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The Great Fever
Toward an Understanding of Yellow Fever

Two men dying on park bench of yellow fever Treatments Administered for Yellow Fever, 1848

An 1848 report by doctor J.C. Nott on the epidemic in Mobile begins with a mild description, but the list of treatments described seems left over from the Middle Ages.

From The Charleston Medical Journal and Review, Vol. 3: 1, Charleston, S.C., January, 1848.

Messrs. Editors:

You ask me for a sketch of the epidemic of Yellow Fever, which has just taken leave of Mobile. If you will accept a hurried sketch you are welcome to it -- I shall not attempt a perfect picture, but will only touch on those points which caught my eye en passant.

So wide spread, so mild in type, and so manageable has been the yellow fever of 1847, that it should properly be called an ephemeral epidemic. During the months of August, September and October, we had probably 7 or 800 cases of yellow fever of all grades, and the books of the sexton, which can be fully relied on showed but 68 deaths from this disease to the 1st of November. When we turn our eyes to the melancholy picture presented by our sister city, New Orleans, where nearly 3000 persons have died of the same disease; when too, we remember the havoc so often committed by it in the West Indies, and more especially in Spain, where instances are recorded of nearly a third of the entire population of a city being swept off by a single epidemic, such results might well excite a doubt as to the identity of these various epidemics. The diseases however are the same, and our ephemeral epidemics, which alone would scarcely be worthy of record, belong as much to the natural history of fever, and possess as much interest as the most deadly pestilence.

So much importance has been attached to weather by writers, that it may be well to say a few words on this head. It would be needless to fatigue you with details, and I will remark in general terms, that appreciable changes in our summer weather, have about as little to do with yellow fever as they have with small pox or measles. Long observation has brought the physicians of Mobile to this conclusion, and the following extract from my note book, will add confirmation to past observations; dated 1st August, 1847. " The summer up to this time has been the most temperate and rainy I have seen in twelve years, the thermometer has in my office but once reached 89 degrees F. -- it rained half the days in June, and twenty-five days in July, often in torrents -- nearly 14 inches of rain fell in the latter month, and yet in the midst of these incessant rains the yellow fever commenced. The first subject was Captain Smith, of the ship Emblem, who had arrived 9 days previous to his attack, direct from New York -- he left his vessel 30 miles below the city, came to the Mansion House, and there remained until attacked. He was attacked on 18th July, and did not die until the 4th Aug. An Irishman died with black vomit on Dauphin, near Cedar street on the 2d August."

Treatment. -- On this head I shall say but little, as our epidemic has been so mild that la medecine expectante, except in a small proportion of cases, night have been safely relied on.

Ample experience and the frequent and friendly interchange of ideas has brought our older practitioners in Mobile to great uniformity in the treatment of yellow fever, and I believe the disease is not better treated anywhere. Our treatment is not only modified to suit different epidemics, but individual cases in each year. The leading remedies about which doctors dispute are bleeding, purging, quinine, mercury and stimulants.

Bleeding. -- Our rule is to be guided in the use of the lancet by the symptoms of each case, and not by the name of the disease -- when the pulse is above par we cut it down; when it is at par or below it we hold off; where there are local determinations we use cups. In every epidemic I have seen, the lancet has been the exception and not the rule, and we have all been led to this conclusion by much practical experience, though we bleed more in some years than in others. Even Dr. [Benjamin] Rush, who sang so loudly the praises of the lancet in '93 [1793], was compelled in after years to moderate his tone; and any one who relies upon the lancet as a universal or even general remedy in the yellow fever of our country, has studied to little purpose the long history of those diseases produced by morbid poisons -- as yellow fever, cholera, scarlet fever, small pox, &c. These diseases, unlike the phlegmasiae, have a course to run, are really cases of strength husbanded, the general result in severe epidemics can never be satisfactory.

Purgatives. -- Many writers tell us that the bowels are much constipated and difficult to operate on in yellow fever; but instances of this kind are exceedingly rare in Mobile -- there is not one case in twenty in which ten grains of calomel and a dose of oil will not evacuate the bowels thoroughly; and after the first stage almost any light aperient will act; and even a Seidlitz powder or dose of magnesia will often produce numerous watery stools, which require to be checked by opium. We therefore use calomel or blue mass, followed by mild purgatives, as oil, rhubarb, some simple pill, &c. The hydorogogues we discard -- even Epsom salts, so often recommended, certainly is not a proper remedy for our disease. Independent of any specific effect we use mercury as a purgative, because it is the least irritating and least apt to produce watery discharges. You see, then, by the manner we use bleeding and purgatives, that we are bearing in mind, with fear and trembling, the approaching collapse, or "that bugbear, debility," of which one of our good friends speaks in a late journal.

Quinine. -- This remedy has met with no favor amongst us, except in a few intermittent cases which are seen in every epidemic; and even here it is a very uncertain remedy. In the uncomplicated cases of one paroxysm, I believe, to say the least of it, it is utterly useless. I understand it has been used in New Orleans the last season with immense success, but some how or other about 3000 persons have died there with yellow fever, and I have no doubt it has injured as many as it has benefited. Experience is often fallacious, and there is nothing more easy, as Mirabeau says, than to deceive ourselves. A new and infallible remedy was discovered in every town the cholera visited. The fact that the profession are all quarrelling about the efficacy of quinine proves it cannot have much. Where a well known remedy produces a decided benefit the profession soon unite on it -- no one doubts the value of quinine in intermittent, neuralgias, and some other affections.

Stimulants. -- We are all agreed in Mobile on this point -- whenever the pulse begins to flag we begin to stimulate, and nothing seems to hit a Mobile stomach like a mint julap -- whether it be or not because we like this charming beverage so much in health I cannot say, but certain it is the brandy julap is the thing for the collapse stage. Sometimes Champagne, sometimes porter, do well; but how any one can recommend carbonate of ammonia I cannot divine -- I have never seen it agree. There is nothing gained by forcing stimulants on the stomach, but when they are kindly borne they may be taken freely.

Mercury. -- One of the grand disputes, even in Mobile, is as to the true value of the specific virtues of this remedy, though we all use it to some extent. Of its advantages as a purgative, from its mildness and efficiency, I have no question; as to its great specific virtues, j'en doute. Baron Louis, whose deep research and whose ability in sifting medical evidence cannot be questioned, says, "The discovery of a remedy must be left to time and chance, and to the acuteness of the observer, for experiences has sufficiently proved that no dependence is to be placed on mercurial preparations of any sort." Now, the Baron has here perhaps gone too far, as I believe that in a certain class of cases calomel or blue mass are often used with decided advantage. Where there is a coated tongue, or watery stools, and the stomach bears them well, they may be used as alternatives with decided benefit, in small and often repeated doses; but where the tongue is clear, particularly where it nauseates, mercury in any shape I regard as worse than useless. It is a fundamental point in this disease to keep the stomach quiet, and no remedy which violates this rule can do good. I have repeatedly seen patients who had been kept nauseated by calomel, commence improving as soon as it was withheld.

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