3ifference in its degrees and extent of contagion, at
different times, and in different countries, - 6
Of the origin of the fever of  794, - 63
An exception to the influence of rain in checking it, 67
Obfervatlons

.AN

ACCOUNT, &c.

I CONCLUDED the Hiltory of the fymp.
toms of the Bilious Remitting Yellow Fever as
it appeared in Philadelphia in the year x793, by"
taking notice that the difcafes which fucceedcd that
Fatal epidemic, were all of a highly inflammatory"
nature.

I have formerly defcribed the weather and dif-
eafes of the months of March and April in the
fpring of 794-

The weather during the firft three weeks of the
month of May xvas dry and temperate, with now
and then a cold day and night. The f[rawberries
were ripe on the isth , and cherries on the a2d
d.y of the month in feveral of the city gardens.
.A flaower

IO AN .'.CCOUNT OF THK
Of bu/inefs, but injure the intere and reputation of
the city in feveral other refpe&s.

" If the difeafe really exied, it would be com-
mendable to found the alarm--it would be crimi-
nal to be filent; but if it is not in the city, or if
being in the city, it is not contagious, it is the
height of cruelty to create ufelcfs terror and alarm
in the minds of the citizens.

" But Mr. Fcnno, is it not very extraordinary,
if the difeafe is in the city, and the phyfician al-
luded to has had twenty-fix cafes of it fince June,
that it has appeared to none of the other phyfi-
clans, not even to thofe who attend the Difpenfary,
xvhich I am affured fi'om the bef authority is the
cafc ?

" A phyfician who has great weight with the cre-
dulous and ignorant, has already attempted to ruin
the reputation of this flourifhing and delightful
city, by publiflfing an opinion that the late peffi-
lential fever was generated in it; and that its fitua-
tion and climate is favourable to the generation of
the mo malignant maladies. If fuch an opinion
was not believed by every man who knows the cha-
ra&er of that phyfician to be a mere invention to
ftpport a miaken theory, or that it proceeded
from

14 AN" ACCOUNT OF THE
brain. 7" A lethargy. 8. P]euri(y.
c. Rhcumafifm. . Colic. 2.
And 3. Sore throat.*

9- Gout.
Dyfentery.

It was laid further, not to be the yellow fever
becaufe it was not contagious, and becaufe fome
who had died of it, had not a fighing in the be-
ginning, and a black vomiting in the clofe of the
diiafe. Even where the black vomiting and yel-
low lkin occurred, they were laid not to conitute
a yellow fever, for that thole t)'mptoms occurred in
other fevers.

A further detail of the names of this fever, and
of the opinions of the phyficians will appear prc-
fcnrly in their report to the Committee of Health
on the 3oth of September.

Truth, it has often been laid, is an unit, but
this is not the care with error. While the phy-
ficians who aflrted that the yellow fever was in
town. agreed in fixing the tme name to every care
of it, the phyficians who propagated the contrary
opinion, gave different names to the fame fever.
In

 A fore throat fometimes occurs as a fymptom of the yel-
low fever. It is taken notice of by Dr. 131ane in his HiProry
of the Fcver in the Weft Indies.

.. AN ACCOJNT OF THE
_Added to that fervility to wealth, xhich difpofes
phyficians to deny the exilence of pef'tilential fever
in cities, there xYere two other reafons xhich led fome
of the phyficians of Philadelphia, to deny th.e pre-
valence of the yellow fever in our city ; there reafons
xvere; fir, The change xvhich they had made in their
pra&ice, for dey had adopted the depleting f)ft.em
in a certain degree ; but they declared that tl:e)" ufed
it not in the yellow fevcr, but in an inflammatory
bilious remittent; and fccondly, Their inability to
derive the difi:afe from importation. To have ac-
knowledged the exience of the dit:afe in our city,
therefore, would have been a dereliction of two of
the t-;rincipal errors held by them in the year
793-

Thus while nurfes, bleeders, clergymen, and oc-
calional vifitors of the tick, and in fo,m.e, inances,
the tick themfelves, united in deciding upon the cha-
rac"ter and name of our fever, a majgrity of the
phyficians united in perfuading the citizens that it
exied only in the imaginations of txo or three

From a review of the conduc"t of cities upon the
fubje:t of difeafes, an important inference may be
made ; and that is to contider their pulzlic reports in
TR,otlr

8 A Acco'r o THE
I. I obfervel but few 'mptoms in the fanguife-
rous fyficm different from what I have mentioned
in the fever of the preceding year. The flow and
intermitting pulfe occurred in many, and a pulfe
nearly imperceptible, in threeinances. It was fel-
dora very fi'equent. In John l'Iadge, an Englifla
farmer who had jufl: arrived in our city, it beat only
154 ltrokes in a minute for feveral days, while
he was fo ill as to require three bleedings a-day,
and at no time of his fever did his pulfe exceed
96 rols in a minute. In Mifs Sally Eyre the
pulfe at one time was at 76, and at another time
it was at 4o but this frequency of pulfe was
very rare. In a majority of the cafes which came
under my notice, where the danger was great, it
feldom exceeded 80 flrokes in a minute. I have
been thus particular in defcrlbing the frequency of
the pulfe, becaufe cuttom has created an expe&ation
f that part of the hiflory of fevers ; but my at-
tention was dire&ed chiefly to the different degrees
of force in the pulfe as manifef[ed by its tenfion,
fi, lnefs, intermiflions, and inequality of a&ion. The
hobbling pull was common. In John Geraud, I
perceived a quick ltroke to fucceed every two
rokes of an ord;nary healdy pu]fe. The inter-
mitting and depreffcd pulfe occurred in many cafes.
I called it the year before afalky pulfe. One of my
pnpils, Mr. Alexander, called it more properly a
locked

32 AN ACCOUNT OF THF..
The maiter difcharged by vomiting was green
or yellow bile in mogt cafes. Mrs. Jones, the
wife of Captain Lloyd Jones, and one other per-
for, difcharged black bile within one hour after
they were attacked by the fever. I have taken
notice in the fecond edition of my Account of the
Yellow Fever, that a difcharge of bile in the be-
ginning of this fever was always a favourable
fymptom. Dr. Davidfon of St. Vincents, in a let-
ter to me, dated the 2zd July 794, makes the
fame remark. It flaews that the biliary du&s are
open, and that the bile is not in that vifcid and
impa&ed ate which is defcribed in the diffe&ions
of Dr. Mitchel. A direffing pain in the fl:o-
rnach, called by Dr. Cullen gaf'trodynia, attended
in two ingtances. A burning pain in the tomach,
and a forencfs to the touch of its whole external
region, occurred in three or four cafes. Two of
them were in March 795. In Mrs. Vogles, who
had the fever in Septemlzer 794, the fenfibility
of the pit of the t0mach was fo exquifite, that
flae could not bear the weight of a fleet upon it.

Pains in the bowels were very common. They
formed the true bilious colic, fo often mentioned
by Weft: India vriters. In John Madge there pains
produced a hardnefs and contra&ion of the whole
external region of the bowels. They were perio-
dical

3 6 Aq .4,CCOUNT OF THE
The tongue was always moipt in the beginning of
the fever, but it was generally of a darker colour
than lapt year. "vVhen the difeafe was left to itfelf,
or treated with bark and wine, the tongue became
of a fiery red colour or dry "and furrowed, as in the
typhus fever.

Swn.,,a's were more common in the remiffions of
this fever, than they were in the year i793, but
they fcldom terminated the difcafe. During the
courfe of the fweats, I obferved a deadly coldnefs
over the whole body to continue in fevcral in-
t]ances, but without any danger or inconvenience
to the patient. In two of the worpt cafes I at-
tended, there were remitlions, but no fweats un-
til the day on which the fever terminated. In
feveral of my patients the fever wore away with-
out the leaPt moitture on the akin. The milk in one
cafe was of a greenith colour, fuch as fometimes ap-
pears in the ferum of the blood. In another female
patient who gave fuck, there was no diminution in
the quantity of her milk during the whole time of
her fever, nor did her infant fuffer the lear injury
fi'on fucking her breaPts.

I obferved tears to flow from the eye of a young
woman in this fever, at a time when her mind feem-
ed free from dit].refs of every kind.
V. I pro-

BILIOUS YELLOW FEVER, IN 1794 . 83

rl.- HE remedies employed for tile cure
of this fever, were the fame that I employed tile
year before. I flaall only relate fuch effe&s of them
as tend more fully to eab]il'h the pra&ice adopted
in the year 793, and fuch as efcapcd my notice in
my former obfcrvations upon thole remedies. My
method of cure confi(t:ed

I. Ill the abPtra&ion of the f[inlulus of blood, and
heat from the whole body, and of bile, and other
acrid humors from the bowels, by means of the fol.
lowing remedies :

. Bleeding.
. Purging.
3" Cool air, and cold drinks.
4. Cold water applied to the
of the body', and to the bowels
glyl[ers.
VoL. iv. N

external parts
by means of

II. In

.AN

INQUIRY

INTO THE

PROXIMAUE CAUSE

OF

FEVER.

All

INQUIRY, &c..

HA V I N G yielded to the folicitations of
my pupils to publifh a defence of blood-letting in
certain difeafes, I found that I could not do juf'tice
to the fubje&, as it relates to the cure of fevers,
without firA delivering" a few obfervations upon that
late of the blood-veffels, which conftitutes the
proximate caufe of fever. I fhall therefore proceed
briefly to deliver the fubfance of what I have taught
for feveral years upon this fubje& in the Univerfity
of Pennfylvania, and what has, for many years, re-
gulated my pra&ice in the treatment of fevers.

Prcvioufly to my entering upon this fubjcc"t,. I
flaall give a lhort account of the changes which I
have made in my opinions upon it. My firt prin-
ciples in medicine were derived from Dr. Boer-
haave, and from his aphorifm.% as explained by
Vanfwieten, I adopted my firgt ideas of fever.
The

- ON T/-IE PROXIMATI
The reader may eafily conceive of the pains I took
to become maf[er of this fubjec"t, when I add, that
before I was twenty years of age, I abridged all
thole volumes of Vanfwieten's Commentaries on
]Dr. Boerhaave's aphorifms which treat of fever.
I need hardly add, that ]Dr. Boerhaave placed its
proximate caufe wholly in a lentor of the blood,
and in morbific matter.

When I went to Edinburgh in the year  766, I
relinquifhed this theory of fever, and embraced a
more rational one, firgt propofcd by ]Dr. Hoffman,
and afterwards revived with many advantages by
]Dr. Cullen, I mean the theory of a fpafin upon the
extremities of the capillary veffeis in every part of
the furface of the body. Soon after my fettlement
in Philadelphia in the year x769 I found that this
theory did not accord with many of the phenomena
of fever. I was therefore forced to defert it ; and
for many years I floundered upon an ocean of
doubt and uncertainty with refpec"t to the proximate
caufe of fever. Many painful hours have I fpent
in contemplating this fubjec"t. .At length light broke
in upon my mind. The phenomena of fever fuddenly
appeared to me in a new order. I inftantly combined
them into a new theory. Vhether this theory be
juft, or not, time muff: difcover. Since I have
adopted it, my pra6ticc in fevers ha been more tim-
ple,

CAUSE OF FEVER. 12 5
The debilitating.paflions of fear, grief, and
defpair. 

3" All excefllve evacuations, 'whether by the
bowels, blood-veffcls, pores, or urinary pail:ages.

4. Famine, or the abltra&ion of the ufual quan-
tity of n0ilriflfing food.

The caufes which predifpofe to fever by inducing
in,tircct debility are,

. Heat. Hence the greater frequency of fevers
in warm climates and in warm weather.

Intemperance in eating and drinking.

3" Fatigue.

4- Certain caufes which a& by over-ltretching a
part of the whole of the body, fuch as lifting heavy
weights, external violence a&ing mechanically in
wounding, bruiting, or comprefllng particular parts,
extraneous fubftances a&ing by their bulk or gra-
vity, burning, and the like.* 8ome of thefe caufes
a& locally, but they affe& the fyfl:em fecondarily by"
inducing

* Cullen's Firlt Lines.

3 6 ON THE PROXIMATE
vuIfion of fever n the artcrcs whcn felt at the
wriils.

6..Are convulfions in the nervous fyfem attended
-ith ahernate action and remiflion ? So is the con-
vulfion of fever.

7" Do convulfions in the nervous fyRem return
at regular and irregular periods ? So does fever.

8. Do convulfions in the nervous fyRem, under
certain circumtq:ances, affe& the fun&ions of the
brain ? So do certain Rates of fever.

9" .Arc there certain convulfions in the nervous
fyl2em 'hich affe& the limbs, without affe,Y, ing the
fun&ions of the brain, fiach as tetanus, and chorea
fanc"ti Viti? So there are certain fevers, particularly
the common he&ic, 'hich fcldom produces delirium
or even head ach, and fi'equently does not confine
a patient to his bed.

x o. _Are there local convulfions in the nervous
fyRem, as in the hands, feet, neck, and eye-lids ?
So there are local fevers. Intermittents often appear
in the autumn with periodical heat and pains in the
eyes, ears, jaws, and back.
i . _Arc

4o or a'Hr r,roxlraATr
xveakened excitement of the blood-veffels. _. _An
increafe of their excitability. 3- Stimulating powers
applicd to them. And, 4- Irregular ac'2ion or con-
vulfion.

I might digrefs here, and fhew that all difeafes,
whether they be feated in the arteries, mufcles,
nerves, brain, or alimentary canal, are all preceded
by debility ; and that their effence confifts in irre-
gular ac'2ion, or in the abfence of the natural order
of motion, produced or invited by predifpofing de-
bility. Itence they have very properly been called
DlSOrDrRS. I might further fl, ew, that all the
moral as well as phyfical evil of the world confiPts
in prcdifpoting weaknefs, and in fubfequent de-
rangement of ac2ion or motion ; but,.thefe collateral
fubjetrts are foreign to our prefent inquiry.

Let us now proceed to examine how far the
theory, which has been delivered, accords ",vith the
phenomena of fever.

I flall divide there phenomena into two kinds.

I. Such as are tranfient, and more or lefs com-
mon to all fevers. Thefe I flmll call fymptoms of
fever,

II. Such

I44 ON THE PROXIMATE
It will be difficult to account for the variety in
the degrees and locality of beat in the body in a
fever, until we know more of the caufe of animal
heat. From whatever caufe it be derived, its excels
and deficiency, as well as all its intermediate de-
grees, are intimately connecCted with more or lefs
excitement in -the arterial fyftcm. It is not neceffary
that this excitement flould exi only in the large
blood-veffels. It will be fufficient for the purpofe
of creating great heat, if it occur only in the cuta-
neous veffcls ; hence we find a hot /kin in rome
cafes of malignant fever in which there is an ab-
fence of pulfc. A dcfccct of excitement produced
by great excels of fiimulu, as in the fir ftage of
violent malignant fevers, is often accompanied by a
deficiency of heat, and in rome inflcances by a cold-
ncfs on the furface of the body. In there cafes
there is a defe& of excitement in the veffels of the
/kin as well as in the larger blood-veffels. Local
heat, whether in the head, breafi, hands, or feet,
I fuppofe to be the effe& of local excitement.

Eruptions fcem to depend upon effufions of re-
rum, lymph, or red blood upon the /kin, with or
vithout inflammation, in the cutaneous veffels,

I decline taldng notice in this place of the fame-
nefs of the fymptoms vdfich are produced by in-
direcCt

CAUSE OF FEVER. 147
Could wc comprehend every part of the fublimc
and incffablcfyllm of the natural, moral, and
litical government of the world, I am furc wc flould
difcovcr nothing in it, but what tended ultimately
to order and happincfs. But there is evil in the
world, and the operations of nature, which were
originally the minifcrs of goodncfs only to man,
arc in many infanccs the vehicles of' this evil. In
religion and morals, as well as in medicine, nature
leads to error and dcfru&ion. When we worfhip
the fun, a cat, a crocodilc, or the devil, wc follow
nature. When we lie, fcal, and commit murder
and adultery, v,e follow nature. In like manner,
when we indulge every appetite and paflion of our
patients in ficknefs, and create h.-'emorrhages, ob-
ru&ions, dropfies, Fairies, apoplexies, and death,
by negle&ing bleeding and purging in fevers, we
follow nature. But while I maintain this unufual
language in medicine, let it be remembered, that
the operations of nature were not originally the
means of reducing or injuring man ; and Revelation
affures us, that a time w-ill come, when the dominion
of order flaall be refored over every a&ion of his
body and mind, and health and happinefs again be
the refult of every movement of nature.

From the view I have given of the 9rate of the
blood-veffeis in fever, the reader will perceive the
VOL. Iv. X diffcrertce

being induced in the excretions, by the violent
ac"tion of the veffels upon the blood, as to render
them detru&ive to the organs of the body. 3" The
inability of the fytcm, from univerfai direc"t debi-
lity, to receive imprefllons, or to fupport the mo-
tions of life. Or lastly, death from fever is the
effec"t of the combined operation of all the three
caufcs that have been mentioned. I cannot difmifs
the blood-vefliIs, as the feat of a general and fre-
quent difeafc, without lamenting that their phyfio-
fogy and pathology have been fo little t[udied by
phyficians. They are the firl born parts of the hu-
man body ; they fupport, in a great meafure, the
fenfibility and irritability of the nervous fyf[cm ;
they are the centinels of the whole fyf[er0 in fleep ;
and, they are the lalt retreat of departing life.
II. I come now to apply the theory which I have
delivered, to the explanation and defcription of the
different phenomena or f[ates of fever.

I have faid that there is but one fever. Of courfe
I do not admit of its artificial divifion into genera
and fpecies. A difeafe which fo frequently changes
its form and place, flaould never have been defig-
hated, like plants and animals, by unchangeable cha-
rac"tcrs. The oak tree and the lion poflfs exac"tly the
fame properties which they did near 6ooo years ago.
But

the body.
ntifplaced.

CAUSE OF FEVER. 155
Thefe tates of fever I flaall call

. I thall begin under the firft head, with the
r,A.icrAr'r fate of fever. It conffitutes the
highefl: grade of inflammatory diathefis. It is known
by attacking frequently without a chilly fit, by
coma, a depreffed, flow, or intermitting pulfe, and
fometimes by a natural temperature or coldnefs of
the /kin. It occurs in the plague, in the yelloxv
fever, in the gout, and in the fmall-pox. Dr. Ofier
has defcribed a pleurify in Jamaica, in which fome of
thofe mali,rant fymptoms took place. They are
the effec"t.of fuch a degree of f[imulus as to prof[rate
the art ial fy/cm, ad to produce a defec"t of ac"tion
from an excefs of force. Such is this excefs of force
in rome infl:ances in this 9tate of fever, that it induces
general convulfion.s, tetanus, and palfy, and fome-
times extinguiflaes life in a few hours by means of
apoplexy or fyncope. The lefs violent degrees of'
/imulus in this fate of fever produce palfy in the
blood-veffcls. It probably begins in the veins, and
extends gradually to the arteries. It feems further
to begin in the extremities of the arteries, and to
extend by degrees to their origin in the heart. This
is evident in the total abfence of pulfe which fome-
times takes place in malignant fevers four-and-
twenty, and even eight and forty hours before
Vow.. Iv. Y death.

,6 oN Trir vgoxiM.'rs
fever, I fhall herea, fter call it, from its duration, the
low d, ronic ttate of fever. I have adopted the term
low,, from Dr. Butter's account of the remitting
fever of children, in order to difl:inguifla it from
ates of fever to be mentioned hereafter, in which
the patient is not confined to his bed. This new
name of the typhus or nervous fever, efl:abliflles its
analogy with feveral other difeafes. We have the
acute and the chronic rheumatifm ; the acute and
chronic pneumony, commonly called the pleurify
and pulmonary confumption ; the acute and chronic
inflammation of the brain, known unfortunately by
the unrelated names of phrenitis, madnefs, and in-
ternal dropfy of the brain. Why fl, ould we heft-
tare, in like manner, in admitting acute and chro-
nic fever in all tho.fe cafes where no local inflamma-
tion attends.

6. The typhoid Rate of fever i-s compofcd of the
fynocha and low chronic fates of fever. It is the
JTow nervous fever of Dr. Butter. The.excitement
of the blood-veffels is fomewhat greater than in the
low chronic ttatc of fever. Perhaps the mufcular
fibres of the blood-veffels, in this ftate of fever, are
aflk&ed by difl]:rent degrees of f[imulus and excite-
ment. Snppofing a pulfe to confifl: of eight cord,
I think I have frequently felt more or lcfs of them
tcnfe or rclaxcd, according as the fever partook
Illor

c^trs, o1 rEvrR, i6 7
fever. They depend, x. Upon local debility in
the part affe&ed. .. Upon increafed excitability in
the part, in confequence of this debility.. And, 3-
Upon the morbid excitement induced in the part,
by the fiimulus of digtention from the blood, and
by the effufion of fcrum, lymph, or red globules in
the weakened, and afterwards inflamed part. The
reader will perceive here that I adopt the error loci
of Dr. Boerhaave, as a link in the chain of caufes
which produce local inflammation. The fiates of
fever which belong to this fecond head are as follow.

6. The INTESTINAL ate of fever. I have
been anticipated in giving this epithet to fever, by
Dr. Balfour.* It includes the colera morbus, diar-
rhoea, dyfentery, and colic. The remitting bilious
fever appears, in all the above forms, in the fummer
months. They all belong to the febris introverfa
of Dr. Sydenham. The jail fever appears likewife
frequently in the form of diarrheca and dyfentery.
The dyfentery is the offspring of miafmata and con-
tagion, but it is often induced in a weak tate of
the bowels, by other exciting caufes. The colic
occafionally occurs with tates of fevcr to be men-
tioned hereafter.

17- The
 _A_ccount of the Intefiinal Remitting Fever of ]3engal.

DEFENCE

OF

BLOOD-LEUUING

.AS A

REMEDY

FO

GER 7"AIN DISEASES.

A DEFENCE OF BLOOD-LETTING.
tained of arrePting the progrefs of nature in pre-
paring and expelling morbific matter from the fyf-
tern. From repeated experience I can affert, that
bleeding is fare in every 9tage of pleurify in vhich
there is pain and a tenfe and oppreffed pulfe ; ancl
that it has, when ufed for the firft time after the
5th and 7th days, rived many lives.

 7" The lofs of a fufficicnt quantity of blood is
often prevented by patients being apparently worfe,
after the fir or fecond bleeding. This change for
the worfe flaews itfelf in fome one or more of the
following fymptoms, viz. increafe of heat, chilis,
delirium, hazmorrhages, convulfions, na.ufea, vomit-
ing, faintnefs, coma, great weaknefs, pain, a tenfe
after a foft pulfe, and a reduc"tion of it in force
and frequency. They are all occafioned by the fyf-
tern rifing fuddenly from a ftate of extreme de-
preffion, in confequence of the abPtrac"tion of the
preffure of the blood to a ftate of vigour and ac-
tivity, fo great in rome intances, as to re-produce
a depreffion below what exifed in the fyPtem be-
fore a vein x,as opened ; or it is occafioned by a
tranflation of morbid ac"tion from one part of the
body to another.

The chills which follow bleeding are the effecqs
of a change in the fever, from an uncommon to a
common

A DEI:ENCE OF BLOOD-LETTING. O 7
afterwards left him. In thus pcrfcvcring in the
ufe of a remedy which, for feveral days, appeared
to do harm, we were guided wholly by the ftate of
his pulfe, which uniformly indicated, by its force,
the necettity of more bleeding.

In the autumn of  794, I was lent for to vifit Sa-
muel Bradford, a young man of about .o years of
age, fon of Mr. Thomas Bradford, who was ill with
the reigning malignant epidemic. Ills pulfe ,vas at
80. I drew about x2 ounces of blood from him.
Immediately after his arm was tied up, his pulfe fell
to 60 ttrokes in a minute. I bled him a fecond
time, but more plentifully than before, and there-
by, in a few minutes, brought his pulfe back again
to 80 ftrokes in a minute. A third bleeding the
next day, aided by the ufual purging phyfic, cured
him in a few days.

In the month of glarch 795, Dr. Phyfick rc-
quefted me to vifit, with him, Mrs. Fries, the wife of
Mr. John Fries, in a malignant fever. He had bled
her four times. After the fourth bleeding, her pulfe
fuddenly fell, fo as fcarce to be perceptible. I found
her hands and feet cold, and her countenance
ghaltly, as a perfon's in the latI moments of life. In
this alarming fituation, I fuggelted nothing to Dr.
Phyfick but to follow his judgment, for I knew that
he

A DEFENCE OF BLOODoLETTING. 227
feeing or converting with the patient, -were impofcd
upon all phyficians.

To render the knowledge of the indications of
blood-letting from the flate of the pulfe as definite
and corrc& as poflible, I fllall add, for the benefit
of young pra&itioners, the following dire&ions for
feeling it.

. Let the arm be placed in a fituation in which
all the mufcles which move it flaall be completely
relaxed; and let it, at the fame time, be fi'ee fi'om
the preffure of the body upon it.

2. Feel the pulfe in all obfcure or dicult cafes,
in both arms.

3" .Apply all the fingers of one hand, when prac-
ticable, to the pulfe. For this purpofe it xvill be
molt convenient to feel the pulfiz of tile right hand
ith your left, and of the left hand with your right.

4. Do not decide upon blood-letting in difficult
cafes, until you have felt tile pulfe for rome time.
The Chinefe phyficians never prefcribe until they
have counted 49 f[rokes.

5- Feel the pulfe at the intervals of four / or five
minutes, when you fufpc& that its force has been
Vor.. Iv. H h varied