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a difficulty presented itself. Night had arrived, -as usual the Prison was under the care of the Warden and Night Watch of officers only, while its other officers were at their homes, or scattered about the town. The Hospital was in another building, some rods distant,—there were no Watchmen on the walls, and darkness might afford facilities for escape. Under these circumstances, I advised with the Warden, and, in co-operation with him, executed the following plan of operations. First-a messenger was sent to summons the whole
of Officers to their posts. Second—the Nurse was required to have all the beds in the Hospital in readiness for the reception of the sick. Third-a man was sent round the Prison, with orders to inquire at every cell, and where he found a’ man sick, to take from him his water-can, and place a mark upon the door. Following close upon the heels of this messenger, I visited all the sick in their cells, encouraged them to bear their pain with fortitude, assured them the means of relief were at hand, and sorted out such as suffered most severely, and placed them together in the gallery An officer was now directed to go round among the cells once in half an hour, and give a pill of opium to each man, until his suffering should abate. The next object was to convey the sickest patients to the Hospital; —and I am happy to say, such was the state of discipline among the officers, and such their alacrity on this occasion, that the Warden had no difficulty in conveying the sick from Prison to Prison, nor in passing every necessary person or article without delay, and without at all endangering the safe keeping of the Convicts, although the Night Watch of officers only was present during these operations. From this time, I am confident thirty minutes had not elapsed before we were able to send aid,
courage and confidence to the remotest cells of this extensive establishment. Having removed the first class of patients to the Hospital, and prescribed for their cases, as will be explained by and by, I returned to the New Prison, examined all the sick in rotation, collected another class of patients, and had them conveyed to the Hospital likewise. In this manner our time passed, until about nine o'clock, when an officer could be spared to invite the Medical gentlemen of this town and the city of Boston, to attend and witness the disease. These gentlemen were soon in attendance, and afforded us much relief by their advice and assistance. Some time after midnight, I made a report of the state of things to your Excellency, and early next morning addressed the following Note to the Warden and Inspectors of the Prison.
I feel it a duty to advise and request that an accurate chemical analysis be made, by some competent persons under your authority, of the remnants of food left from yesterday's ration, and likewise of the stools of the sick; and in a particular manner to inquire, if they contain any thing poisonous or deleterious to health.
Respectfully Yours, &c.
Physician Mass. S. Prison. Monday morning 7 o'clock,
August 6, 1832.
P.S. I have further to request, that an able Apothecary may examine and weigh all the articles in the Dispensary,-compare them with the prescriptions made, with the quantities purchased, and report any deficiency
of medicines which might prove deleterious, if mixed with food,—and that his Report be sealed, and not opened until the Report of the Analyzing Committee.
I was prompted to the above course by the conviction, that there might be those who would believe this disease had been produced by culpable negligence, in not securing healthy food for the Convicts, or by poisonous articles mixed therewith ;—that important legislative or judicial proceedings might grow out of the case, and that it would be expected of the Officers of this Institution to establish the facts as they actually existed, and upon the most unquestionable authority.
In compliance with this Note and instructions,* soon after received from your Excellency, the Inspectors employed Professor Webster, of Harvard College, to examine the utensils and premises of the Prison, and to analyze the food used by the Convicts, on the day preceding the appearance of the disease. They likewise employed Mr. Daniel White, of the firm of Samuel Kidder & Co., a highly respectable Druggist of this town, to examine the medicines in the Dispensary of the Prison, and to report any thing wrong in that department. These gentlemen have performed the duties assigned them with their accustomed accuracy, as will be seen by their Reports.f At the same time, John Ware, M. D., and Joshua B. Flint, M. D., of Boston, and Josiah S. Hurd, M. D., of this town, were joined with me in consultation to attend the sick, and develope the true nature of the disease. To these gentlemen I shall always feel grateful for their kind attention and judicious advice on this occasion.
* Vide Appendix, A.
# Vide Appendix, B & C.
Having premised thus much, I shall proceed to record the phenomena which characterized the disease,-the treatment adopted, with its success,-its resemblance and discrepancy with certain diseases familiar to usand finally, to draw such inferences as to its origin and nature, as facts seem to warrant and require.
During the first 48 hours, there was neither pain in the head, nor disturbance of the intellectual functions ; but when fever supervened upon the primary affection, head-ach was among its concomitant symptoms. It likewise existed as a primary symptom in some of the cases which commenced subsequent to the 6th of August. The air thrown out by expiration was in no case as warm as usual, and in some cases it was cold. The lungs could be inflated and emptied of air to the full extent, without increasing pain. The tone of voice was similar in all the cases, and such as to indicate severe suffering. The attitude chosen by the sick was recumbent, upon the back,-head thrown backwards,-arms not folded on the epigastrium,-legs drawn up with the heels close to the buttocks, so as to enable the patient to maintain a constant rocking of the body from side to side. The pain was confined to the abdomen. There .. was no permanent contraction of the abdominal muscles, nor did pressure on them either increase or diminish suffering. There was no flatulence,-no tenesmus. During my whole attendance, I did not observe any spasmodic action of the abdominal muscles, or of the limbs. In one case, treated by Dr. Hurd, spasmodic motions were observed ;-and another patient told me, some days after, that, during his sickness, he could not prevent his legs from starting and suddenly drawing up. The countenance was pallid ;—the features contracted,
and somewhat distorted ;-the skin was cool in all, and in some cases it was cold ;-it was not sweaty, or unctuous ;-the thirst was insatiable and distressing ;-the tongue was not coated, but was somewhat exanguious, and inclined to a sub-livid color ;-its temperature varied much and often ;-at one time it would be but little below its natural temperature ;-at another, cool,-and again cold ;-its greatest degree of coldness equalled that of the flesh or blood ol a cold blooded animal, or what we experience when we place our hand on a wall recently drenched by a summer shower. During the progress of this disease, the tongue was seldom found to be coated ;-it was sometimes whitish, but generally of a cherry red, -not smooth or swollen, but retaining its usual villous appearance, and differing from a natural-state mostly in color. The taste was not bitter or nauseous. A disposition to vomit was common to all. The quantity of matter thrown from the stomach, however, was small; and, excepting in a few cases, where food' was discharged, consisted of a white tenacious liquid, unmixed with bile, ascidities, or any thing likely to provoke vomiting. The evacuations by stool consisted, at first, of healthy natural fæces,-next, a brownish liquid, changing to a pink, being tinged with blood, after the disease had continued a certain time. There were, however, no coagula of blood, bile, or undigested food to be found in them. In a few cases, these stools were succeeded by others, having the appearance and consistence of cream. I have since queried with myself if this might not have been pure chyle, thrown back upon the intestines by an inverted action of the chyliferous vessels. The quantity evacuated was great in all cases,-in some, it was enormous ;-most of them filled