PART SECOND. (continued 3)

The exemption of those employed in burying the dead, even in the true plague, is observable. Dr. Canestrinus supposed it might be owing to the use of garlic, which they were wont to bruise and rub their hands, face and breast with, and likewise to chew, before they entered into an infected house; but this cannot be supposed a very powerful antidote. Dr. Rush is of opinion that grave diggers escaped in Philadelphia by the circumstance of their digging in the earth; and he says also that scarce an instance was heard of those employed in digging cellars being attacked with the disease. “There seems to be something (says he) in the fresh earth, which attracts, or destroys, by mixture, contagion of every kind. Clothes infected by the small pox are more certainly purified by being buried underground than in any other way. Even poisons, are rendered inert by the action of the earth upon them. Dogs have long ago established this fact, by scratching a hole in the ground and burying their limbs or noses in it, when bitten by poisonous snakes. The practice, I am told, has been imitated with success by the settlers upon new lands in several parts of the United States.”

This reason is very plausible for the exemption, of such as work in the ground, from contagion; but it cannot do for scavengers and butchers, who by the nature of their employment are frequently exposed to steams from the vilest matters. We may, on the contrary, derive from thence a very strong argument that these steams are by no means essentially connected with contagion. We have already seen from Dr. Fordyce (p. 169 of this treatise) that contagion or infection is not the object of sense. Dr. Rush, though he doth not absolutely say that the contagion of the yellow fever hath no smell, yet informs us, that “the smell of the contagion, as emitted from a patient in a clean room, was like that of the small pox,166 but in most cases of a less disagreeable nature. Putrid smells in sick rooms were the effects of a mixture of the contagion with some filthy matters. In small rooms, crowded in some instances with four or five sick people, there was an effluvium that produced giddiness, sickness at the stomach, a weakness of the limbs, faintness, and, in some cases, a diarrhœa. The contagion adhered to all kinds of clothing. It was in no instance communicated by paper.” From so great authority we may certainly conclude that, according to the best observation, there is an essential difference between the contagion of a disease and the effluvia of a putrefying carcase; and that, though the latter may be the vehicle of the former, and may increase its virulence, either by being partly assimilated to its nature, or by affording it a proper nidus for concentrating itself; yet that originally the one is not the other; and, though contagion may bring on a fever without putrid effluvia, yet putrid effluvia cannot do so without contagion. With regard to pure contagion, I shall here, to the evidences already produced, subjoin the testimony of Dr. Davidson, formerly quoted. “I must declare167 (says he) I have seen the disease evidently propagated in this way (by contagion;) but in many instances it could not be traced. I have known three cases of the fever brought on by persons bathing in the sea along side the vessel, some distance from the shore, and neglecting to dry themselves properly afterwards. The seminia of the disease were here present, and, like the electrical jar charged, required only the approach of a conductor.” This shows an amazing subtilty and diffusibility in the contagion, scarcely indeed credible, if it were not known to be equally subtile in other cases. In the correspondence between Dr. Haygarth, of Chester in England, and Dr. Waterhouse, professor of medicine at Cambridge near Boston, the latter informs us, from Dr. Rand, that by burning, in a field near Charlestown, the bedding, furniture, &c. belonging to a person who had been ill of the small pox, the people who lived in the wake of the smoke proceeding from it were attacked with the small pox, and the disease spread. This is similar to an observation formerly quoted from Huxham; but the following are much more remarkable: “A vessel arrived at Charlestown from Lisbon, laden with salt, and lemons in boxes.168 A person had the small pox on board, and the small pox officers would not suffer the lemons to be sold, without being first unpacked and the paper surrounding each lemon taken off. These papers were kept by themselves in a storehouse for several weeks; and after this, by order of the overseers, they were brought out and burnt; when, of two children playing round the fire, one, named Manning, took the disorder, and broke out at the usual time. . . .

“Dr. Rand was called to a lady, whom he found hot and feverish with a violent pain in her head and back; but he had no suspicion of the small pox. He bled her, and a Mrs. Brandon held the vessel to receive the blood, some of which spirted on her hand and arm. Next day the small pox appeared on the lady who was bled; and she was of course immediately separated from Mrs. Brandon; notwithstanding, in twelve or fourteen days, Mrs. Brandon was seized with the small pox, and died. Several other persons present were also liable to the infection, yet no one took the disease but this woman, who stood over the blood while it was running, and received some on her arm, except Mrs. Benjamins, to whom the bason of blood was handed over the bed, who also took the small pox from the effluvia of the blood. The same physician was called to the child of Manning (who was supposed to have taken the small pox from the burning of lemon-papers as aforesaid;) he found the child bleeding at the nose in its mother’s lap, who was then in the ninth month of her pregnancy. The next day the small pox appeared on the child, and it was of course immediately separated from its mother and all the family; nevertheless, in about fourteen days the mother was seized with the disorder, and not long after delivered of a dead child, which child had distinct eruptions over its whole body.”

These facts are of the utmost importance in determining the nature of contagious diseases. In conjunction with others, they show that such diseases originate in the blood, and from thence are communicated to the rest of the body. They show also, that the contagion is in all cases truly specific, and immutable. Thus the contagion of the small pox, whether existing in the matter of a pustule, in the smoke of burning clothes or paper, or in the effluvia of blood, is invariably the same, and never produces any other disease. It is the same whether applied to the human body, or to that of a brute animal; of which we have a remarkable instance in the Medical Repository, vol. i, p. 258. “A peasant of the county of Essex, in England, seeing a great many children carried off by the natural small pox, was desirous of inoculating his two boys; one nine, and the other twelve years old. Not being able to employ a surgeon, he collected the scabs of a child then sick of the disease, powdered them, and sprinkled the powder upon slices of bread and butter. The two sons ate them, and gave a bit to the house-dog. They had a mild small pox, and got well without any remarkable accident. The dog remained sick for two or three days, drank a great deal, and refused to eat: on the fourth he had a very decided variolous eruption: on the ninth the pustules were full ripe, and dried up and fell off like those of the two children. An English author says he has seen the same epidemic in a flock of sheep, the greater part of which were infected, and communicated it to two cows, one of which died. The symptoms that manifested themselves in these animals in the course of the disease were in every respect the same as in the human species.”

This instance, partly quoted in the former part of this treatise, likewise is a strong proof of the contagion of small pox being first communicated to the blood; for, by swallowing it along with the aliment, it would, in the common course of digestion, be absorbed by the lacteals, and enter the blood with the chyle. The experiments with dogs made by M. Deidier, of which an account is given p. 268, show that the contagion of the plague is equally specific with that of the small pox; and we see that it acted in all cases in which it was tried by being mixed with the blood. Being thus first mixed with the blood, it is plain that the contagion must have passed from this fluid to all the other parts of the body; and, if diseased blood is capable of communicating its disease to all the sound parts of the body in which it circulates, we must own that this strongly corroborates Dr. Waterhouse’s suspicion, “that the blood is capable of producing the infection before the disease is so far advanced as to be apparent on the surface.” If the disease originates in the blood, the latter should indeed seem more capable of communicating it at first than afterwards; because we must suppose that the diseased parts would be thrown off to the surface, and so pass off altogether. On this subject Dr. Waterhouse also quotes the opinion of Dr. Holyoke of Salem, “who, for his learning, professional abilities and integrity, is justly esteemed one of the first physicians in this country, and whose extensive practice has afforded him ample experience in the small pox.” He writes to Dr. Waterhouse, “that, although he has reason to believe that an infected person seldom gives the disease till after the eruption is considerably advanced, yet there are facts which make it probable that it is sometimes communicated earlier.”

In the same letter Dr. Waterhouse gives other instances of the inconceivable subtilty of variolous contagion, no less remarkable than those already mentioned. One is of Dr. Brattle, who, having visited patients infected with the small pox, “used the common precaution of covering his clothes with a loose gown, &c. but neglected his wig. In consequence of this small neglect, after riding six miles on horseback, he gave the disease to a person in a room through which he passed, where he did not stay to sit down.” Another is, if possible, still more remarkable: “David Anthony, esq. one of the overseers of the small pox in Rhode Island, after going into the hospital, and using the common precautions, neglected to smoke his wig. In his way home, two miles from the hospital, he called at the house of his daughter. He did not dismount, but sat on his horse, and talked to her through an open window; and, at the common period (by which we usually understand about fourteen days) she took the disease and died. Many such instances, adds the Doctor, could I relate, where wigs have given the infection, after being exposed to the open air during the passage of several miles.”

From all this it appears how difficult a task they undertake who contend for the domestic origin of the yellow fever, without contagion. In all cases they must have recourse to something visible and obvious to the senses. Thus putrid beef, putrid fish, ponds of water, marshes, &c. are all easily seen, and we are able to prove their absence as well as their presence. But we certainly know that the yellow fever has arisen where none of those supposed causes have existed, as in the Busbridge Indiaman; and, on the other hand, all the supposed causes have existed without the production of any fever. Of this last Dr. Chisholm, in the conclusion of his defence against Dr. Smith, gives the following remarkable instance:169 “During a considerable part of the years 1776 and 1778 my duty led me very much to reside in New York; and during my residence, particularly in the summer and autumn of 1778, which were remarkably hot, and insufferably so in the lower streets of New York, no disease of a very alarming nature, and none which assumed the form of an epidemic, appeared among the troops or inhabitants. The smell from all the ships, and from those in particular delineated by Dr. Seaman (who has written a treatise on the subject) was in the highest degree offensive. The police at that time was by no means strict: putrid substances of every description were accumulated in the ships, and in many parts of the city unconnected with wharves, and yet no disease was the consequence.”

Some particulars above related may perhaps appear, to those who deny the existence of contagion, in rather a ludicrous point of view. It is indeed too common for people to laugh at what they cannot answer; but if we consider the instantaneous and inexplicable action of the poison of serpents, and in how little time they produce a mortal disorder, or even death itself; when we consider that contagion is only a volatile poison, and that it for the most part takes up an incomparably longer time to bring on death than the bites of some venomous animals; we cannot be surprised that a quantity of this volatile matter inconceivably less than that of animal poison should be capable of bringing on the disorder; for the length of time may be supposed to make up for the deficiency of quantity. Yet, if we consider the extreme activity of some animal poisons, the wonder at the small quantity of contagion necessary to produce a deleterious effect will in a great measure cease. In the former part of this treatise it has been observed, from Dr. Mead, that the whole quantity of poison emitted by a viper, when it bites, does not exceed the bulk of a good drop. An ordinary drop from a vial weighs half a grain, so that we cannot suppose a large drop to be more than a whole grain. But there are instances in which effects equally deleterious are occasioned by the bites of animals the whole bulk of which is scarcely equivalent to that of the poison of the viper. In the northern climates of the Old World, spiders do not grow to any remarkable bulk, yet the bite of the poisonous spider of Russia is as mortal as that of the rattlesnake.170 The effect of the furia infernalis of Linnæus is still more to our purpose. It is an insect found in the forests of Kemi in Lapland, and likewise in Sweden and Russia; and, if we can give credit to Mr. Pennant, in some of the Western Islands of Scotland. This insect falls down out of the air, and, if it happens to light upon any uncovered part of the human body, it almost instantly penetrates down to the bone, occasioning the most excruciating pain, and death in a quarter of an hour.171 Now, should we suppose the whole body of this insect to be poison, as it is probable that it is not, it is so minute, that though the whole were volatilized into contagion, it might be well supposed to adhere to a wig, or even a more diminutive part of the clothing; and, considering the virulent effects of even this small quantity of contagion when concentrated, it would easily follow by fair calculation, that a very minute proportion of even this small quantity might bring on a dangerous disease.

Lastly, it may be urged on the side of contagion that, when a vessel arrives from a sickly country, it is no proof that she has not brought a disease with her, that the people aboard are in health. There is abundance of evidence that very dangerous maladies may be communicated by those who do not labour under the same. The prisoners at the Oxford assizes were not sick at the time they communicated a dreadful distemper to those around them. Dr. Brattle and Mr. Anthony were in perfect health when they communicated the contagion of the small pox, yet the effect was not less fatal. In short, contagion being a power certainly known to exist, though invisible and imperceptible, it is impossible ever to prove that it is absent; neither after the contagion of any disease has once got into a country can we be assured that it may not revive. The experience, we may say, of the whole world testifies that it does adhere particularly to clothing. Dr. Lind thinks it may adhere to the timbers of ships; and there is the greatest reason to believe that it may also adhere to the walls of apartments in houses. The appearance of fever therefore without any new importation cannot prove that it has not arisen from contagion. But it is now time to state the evidence on the opposite side.

In Webster’s Collection we find the domestic origin of yellow fever supported by Drs. Valentine Seaman, and E. H. Smith of New York; and by Drs. Taylor and Hansford, and Dr. Ramsay of Norfolk. Dr. W. Buel of Sheffield has also given an account of a fever, but so unlike that of which we treat, that what is said of the one cannot be applicable to the other.

The arguments used by Dr. Seaman are, 1. Several persons were infected, who had taken the utmost care to avoid all communication with the sick, who had not been for several weeks out of their houses, or within eighty feet of an infected person. 2. The nurses and attendants in some places were infected, but in others generally escaped. Neither did the disease spread into the country, as was reported; the Doctor having inquired into these reports, and found them groundless. 3. Dr. Lining says in his letter to Dr. Whytt,172 “If any person from the country received it in town, and sickened on his return home, the infection spread no further, not even to one in the same house.”173

Several other arguments of the same negative kind are adduced, which, being not essentially different from those already quoted, it is needless to detail. The following are rather of a different nature: 4. Some contagions are propagated by contact only, others at a distance; but at any rate we may suppose that contact will propagate contagion more readily and more powerfully than any other mode that can be imagined. Yet multitudes of dissections have been made, and those who made them are still alive. 5. “Specific and acknowledged contagions all seem to arise from themselves only: hence it would be almost as hard for me to believe that the siphylis, small pox, or measles, could be produced from any other cause than their own proper virus, obtained from persons affected with the like disease, as it would be for me to conceive of the formation of a plant without its having received its seed, or radical, from one of the same nature.174 Contagions seem to fix in the soil of our bodies, and there seed, as naturally and regularly as vegetables do on the earth. But the yellow fever has been produced from other causes than contagion.175 Does it not then admit of a doubt, whether it can possess a power of propagating itself?” 7. Contagions respect no persons, but all of every clime and colour are equally attacked with them; but the yellow fever is known to attack some much more readily than others. 8. Contagious diseases generally have a determined time of invasion after an exposure to their cause: but the advocates for contagion in the yellow fever cannot be confined in this manner. “Their doctrine requires that it (the contagion of yellow fever) be permitted to act at any time between that of the exposure and the sixteenth day; otherwise it would not embrace cases enough to give it a currency.”176 9. “Contagions act more or less at all places and seasons, simply of themselves, without the aid of any particular circumstance of air or climate; but the supporters of the yellow fever being contagious are obliged, by the force of the foregoing observations, to acknowledge their imaginary fondling to be but a half-formed monster, and perfectly inactive without being assisted by the concurrence of a predisposing constitution of the air. (Rush on yellow fever.) This fever exists only in warm weather: hence its cause in this city (New York) was perfectly extinguished by the frosty nights in the 10th month. It is confined mostly to low situations in thick-settled places; otherwise our almshouse and the surrounding country would have sadly experienced its deleterious effects.”

This argument merits a particular consideration, as involving a question of very great importance, namely, concerning the constitution of the atmosphere, which we have had occasion formerly to speak of, and which is by some thought to be sufficient of itself to produce epidemics, without the intervention of any other cause. This constitution of the atmosphere is, it is true, something unknown; and, when people appeal to it, it is only in other words owning their ignorance; but the necessity of recurring to some cause imperceptible by our senses has in all ages been obvious. So much indeed has been said in this treatise on the causes of plague (which may apply also to yellow fever)177 that more would be superfluous, even if our limits would admit of it. The dilemma (and it is equally insoluble let us say what we will) stands thus: If the yellow fever is produced by the effluvia of marshes, by putrid streams, or by any thing else, how comes it to pass that it has been so frequent in the United States since the year 1792 in comparison of what it was for 30 years before? Have the American cities all at once become sinks of filth and nastiness? Have the seasons been changed, or have the inhabitants given themselves up at once to swinish intemperance and gluttony, devouring, like savages, their meat half-rotten, half-roasted or half-boiled? From some declamatory publications indeed one might be apt to think that the authors certainly meant to bring such accusations against them. But it undoubtedly will be found an hard matter to prove that the general cleanliness of the country is inferior to what it was, or that the people are less virtuous than they were before. Besides, has not the vigilance of the magistrate, ever since 1793, been exerted to the utmost to procure a removal of those nuisances from which the disease might be supposed to arise? Yet their efforts have not availed; for it is confessed that the attack in 1798 was the most severe ever experienced. If cold could have exterminated the disease, certainly the three last winters have been abundantly sufficient to do so; yet it is certain that cases of the fever did appear in the end of December last, when the cold must certainly have been deemed sufficiently intense to put a stop to putrefaction of every kind. No wonder then that people, unable to see the causes of these things, should have recourse to something invisible, which they called the constitution of the atmosphere. On this subject Dr. Haygarth of Chester makes the following objections to the commonly received opinions concerning epidemic constitutions of the atmosphere:178

“1. Dr. Odier of Geneva, in a letter to Dr. Haygarth, writes thus: ‘I believe it would not be difficult to prove that the state of the atmosphere is in no respect the cause (of the regular epidemics of that city;) for the villages and towns which surround it do not experience the same epidemic all years as Geneva, although they are situated under the same heavens, and exposed to the same vicissitudes of atmosphere.’ 2. Sydenham conjectures that some effluvia, issuing from the bowels of the earth, produce epidemics. Were this true, it might advance one step towards a solution of the difficulty by discovering a local difference in the atmosphere. But it has never yet been pretended that any such vapour was perceived. Yet every part of the earth must be capable of furnishing it; as no portion of the whole habitable globe has been discovered where the air could not propagate the small pox. . . . 3. Hence we may safely conclude, that the slight variations of the same climate, and the same season, must be altogether insignificant and nugatory. What important difference of atmosphere can be supposed to exist for weeks or months together in two neighbouring villages, or in the adjacent streets of the same town? This remark is plainly applicable to the propagation of the plague and other infectious distempers. Yet the latest and most respectable authors continue to be misled by this groundless hypothesis.”

Objections of this kind do not solve the difficulty. The excessive disparity of seasons with respect to the spreading of epidemic diseases, the long cessation of them at some times, and their sudden revival, as if with redoubled fury, at others, indicate the operation of some cause invisible to us; but whether that cause resides in the earth or in the air, cannot easily be known. As contagious matter seems to operate by being received with the air into the lungs, it would seem rather probable that the ultimate cause of epidemics resides also in the air. Dr. Haygarth complains that the vapour arising from the earth, supposed to produce epidemics, should be invisible; but the contagion of the small pox, or of any other infectious disorder, is equally so. It must, he says, be diffused all over the earth. The electric fluid is so; it issues from the earth in every part of its surface, as is demonstrated by the common experiments of electric machines; and there are the strongest reasons to believe that it issues at some times and in some places in much greater abundance than others. But enough has been said on this subject; we must now consider matters a little more obvious.

Though it is not easily seen in what manner the proportion of the ingredients which compose the atmosphere can be changed, and we are unable to discover the operation of the more subtile fluid contained in it, yet we are certain that its constitution must be different in different parts of the world. Islands, from their being surrounded on all sides by the sea, must of consequence have an atmosphere considerably different from that of the internal parts of continents, where the air always passes over large tracts of land. Hence the continent of America, being situated between the two vast oceans called the Atlantic and Pacific, must possess a constitution of atmosphere considerably different from that of the Eastern. Of consequence, the diseases of Europe and Asia, when transplanted to America, or to the American islands, will probably, sooner or later, assume a type different from that which they had in their own country. Dr. Waterhouse has taken notice of this in his letter to Dr. Haygarth, and thinks that it may hold good even in the small pox. “May not the small pox (says he) operate differently in the two countries? It has certainly had a different appearance, and required a somewhat different treatment, almost every time it has come among us. That the difference in the virulency of the small pox, observed at different periods, when epidemic here, may be attributed to a peculiar constitution of the atmosphere, no one seems to doubt; and why may not the difference, so reasonably to be expected between the atmosphere of your island and this continent, allow us to suppose that there is some difference in the facility of receiving the infection?” This is also an important consideration, and may throw some light on the cause, as well as the mode of prevention, of this disease.

Lastly, Dr. Seaman attempts to disprove the authenticity of some cases which have been brought as positive proofs of the disease having been received by infection. These belong not to us to consider; it being impossible, by reason of the invisible nature of contagion, to determine from a simple consideration of any patient’s case whether it was infectious or not. Dr. Fordyce has laid down the proper rule for judging in such cases.179 One only of the instances brought by Dr. Seaman therefore we shall mention, and that, not because it proves any thing, but on account of its singularity. “Daniel Phœnix, city-treasurer of New York, is supposed without doubt to have taken his complaints from contagion: the corporation, some time past, having issued into circulation, for the accommodation of the inhabitants, a great number of paper penny bills, it has been concluded that he must have received contagion through the medium of some bundles of these bills, which he opened, that had been nearly worn out, to be exchanged, and which he opened and examined to ascertain their amount some days after he had received them.” The Doctor allows that he might have been infected by the bills, but ascribes it to putrid effluvia.180

Dr. Smith, in his letters to Dr. Buel, insists much on the vitiated state of the atmosphere, and is at some pains to describe the persons who were most subject to it. These, in 1795, were for the most part foreigners; under which denomination the Doctor comprehends those who came from other states, from the West Indies, and from Europe, or who had not been many months or years settled in the city. The number of citizens who suffered he does not suppose to have exceeded one in seven; but he remarks, that, both among foreigners and citizens, the severity of the disease fell chiefly on the poor. This mixture of different nations he accounts, and with great probability, one of the causes of the distemper. In confirmation of it he quotes Dr. Blane, on the diseases of seamen, remarking, “that it sometimes happens that a ship, with a long-established crew, shall be very healthy; yet if strangers are introduced among them, who are also healthy, sickness will be mutually produced.” The same observation is made by Dr. Rush, who, besides a general reference to the history of diseases, adds the following remarkable fact: “While the American army at Cambridge, in the year 1775, consisted only of New England-men, whose habits and manners were the same, there was scarcely any sickness among them. It was not till the troops of the eastern, southern and middle states met at New York and Ticonderoga, in the year 1776, that the typhus became universal, and spread with such peculiar mortality in the armies of the United States.”

This confirms the observation made in the former part of this treatise, when speaking of the English embassy to China. It may likewise with probability be assigned as one reason why large manufactories are generally so unhealthy. In them there always is a collection of people from many different and distant parts; and what holds good on a large scale must also do so on a smaller one. But this does not disprove the doctrine of contagion, but rather confirms it; for, if the discordant effluvia rising from healthy bodies of different constitutions can generate a disease, much more may we suppose the effluvia from sick persons capable of continuing and propagating it.

Now, let us consider the account, imperfect as it is, which we have been able to collect concerning the appearance of the yellow fever on the Western Continent. We have seen (p. 377, n.) that, at the time the plague was in England, five of the Americans were transported to that country; two of whom, after staying some time in England, were sent back, with other strangers, to America. This first colony having failed, another was sent; the Indians went to war among themselves, and the yellow fever is supposed to have made its appearance. Here a suspicion naturally arises, that a slight pestilential taint had been imported by some of these strangers, and that what would have been the true plague in Europe or Asia, by reason of the peculiar constitution of the atmosphere in the New World, there became the yellow fever. The same may be said of the original importation of it into Martinico. Sauvages expressly says it was the plague which was imported. Moseley and others deny that any such disease as the yellow fever exists in Siam; and indeed it seems at any rate to be a new disease. It seems possible that diseases may change their nature; and Dr. Ferriar has given a dissertation on the conversion of diseases. As therefore the true plague never made its appearance in America or the West Indies, it seems not unreasonable to suppose that these countries are incapable of receiving it, but that the pestilential poison, when transported to the Western Continent, may assume a different, and in many respects an opposite, nature; the two diseases being thus like the opposite poles of a magnet, scarce agreeing in any thing but the common work of destruction.

It is needless to spend time in attempting to investigate the cause of this disease appearing at different periods. That of 1793 has been the most remarkable and the most destructive; the disease having never since that time ceased its ravages. Previous to its appearance at Philadelphia that year, Dr. Rush observes, that, “during the latter part of July, and the beginning of August, a number of the distressed inhabitants of St. Domingo, who had escaped the destruction of fire and sword, arrived in the city. Soon after their arrival the influenza made its appearance, and spread rapidly among the citizens.” The yellow fever quickly followed; for on the 5th of August the Doctor mentions his being called to his first patient. To the same purpose we are informed by Dr. Clarke that “the fever made its appearance in Dominica about the 15th of June, 1793, a few days after the arrival of a great number of French emigrants. They were not sick, and the fever had not made its appearance in Martinique when they left it. From the 1st of July to the 1st of October it was computed that eight hundred emigrants, including their servants and slaves, were cut off by this fever; and about two hundred English, including new comers, sailors, soldiers and negroes, all fell victims to it in the same space of time. Few new comers escaped an attack, and few recovered. It spared neither age nor sex among the Europeans and emigrants; and not only the people of colour from the other islands, but the new negroes who had been lately imported, were all attacked. Such as had been long on the island escaped.”181

These facts seem to point out one of the causes, and very probably a principal cause, of this dreadful distemper. They show very evidently that there is a connexion between war and diseases. It has formerly been attempted to point out a natural connexion between the horrid practices of men, on these occasions, and the production of disease. These investigations, however chimerical they may be reckoned, are yet supported by many facts, which undoubtedly prove that mankind cannot always maltreat and torment one another with impunity. The affair of the Black assizes, and Old Bailey session, in 1750, shows, that by confinement and bad usage the human body, without being apparently deprived even of health, may become poisonous to those around it, and produce dreadful diseases. In like manner the inhabitants of St. Domingo, having been put to the most dreadful distress, became properly fitted for spreading destruction wherever they went.182 It is even probable that, in proportion to the degree of distress suffered by these people, the disease communicated by them will be malignant; nay, that new diseases may spring up, which cannot be treated with success by any method yet known to physicians. With regard to the disease in question, it seems plainly to have from some cause or other received an additional malignity. Dr. Chisholm says that what he calls the Boullam fever was supposed in Grenada to have been the common yellow fever of the West Indies engrafted on the jail fever. Dr. Lind, Dr. Jackson, and even Dr. Chisholm himself, agree that the former is not infectious: but from what has been already said the evidence seems to prevail in favour of the opinion that the latter is so. Should we then allow that two kinds of this fever might exist at the same time, in one city, the difficulty would be at once removed. But this has been reckoned by many, particularly by Dr. Rush, as totally inadmissible; and indeed it is a maxim consonant to general experience, that two epidemics cannot exist in one place at the same time, or that two diseases can scarcely exist at once in the human body. This however must be understood, principally at least, of acute diseases, or such as affect the whole system; for if any disease of a particular part shall take place, it does not seem impossible that a fever may be superadded to such local disease. The following considerations may perhaps throw some light on the subject:

It appears from the experiments of Dr. Adair Crawford, that, when animals are immersed in hot water, the blood drawn from a vein is of a florid red colour. In summer it is likewise observed to be of a more florid colour than in winter. If heat thus gives a more bright red to the blood, it undoubtedly also makes it more fluid, and in proportion to its fluidity it will likewise become acrimonious; though this acrimony is not necessarily connected with a florid colour, as the blood of the arteries is not more so than that in the veins. In the yellow fever, however, the blood sometimes, towards the end of the disease, becomes endowed with extreme acrimony. Dr. Smith, in one of his letters to Dr. Buel, observes, that “blood drawn in the fever of 1795 was remarkably wanting in floridity; especially what was evacuated towards the close of the disease, whether by art, or spontaneous effusion. In one instance it seemed endowed with a caustic quality, and affected a lancet so as to leave a permanent discolouration and inequality on its surface.” He observes also, nay, considers it as demonstrated, that the yellow fever is not a disease of vascular debility, and he says that it is attended with an astonishing fluidity, or, as it is called, dissolution of the blood. Every one therefore who comes from a cold to a warm climate must in some degree or other have his blood liquefied, and in a certain proportion rendered more acrimonious than before. This acrimony may be undoubtedly augmented by certain causes, and by none more probably than immoderate drinking of spiritous liquors. Every one therefore who comes from a cold country to a warm one, especially where the air is also moist, may consider himself as already diseased, at least in comparison with what he was when at home. For the blood is now exposed to a greater degree of heat, and consequently is about to absorb, or rather may be considered as in the act of absorbing, more, and consequently of changing from a thicker to a thinner or more fluid state; the latter being the natural situation of the blood in warm countries. Dr. Rush, in his inquiry into the proximate cause of fever, has accounted for the dissolved appearance of the blood in malignant fevers to a tendency in the blood-vessels to paralytic affection. He says that “it (the dissolution of the blood) begins in the veins, in which muscular action is more feeble than in the arteries. This has been proved by Dr. Mitchill in his account of the yellow fever in Virginia in 1741. He found the blood to be dissolved when drawn from the veins, which, when drawn from the arteries of the same persons, exhibited no marks of dissolution.” This, as the Doctor observes, “is a fact of great importance;” only we must remember, that, in every thing relative to the human body, when we find two phenomena constantly accompanying each other, it is extremely difficult for us to determine which is cause or effect. Instances of this often occur; and in the present case the dilemma is as great as any other. Though, from the testimony of Dr. Mitchill, we cannot doubt that in yellow fever the dissolution begins in the veins; and though it is likewise extremely probable that this dissolution is attended with a paralytic tendency, we cannot know whether the dissolution is the cause of the paralytic tendency, or the paralytic tendency the cause of the dissolution. The point, however, is of no importance. We see that in warm climates the blood of a person newly arrived has a natural tendency to dissolution, and of course the veins to the paralytic affection just mentioned. The liver therefore, which is supplied with blood by a large vein branched out like an artery, and terminating in other veins to carry back the blood from the former,183 must be much more affected than any other part of the body; and this indeed seems a very probable reason why all those who come to warm countries become much more inclined to bilious complaints, which denote an affection of the liver, than they were before. This hepatic affection may very probably be greatly augmented, in new comers, by various causes. One of these is hard labour under a greater heat than they have been accustomed to; a second, that in the West India islands they have not access to that plentiful supply of fermented liquor, abounding in fixed air, which they had at home. This, though not generally taken notice of, is far from being a matter of little consequence; for, though emigrants from Britain and Ireland have been for the most part accustomed to drink spiritous liquors, yet fermented malt liquors certainly constitute the principal part of their drink. The total want of these, and the substitution of ardent spirit and water, must certainly be detrimental, even though they keep within the bounds of moderation, and much more if they do not. Dr. Moseley relates,184 from Dr. Irving, that, in a bad kind of intermittent which broke out among the troops in service on the Spanish main in 1780, “nothing was so grateful as London bottled porter. Wine was neither so much desired by the sick, nor so serviceable in corroborating and keeping up the powers of the stomach; which, like the rest of the body, was soon reduced, from the slightest indisposition, to the lowest state of debility.” A third cause is no doubt their frequently drinking too freely of spiritous liquors, perhaps not of the best quality; and which, as they are neither conjoined with the fixed air nor with the mucilage which as it were inviscate and blunt their force in malt liquors, cannot fail of exerting their deleterious properties in a very remarkable manner.

From these and other causes there must necessarily arise a predisposition to hepatic diseases; and this predisposition cannot be removed until the blood has assumed the state of fluidity proper to the climate in which they are, and the body has acquiesced in the change. They are then said to be seasoned to the climate; and it is seldom that this seasoning takes place without a disease; indeed so seldom, that the first illness which happens to seize them after their arrival is called the seasoning. Dr. Trotter indeed gives a very different account of this seasoning. He considers those who come from a cold to a warm climate as having a redundancy both of excitement and excitability, and says that “to wear out this accumulated excitability by slow and gentle gradations is the grand explanation of the word seasoning: it is the secret which constitutes the only difference between the inhabitants of England and Jamaica. The yellow fever of the West Indies therefore, as it appears in the body of a raw European, is a disease of the utmost excitement, in a constitution of accumulated excitability; where a tense fibre and dense blood permit it to be carried to the highest pitch of inflammatory tendency; which, from the nature of the animal economy, speedily exhausts the powers of life, even in a day or two, inducing putrefaction and death.”

Explanations of this kind may edify those who understand them; but, though we should declaim ever so much about excitement and excitability, it is plain, that, in every one who comes from a cold country to a warm one, the liver is affected in a manner that the rest of the body is not. In some constitutions, or from exciting causes in any constitution, this affection of the liver may be augmented, and no doubt at last produce a bilious fever, which may be varied in a number of ways, according to the nature or the energy of these causes. The pure bilious fever, being of itself properly a local affection, may not be contagious; and we find it generally agreed among physicians that the common yellow fever of the West Indies is not infectious. Nevertheless, it seems by no means improbable that from certain circumstances contagion may be joined with it, and it may then spread and infect, even as the most deadly plague. Dr. Crawford relates, that, in the year 1770, a new kind of fever broke out in the Middlesex Indiaman, of which many died. It is not said that the disease was contagious; but, on opening the bodies of some who died, the liver was found enlarged, and of a more florid colour than it ought to be. It cannot be deemed impossible that contagion, even that of the true plague, might be mixed with this fever, which (as the affection of the liver was probably the original disease, might have been accounted little other than symptomatic) would then have assumed very malignant symptoms.

We might now say that we have got to the end of our subject. Having so amply discussed the question concerning contagion, and stated the principal part of the evidence against it, it seems proper to conclude the section with a short history of the disease in the malignant form it has assumed in the United States since the year 1792. Still, however, it is necessary to say something further of one or two of the causes which have been commonly assigned as necessarily inducing this disease. These are, 1. Extreme heat, and, 2. Marsh effluvia. The effect of the former has already been partly considered as a predisponent cause of yellow fever: but it doth not appear that merely from this cause the disease has ever been produced. It hath indeed been observed by very intelligent physicians, that in Virginia the remitting fever has often been brought on by mere exposure to the sun. Dr. Oliver of Salem hath obligingly informed me, that he has “in more than one instance been seized with that disease after riding in the sun;” and that an eminent practitioner in Virginia had informed him that he had also more than once suffered in the same way. Drs. Taylor and Hansforth observe, that, when the remitting fever proves mortal, it is generally attended by sickness and perpetual vomiting; which is the termination of the yellow fever. The above evidence is decisive with regard to heat being able to produce a remittent, but cannot exactly apply to the yellow fever, which has no remissions. Two sailors indeed, lately brought from a coasting vessel to the Salem hospital, were attacked with violent symptoms of yellow fever without having been, as is said, exposed to any infection. But evidence of this kind cannot be supposed to be incontrovertible. We have already seen the difficulty of ascertaining facts; and if it is difficult to prove that contagion has been received, it must be still more so to prove that it has not. The persons in question had both worked during a very hot day in a vessel’s hold, they afterwards sat exposed in the damp air of the evening on the deck until 10 o’clock at night, and then slept in the vessel’s cabin with the windows open. One of them was seized in the night with a most violent pain, and the other on the morning succeeding. It is said that about 11 months since this vessel was at New York, and that a person on board had the yellow fever; it is also alleged that the vessel was not purified, and that the beds remained on board. It has therefore been by some conjectured that the disease might have been derived from this source.

Dr. Ramsay, in a letter to Dr. Currie of Philadelphia, censures Dr. Lining for saying that the yellow fever was imported into South Carolina. “The greater yellowness of the skin (says he) appears to be the only circumstance in which it differs from the bilious remittent fevers of hot climates, or very hot seasons of any climate.” Our author also censures Dr. Lind of Haslar,185 who, he says, has been misled by the misrepresentations of Dr. Warren and others. He also gives into the opinion that contagion acts only by contact, or at a very little distance; but this subject we cannot enter farther into at present. If we can believe Dr. Moseley, the sure criterion by which the yellow fever may be distinguished from any other is, that the former hath no remissions.186 If solitary cases of it appear in Carolina and the southern States every year, this will not prove that the disease was generated in the country, any more than that the plague was generated in London, because it appeared there for many years successively.

But, if the heat of the sun cannot produce the true yellow fever, it can kill suddenly without any fever whatever. This is said by Dr. Moseley to be less frequent in the West India islands than on the eastern and western continents. He says that he has felt as great inconvenience from the sun’s heat at Venice, Naples, Rome, Montpelier, and in Virginia, as in the West Indies;187 but he concludes that the transitions from heat to cold are more pernicious to the human body than any continued heat, however violent.

With regard to the effluvia of marshes, it is not denied that they produce fevers, but those fevers are of the intermittent or remittent kind. Dr. Smith indeed, in the first volume of the Medical Repository, labours to prove that the plague described by Thucydides was not essentially different from the fevers which sometimes prevail in North America, and that it had its origin from marsh effluvia and the ravages of war. That this distemper was not the plague described by Russel we may gather from a single circumstance: for Russel tells us that sneezing never occurred in the plague described by him,188 while Thucydides says that it was one of the common symptoms of his. Neither does the description of it (Appendix No. 1) at all agree with any of the accounts of the yellow fever we have. The climate of Attica no doubt was variable, and may in this respect resemble that of North America; but so is the climate of China, yet no such diseases are there produced. The Doctor concludes that the distemper originated from local causes; but the difficulty we find in proving such origin of diseases in our own days, and in the country where we reside, must certainly make us look upon the proofs which can be brought for the local origin of a disease which happened two thousand years ago, and in a distant country, as very equivocal. The following extract from the Paris Medical Memoirs may be adduced as a proof of the intrinsic power of marsh mud to produce fevers. It is contained in a paper written by Dr. Perkins of Boston. “A farmer was in the practice of spreading, upon about thirty acres of land, some new marsh mud, from October to April annually, to increase the fertility of the soil. In the summer of the third year, those inhabitants who lived to the northward and eastward of the place were attacked with a very malignant fever, which generally proved mortal. What is a proof that the marsh mud was the cause of the disease is, its extent, which was not more than a mile and an half from the farmer’s house, in the direction of the southerly and westerly winds. Perhaps had this marsh mud been washed by plentiful rains, the danger would have been less. Something like it happened to the inhabitants of the marshes in East Sudbury, (les marais situes a l’est dans le Sudberg) where the passage for the waters was too deep, and too confined. In regular seasons they were attacked with simple intermittent fevers; but, after wet seasons, there prevailed among them malignant fevers, and very obstinate remittents. Since the marshes have been drained, the inhabitants are no longer subject to fevers, and are as healthy as those of others places. We know that there are local epidemics, which are produced by a low, wet and rich soil; such are, probably, those which prevail in the lower part of New York, which, according to the informations obtained by Mr. Perkins, is more unhealthy towards the end of the summer than the other part of the city, and whose inhabitants are subject to diseases of a putrid caractere.

“It appears, from several observations, that the most mortal epidemic fevers are not commonly produced by causes operating immediately; the cause often existing several months before the disease even appears.”

The other arguments used by Dr. Smith in his letters to Dr. Buel proceed upon the state of the city, the mode of living, &c. and the condition of most of the emigrants, their bad accommodations, and especially their abuse of spiritous liquors. The neglect of bathing is also much complained of, and a comparison made with the conduct of the French in this and other respects, greatly to the advantage of the latter.

Drs. Taylor and Hansforth consider the disease which took place in Norfolk in Virginia as only an higher degree of the common remittent fever which usually prevails, and ascribe it to the long-continued heat, putrescence, &c. Some French ships were said to have brought the disease, but these arrived “so long before the disease appeared, that (the Doctors think) it would be absurd to suppose even a possibility of its being derived from them.” Mr. Webster adds, in a note, that the French corvettes, three of which squadron were taken by the Thetis, capt. Cochran, “anchored in Hampton Roads, May 18th. The fever did not appear in Norfolk till August. Captain Cochran’s crew, however, took the fever from the French prisoners, and twelve of them died before the Thetis reached Halifax.” This is certainly a suspicious circumstance.

Dr. Ramsay, in his letter to Dr. Mitchill concerning the same distemper, observes that it was confined almost entirely to foreigners, of whom he gives a very unfavourable account. The situation of the town, putrescence, &c. are likewise brought in for a share, as well as the season, which had been uncommonly warm.

These are the principal evidences that have been brought for and against the origin of the disease which since 1792 has raged with such violence in the United States. Innumerable pieces have appeared in the Newspapers on both sides of the question, the most remarkable of which are the letters of Mr. Noah Webster to Dr. Currie. These, however, we cannot now consider, as we cannot expect indeed that they should contain any thing else than a fuller detail of what has already been set forth. Mr. Webster besides, in his letters, owns that he is not a medical man; nay, that he had not “read above three or four medical books.” I hope therefore the reader will excuse the preference given in this treatise to the writings and arguments of those who are acquainted with medicine both by reading and practice. The dispute between the College and Academy of medicine can be settled only by themselves; the only safe line of conduct seems to be to admit both doctrines, and to take every method of preventing the introduction of the disease, whether supposed to be generated or imported.

Whether the distemper which has so fatally prevailed since the year 1793 be naturally connected with the troubles in Europe and the West Indies or not, it is certain that it has been cotemporary with them. In New York the disease appeared in 1791, but we are not furnished with any particular accounts of it at that time; nor does it appear to have made any great ravages, either on the continent or the West India islands, till 1793. At this time the war raged in Europe with fury; the French royalists were every where driven out, and distressed in every possible way. Desolation and slaughter prevailed at St. Domingo, while an unbounded intercourse took place between the United States and all those nations who were involved in the calamities resulting from the unbridled passions of man excited to their utmost pitch of ferocity. In the midst of this general commotion the fever broke out in the West India islands, appearing first in the island of Grenada. We have seen, that, according to Dr. Chisholm, this disease was brought to Grenada in the Hankey, from the coast of Africa, on the 18th of February. About the middle of April it began to appear on land. In the beginning of May it reached a detachment of the royal artillery lying at a distance from the focus of infection, “but (says Dr. Chisholm) by the communication which the gunners in Fort George had with the 45th regiment, and the predisposition of the men to receive the infection as far as that could be induced by excesses in drinking, and other irregularities.” About the first of June the disease began to appear among the negroes of the estates in the neighbourhood of the town, but never attacked them with the same violence that it did the white people. During the months of May, June and July, it appeared in different parts of the country; being, as our author supposes, carried thither by infected persons. From Grenada, the Doctor says, the disease spread to the islands of Jamaica and St. Domingo, and from the latter to Philadelphia, “by vessels on which the infection was retained by the clothes, more especially the woollen jackets, of the deceased sailors.”

This account of the origin of the fever at Philadelphia, as we have already seen, is inadmissible by those who deny the contagious nature of the disease; but as the latter have never given any distinct account of its rise, or shown why it should first appear in one island and then in another, instead of beginning in them all at once, we must adhere to that of Dr. Chisholm, till we are furnished with a better.

In Philadelphia it has already been observed, that Dr. Rush was called to his first patient on the 5th of August; but Mr. Carey mentions a child of Dr. Hodges “as probably the first victim;” who was taken ill on the 26th or 27th of July. This same month the unfortunate fugitives had arrived from Cape Francois; and we have already seen, from Dr. Clarke, that the arrival of some of their fellow-sufferers in Dominica had the same dreadful attendant. Whether the disorder is to be ascribed to the arrival of these people in either place, the reader will judge. Other vessels are charged with having imported the same; but, facts being disputed, we cannot enter into the controversy.

The disease began in Water-street, to a particular part of which, near to that where the suspected ships lay, it was for some time confined, but did not excite public alarm till about the 19th of August. From this time to the 25th of the month the attention of the citizens was so much aroused, that they began to move into the country; and on the 22d, the city commissioners were peremptorily ordered by the mayor to keep the city clean. On the 26th the College met, and addressed the citizens on the subject; recommending such means of preventing the spreading of the sickness as to them seemed most proper. Among these were, to avoid any intercourse with the infected, to live temperate, keep their minds easy, and to avoid fatigue. Lighting of fires was particularly disapproved of; but the burning of gunpowder, and the steams of vinegar and camphor, were recommended for infected rooms, and for using on handkerchiefs, and in smelling-bottles.

In consequence of this address also the bells were stopped from tolling, the constant noise of which had greatly contributed to increase the public alarm. The people, who had been in use to light large fires in the corners of the streets, being forbid on the 29th by proclamation to do so, had recourse to firing of guns; which was at last carried to such excess, that it also was prohibited by proclamation on the 4th of September.

Notwithstanding all these precautions, the distemper continued to increase in such a manner as to produce the most dreadful terror and dismay. “Indeed (says Mr. Carey) it is not probable that London, at the last stage of the plague, exhibited stronger marks of terror than were to be seen in Philadelphia, from the 26th or 27th of August, till pretty late in September.” This produced scenes of distress unparalleled till this time in the city, and of which many instances are to be met with in Mr. Carey’s account. It cannot, however, be doubted that the violence of the distemper, its contagious nature, and the consequent danger of visiting the metropolis, were greatly exaggerated. Thus terror was struck throughout all the adjacent states. At Chester-town, in Maryland, a meeting was held, on the 10th of September, in consequence of which the Eastern shore line of stages was quickly stopped. On the 10th of the same month it was ordered by the mayor of New York that the names of all such persons as had arrived or should arrive from Philadelphia or other place, by land or water, that were or should be sick, should be reported to him, that those who were sick of infectious diseases might be removed out of the city. Next day the governor proclaimed that all vessels from Philadelphia should approach no nearer than Bedlow’s island, about two miles from the town, till license was given. But these precautions not being deemed sufficient, a night watch was established, and next day an address was published by delegates, purporting the insufficiency of all that had been done, and again calling upon their fellow-citizens to exert their utmost vigilance in detecting the fugitives from Philadelphia. Various other resolutions were passed in New York; and throughout the whole continent such measures were taken as seemed most likely to proscribe the unhappy Philadelphians, and to prevent their having any place of refuge from the sickness they so much dreaded. On the 1st of October, however, the inhabitants of Springfield, in New Jersey, passed a resolve, offering their town as an asylum for the people of Philadelphia, and directing an hospital to be provided for the reception of such as might fall sick. Similar resolutions were passed by the inhabitants of Elizabethtown, and Elkton in Maryland.

The distemper in the mean time arrived at the most dreadful height in Philadelphia, and almost all those who could take the charge and burthen of public affairs were absent. An hospital had been established at Bush Hill, but, for want of superintendence, had fallen into such disorder, that the poor chose rather to deny their illness than to be sent to it. On the 15th of September, however, Stephen Girard, a native of France, and a wealthy merchant, together with Peter Helm, a native of Pennsylvania, offered their services as superintendants. By their exertions the credit of the hospital was soon retrieved, and such numbers demanded admittance, that it became necessary for each candidate to procure a certificate from a physician, that the patient really laboured under a malignant fever. In a short time the affairs of the city went on, in every respect, with as much regularity as could be expected; but the mortality increased throughout the month of September, and the three first weeks of October. Great hopes were entertained from some cold and rainy weather in the end September; but they proved illusive, and the disease became even more fatal than before, till the 26th of October, when it suddenly ceased, as Mr. Carey says, with hardly any rain, and a very moderate degree of cold. “That day (adds he) was as warm as many of the most fatal ones in the early part of the month. To account for this is perhaps above our power. In fact, the whole of the disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance.” During the time of this calamity Mr. Carey computes that seventeen thousand left the city, and four thousand and thirty-one perished.

This city suffered another attack in 1794 but far less severe than before. In 1795 and 1796 the disease seems scarcely to have made its appearance; but in 1797 it revived, and, in 1798, broke out with greater fury than even in 1793. No particular history hath been published of this last severe attack. We know only in general, that, though a much greater number of the inhabitants fled out of town in 1798 than in 1793, the number of deaths was almost as great; being estimated at three thousand eight hundred and forty-one. Great disputes, as has been observed, have taken place concerning the origin of these diseases; on which we shall only further remark, that if, after such repeated and dreadful experience of the bad effects of allowing putrid matters to accumulate, such quantities could be collected as to produce the very fatal sickness of last year, it argues a most unaccountable, and indeed incredible, insensibility on the part of the people, as well as remissness on that of the magistrates; and this perhaps may be accounted as strong an argument in favour of contagion as can be adduced.

That such a violent distemper should cease all at once, is indeed not to be expected; and we have already heard of its again appearing in the city. Fear has been very justly excited, there and in other places; but it is to be hoped that the remarkable coolness of the season will operate favourably in preventing any very violent attack for this year.

New York has also suffered very considerably from this disease. Here it appeared in 1791, in the autumn, and in a part of the town remarkable for its vicinity to a collection of filth. In 1792 it made no progress; and in 1793, though some died of it who fled from Philadelphia, it did not spread. In 1794 it returned with considerable violence, and with still greater in 1795. In the history of this disease by Dr. Seaman,189 he takes notice that in July and August an unusual number of persons suffered from drinking cold water, and some fell down and died in the streets; but the Doctor supposes this to have happened rather through the excessive heat of the sun than the drinking of water. As the disease came on, all others gave way to it, even “the common remitting bilious fever;”190 and in the month of July some cases occurred. We have already had occasion to take notice of the death of Dr. Treat, who was taken ill on the 22d of July; but before that time, on the 6th of the same month, Dr. Seaman says that, in conjunction with this gentleman, he had visited a patient “affected with all the full-marked and decided symptoms of an highly malignant yellow fever.”191 The disease continued to gain ground in August, and became extremely violent in that and the following month; but, according to our author, the low ground in the southeast part of the city was the “grand centre of the calamity, diffusing its effects like diverging rays, aiding, by its most powerful influence, different secondary centres, already smoking hot, to flame out its pestiferous operations.” In this part of the town five hundred died in three months.

The attack at this time did not arouse the people to a proper sense of their danger. As formerly, the origin of the disease in 1795 had been attributed to the filth of the city. Next year it was attributed to the same, and so in 1797 and 1798. This last year, particularly, it is said to have originated partly from great quantities of putrid beef and fish, collected for exportation, and which could not be exported. In Mr. Hardy’s account of this fever, it is calculated that there died in 1798 two thousand and eighty-six; but that, if it were taken into the account how many left the town and died in the country, the number would amount to between two thousand four hundred, and two thousand five hundred.

It is not in Philadelphia and New York alone that this distemper has prevailed. Boston, Newburyport, Portsmouth, Portland, and even detached spots in the country, to which it is not possible to trace any infection, have felt its ravages. At Salem also, where the disease was never known before, twenty-one cases, including some doubtful ones, appeared in 1798; and of these, eleven proved fatal. In 1796, when it prevailed in Newburyport, it was supposed to have been introduced by a vessel from the West Indies; and, according to Dr. Coffin, the opinion would have been incontrovertible, had not a large quantity of fish-garbage been collected at the place where the vessel landed; so that, though the disease spread from that place, it could not be known whether it proceeded from the vessel, or the fish, or both. It seems now unfortunately to be the case, that where this disease once gets footing it cannot easily be eradicated. If we suppose it always to be imported, the continual intercourse with the West India islands will account for this; but the extreme difficulty, or rather impossibility, of procuring an account of facts or even a single fact which cannot be controverted, renders every thing that can be said upon the subject uncertain and precarious. In the case of New London particularly, where 81 persons were destroyed by it last year, neither importation nor collections of filth could be assigned as the cause; nevertheless it began near a wharf; but Mr. Holt, in his account of the disease, thinks it was most probably owing to the mere heat and dryness of the season. On the other side of the question, however, we must still insert Dr. Brackett’s account of the origin of the disease at Portsmouth, in answer to a letter from Dr. Oliver of this place.

“The yellow or pestilential fever made its first appearance at Portsmouth, about the first of August last. Eight or ten days before that time a vessel arrived here from Martinico, and brought a French family (four or five in number.) This vessel, before she left the West Indies, had two sailors taken sick (as the captain informed me) one of whom died on the passage home; the other was on the recovery when the vessel came into this port.

“There was not, nor had not been for a long time before, any fever in this town. Two or three days after, I heard that one or two men, who were labourers (and probably had been on board, as they lived nigh where the vessel lay at the wharf) died suddenly with fever, but am uncertain whether with yellow fever, as I never saw them. The first of August, the owner, whose house was about four or five rods distant from the vessel, had a child of four or five years of age taken sick; the next day I visited it, and two days after he died. The symptoms appeared like a cholera morbus—sick stomach, and frequent puking of black bile. The day before he died a brother of his, fifteen years old, was taken ill, and had much the same symptoms, only greater inflammation and distress. He was blooded freely, took calomel, bark, &c. He died five days after sickened. Between the 8th and the 20th of August, four or five of the other children and servants were taken with the same symptoms, and recovered. On the sixteenth day, a daughter, seventeen years of age, was taken down with the same disease: she was treated in the same manner, with bleeding, mercury, warm bath, bark, &c. and died on the 9th day. This patient had a great discharge of blood from her mouth and gums for three days before she died. One or two more of the family had it afterwards, and recovered. All these patients took the infection, I believe, about the same time. Many others in that neighbourhood had the fever during this time, about one half of whom died: out of forty-six patients I lost fifteen. If I could procure a soreness of the fauces, by administering calomel in small doses, and rubbing it in the gums, or by frictions on the legs and arms with mercurial ointment, the third or fourth day, I was sure of their recovery.

“How many died of this disease in the whole, I have forgotten; as, through fatigue, and debility of body and mind, I kept no notes: I think rather more than half of those who had it. The fever agreed in every symptom, almost, with that described by Dr. Rush and others. The contagion did not appear to be propagated, as the largest number who had the disease were seized in the month of August, and lived in the streets only which communicated with the wharf where the vessel lay, and the beach where she was graved. These streets are in the highest part of the town, and always esteemed the most healthy, and as free of putrid substances as any in it. In the months of September and October the fever was followed by dysentery, and spread through almost every part of the town and its environs. There has been no case of fever or dysentery since last fall: this place, during the winter, and summer thus far, has been uncommonly healthy; and it appears likely to continue so, if the committee of health should not be remiss in their duty. Thus, without any comments, I have endeavoured to give you a short history of the pestilential fever, as it appeared here last summer. The ideas, you may communicate to the author of the book intended to be published.”

The following letter from Dr. Warren, which he obligingly sent to two physicians in Salem, gives an accurate account of the distemper which prevailed in Boston last year:

“I should immediately have answered your favour of last month, but for a wish to give you as complete an account of the causes and mortality of the late epidemic as could be collected.

“There were a number of suspected causes, which, though concealed during the prevalence of the disease, it was hoped would be developed after the agitation of the public mind had entirely subsided; and I was in expectation that some regular returns would have been made of the numbers who had passed through the disease, and of those who had died with it, so that some estimate might be formed of its malignity and mortality; but such returns have not yet been made, and it is therefore impossible to obtain any satisfactory evidence on those heads. I suppose the number of deaths to have been rather short of two hundred; but this is only a rude guess, and should not be relied on in forming any consequential deductions on the subject. I shall, however, now offer such an account of the disorder as my present materials have enabled me to prepare.

“The first unequivocal appearance of the malignant fever, in the town of Boston, was on the 20th of July 1798 (though one family had been attacked with a fever, attended with unusual symptoms, as early as the middle of June; but, as no other instances occurred for so long a time, of an alarming nature, some doubts may perhaps be justly entertained of the identity of the affection.) Three or four cases only, I believe, happened between this and the latter end of the month. The two first of these were young men employed in stores directly opposite to each other, on Green’s wharf, near the Town-dock. A few days after, three or four persons were seized with the same complaint, whilst following their respective occupation in Market square, on the east and south sides of Faneuil Hall, or the Market-house. In the beginning of the month of August several persons were taken sick in the same neighbourhood, chiefly young men between 16 and 24 years of age, whilst employed in stores and counting houses there situated. The stores in Merchant’s row, extending from the Market to State-street were more especially visited with the disease, and, in the course of the same month, a family at the bottom of State-street, and several persons at Oliver’s dock, were taken sick. At this place a kind of bason is formed between a point of the town projecting from Fort hill, and the Long wharf, which is constantly receiving the offals of fish, and other animal substances, which from its situation could not be washed off by the waters contained in it. This spot is remarkable for having been the residence of most of the persons first attacked with the bilious remittent fever of 1796. To the latter end of this month the number of sick continued to be increasing; but the attacks were principally confined to the above-mentioned quarters, till at length the disease appeared on the south side of Fort hill, at some distance to the southward of Oliver’s dock, leaping, as it were, over the summit of the hill, without lighting upon the inhabitants on the north of that eminence. The fatality of the disease was here probably greater than in any part of the town of equal population; and it was nearly the last place in which it disappeared. Very few families who remained in their own houses upon the hill escaped its attack; and the progress of the disease, in all the places above mentioned, seemed to have been arrested only by means of the evacuation of the buildings by the people who inhabited them. In the latter end of August, and through the month of September, many persons were taken sick in Fore-street, which runs northerly from Market of Dock square, along the heads of the wharves, on the eastern side of the town.

“Through the whole period of the sickness scarcely a person was taken ill who had not resided, or been in daily employment, in the vicinity of these places. The subjects of the disease were generally natives of the town, chiefly in the prime of life, and in the vigour of health. I recollect no instance of any French inhabitants being assailed by it, and have heard of only one or two instances of the blacks being affected with it.

“That the fever was in a degree contagious, I cannot entertain a doubt; but that it was not so in a very high degree, I am as fully persuaded, from the number of cases in which there was reason to believe it could not have been taken in that way. In most instances, where contagion might have been suspected, the subjects were so situated that they might have received it from the same source as those with whom they had communicated. I cannot learn that any evidence has been furnished of infection from the sick who had been removed into the country, though there were many instances of such removals, under the most malignant forms which it assumed.

“The fever was generally ushered in by a chill, but I think by no means equal to that which commonly precedes fevers of the ardent kind, nor in proportion to the violence of its subsequent periods. In a short time the rigors were succeeded by excessive heat; the pulse, which had been small and contracted, became hard and full; the respiration laborious from violent oppression at the scrobiculus cordis; the tongue assumed a whitish cast; the eyes became highly inflamed, while the pains in the head, back, and legs, were intolerably severe. To these symptoms succeeded nausea, and vomiting sometimes of a highly bilious matter, seldom attended with diarrhœa, but often with a burning at the stomach, tenderness of the abdomen, parcity of urine; and, in one instance, a dysuria, with a great proportion of blood at each evacuation of that fluid.

“These appearances usually continued about 48 hours, after which they often suddenly gave place to a very different train of symptoms. The pulse sunk astonishingly, and became intermittent; the heat and pains entirely subsided; and the patient supposed himself to be out of danger. From a perfect possession of all his intellectual faculties, with a serenity of mind, which in no other disease, I believe, is so generally observed to accompany its last stages, on or about the 5th day from the accession of the fever, he fell into a state of insensibility, and thence sunk gently into the arms of death. In others this change was less rapid; the pulse became gradually smaller, the distressing symptoms slowly abated, a coldness of the extremities took place, and continued for several days before death, accompanied with clammy sweats, often without any perceptible pulse in the wrists, for several hours before the fatal termination. The tongue seldom became much coated, to the last. Delirium was by no means generally attendant; and a yellowness of the skin was far from being universal; sometimes, however, this appearance was observed within the three first days; often on the fourth and fifth; and I was induced to consider it as an accident, rather than a constituent character of the disease.

“The black vomit, as it has been usually called, though in my opinion by no means to be considered as a pathognomic sign of the disease (as I have frequently seen it take place in other acute fevers, especially the puerperal) was very frequently attendant on the last stages of the disorder; very few recovered after this circumstance had taken place; in one person, however, who had it in the most alarming form, together with an intermittent pulse, coldness of the extremities, singultus, and every usual mark of immediate dissolution, a most unexpected recovery happily disappointed the positive prognostics of his physicians. As the cure advanced, the skin in this instance became extremely yellow, and continued so for many weeks after the fever had subsided; the biliary ducts having been completely obstructed, and consequently the alvine evacuations of a clayey colour, and with much difficulty procured. Frequent repetitions of rhubarb and calomel in large doses, the continuance of the mercurial medicine in small doses, so as to keep up a continual ptyalism, and a laxative diet, restored him to perfect health.

“For the discoveries which were made on dissecting the bodies of some of those who died with the disease, I beg leave to refer you to a publication in the Boston Centinel, made during the prevalence of the disorder in this place, and subscribed by Dr. Isaac Rand, sen. President of the M. Medical Society, and myself.” (For these discoveries see the table, facing p. 434.)

“We had heretofore treated our patients agreeably to the method practised at Philadelphia in 1793, with bleeding in most instances, and active purges of jalap and calomel, or Rochelle salts. The diseased state of the liver, the known effects of mercury in hepatitis, and the recollection of the suggestions contained in Dr. Rush’s publication on the yellow fever, together with those of several other celebrated writers on the same subject, induced us to enter immediately on the use of calomel in small doses, as recommended in our paper above referred to.

“In my own practice I now usually commenced the treatment by bleeding from ten to sixteen ounces, and followed it by a dose of between ten and fifteen grains of calomel with between twenty and twenty-five grains of jalap, or an ounce of Rochelle salts, or more, according to the constitution. Immediately after the operation of these medicines I began with the use of calomel in small doses, in pills of a grain, every hour, and sometimes of 3 grains every two hours. Within the first twenty-four hours, but scarcely ever after, I found occasion frequently to repeat the bleeding, and it is worthy of remark, that in scarcely a single instance was this operation performed without almost instantaneous relief; although in most cases, a few hours after, there was a recurrence of the symptoms. The blood for the most part was dark. In three cases there was no separation of serum from the coagulated mass at the end of forty-eight hours. In two of these (and they were the only cases in which I observed it) a firm buff was formed on its surface; and all three died of the disease.

“The calomel was often continued through the whole course of the fever; and ptyalism was usually brought on within three or four days: though sometimes upwards of 200 grains were given, at the rate of a grain every hour, without any specific effect on the salivary glands. In proportion as the soreness of the mouth advanced, the symptoms universally gave way; and in every patient, two only excepted, this effect of the remedy was a sure pledge of recovery. In this exception were comprehended two persons of the same family, a father and daughter, both of whom had survived the 14th day of the disease, had copious hæmorrhages from the mouth (a circumstance which also attended on many who recovered) and died in a state of apparent putrefaction.

“The purgative medicines were generally repeated every second day; or an enema of water gruel was administered occasionally, if the bowels were constipated; but if otherwise, and the calomel passed off by those emunctories, opium was combined with it in sufficient quantities to restrain the discharge. The evacuations which took place from the intestines, during the use of the mercury, were almost universally of a remarkably dark colour, generally approaching to a deep green, but by no means remarkably fœtid. When spontaneous, they were often observed to be of the colour and consistence of water gruel.

“In cases of very laborious respiration, which was frequently in an extreme degree distressing, especially after the first 36 or 48 hours had elapsed, blisters, applied either to the chest or extremities, had a favourable effect; on the latter, they were most useful in the advanced stages of the disease, by exciting to action the debilitated vessels, and by restoring circulation and warmth to the parts. In the same intention, wine, snake-root, and the bark, were sometimes used with advantage.

“The diet was generally of the lightest and most cooling nature; barley-water, apple-water, and spruce-beer, were generally both grateful and salutary. The warm bath was often exhibited with apparent success, especially in the beginning of the disease, and when a copious sweat had been induced by it. The cold bath was also resorted to by some respectable practitioners, and perhaps, under some circumstances, with good effects; but I have no reason to think it was generally advantageous.

“Upon the whole, I believe that the most efficacious remedy, and the only one to be relied on, is mercury. It is certain that, as far as my observation has extended, under no other method of treatment did so many recover; and there were but few instances of a fatal termination, when it had been administered from the commencement of the fever.

“Various have been the causes assigned to this disease. That its origin was domestic, I have not a single doubt. No instance of the arrival of any vessel from the warmer latitudes, with this sickness on board, has been discovered; and it is believed that the local causes are sufficiently numerous to account for its existence. At most of the places, where its ravages have been made, very large quantities of putrid substances had been for some time accumulating. The offals from the fish market, as well as damaged fresh and salted fish to an immense amount, had been thrown into the dock. A very great number of raw hides had been imported, and stored in places contiguous to those in which business was constantly going on. The influence of a continued heat through the summer, to a degree scarcely before known in this country, had rendered these articles highly putrid; and from the same cause several articles of provision, such as barrelled beef, &c. which had been prepared for exportation, but, by reason of the restraints laid on our commerce, retained in store, had become tainted. The effects of these were in some instances incontestibly evinced; three lads, who had been employed in repacking beef, were at about the same time seized with the disease in its most fatal form; and a person, who had purchased some of the hides at a low price, immediately after their removal fell a sacrifice to his folly.

“Two or three thousand of the inhabitants removed into the country, and began to return about the middle of October, when the decline of the disease justified the measure.”192

SECTION III.

Methods of Prevention and Cure.

IN the yellow fever, as in the plague, where an attack is frequently made with such violence as to bring on death in twenty-four hours, or even a still shorter time, it is plain that much more dependence must be placed on prevention than the efforts of the most skilful physician after the disease has once begun; for, in such violent attacks, medicines, though ever so powerful, have not time to act. In countries therefore where this terrible disease exists, the first consideration necessary for every individual is, whether he is one of those likely to be attacked by it. Now, from the general testimony of those who have seen this fever, it appears that such as are newly arrived, the young, and in other respects the healthy and strong, the laborious, and the intemperate, are most liable to be attacked. Dr. Nassy of Philadelphia seems alone to afford an exception to the general testimony. Speaking of the cause of epidemics, after having ascribed them to some constitution of the atmosphere, he says, “If the air is not infected, diseases cannot be epidemic; and this is so, indeed, though it only attacks the natives. What can be the cause of that corruption of the air? For what reason are the natives, and those inured to the climate of Philadelphia, alone infected with the prevailing disease, while foreigners escape it?” Dr. Chisholm particularly points out those who, in 1793, were most liable to the Boullam fever. These were, “1. Sailors; more especially the robust and young; those least accustomed to the climate; and those most given to drink new rum. 2. Soldiers; more especially recruits from Europe; and the most intemperate. 3. White males in general lately arrived; more especially young men from Europe. 4. All other white males; more especially the lower classes; and of them the most intemperate; those debilitated by recent sickness. 5. White, females, more especially those connected with the shipping; and those lately from Europe. 6. People of colour, from Mustees to Cabres. 7. Negro men; more especially sailors and porters. 8. Negro women; more especially house wenches. 9. Children; more especially those of colour.” It is certain, however, that, when the distemper rages with great violence, natives as well as foreigners are liable to be attacked. We cannot suppose that all who perished at Philadelphia in 1793 and 1798 were foreigners. Though the latter therefore have the greatest occasion to fear, the natives must not think themselves absolutely secure; neither are foreigners to be terrified in such a manner as if they could not escape. With respect to the general modes of prevention, then, to which it is the business of every individual to attend, the following things are to be taken into consideration:

1. Every one who comes from a cold to a warm climate may be assured that on his arrival the temperature of his body is higher by three or four degrees than that of the native inhabitants.

2. In this situation he must consider himself as necessarily about to undergo a change of constitution; and such change he may likewise be assured will best be made by the gradual operations of nature; concerning which we know so little, that it does not seem adviseable to use any artificial method of promoting or accelerating it.

3. As the voyage from the Eastern continent must have taken up a considerable time, and as the mode of living on sea must have been very different from that to which he was formerly accustomed, we must consider the constitution as already in some degree altered from what it was when the person first went on board.

4. This alteration will be greater or less according to circumstances. If the vessel has been much crowded with passengers; if the weather has been stormy, so that he has been exposed to damp; if they have had little water, or of bad quality; if their provisions have been bad, or if there has not been a sufficient supply of fresh air in the place where he slept; the body must be considered as already predisposed to disease, which the new climate will scarcely fail of bringing to maturity.

5. Every one must consider that mode of living to which he has been accustomed the greatest part of his life as natural to him. Any considerable deviation from it, especially if sudden, would be of bad consequence, even in his own country; much more must it be so in another. As much as possible therefore he ought to conform his mode of life in the new country to what it was in the old, adhering only to the rules of temperance.

6. It has already been observed, that we must take into account the time that the person has been at sea, and the difference between his mode of life during his voyage, and that to which he was formerly accustomed. This difference consists in one particular in having lived for some weeks entirely upon salt provisions. To these he has been in some measure accustomed; and therefore it must be reckoned injudicious to give up the use of salted meat at once for such as is fresh. In fact, this mode of abandoning salt meat for fresh has been reckoned by the best physicians one of the causes by which the disease is brought on. Drs. Taylor and Hansforth express themselves in the following manner on this subject: “It has been noticed by several medical writers, that fresh meats, and particularly beef, in southern climates, apparently generate fluxes and other malignant diseases.” Dr. Ramsay, also, says of those who were mostly affected with the yellow fever in Norfolk, that, “being foreigners, they dealt lavishly in beef, fish, and all kinds of fresh food. Observe, this beef was driven perhaps from one to two hundred miles before killed, then exposed in a hot market to vend; that, by one o’clock, their dining hour, I always did, and do, believe it must have been tainted. Observe, the fish were all dead by break of day, and brought by land from twenty to twelve miles—hard drinkers of spirits mostly. . . . One or two natural born citizens were the whole, out of upwards of two hundred and twenty, who, in the space of six weeks, fell victims to this disease. The natives live chiefly on salted meats and fowls, or other kinds of poultry, which are killed but a little time before dressing.” It is unfortunate that among the emigrants from cold countries there is a general prejudice against salt, as highly inflammatory; and many diseases are imputed to the use of it where it is undoubtedly entirely innocent. In very cold climates indeed it has with great reason been supposed to produce the scurvy; and the Tchutski, who conducted capt. Billings through their frozen regions, informed him that salt was poison in their climate; throwing away, with marks of abhorrence, a quantity he had brought with him from his frigate. We cannot indeed argue from salt being pernicious in a cold climate that it is medicinal in a warm one, but we shall soon see that it has been recommended in the plague, and may not improbably be useful in the yellow fever. At any rate the practice of the natives ought in this respect to be a rule for emigrants, rather than any theories they may have laid down previous to their leaving their own country.