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resemble convulsions. In a less number of cases, it came on gradually, and after a slowly-increasing illness of several days. It began with great pain of the head, heat, and redness of the face, and fullness and redness of the eyes, accompanied by a strong, full, tense pulse, and an almost universal costiveness. Pains in the back and limbs were common, but not as much so as of the head. A very great inquietude, or anxiety, of the stomach and breast, was common; approaching, sometimes, to syncope; and sometimes a vomiting, which soon ceased, or continued at intervals through the disorder. The fever which now commenced, was rarely ushered in by a chill, continued for a greater or lesser period, according to circumstances, and with so many varieties and combinations of symptoms, as to render it impossible to pursue a regular description.
Though the pulse was generally full, strong, and tense, in the beginning of the fever, it was not always so. It was sometimes weak and low, but still tense, if it be proper to use this term, to point out a condition of the pulse, as it appears to me, wholly peculiar to this fever. I well remember that, in a youth of twelve or thirteen years of age, the pulse became much fuller after a plentiful bleeding; though he was of a feeble constitution, and had been slightly affected with the fever once before. Hemorrhages, from various parts of the body, were frequent; especially in the advanced stage of the disease, and where it had been violent from the first. These were from the nose, fauces, especially the gums, from punctures made in blood-letting, and from the stomach; I saw no other. Bleeding from the nose and fauces, often occurred in the beginning of the disease, and were removable by the general remedies. Bleedings from the punctures made in blood-letting, were seen in the close of the disease, and were restrained with the greatest difficulty. I recollect to have been constantly engaged in an attempt to restrain such a hemorrhage, in company with another physician; two of the most melancholy hours I ever experienced. Symptoms of pulmonic affection were not uncommon; though I do not recollect to have observed them till the last of September, or beginning of October. They sometimes rose nearly to the height of pneumonia. Hiccough was a troublesome symptom, and often accompanied vomiting; and there was sometimes, as it appeared to me, a mingled hiccoughing and belching.
The marks of congestion in the brain were too numerous and unequivocal to be mistaken. A violent pain of the head was one of the earliest, most constant, and most distressing, symptoms of this disease. Coma was a very frequent symptom; and, as I thought, in proportion to the severity of the disorder. Toward the close, it amounted almost to total stupefaction; it being scarcely possible to rouse the patient. Some degree of delirium was common; particularly at the commencement of an exacerbation of the fever; manifesting itself in the hurried way in which the patient performed any action, and in the rambling manner in which he conversed. That kind of delirium which some have called light-headedness,' was remarkably present, in one person, at the close of his disorder. He often started up wildly, without any apparent object, then lay down, and commenced singing in an interrupted, incoherent manner, but without any violence. And the day before his death, he continued to sing, with slight intervals,
more than an hour. At other times, he would fix on some particular words, and repeat them over and over; sometimes with no appearance of emotion, at others with some glimmering of consciousness. In another person, a patient of a physician of my acquaintance, the affection of the brain was like that in phrenitis. A blistering-plaster applied, if I remember accurately, for twenty-four hours to the head, which had been shaved, excited no vesication, and scarcely any redness, though twice the usual quantity of cantharides was incorporated, and the patient was of a delicate habit. In this case, the affection of the brain took place on the third day, and the patient died on the fifth or sixth. On an examination and dissection of the contents of the cranium, all the membranes, and the very substance of the brain, were discovered to be in a remarkable and uncommon state of inflammation. I have been the more particular in relating this case, as it seems to contradict, in a degree, the ideas of Dr. Rush, in his history of the Philadelphia fever; our season having been unusually wet.
'As connected with the state of the brain, it may be proper to mention here, that the eyes were often suffused, the whites of them tinged with yellow, and the small vessels turgid with blood. In some patients, they had an expression of singular wildness; while in others, there was a remarkable vacuity, or absence of all expression. I saw no instance of squinting; nor observed any uncommon state of the pupil.
The state of the mind was very variable. Some were exceedingly impatient and irrascible; others, nearly torpid. Some were gentle, and easily managed; others, astonishingly obstinate: and this particularly, when, as was often the case, there was a loss of memory, or some degree of mania. A strong appeal to their good sense, calling them by name, seemed to effect a temporary restoration of their docility and recollection, which were soon lost. Many were very confident, at first, supposing their illness not to be the fever; but gave themselves up to despair, immediately on being convinced that it was the disease. Many were full of dreadful apprehension from the first; and oftentimes exceedingly aggravated what would have been otherwise a slight disease. A few were calm, collected, undaunted, throughout their sickness. And here it may not be unseasonable to remark, that these same varieties were, in a degree, observable in those who continued well. Some physicians thought they could discern a tendency amoug the citizens generally, to mania. It is certain that fear was a terrible evil, and frequently proved the exciting cause of the fever.
'I have remarked that a great anxiety at the stomach was sometimes felt, on the patient's being first seized with the fever. This anxiety, it may now be added, in some cases, extended through the complaint; but was most distressing when the fever was most violent. A great sense of soreness was often complained of, when any thing was taken into the stomach, as if it were raw — to use the words of one in whom it was observed. In some, the sensibility of this organ was so excessive, as to make it almost impossible to administer either food or medicine. Patients were often afflicted with extreme pain in the bowels; but more resembling that in dysentery than in cholic.
'Flatulency, both of the stomach and bowels, was almost universal, and to an extraordinary degree. Several dissections showed the stomach to have been in a remarkable state of inflammation and excoriation. Though a constant tendency to a costive state was general in those sick with the disorder; yet, in some, the fever was attended from the first, or for a while, by a diarrhoea; and, in one instance, the whole of the disease appeared to me to be turned upon the bowels, and to be converted into, or assume the form of, a diarrhœa.
'Some were seized with vomiting at the first, which was soon stopped, or ceased spontaneously, and never returned. One case of this kind proved favorable, the patient recovering; another unfavorable, the patient dying. In others, vomiting commenced the disease, and continued through it; while in others, again, it came on in the course, or at the close of the disorder; and this both in successful and unsuccessful cases. The matter was most commonly of a yellowish-greenish, or a muddy green-and-yellow appearance, and very fluid. Emissions of this kind were seen both in those who recovered and who died; and were both temporary and continued. Next in frequency, was that of a blackish appearance, commonly described as resembling coffeegrounds; but a species bearing a nearer resemblance to blood partly burnt and diluted with muddy water. Several who had this species, recovered. I never saw an instance of that tar-like matter which has been noticed by some writers. But of all others, that which struck me as evidence of the greatest derangement of the stomach, was the vomiting up of what appeared to be a thin blood, in which floated a flaky, filmy substance, which I supposed to have been the villous coat of the stomach. This I saw but in a single instance, a few hours before death. Thisdischarge was frequent, though small, and accompanied by a large worm.
The discharges from the bowels were very dark, in general, even where no mercurial preparation was used, and in most cases, remarkably fluid; and in all severe cases, excessively offensive. They were, sometimes, of a dark, shining appearance, somewhat like molasses, or melted pitch. Blood, drawn in this fever, was remarkably wanting in floridity; and this was especially true of that which was evacuated in the close of the disease, whether by art, or spontaneous effusion. In one instance, it seemed endowed with a caustic quality, and affected a lancet so as to leave a permanent inequality and discoloration of its surface.
'Sleep, for the most part, appeared unnatural and unrefreshing; attended by great restlessness; and sometimes by great mobility of the muscles, twitchings of the tendons, and frequent starting up. One of my patients often raised himself up suddenly out of bed, with every appearance of extraordinary terror; but with no evident or clear consciousness of the act. There was great variety in muscular power, in different persons. A man who died with the very worst symptoms of the fever, the evening before his death, rose from his bed, ran down two flights of stairs, returned, and was only prevented from going down a second time, by his nurses having locked him in his chamber. In another case, where the disease was mild, the patient felt perfectly easy and composed, and in full possession of mental and corporeal strength, while he lay on his bed; but when he rose, and
attempted to walk, a sense of universal anxiety was felt, his ideas became confused, his strength seemed to desert him, a sudden faintness came over him, and twice he sank down, unable to proceed.
'The taste was fickle, and the hearing gone. An astonishing insensibility to cold was nearly universal. I remember, in one of those cold turns which we had in September, a remarkable instance of this. One of my patients occupied a chamber in the second story; the room was very large, extending the whole width of the house; and having a chimney, a large door, and two windows at the end. The bed was hard, in the middle of the room, the door and all the windows open, and he covered with a single sheet, frequently thrown off, in his restlessness; yet he complained of no cold, while I was chilled through, though sheltered from the draught of air, with my usual clothes on, and the addition of a surtout and double cloak. Yellowness of the skin was not constantly present, in this disease; at least, not in any remarkable degree. A tinge of it was common in the eyes and on the skin; but not stronger, in numerous instances, than in ordinary fevers. Others were exceedingly yellow even to being tawny-so that the bed and body linen were stained. I have, sometimes observed a coldness of the skin, on the body, generally, but especially of the feet, of which the patient was unconscious, while the face and breast were red, and communicated a burning sensation to the touch.
'The period of convalescence, as well as that of the fever, was variable. In the former part of the time, and before the weather began to grow cool, patients seldom died after the tenth day, as far as I could learn; but their deaths took place on the third, fifth, sixth, seventh, eighth, and more rarely on the ninth day. After the cold weather appeared, they sometimes dropped off suddenly, and after having exhibited all the marks of convalescence, three weeks from the time of their seizure. So, of those who recovered, some regained their health with an elastic quickness; while others were very slow in the acquisition of strength; were a long time troubled with great weakness in some of their joints, oftenest the knees; and were afflicted by adematous swellings of the feet, ankles, and legs. It is worthy of remark, that the meazles had begun to appear, when the fever came, and they disappeared; but, no sooner was the fever vanquished, than they returned more generally than ever.'
The length to which our extracts have extended, compels us to advert very briefly to the means generally adopted in the treatment of the disease. The effects of bleeding, in its early stages, are declared to have been salutary, and to have communicated, in most cases, a new energy to the system. Little or no advantage was derived from blistering. The good effects of cathartics, however, were not less obvious than venesection. From the commencement of the disorder, the application of cool air to the body of the patient, and the use of cool drinks, were deemed of the utmost importance; and cleanliness, in every thing, was indispensable. We shall return, before long, to this copious diary, kept at a remote and fruitful period, for farther matters, greatly varied in kind, but all of general interest, for the present reader.
DESCENDING to me by hereditary right, the time-piece that was my father's, and my grandfather's before me, is now in my possession, and occupies a prominent place in the vesture of my study. How often have I sat and gazed upon its time-worn countenance, listening to its regular and monotonous ticking, and inly longing that it could speak, and tell me what it had seen in its younger days! Doubtless it has gazed on many a scene of bloodshed and slaughter, of revelling and mirth. Doubtless it has lifted its hands in horror at some enacting tragedy, never failing to sound its customary alarm. At any rate, whoever has walked upon the earth for an hundred years, or even if he has been confined for so long a time in one position, must have been the witness of much that would now be interesting. Oh that the old clock could speak! How many bright and sparkling eyes have been turned to its paternal-looking face, only to lose their vivacity, by seeing that it pointed its hand to the dreaded IX! How But to our story.
Other authors describe their heroes and heroines; why should not I describe mine? It is encased in an upright box, some eight feet in height, two in width, and the same in depth; so that when it is erect, with its black metal face peering through its glass covering, it resembles more an Egyptian mummy, than a chronicler of time. Its machinery is of that complicated character, which is an unfathomable mystery to modern tinkers, who are altogether unable to regulate its labyrinthine tortuosities. There are a few antique figures carved