As the opinions of physicians, concerning the nature and treatment of the Yellow Fever, are various and contradictory, we shall avail ourselves of the clear and satisfactory view of this malignant disease, lately given by Dr. Thomas Dancer, in his excellent work, entitled " The Medical As-sistant, or Jamaica Practice of Physic, " (4to. Kingston, Jamaica; and Lond. Murray and Highley, pp.384, 11 1s. ll. Is. in boards), designed chiefly for the use of families and plantations." - This intelligent practitioner justly observes, that the misunderstanding on the subject has probably arisen from an improper use of terms, or from the variable character of the disease; according to the prevailing constitution of the season; the quantity and force of contagious matter, and other causes. He is fully convinced, that it is not regularly one and the same disorder; but is often a compound, at one time partaking of the nature of the Malignant Fever, at another resembling the Bilious Remittent. Hence, it is not uniformly contagious, and the fever of new-comers may not always be malignant: there are instances in which, on their first arrival, they bad a common fever, which afterwards changed into the yellow fever ; though the reverse of this generally occurs.
Means of Prevention: - Dr.DAN-cer observes, that, though bleeding is precarious and hazardous after the fever has commenced, it may, nevertheless, in particular cases, where the habit is very full, etc. be considered as a mean of preservation. Young and athletic persons, therefore, may on their first arrival lose a lew ounces of blood : their bowels should, on the same principle, be kept open ; and every species of intemperance, as also exposure to the sun, and evening air, ought to be carefully avoided. It is, however, of still greater consequence to retreat, as soon as possible, from the shipping and seashore, the seats of infection, to a pure, airy, cool situation in the country, and there to remain for some months. Dr. D. has known many young men, who thus have avoided any dangerous fever; and some who, by returning too speedily to the towns or sea-ports, fell victims to the disease.
"The prevailing mortality among new comers (says this accurate observer), is a good deal to be attributed to their own misconduct. Coming out in convoys, they arrive in numbers ; meet at taverns ; and, allured by scenes of novelty, they walk the streets, indulge to excess in the use of the country fruits; and enter too readily into the customs of the seasoned inhabitants, which are not at all suited to persons in their situation."
According to the experience of Dr. Clark, the best preventive of this destructive epidemic, is mercury. Hence, he advises all persons, who have sufficient leisure, to undergo one or two courses of that medicine, after their arrival in the West Indies; to take a few laxatives; to confine themselves to a moderate use of wine; and to live principally on fruits and vegetables, for the first two months: tor, by pursuing such conduct, " they may rely almost to a certainty on escaping the fever."
With respect to the character-istic symptoms of this malignant disorder, we cannot, on comparing several authors who have written on the subject, select a better or more correct description, than the following, given by Dr. Dancer ; whose words we do not hesitate to quote ; especially as many of our readers, or their relations, residing in Jamaica, or other parts of the Western World, must feel greatly interested on the occasion : " This fever, then, peculiar to new-comers, attacks suddenly; with alternate fits of heat and cold ; violent pain in • the head and back. The face is prodigiously flushed; eyes a red and watery; the whole physi-ognomy of the patient is very culiar, denoting anxiety and deon of mind ; and this unnatural appearance continues, till recovery begins to take place. The pulse, in the beginning, is frequent, full, and hard, sometimes irregular; the heat of the body very great; and the patient labours under great inquietude. This state of the fever continues for a longer or shorter period; sometimes only for a few hours; at others, for several days ; and, when the ardent symptoms begin to decline, if not sooner, an irritation at the stomach commences, which is hardly, by any means, to be subdued, or even allayed. The patient now feels himself in other respects well; his pulse and heat being nearly natural, and he has seldom any return of fever; but the irritation and anguish at the stomach continuing, he at length vomits blackish matter; his eyes and neck first become yellow, and then the whole body. Blood flows from the mouth and nose: Delirium, preceded by a hurried, perturbed state of mind, and great restlessness, at length comes on; ending in total insensibility, etc. and ultimately in death."
The yellowness of the skin, however, is not a constant symptom ; for sometimes it does not appear, or at least not till after death. Dr. Dancer farther observes, that the yellow fever is particularly distinguished by its sudden attack ; as it is seldom, like other fevers, preceded with any symptoms of languor, weariness, etc.; by its having no Very sensible abatement or remission, till it totally subsides; by the extraordinary anguish abou the fore-part of the chest, and at the same time a torpid state of the bowels; so that the strongest purgatives, and in large doses, are attended with little or no effect.
Such are the general symptoms, attending this fever in Jamaica , but numerous variations often occur in America, and other warm climates, where it is modified by the season of the year, or other circumstances, which our limits will not permit us to detail: we shall, therefore, briefly mention the supposed origin of this malady. and exhibit an account of the treatment that ought to be adopted.
The yellow fever is certainly endemial in the West Indies : its cause is reputed to be a peculiar contagion, which very generally affects persons recently arrived from a cold climate, and especially Europeans, or those who have not long resided in hot countries. Females, and negroes are, in general, exempt from its influence ; but mulattoes and tawmies, or such as are descended from European and black parents, are equally subject to the fever with the whites. - From the West Indies, this epidemic has been conveyed to America, where it committed dreadful ravages, in the year 1793, especially in the province of Pennsylvania : nor is any person, who has once been seized with with it, secure from a second attack.
Cure : - Conformably to the symptoms above stated, and drawn from actual observation by Dr. DaNcer, we shall first exhibit his mode of treatment, in the different stages of the yellow fever, as applicable to the climate of Jamaica. He previously remarks, that his account, though incomplete, is suffi ciently full and accurate, to enable any person to distinguish that disease from any other, except the malignant fever ; to which it has an obvious affinity.
Where the yellow fever attacks in the manner of a common remittent, and shews no symptoms of malignity, till after some continuance, Dr. D.observes, that the following treatment may not be deemed necessary or suitable ; though, he thinks it is, on the whole, the safest plan, to consider every fever with which a new comer may be seized, as being of this kind: for, unless the method of cure suited to it, be adopted in the beginning, it cannot afterwards be employed with any probability of success.
On a supposition, that a person newly arrived in Jamaica, or any other tropical country, be suddenly attacked with violent pain of the head and back, with heat and flushing of the face, etc. in the manner before described, Dr. D. recommends, in the first place, to let the patient be put. to bed, as soon as he is taken ill ; then an opening clyster to be administered; and, immediately after, a dose of calomel and jalap to be taken, either in powder, mixed with syrup of tamarinds, or made into pills. The dose must be regulated by the constitution of the patient, and the greater or less violence of the symptoms ; so that from 5 to 10 grains of calomel, and from 15 to 30 grains of jalap, have been occasionally prescribed. Some time (from 2 to 3 hours) afterwards, a tea-cupful of tamarind-water, or a decoction of tamarinds with cream of tartar, should be drunk ; and, if stools do not freely follow, the preceding, or a smaller dose, may be repeated in the course of 5 or 6 hours. If plentiful evacuations have taken place, but without any abatement of symptoms, small doses of calomel and antimonial powder should be given, in the proportion of from 5 to 10 grains of the former, to 3 or 5 grains of the latter; to be taken every three hours in barley-water, or thin panada. During the intervals, Dr. D. directs the following saline julep : Salt of wormwood, or salt of tartar, 2 drams, to be dissolved in half a pint of mint-tea. To every two table-spoonfuls of this solution, add one. table-spoonful of strained lime-juice ; which mixture is to be swallowed during its effervescence, or immediately after. In order to ascertain the exact quantity of the acid requisite to neutralize the saline draught, it should be tried first, by pouring into the latter small portions of the former, till the frothing be completed. At the same time, the mercurial frictions must be commenced; namely, two drams of the strong mercurial ointment, rubbed into the inside of the knees or thighs, every six hours; or, in some cases, every three hours; or, otherwise, half an ounce every six hours. If, in 12 or 15 hours from the first attack, there be no obvious remission, in consequence of such treatment, the frictions ought to be continued every three hours ; and, if the bowels have not been opened, ten grains of calomel must be given in combination with jalap; or, in the contrary case, with one quarter of a grain of opium, to prevent the calomel from acting on the bowels, if already too loose. Thin barley-water, or other diluents, may be allowed frequently, and the medicines above specified be continued, till the mouth becomes sore, and the breath affect-B b 2 ed; ed ; unless a distinct remission of the fever be perceived. Should the stomach become irritable, and retchings commence, a blister must be instantly applied, either to the pit of the stomach, or between the shoulders; and vitriolic aether be administered in a little water, or in the saline julep before described.
The quantity of mercurial ointment to be used, as well as the calomel to be taken, during the whole course of this malady, is sometimes very considerable, before either the glands of the mouth are affected, or any remission of the symptoms takes place. In some cases, more than 1000 grains of calomel have been given, and several ounces of mercurial ointment have been rubbed in, not only with impunity, but with evident success. - In general, when the salivation commences, the fever and irritation at the stomach subside. Ne-vertheless, it will be necessary to continue the frictions, in a more moderate degree, to support the flow of saliva.
Although Dr. D. does not pretend that this mode of treatment is uniformly efficacious, yet, on comparing it with any other in use, it is, in his opinion, eminently successful, and affords the patient a double chance ; because it does not hinder the employment of any other means that could be devised, if mercury were not administered. The violence, however, with which the fever frequently attacks, leaves, in many cases, but little hope from any plan of cure whatever: hence, Dr. Blase justly observes, that there are instances, where the disease is determinedly fatal, or where the animal functions are, from the beginning, so deranged, that there are no possible means of restraining the morbid motions; and dissolution necessarily takes place. In more favorable circum stances, however, Dr. Dancer remarks, that the sore mouth resulting from the use of mercury, though often very distressing, is seldom a tended with any danger, or inconvenience of long duration. He quotes, on this occasion, Mr. BlaiR, who, in his late publication on the use of the nitric acid, says, that although this sometimes causes salivation, yet it is the most powerful means of allaying ptyalism, induced by mercury. Indeed, this affection of the mouth is not easily removed; but it may be greatly alleviated by the frequent use of proper gargles, such as the following, directed by Dr. Dancer : - Sage-tea, 1 pint; vinegar, 4 oz. ; and honey, 1 oz.; - or, sage-tea, 1 pint; honey, 1 or 2 oz.; and alum, I dram. - The following gargarism we can recommend, from the frequent experience of its good effects in similar cases, namely: Equal parts of distilled vinegar and lime-water; adding a small portion of syrup of red roses, sufficient to sweeten the mixture.
The Peruvian bark may, occasionally, be given in the latter stages of the yellow fever, to complete the cure; but, as it is not always found to agree, Dr. Dancer concludes with saying, that " food and wine are the only things farther required."
However inconsonant to theory, or to preconceived notions, this mode of treatment may appear to others, Dr. Dancer affirms, that " it has stood the test of experience, and ought to be adopted, till a better one has been discovered." - Having thus fairly stated his practice, in this virulent disorder, he briefly recapitulates that of other physicians ; and, as it may be of some service to persons, who reside in those tropical climates, or propose to visit them at any future period, we shall also subjoin a concise view of the various moles of treating this malady, practised by Drs. Hillary, MosEley, Rush, Clark, Blane and Jackson.
With a view to moderate the rapid motion of the fluids, and to abate the violence of the yellow fever, during the first two days, Dr. Hillary directs blood-letting, in the proportion of from 12 to 20 oz. according to the age, strength and other circumstances attending the case of the patient. The next indication is, to evacuate putrid bile, and corrupted humours, with such expedition as may be consistent with safety : hence Dr. H. advises small but frequent draughts of warm water to be swallowed, with the occasional addition of a little oxymel, green tea, etc; when a grain, or a grain and a half, of crude opium is given, in order to compose the stomach after the violent retching, pain, and anxiety, necessarily occasioned by severe vomiting. And, as this organ is unable to retain either solid or fluid matters, the body should be kept open, by means of a mild purging clyster. The third indication is, to prevent the putridity of the fluids, and also the approach of gangrene, by exhibiting proper antiseptics: - For such purpose, Dr. H. prescribes a slight infusion of the Virginian Snake-root; as it braces the stomach, and enables it to bear the Peruvian bark. - A more particular account of Dr. Hillary's treatment, may be found in his " Observations on the Air and Diseases of Barbadoes."
Dr. Moseley recommends repeated bleeding in the first stage, and continued purging with vitrio-lated tartar.
Dr. Rush bleeds copiously and repeatedly; gives purgatives composed of calomel and jalap; then continues the calomel alone, till it affects the mouth. He conceives, that as the symptoms of the yellow fever are extremely violent, and its progress is uncommonly rapid, the most efficacious remedies ought to be employed, as early as possible. Hence venesection should, in his opinion, not be deferred beyond the first day; for it is of peculiar service to persons of robust and plethoric habits, especially such as have recently arrived from Europe. And, though this operation may not be performed sufficiently early to save life, yet it contributes greatly to relieve the sufferings of the patient. Farther, it will be advisable to take some blood, every day, while the fever continues: the quantity to be drawn depends on the state of the pulse, and that of the weather. Thus, Dr. Rush found two bleedings sufficient to subdue the fever in September (the hottest month in America) ; but, in proportion as the violence of the inflammatory fever increased, it was deemed necessary to take from 12 to 20 ounces, twice, and in some cases, three times, in the course of the day. The blood appeared thick and sizy ; nay, it is a remarkable fact, that patients of every age can support the loss of that fluid, much better in the yellow, than in any other inflammatory fever. After venesection, purgatives were administered: with this intention, small doses of calomel, consisting of 2 or 3 grains, taken every hour ; or, of 5 grains, combined with half a grain of opiBb3 um; um; or, of 10 grains of calomel mixed with 15 grains of jalap; to be swallowed every 5 or 6 hours, have been prescribed in Drs.RuSh, Clark, and other practitioners, with the best effect. Instances have occurred, in which patients have taken from 100 to 230 grains of calomel, within three or four days ; in all of whom the violence of the disease abated, immediately after salivation commenced. - Blisters, applied to the legs and thighs, have likewise proved very useful.
According to Dr. Jackson, great benefit has been derived from the affusion of cold water on the body of the patient, after having lost 20 or more ounces of blood. But, as this remedy has in some cases produced contrary effects, from being injudiciously employed, Dr. BlanE proposes the application of cloths soaked either in cold water, or in a mixture of that fluid and of vinegar : by such treatment, patients have been recovered, whose cases were apparently desperate.
As vomiting is the most distressing symptom in the yellow fever, various remedies have been proposed, with a view to check it, and to dispose the stomach for the reception of the Peruvian bark, at other tonics and antiseptics. With this intention, the saline draughts above mentioned, when in a state of effervescence, have been advantageously swallowed. Similar effects have resulted from the use of acid juices, such as those of oranges, and lemons, combined with wine, hot water, sugar, and nutmeg; then succeeded by frequent doses of magnesia and mint-water. - M. DespoRTES affirms, that milk, boiled with a little flour or bread, and given repeatedly, in the quantity of one spoonful, operated more powerfully than any other remedy, for stopping bilious vomiting. Dr. Blane, however, states, that this symptom was relieved by fomenting the stomach with stupes, or cloths, dipped in a decoction of bark, and sprinkled with camphorated spirits, or with the tincture of bark. But the most efficacious means, which he prescribed for checking such symptom, was that of blisters laid on the stomach : these were attended with the greatest success ; and his practice has been justly recommended by Drs. Clark, and Mac-leax.
When the irritation of the stomach has subsided, Peruvian bark may be administered ; and, if such drug disagree, it may be given in the form of a clyster. Farther, it may perhaps be of some service to try the essence of spruce; as that vegetable preparation has been retained on the stomach, when every other remedy was discharged by the mouth : - it must be diluted with hot water, in the proportion of 3 oz. to one quart; and half a pint of the solution should be swallowed every two hours.
Lastly, in the more advanced stages, camphor combined with opium, may be given with advantage, particularly in the evening ; as perspiration and sleep will thus probably be procured, and consequently the patient will be greatly relieved.
During the continuance of the yellow fever, few patients are able to take any food : they ought, therefore, to be kept as quiet as possible ; and should endeavour to dispel all intense thought or care; for anxiety cannot fail to aggravate the violence of the disorder.
Those of our readers, who wish to acquire more extensive information respectingthis terrible scourge, in all its various modifications, will meet with complete statements in Dr. Clark's " Treatise on the Yellow Fever, as it appeared in the Isle of Dominica, " etc. 8vo. Murray and Highley, 3s. 6d.; - in Dr. Jackson's " Outline of the His-tory and Cure of Fever , " etc. 8vo. 5s.; - in Dr. Rush's " Account of the Bilious Remitting Fever, as it appeared in the City of Philadelphia, in the Year 1793, " 8vo. Maw-man, 6s. ; - in Dr. Maclean's " Inquiry into the Nature and Causes of the great Mortality among the Troops at St. Domingo, " 1797, 8vo. 7s.; - and in Dr. BlanE's valuable " Observations on the Diseases of Seamen" 3d edit. 8vo. 1799, 7s. Murray and Highley.