Bleeding and purging

The baths are all Emptyed as soone as the Company goes out, which is about 10 or 11 of ye Clock in the morning ; then by sluces they empty at once ye bath so it fills againe. I have seen all ye springs bubble up as thicke out of ye ground when the baths have been empty. Ye bottom is gravell. So they will be full for ye evening if Company would go in againe, if so they empty them againe at Night and they are filled against ye morning and there will be such a white scum on the bath wch ye guides goes and scimms off Cleane before any Company goes in ; if they go in while this scum is on it gives them the bath mantle as they call it, makes them breake out into heate and pimples ; ye like will be on them if they go into ye bath before they have purged, especially in ye hotter bath.

The baths are all emptied as soon as the company goes out, which is about ten or eleven o'clock in the morning. Then they empty the bath all at once by sluices, so it fills again. I have seen all the springs bubble up as thick out of the ground when the baths have been empty. The bottom is gravel. So they will be full for the evening, if company wants to go in again. If so, they empty them again at night, and they are filled by the morning. And there will be a white scum on the bath, which the guides go and skim off clean before any company goes in. If people go in while this scum is on, it gives them “the bath mantle,” as they call it: it makes them break out in heat and pimples. The same will happen to them if they go into the bath before they have purged, especially in the hotter bath.

The streets every where discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading, or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night.

The streets everywhere discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading or driving a horse with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements kept alive anguish and fear in the sick and well, every hour of the night.

I resolved after mature deliberation, to prescribe this purge. Finding ten grains of jalap insufficient to carry the calomel through the bowels, in the rapid manner I wished, I added fifteen grains of the former, to ten of the latter; but even this dose was slow, and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap, and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder, not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disorder.

I resolved, after mature deliberation, to prescribe this purge [of calomel and jalap]. Finding ten grains of jalap insufficient to carry the calomel through the bowels in the rapid manner I wished, I added fifteen grains of the former to ten of the latter; but even this dose was slow and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disorder.

But I did not rely upon purging alone, to cure the disease. The theory of its proximate cause, which I had adopted, led me to use other remedies, to abstract excess of stimulus from the system. These were blood-letting, cool air, cold drinks, low diet, and applications of cold water to the body. I had bled Mrs Bradford, Mrs Leaming, and one of Mrs Palmer's sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had moreover, heard of a man who had been bled on the first day of the disorder, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type, and instead of tending to a crisis on the third, to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease, was not the effect of accident, nor of the application of a single remedy; but, it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind, when I add a short extract from my note book, dated the 10th of September. "Thank God! Out of one hundred patients, whom I have visited, or prescribed for, this day, I have lost none."

But I did not rely upon purging alone to cure the disease. The theory of its proximate cause, which I had adopted, led me to use other remedies, to abstract excess of stimulus from the system. These were bloodletting, cool air, cold drinks, low diet, and applications of cold water to the body. I had bled Mrs. Bradford, Mrs. Leaming, and one of Mrs. Palmer’s sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had, moreover, heard of a man who had been bled on the first day of the disorder, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type and, instead of tending to a crisis on the third [day], to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease was not the effect of accident, nor of the application of a single remedy; but it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind, when I add a short extract from my notebook, dated September 10. “Thank God! Out of one hundred patients whom I have visited or prescribed for this day, I have lost none.”

The consternation of the people of Philadelphia at this period was carried beyond all bounds. Dismay and affright were visible in almost every person's countenance. Most people who could by any means make it convenient, fled from the city. Of those who remained, many shut themselves up in their houses, and were afraid to walk the streets. The smoke of tobacco being regarded as a preventative, many persons, even women and small boys, had segars constantly in their mouths. Others placing full confidence in garlic, chewed it almost the whole day; some kept it in their shoes. Many were afraid to allow the barbers or hair-dressers to come near them, as instances had occurred of some of them having shaved the dead — and many of them had engaged as bleeders. Some who carried their caution pretty far, bought lancets for themselves, not daring to be bled with the lancets of the bleeders. Some houses were hardly a moment in the day free from the smell of gunpowder, burned tobacco, nitre, sprinkled vinegar, &c. Many of the churches were almost deserted, and some wholly closed. The coffee house was shut up, as was the city library, and most of the public offices — three out of the four daily papers were dropped, as were some of the other papers.

The consternation of the people of Philadelphia at this period was carried beyond all bounds. Dismay and affright were visible in almost every person’s countenance. Most people who could by any means make it convenient fled from the city. Of those who remained, many shut themselves up in their houses, and were afraid to walk the streets. The smoke of tobacco being regarded as a preventative, many persons, even women and small boys, had cigars constantly in their mouths. Others, placing full confidence in garlic, chewed it almost the whole day; some kept it in their shoes. Many were afraid to allow the barbers or hairdressers to come near them, as instances had occurred of some of them having shaved the dead, and many of them had engaged as bleeders. Some who carried their caution pretty far bought lancets for themselves, not daring to be bled with the lancets of the bleeders. Some houses were hardly a moment in the day free from the smell of gunpowder, burned tobacco, niter, sprinkled vinegar, etc. Many of the churches were almost deserted, and some wholly closed. The coffeehouse was shut up, as was the city library, and most of the public offices. Three out of the four daily papers were dropped, as were some of the other papers.