man, if the cases of fever which he refers to had not occurred in my own house. The following extract contains the statement upon which I intend to remark. "When I visited this island (St. Thomas's), in November, 1796, an accident furnished me with an opportunity of informing myself relative to the history of the malignant pestilential fever as it appeared there in 1793, 1794, and 1795, and at that time. The history was indeed a melancholy, but it was an instructive one. An eminent merchant, Mr. C. G. Fleicker, with whom I had been acquainted at St. Croix, requested me to visit a valuable young German gentleman of his house, of the name of Schmaler, who had arrived from Hamburgh only about ten days before, and at this time, unhappily, laboured under a fatal attack of this most dreadful malady. In Mr. Fleicker's house the malignant pestilential fever had very frequently made its appearance during and since 1793, and, except in one instance, (the Captain of a Hamburgh ship) always fatally. No means, at least none sufficient for the eradication of the infection, had been employed on the death of the unfortunate sick; consequently the chambers which were successively occupied by strangers from Europe, became a never-failing seminium of the pestilential contagion."* Dr. Chisholm, no doubt, alludes, in the above paragraph, to Mr. C. G. Fleischer, who resided at St. Thomas's, but who had not, at the period of Dr. Chisholm's visit, any regular establishment in the island, but acted as an assistant to my house, of which Mr. Schmaler was clerk. There being a great intimacy between Mr. Fleischer and myself, he often, in my absence, was authorized to superintend my concerns, and this was the case at the time Mr. Schmaler died. I was, however, at home when he arrived from Europe, and returned soon after his death. More young men had died in my house, from 1793 to 1796, and even later, than, perhaps, in any other in the town; because more had come out to me from Europe than to other merchants. Their deaths, however, could not have been occasioned by the contagion remaining in the chambers of the house, as Dr. Chisholm supposes; for the cases took place at remote periods, in different houses, I having changed my dwelling in 1795. Neither could their deaths have been oc * Vol. ii. p. 320. casioned by the contagion remaining in the bedding; for the beds and bedding of those who died of a putrid fever in my house were never used again. Further, according to the best of my recollection, two persons were never ill of the fever, at any time, in the same chamber, in either of my houses, in both of which I had four or five rooms appropriated for clerks; besides, many persons slept in those chambers without inconvenience. If Dr. Chisholm's account were correct, my house must have been a lazaretto, for those supposed pestiferous chambers were almost always occupied; and I can assure him, that commonly a whole year, and sometimes a longer period, passed without any one of my family being sick of fever. It is, moreover, incorrect, that all those persons died who had been sick of the pestilential fever during and since 1793, except the Hamburgh Captain; and also, "that after the first two years of the introduction of this fever, the inhabitants, without exception, whether creoles or foreigners, equally suffered." The truth is, that many Europeans and Americans recovered, both before and after the time of Dr. Chisholm's visit to St. Thomas's, and the fever never spread to the inhabitants at large, but was confined to persons recently arrived from northern climates, and to those on board the vessels in the harbour; nor was there any apprehension of contagion except among the shipping. I never heard of a single instance of any person who had resided for some years in the island being afflicted with the malignant fever. A residence of nearly twenty years in the island enables me to speak positively as to this fact. I have not the honour of Dr. Chisholm's personal acquaintance, but as he was so polite as to visit Mr. Schmaler in my absence, I feel myself obliged to him, and I am sorry I have been under the necessity of correcting his mistatements. He mentions Mr. Jennings and Dr. Tucker as his acquaintances at St. Thomas's, and to these gentlemen, as well as to Mr. Fleischer, I refer for corroboration of any part of my statement, if required. I am, Sir, respectfully, Philadelphia, Feb. 1, 1804. J. F. ECKARD. ARTICLE IV. An AccoUNT of an extraordinary CASE of BLIND PILES, radically cured by Compression and Dilatation of the Anus: Communicated in a Letter from Dr., of Maryland, to Dr. MILLER, dated February 22, 1804. DEAR SIR, HAVE long entertained an opinion, in some measure founded on experience, that every disease to which the human body is liable, has a remedy suited to its cure, provided the organs which are properly called vital, or other essential parts, have not sustained so much injury as to make recovery impossible. From this it will not follow I have taken up an idea that the healing art will ever attain to a state of perfection. Unfortunately there is only one right way of healing a disease, though a great many wrong methods may be pursued to harass a patient, or, in other words, " to kill by rule, or cure by chance." It may also be mentioned as a fact, that a patient will sometimes get well by the efforts of nature, the efforts of the doctor to the contrary notwithstanding. The following case will satisfy you that I do not pretend to exempt myself from this unhappy state of imperfection. I only wish to be understood, that cases every now and then occur in practice, which all the physicians and old women in the country think they have a perfect knowledge of, that can only be cured to the comfort and satisfaction of the afflicted patient in one way that can be called proper and right, though the physician or surgeon may have very implicitly followed the advice and directions of the most approved and celebrated authors!! Is there a candid physician in the world who will not confess he has treated certain cases in a very bungling manner, to the no small distress of his patient? But if, by chance or reflection, he has, after some time, hit on the proper method of cure, what exalted sensations! What internal satisfaction is communicated, on such an occasion, as well to his patient as himself! I have been led to these reflections and observations from an extraordinary case of blind piles which came under my notice last spring. I. M. aged 39 years, of sound constitution and athletic conformation of body, had been, ten years before, severely afflicted with a spasmodic disease in his bowels, commonly called the dry gripes, but had entirely recovered, and remained so for that space of time, living a very active life, and enjoying almost an uninterrupted state of health, with this exception, that shortly after recovering from the disorder in his bowels, he was troubled with the bleeding piles, which were brought on by a costive habit of body, and somewhat increased by aloes, which were used to obviate that predisposition. He says, and there can be no doubt as to the truth of his report, for ten years he rarely had a discharge by stool which was not accompanied with blood in greater or smaller quantities (invariably without pain), whether procured by nature or art; but that his general health was seldom otherwise affected, except in one instance, about five years ago, of catarrhal fever, from which he soon recovered. In March last, 1803, almost twelve months ago, the bleeding piles stopped, which were immediately succeeded by a smart fever, and uncommon painful sensations about the anus, and up the rectum, after stool; symptoms heretofore altogether unusual; which made it necessary to take blood from the arm two or three times in the course of as many days. Laxative medicines, such as sulphur and cream of tartar, and castor oil, were administered. Anodyne injections, as well as anodyne ointments, were advised, but all to little purpose, for scarcely momentary relief was afforded. For some time the stools were made frequent, with some hope that benefit would be obtained by such means; but instead of relief, the pains were aggravated after every stool, so that it soon became an object to procure them no oftener than was thought really necessary to obviate costiveness; for it was soon observed that every stool was accompanied with great pain in the discharge of fæces, which seemed rather to abate for half an hour, and after that to increase with aggravated violence, and continue for twelve hours. Observing a kind of habit established, which harassed him exceedingly, notwithstanding the means used to obviate pain, he would procure a stool by sulphur and crem. tart. or bals. copaiba, as inclination might direct, in 24 or 48 hours, but whether at one period or the other, the effects were invariably the same-that is, great pain in the discharge of fæces, aggravated in half an hour, and continued twelve hours regularly by the watch. Some respite from pain after this, though a great soreness about the anus and up the rectum remained, would have cheered the drooping spirits, had not the most dreadful anticipations constantly hung on the mind. The imagination can scarcely picture a more distressing case; while it appears almost incredible that a human being could live almost five months in so much torture one half or one fourth of his time: but so it was, that after being wearied out with pain, and very much emaciated, in the course of three or four months he seemed habituated to suffering. Exhausted nature began to revive, and he to recover some strength and even flesh. Besides those I have mentioned, you may readily suppose all the remedies recommended by authors, some of which are stiled "infallible," particularly by the celebrated Pott, were tried again and again to no purpose. Several physicians were consulted. The old women, far and near, were sending prescriptions after prescriptions, which were said to have performed little short of miracles on former occasions: but, alas! the same periodical symptoms would return after every stool, in defiance of them all. I was certain matter would form up the rectum, and really wished such a termination would take place, however inconvenient a fistula might be, conceiving any thing preferable to such habitual torment. In this expectation I was mistaken. "Tell it not in Gath," as the opprobrium medicorum:-An old woman, towards the end of the fifth month, hearing the torture a fellow creature had been labouring under for almost five months, sent word to him that her father, some certain number of years ago, had been afflicted for twelve or eighteen months as she understood Mr. I. M. was at that time, and that every thing failed that was tried, or, in other words, did no good, until some other old woman came and advised him to take a little fine hackled tow, and make it into the form of a cushion, so as to press up against the anus, and to confine it by bandages. This, she said, gave great relief, and he soon recovered. Mr. I. M. asked me, Shall I try this simple thing? Yes, by all means, was my reply! He tried it, and found considerably more relief than be had experienced for almost five months; but a thought struck him that something which would dilate the anus, and destroy that spasmodic action which he had so often experienced up the rectum, would be still more effectual, and more certainly confine the compress. To answer this grand intention, he twisted up a tent from the middle of the tow cushion, about two inches long, and an inch at its basis in diameter, and introduced it up the anus immediately after every stool, anointing it with hog's lard. This answered the intention completely; for from that VOL. I. 2 X |