Tuesday, April 12, 2011
Dr. James Hutchinson
On Saturday morning Dr. James Hutchinson awoke with a sharp pain in his head. The night before he had dined with Secretary of State Thomas Jefferson at an estate along the Schuylkill. Famous as the former ambassador to France's wine cellar was, Hutchinson knew he did not have a hangover. At dinner he had described the fever's symptoms to Jefferson. It "begins with a pain in the head," and could end in death "from the 2nd to the 8th day."
Hutchinson summoned Dr. Adam Kuhn, considered by many the city's best practitioner.
Hutchinson explained how "he had gone to bed about 11 o'clock perfectly well and he indeed never felt better or in higher spirits." At three, he woke with "a most violent headache attended with fever." A few days before, Kuhn had opined that only 9 people had died of yellow fever in the city. So he quizzed Hutchinson sharply, asking several times if he had a chill, a pain in the back or uneasiness in the stomach. "He declared that he had no chill, sickness, or pain any where but in his head, which he described as excruciating." Kuhn noted that his skin was dry, his pulse "not much more frequent and not fuller than in health."
Kuhn suggested that Hutchinson take a lenient purge. The two doctors decided that cream of tartar would be best. Hutchinson's wife, who was in her ninth month of pregnancy, was an uneasy bystander during this consultation. "With great anxiety," Kuhn recalled, she asked him if her husband had yellow fever. Hutchinson saw Kuhn's embarrassment and "immediately answered there was no doubt of it. A week ago he had examined the houses along Water Street" where several people had died of fevers. Kuhn did not disagree.
That evening Kuhn returned to his patient. He had had one bowel movement "of a putrid nature." Once the stomach and bowels were evacuated, Kuhn treated putrid fever by using remedies that would "produce a fermentation in the stomach and correct putrefaction." He suggested wine whey and water, or lemonade, and ripe fruit. Once putrefaction was checked he would "restore tone to the system." Hutchinson indicated he wanted a tonic and chose elixir of vitriol, sulfuric acid in wine with cinnamon and ginger which thanks to it's "grateful acid taste," had been a popular pick-me-up at least since 75 B.C.
Kuhn also suggested a cold bath of which doctors with experience in the West Indies spoke so highly. When Kuhn left, Hutchinson had himself splashed with cold water and found it refreshing. He also decided he didn't feel adequately purged. He took more cream of tartar and passed a restless Saturday night.
The cream of tartar inspired three bowel movements that Sunday and the whale of a man who weighed over 300 pounds had gone down two flights of stairs and his back steps so that he could do it in the out house. Kuhn thought Hutchinson was too weak for such exertion, and expressed "extreme regret." During the night Hutchinson could not stop his bowels, and had eight more movements. Kuhn thought that very dangerous in a putrid fever and tried to stop it with laudanum, an opiate. He also prescribed one ounce of Peruvian bark as a tonic.
Hutchinson passed 10 stools on Monday and had bleeding hemorrhoids. Kuhn was not sanguine, as he explained to Samuel Coates, president of the Pennsylvania Hospital, whom he met in the streets: "What would you think of him venturing down three pairs of stairs, after such a severe illness. He would have whipped one of his own patients for such an act of impudence." Kuhn said he had great hopes of recovery, but no more, "Hutchinson must submit to his fate."
Hutchinson summoned two younger doctors, William Currie and Benjamin Barton. Currie came Tuesday evening, Hutchinson was sitting up talking, lucid enough to describe his own case and give Currie permission to write about in a book he was preparing that described the current fever epidemic.
Hutchinson told Currie that he liked the baths and vitriolic salt tonics. When he felt well, as he did then, he took no medicine but lime juice punch. In the essay Currie would send to the printer at the end of the week, Hutchinson's treatment was held up as a model.
After Currie left him on Tuesday night, Hutchinson walked downstairs. When he came back up, his nose bled until "he was much debilitated and faint." He took 45 drops of laudanum, got to sleep, and rested well until he awoke "with sickness and great distress."
Currie came back at 10 o'clock Wednesday morning and found Hutchinson with a low pulse, and cold and dry skin. His face was bloated and livid. "His mind was considerably deranged -his thirst became insatiable - he cast up all he drank, as soon as his stomach became full, with straining and noise." When he wasn't puking he was hiccupping. No matter what medicine Currie suggested, Hutchinson "obstinately" refused it, claiming that "nothing was the matter." Currie sent his manuscript to the printer anyway.
On Thursday the 5th Dr. Benjamin Rush went to Hutchinson. He found the massive doctor "sitting in a chair near the head of his bed, with all his clothes on, as if he had been in his usual health." But he wasn't. Rush saw that he was delirious with a face "suffused with blood." Rush urged "a strong mercurial purge," explaining that it had saved 29 out of 30 who had taken it. Hutchinson refused for the moment, but did send one of his apprentices to Kuhn. "Rush should know," Kuhn replied sharply, "that Hutchinson had 30 stools in three days." He did not need further purging.
On Thursday morning he lapsed into a coma. Hutchinson lived through Friday in a coma. He died Saturday. His wife went into labor that same day, and bore him his fifth child, a girl. His began to "mortify before he died," and had to be buried in a hurry that night.
Hutchinson's friends were inconsolable. His obituary was in newspapers all over the country. "For five days no two or more persons met when the first interrogatory was not 'How does Hutchinson.'" the young editor Samuel Smith wrote to his sister. "Now he is no more - but I cannot dwell on the gloomy subject." Hutchinson had given Smith courage to stay in the city, but as he sealed his letter, a carriage waited to take him to Lancaster 60 miles away.