ARTICLE IV.--_Remarks on the Pathology and Treatment of Yellow Fever._ Arranged from the Notes of Dr. J. A. MONGES, of Philadelphia.
I arrived at St. Domingo in the year 1785, and from that period to the time of my departure from thence, I had very ample opportunities of observing and treating the diseases of that island, both in the country and at the Cape. During the whole time of my residence there, the ordinary febrile diseases of hot climates were of very frequent occurrence, especially among the new comers, and those not acclimated; but the real yellow fever, or vomito negro, never prevailed. So that when I reached this city in 1793, I never had had an opportunity of observing this disease.
As introductory to the subject more particularly before us, I shall offer a few remarks on the nature and treatment of the fever, which prevailed in that island. It was usually of the remittent type, of a bilious nature, and rather violent in its character; presenting very often symptoms of a typhoid, or malignant condition of the system. In almost every case, it was attended with great gastric irritability and pain; and, in very many instances, accompanied with vomiting of dark green, and even of black bilious matter,--determination to the brain producing delirium, coma, &c. &c. In general, this fever differed but little from the bilious fevers of this country; except, perhaps, in its greater severity, and in a larger quantity of bile commonly evacuated. The treatment of this disease, at the time of my arrival, was generally attended with some difficulty, owing to the great prejudice prevailing against the use of the lancet; not only among the mass of the population, but even among the old physicians of the island. Experience, however, having taught me, that venesection was essentially necessary in fevers of the same sort, which I had noticed in other places, I resorted to it, notwithstanding the existing opinion; and am now convinced, that by its means I saved many patients. Nor was I the only one to adopt this mode of practice; as it was commonly resorted to by all _new_ physicians, who were soon found to be more successful than the older practitioners. To arrest the violent vomiting, already alluded to, it was of the highest utility, and, in many instances, the only remedy that could be depended upon. Emetics were very commonly used, and sometimes with great benefit; but, in many instances, they were contraindicated by the pain and irritation of the stomach.