HISTORY 135F

Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Week 7.  Cure?

Observations of Several Yellow Fever Victims
by Dr. Jean Devèze

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

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

Every method I made use of to re-animate the vital powers, were useless; the patient died during the night.  The second [of October] I opened him....
Third Observation
A man, thirty-four years of age, of a sanguine and robust habit, accustomed to drinking, fell sick the 11th of October, after a debauch in which he had drank brandy to excess.  I saw him at the hospital the first day of the disease; he had a burning heat, his skin was hot and dry, his face the colour of crimson, his eyes sparkling, he was extremely thirsty, his tongue very dry and covered with a fir that was pale yellow, his respiration high and difficult, he vomited with violent straining green and yellow bile, his pulse was hard and tight, he complained of pains in the epigastrick region, and in the head.

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

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

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

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

The fourth he experienced weakness, and the whole body was of a deep yellow, the extremities became cold, the pulse little and intermittent, his respiration more difficult, the feces continued to be marked with a glaucous bloody matter, and strength wore away by degrees; in short he died on the 15th of October, the beginning of the fifth day.  He preserved his senses to the last....
Ninth Observation
A woman, about twenty-eight years of age, robust, and of a sanguine habit, entered the hospital the 30th of September.  She was attacked with the fever two days before; her respiration was short, quick, and hot; pulse hard and tight, face red, eyes watery and bright, skin hot and dry; she had pains in the head and epigastrick region, her urine was in small quantity and very red, she vomited white glairous [thick, transparent liquid, like the white of an egg] matter of so strong an acid as to set her teeth on edge, her tongue was dry and red, accompanied by excessive thirst.

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

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

In the afternoon she was less agitated; her pulse a little dilated, the vomiting and pain in the epigastrick region ceased about noon; her tongue was moist, and a little white; she complained of pain in the [groin].  The bolus and alkalised water were continued as before.

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

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

The fifth day passed without fever; she took creamed rice, and the usual drink.  The following day I gave her a cathartic.  The seventh passed without fever.  The eighth she again took an opening medicine, and was then sent among the convalescent, where she recovered, and left the hospital in perfect health.
Tenth Observation
The 30th of September I saw a young man, about twenty years of age, of a sanguine habit, who had been ill two days, and was bled at home.  His respiration was high, pulse quick and short, face inflamed, eyes sparkling, skin dry and hot; he had pains about the heart and in the head, his tongue was red and dry, he was thirsty, and vomited yellow matter with violence; for some days he had been costive, his urine was red and in small quantity.

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

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

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

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

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

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

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

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

On the sixteenth he took a similar dose; and on the seventeenth was sent among the convalescent, from whence he went out in perfect health....
Thirteenth Observation
The 27th of September, a young woman, about twenty-six years of age, was brought to the hospital.  She was of a phlegmatic constitution, and had a fit of sickness a short time before.  She was attacked with the fever in the morning; her skin was dry, tongue and lips in the same state; she felt a lassitude and pain in the epigastrick region, she had a difficulty in breathing, and was thirsty; her urine was excoriating and small quantity.

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

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

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

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

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

The eighth, ninth and tenth she was the same, and did not recover her senses till the eleventh; then the mortified slough fell from the blisters, and suppuration was great.  She continued the acidulated bark till the twentieth, when the hemorrage ceased; she also used a detergent gargle, to brace and cleanse the inside of the mouth, which was excoriated and covered with little ulcers, her lips were in the same state and swelled.  I made use of means to support her strength, gave her cathartics when the blisters dried up, and sent her among the convalescent, where she entirely recovered....
 
Go to:
  • "Procuring the Small Pox," selected communications on the method of inoculation, from the Philosophical Transactions of the Royal Society of London (1714-1723);
  • An Inquiry into the Causes and Effects of the Variolae Vaccinae.... (1798) by Edward Jenner (1749-1843); and
  • A Short Account of the Malignant Fever Lately Prevalent in Philadelphia... (1794) by Mathew Carey (1760-1839);
  • a letter addressed to "My beloved Sister" (September 25, 1793) written by Margaret (Hill) Morris (1737-1816);
  • "An Account of the Bilious Remitting Yellow Fever, as it Appeared in Philadelphia, in the Year 1793," in Vol. III, Medical Inquiries and Observations, 4th ed. (1815) by Dr. Benjamin Rush (1746-1813);
  • An Enquiry into, and Observations Upon the Causes and Effects of the Epidemic Disease Which raged in Philadelphia from the month of August till towards the middle of December 1793 (1794) by Dr. Jean Devèze (1753-1829); and
  • "Yellow Fever," in Vol. XV, The International Cyclopedia (1898).
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