An Account of Refufcitation in a Cafe of fuppofed Death from Yellow Fever. In a Letter from JOHN RUSH, M. D. to DR. Coxь.

IN

SIR,

N the month of August of the year 1798, the yellow fever appeared in Marcus Hook, a fmall village fituated on the banks of the river Delaware. The crews of the United States veffels Ganges and Retaliation, which lay along-fide of the village, were at the same time attacked with this disease. Upon the first indisposition, each person was removed from the vessels and conveyed to tents fitted up for his reception, on an elevated and healthy spot of ground in the neighbourhood; where, through the humane attentions of his commander,* he was provided with every neceffary that his fituation required.

Out of fixty feamen, ordinary feamen, and marines, who had been sent to the tents, many had the difeafe mildly, fome fuffered feverely, and four died, on the third, fifth and seventh days, with black vomiting and other symptoms of great malignity. Of the whole number, I have selected a cafe, which, from the rareness of its occurrence may be interesting and important.

The particular fymptoms that marked the progress of the disease in this cafe, from the apparent ceffation of life, to its complete refuscitation, I am unable to ftate, owing to the circumstance of the daily journal remaining in the poffeffion of my affiftant Mr. Parker, after he had retired from the United States fservice. What I obferved at the time of my vifits, which through neceffity were short and few, I have correctly stated, and have no reason for doubting the truth of what is farther advanced, from the representation of Mr. Parker.

• Dale.

Refufcitation in a Cafe of fuppofed Death from Yellow Fever. 63

CASE.

James Clark, an ordinary feaman belonging to the Ganges, about nineteen years of age and of a hale constitution, was attacked on the seventh of September with the yellow fever. The fymptoms were fuch as characterize the malignant forms of this. difeafe. The force of the difeafe, feemed principally exerted on the arterial fyftem, while the mufcular and nervous systems, appeared to be but fecondarily affected. The pulfe was depressed at the commencement of the attack, but rofe foon afterwards and became full and ftrong. Twenty-four ounces of blood, in all, were taken from his arm in the firft paroxyfm; during which, he was copiously purged with strong dofes of calomel. On the second day, bleeding and purging were discontinued, and mercurial frictions, together with small and repeated dofes of calomel were prefcribed, in order to produce a falivation. This however could not be effected. The difeafe, notwithftanding the use of a variety of stimulants, fuch as brandy, ether and laudanum, arrived at the last stage, when, on the morning of the fourth day, the black vomiting began and continued until twelve o'clock at noon; at which time, it was faid, he had expired. Upon paying my fecond vifit to the tents, at four o'clock in the afternoon of the fame day, I faw the body of Clark lying in a coffin and apparently lifelefs. On closely examining it, I observed the pale yellow, that previously tinged the temples, nails and neck, changed to an orange-like hue, and interfperfed with purplish spots refembling petechiæ: neither pulfe nor heat were perceptible, nor was refpiration discoverable on the mirror, which was held before the mouth. Putre faction, however, had not taken place; the lower jaw was still flexible, and upon a more minute examination, I felt (or thought I felt,) a flight warmth about the epigastric region. With fuch flender, and evanefcent fymptoms, of life, experiment indeed promised little. But fomething I was refolved to attempt: I therefore ordered the body to be covered with warm afhes from

the cook's fire, and a gill of very strong brandy toddy to be poured down the throat every half hour. Being called away, I could not wait to fee the effect of thefe remedies; but requefted Mr. Parker to continue the use of them, whilst any hope remained of their being fuccefsful. On my return at sunrise the following morning, I had the pleafure to find Clark propped up, indulging himself with foup. From Mr. Parker I learned, that about eight o'clock, after he had received a quart of brandy, he began to refpire; that the brandy was continued in the fame proportion which I had prescribed, until eleven o'clock, when he was fo far recovered, as to complain of the warmth of the ashes; that he was then taken out of the coffin, and laid on ftraw on the ground. Port wine fangree was then substituted for brandy, and was regularly administered until day light, when he refused to take any more and called for food.

On the treatment of the above cafe, it may be proper to remark, that had convulfions or fpafms attended the apparent diffolution, I should have hefitated in pouring a fluid down the throat; as when death occurs in convulfions, the glottis might not be completely clofed, while the muscles of the epiglottis, partaking alfo of the general convulfion, might retain it in an erect pofition: hence a fluid would pafs into the lungs, as well as into the ftomach, a circumftance which would prevent refufcitation. But in cafes like Clark's, where muscular relaxation accompanied the apparent extinction of life, the epiglottis muft neceffarily be in contact with the glottis, and thereby prevent the admiflion of a fluid into the lungs.

If the hiftory of the above cafe, fhould ferve to prevent premature interment, and lead to the use of remedies for refufcitation in doubtful cafes of death from fever, as well as from caufes which induce it fuddenly, it will be a high gratification, to

Your Friend,

JOHN RUSH.

PHILADELPHIA, -August 17, 1804.

Hiftory of a Cafe of Aneurism. By PHILIP SYNG PHYSICK, M. D.

A

Philadelphia, August 29, 1804.

YOUNG gentleman from Virginia applied to me last April to undertake the treatment of an aneurism, fituated at the bend of the elbow, occafioned by his having been bled in the bafilic vein in October, 1801. He informed me that the bleeder at the time of the operation experienced no difficulty in ftopping the blood, but that a very confiderable ecchymofis formed, occafioning a livid colour of the skin about the wound. and extending both above and below the elbow. The ecchymofis difappeared after a few days; but a pulfating tumor was obferved directly under that part of the vein which had been punctured. This tumor gradually increafed in fize for fix months, but afterwards the increase of the tumor, if any, was fo flow as not to be observed, though the bafilic vein running over it began to enlarge.

On examining the arm I found a tumor at the bend of the elbow pulfating very strongly; exactly resembling a true aneurifm: there were also two tumors, one fituated above, and the other immediately below this aneurismal fac, in which the particular thrill always met with in varicofe aneurisms was very diftinctly felt. Thefe tumors were evidently diftentions of the bafilic vein, the trunk of which however for about three-fourths of an inch, where it paffed over the aneurifmal fac, was very little enlarged by making preffure on the middle of this last mentioned portion of the vein, the orifice of communication between the aneurismal fac and the vein could be felt; and, by applying the finger accurately over it, the flow of blood into the vein could be prevented, and the thrill, while the preffure was continued, ceafed.

The cafe was now easily understood: the artery had no doubt been punctured by the lancet, pushed into it through the vein by the bleeder; the pulfating tumor was a fac formed in the VOL. I.

K

cellular membrane between the artery and vein, by the impulfe of the arterial blood: the enlargement of this fac went on until its fides became firm and refifting, and then the blood from the fac was thrown with fuch force into the vein through the puncture in its lower fide, as to cause it to diftend very confiderably, for two or three inches above and below the fac; the intermediate portion of the vein however running over the fac being fupported by it, was very little enlarged.

As the upper portion of the vein was obferved to distend very rapidly, the fkin covering it being very thin and every where marked with cicatrices; the patient apprehending a fudden rupture of the tumor, became very uneafy in his mind: the forearm was much diminished in size, and the hand was constantly cold. These circumftances together with the existence of the aneurifial fac, determined Dr. Wiftar and my felf to advife the operation of tying the artery above and below the fac.

I performed the operation in April, 1804; within a quarter of an hour after, the pulfe of the artery at the wrift was dif tinctly perceived: in three weeks the wound was cicatrized, and the patient very foon recovered the most perfect ufe of his arm and hand. It feems unneceffary to defcribe the operation further than to mention, that after dividing the skin and cellular membrane covering the fwelling by a ftraight incifion, I diffected round the tumors, then tied the trunk of the vein above and below its enlargement, next tied the artery above and below the fac; the parts comprehended between the ligatures were then cut out, which has enabled me to have the annexed drawing of them made. They are reprefented of their natural fize.

Fig. 1. A A The bafilic vein diftended above and below the puncture.

B The cicatrix from bleeding.

D The aneurismal fac.

CC The brachial artery.

Fig. 2. A A The enlarged vein.

e Orifice of communication between the vein and ancurif

mal fac.