Volume 3 — AN ACCOUNT OF THE Bilious Remitting Yellow Fever, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1793. (continued 2)

The facts I have delivered upon this subject will admit of a very important application to the cure, not only of the yellow fever, but of all other acute and dangerous epidemics. I shall hereafter assign a final cause for the law of epidemics which has been mentioned, which will discover a union of the goodness of the Supreme Being with one of the greatest calamities of human life.

All ages were affected by this fever, but persons between fourteen and forty years of age were most subject to it. Many old people had it, but it was not so fatal to them as to robust persons in middle life. It affected children of all ages. I met with a violent case of the disease, in a child of four months, and a moderate case of it, in a child of but ten weeks old. The latter had a deep yellow skin. Both these children recovered.

The proportion of children who suffered by this fever may be conceived from a single fact. Seventy-five persons were buried in the grave-yard of the Swedish church in the months of August, September, and October, twenty-four of whom were children. They were buried chiefly in September and October; months in which children generally enjoy good health in our city.

Men were more subject to the disease than women. Pregnancy seemed to expose women to it.

The refugees from the French West-Indies universally escaped it. This was not the case with the natives of France, who had been settled in the city.

It is nothing new for epidemics to affect persons of one nation, and to pass by persons of other nations, in the same city or country. At Nimeguen, in the year 1736, Deigner informs us, that the French people (two old men excepted), and the Jews, escaped a dysentery which was universal among persons of all other nations. Ramazini tells us, that the Jews at Modena escaped a tertian fever which affected nearly all the other inhabitants of the town. Shenkius says, that the Dutch and Italians escaped a plague, which prevailed for two years in one of the towns of Switzerland; and Dr. Bell, in an inaugural dissertation, published at Edinburgh, in 1779, remarks, that the jail fever, which attacked the soldiers of the duke of Buccleugh's regiment, spared the French prisoners who were guarded by them. It is difficult to account for these facts. However numerous their causes may be, a difference in diet, which is as much a distinguishing mark of nations as dress or manners, will probably be found to be one of them.

From the accounts of the yellow fever which had been published by many writers, I was led to believe that the negroes in our city would escape it. In consequence of this belief, I published the following extract in the American Daily Advertiser, from Dr. Lining's history of the yellow fever, as it had four times appeared in Charleston, in South-Carolina.

“There is something very singular (says the doctor) in the constitution of the negroes, which renders them not liable to this fever; for though many of them were as much exposed as the nurses to the infection, yet I never knew of one instance of this fever among them, though they are equally subject with the white people to the bilious fever[46].”

A day or two after this publication the following letter from the mayor of the city, to Mr. Claypoole, the printer of the Mail, appeared in his paper.

“Sir,

“It is with peculiar satisfaction that I communicate to the public, through your paper, that the African Society, touched with the distresses which arise from the present dangerous disorder, have voluntarily undertaken to furnish nurses to attend the afflicted; and that, by applying to Absalom Jones and William Gray, both members of that society, they may be supplied.

MATTH. CLARKSON,

September 6th, 1793.Mayor.”

It was not long after these worthy Africans undertook the execution of their humane offer of services to the sick before I was convinced I had been mistaken. They took the disease in common with the white people, and many of them died with it. I think I observed the greatest number of them to sicken after the mornings and evenings became cool. A large number of them were my patients. The disease was lighter in them than in white people. I met with no case of hæmorrhage in a black patient.

The tobacconists and persons who used tobacco did not escape the disease. I observed snuff-takers to be more devoted to their boxes than usual, during the prevalence of the fever.

I have remarked, formerly, that servant maids suffered much by the disease. They were the only patients I lost in several large families. I ascribe their deaths to the following causes:

1st. To the great and unusual debility induced upon their systems by labour in attending their masters and mistresses, or their children. Debility, according to its degrees and duration, seems to have had the same effect upon the mortality of this fever that it has upon the mortality of an inflammation of the lungs. When it is moderate and of short duration it predisposes only to a common pneumony, but when it is violent and protracted, in its degrees and duration, it predisposes to a pulmonary consumption.

2dly. To their receiving large quantities of impure air into their bodies, and in a most concentrated state, by being obliged to perform the most menial offices for the sick, and by washing, as well as removing foul linen, and the like.

3dly. To their being left more alone in confined or distant rooms, and thereby suffering from depression of spirits, or the want of a punctual supply of food and medicines.

There did not appear to be any advantage from smelling vinegar, tar, camphor, or volatile salts, in preventing the disease. Bark and wine were equally ineffectual for that purpose. I was called to many hundred people who were infected after using one or more of them. Nor did the white washing of walls secure families from the disease. I am disposed to believe garlic was the only substance that was in any degree useful in preventing it. I met with several persons who chewed it constantly, and who were much exposed to the miasmata, without being infected. All other substances seemed to do harm by begetting a false confidence in the mind, to the exclusion of more rational preservatives. I have suspected further, that such of them as were of a volatile nature helped to spread the disease by affording a vehicle for miasmata through the air.

There was great mortality in all those families who lived in wooden houses. Whether this arose from the small size of these houses, or from the want of cleanliness of the people who occupied them, or from the miasmata becoming more accumulated, by adhering to the wood, I am unable to determine. Perhaps it was the effect of the co-operation of all three of those causes.

I have said, formerly, that intemperance in drinking predisposed to the disease; but there were several instances of persons having escaped it who were constantly under the influence of strong drink. The stimulus of ardent spirits probably predominated over the stimulus of the miasmata, and thus excited an artificial fever which defended the system from that which was epidemic.

I heard of some sea-faring people who lived on board their vessels who escaped the disease. The smell of the tar was supposed to have preserved them; but, from its being ineffectual in other cases, I am disposed to ascribe their escape to the infected air of the city being destroyed by a mixture with the water of the Delaware.

Many people who were infected in the city were attacked by the disease in the country, but they did not propagate it, even to persons who slept in the same room with them.

Dr. Lind informs us that many persons escaped the yellow fever which prevailed in Pensacola in the year 1765, by retiring to the ships which lay in the harbour, and that when the disease had been taken, the pure air of the water changed it into an intermitting fever[47]. The same changes have frequently been produced in malignant fevers, by sending patients infected with them from the foul air of a city, into the pure air of the country.

Persons confined in the house of employment, in the hospital, and in the jail, escaped the fever. The airy and remote situation of those buildings was probably the chief means of their preservation. Perhaps they derived additional security from their simple diet, their exemption from hard labour, and from being constantly sheltered from heat and cold.

Several families, who shut up their front and back doors and windows, and avoided going out of their houses except to procure provisions, escaped the disease.

I have taken some pains to ascertain, whether any class of tradesmen escaped the fever, or whether there was any species of labour which protected from it. The result of my inquiries is as follows: Three butchers only, out of nearly one hundred who remained in the city, died with the disease. Many of them attended the markets every day. Two painters, who worked at their business during the whole time of the prevalence of the fever, and in exposed situations, escaped it. Out of forty scavengers who were employed in collecting and carrying away the dirt of the streets, only one was affected by the fever and died. Very few grave-diggers, compared with the number who were employed in that business, were infected; and it is well known, that scarcely an instance was heard of persons taking the disease, who were constantly employed in digging cellars. The fact is not new that grave-diggers escape malignant fevers. It is taken notice of by Dr. Clark.

It was said by some physicians in the public papers, that the neighbourhood of the grave-yards was more infected than other parts of the city. The reverse of this assertion was true in several cases, owing probably to the miasmata being diluted and weakened by its mixture with the air of the grave-yards: for this air was pure, compared with that which stagnated in the streets.

It was said further, that the disease was propagated by the inhabitants assembling on Sundays for public worship; and, as a proof of this assertion, it was reported, that the deaths were more numerous on Sundays than on other days; occasioned by the infection received on one Sunday producing death on the succeeding first day of the week. The register of the deaths shows that this was not the case. I am disposed to believe that fewer people sickened on Sundays, than on any other day of the week; owing to the general rest from labour, which I have before said was one of the exciting causes of the disease. From some facts to be mentioned presently, it will appear probable, that places of public worship, in consequence of their size, as well as of their being shut up during the greatest part of the week, were the freest from miasmata of any houses in the city. It is agreeable to discover in this, as well as in all other cases of public and private duty, that the means of health and moral happiness are in no one instance opposed to each other.

The disease, which was at first confined to Water-street, soon spread through the whole city. After the 15th of September, the atmosphere of every street in the city was charged with miasmata; and there were few citizens in apparent good health, who did not exhibit one or more of the following marks of their presence in their bodies.

1. A yellowness in the eyes, and a sallow colour upon their skin.

2. A preternatural quickness in the pulse. I found but two exceptions to this remark, out of a great number of persons whose pulses I examined. In one of them it discovered several preternatural intermissions in the course of a minute. This quickness of pulse occurred in the negroes, as well as in the white people. I met with it in a woman who had had the yellow fever in 1762. In two women, and in one man above 70, the pulse beat upwards of 90 strokes in a minute. This preternatural state of the pulse during the prevalence of a pestilential fever, in persons in health, is taken notice of by Riverius[48].

3. Frequent and copious discharges by the skin of yellow sweats. In some persons these sweats sometimes had an offensive smell, resembling that of the washings of a gun.

4. A scanty discharge of high coloured or turbid urine.

5. A deficiency of appetite, or a greater degree of it than was natural.

6. Costiveness.

7. Wakefulness.

8. Head-ach.

9. A preternatural dilatation of the pupils. This was universal. I was much struck in observing the pupil in one of the eyes of a young man who called upon me for advice, to be of an oblong figure. Whether it was natural, or the effect of the miasmata acting on his brain, I could not determine.

It will be thought less strange that the miasmata should produce these changes in the systems of persons who resided constantly in the city, when I add, that many country people who spent but a few hours in the streets in the day, in attending the markets, were infected by the disease, and sickened and died after they returned home; and that others, whom business compelled to spend a day or two in the city during the prevalence of the fever, but who escaped an attack of it, declared that they were indisposed, during the whole time, with languor or head-ach.

I was led to observe and record the above effects of the miasmata upon persons in apparent good health, by a fact I met with in Dr. Mitchell's history of the yellow fever in Virginia, in the year 1741. In that fever, blood drawn from a vein was always dissolved. The same state of the blood was observed in many persons who had been exposed to the miasmata, who discovered no other symptom of the disease.

A woman whom I had formerly cured of a mania, who lived in an infected neighbourhood, had a fresh attack of that disease, accompanied by an unusual menstrual flux. I ascribed both these complaints to the action of the miasmata upon her system.

The smell emitted from a patient, in a clean room, was like that of the small-pox, but in most cases of a less disagreeable nature. Putrid smells in sick rooms were the effects of the excretions, or of some other filthy matters. In small rooms, crowded in some instances with four or five sick people, there was an effluvia that produced giddiness, sickness at stomach, a weakness of the limbs, faintness, and in some cases a diarrhœa. I met with a fœtid breath in one patient, which was not the effect of that medicine which sometimes produces it.

The state of the atmosphere, during the whole month of September, and the first two weeks in October, favoured the accumulation of the miasmata in the city.

The register of the weather shows how little the air was agitated by winds during the above time. In vain were changes in the moon expected to alter the state of the air. The light of the morning mocked the hopes that were raised by a cloudy sky in the evening. The sun ceased to be viewed with pleasure. Hundreds sickened every day beneath the influence of his rays: and even where they did not excite the disease, they produced a languor in the body unknown to the oldest inhabitant of the city, at the same season of the year.

A meteor was seen at two o'clock in the morning, on or about the twelfth of September. It fell between Third-street and the hospital, nearly in a line with Pine-street. Moschetoes (the usual attendants of a sickly autumn) were uncommonly numerous. Here and there a dead cat added to the impurity of the air of the streets. It was supposed those animals perished with hunger in the city, in consequence of so many houses being deserted by the inhabitants who had fled into the country, but the observations of subsequent years made it more probable they were destroyed by the same morbid state of the atmosphere which produced the reigning epidemic.

It appears further, from the register of the weather, that there was no rain between the 25th of August and the 15th of October, except a few drops, hardly enough to lay the dust of the streets, on the 9th of September, and the 12th of October. In consequence of this drought, the springs and wells failed in many parts of the country. The dust in some places extended two feet below the surface of the ground. The pastures were deficient, or burnt up. There was a scarcity of autumnal fruits in the neighbourhood of the city. But while vegetation drooped or died from the want of moisture in some places, it revived with preternatural vigour from unusual heat in others. Cherry-trees blossomed, and apple, pear, and plum-trees bore young fruit in several gardens in Trenton, thirty miles from Philadelphia, in the month of October.

However inoffensive uniform heat, when agitated by gentle breezes, may be, there is, I believe, no record of a dry, warm, and stagnating air, having existed for any length of time without producing diseases. Hippocrates, in describing a pestilential fever, says the year in which it prevailed was without a breeze of wind[49]. The same state of the atmosphere, for six weeks, is mentioned in many of the histories of the plague which prevailed in London, in 1665[50]. Even the sea air itself becomes unwholesome by stagnating; hence Dr. Clark informs us, that sailors become sickly after long calms in East-India voyages[51]. Sir John Pringle delivers the following aphorism from a number of similar observations upon this subject: “When the heats come on soon, and continue throughout autumn, not moderated by winds or rains, the season proves sickly, distempers appear early, and are dangerous[52].”

Who can review this account of the universal diffusion of the miasmata which produced this disease, its universal effects upon persons apparently in good health, and its accumulation and concentration, in consequence of the calmness of the air, and believe that it was possible for a febrile disease to exist at that time in our city that was not derived from that source?

The West-India writers upon the yellow fever have said that it is seldom taken twice, except by persons who have spent some years in Europe or America in the interval between its first and second attack. I directed my inquiries to this question, and I now proceed to mention the result of them. I met with five persons, during the prevalence of the disease, who had had it formerly, two of them in the year 1741, and three in 1762, who escaped it in 1793, although they were all more or less exposed to the infection. One of them felt a constant pain in her head while the disease was in her family. Four of them were aged, and of course less liable to be acted upon by the miasmata than persons in early or middle life. Mr. Thomas Shields furnished an unequivocal proof that the disease could be taken after an interval of many years. He had it in the year 1762, and narrowly escaped from a violent attack of it this year. Cases of reinfection were very common during the prevalence of this fever. They occurred most frequently where the first attack had been light. But they succeeded attacks that were severe in Dr. Griffitts, Dr. Mease, my pupil Mr. Coxe, and several others, whose cases came under my notice.

I have before remarked that the miasmata sometimes excited a fever as soon as they were taken into the body, but that they often lay there from one to sixteen days before they produced the disease. How long they existed in the body after a recovery from the fever I could not tell, for persons who recovered were, in most cases, exposed to their action from external sources. The preternatural dilatation of the pupils was a certain mark of the continuance of some portion of them in the system. In one person who was attacked with the fever on the night of the 9th of October, the pupils did not contract to their natural dimensions until the 7th of November.

Having described the effects of the miasmata upon the body, I proceed now to mention the changes induced upon it by death.

Let us first take a view of it as it appeared soon after death. Some new light may perhaps be thrown upon the proximate cause of the disease by this mode of examining the body.

My information upon this subject was derived from the attendants upon the sick, and from the two African citizens who were employed in burying the dead, viz. Richard Allen and Absalom Jones. The coincidence of the information received from different persons satisfied me that all that I shall here relate is both accurate and just.

A deep yellow colour appeared in many cases within a few minutes after death. In some the skin became purple, and in others black. I heard of one case in which the body was yellow above, and black below its middle. In some the skin was as pale as it is in persons who die of common fevers. A placid countenance was observed in many, resembling that which occurs in an easy and healthful sleep.

Some were stiff within one hour after death. Others were not so for six hours afterwards. This sudden stiffness after death, Dr. Valli informs us, occurred in persons who died of the plague in Smyrna, in the year 1784[53].

Some grew cold soon after death, while others retained a considerable degree of heat for six hours, more especially on their backs.

A stream of tears appeared on the cheeks of a young woman, which seemed to have flowed after her death.

Some putrified in a short time after their dissolution, but others had no smell for twelve, eighteen, and twenty hours afterwards. This absence of smell occurred in those cases in which evacuations had been used without success in the treatment of the disease.

Many discharged large quantities of black matter from the bowels, and others blood from the nose, mouth, and bowels after death. The frequency of these discharges gave rise to the practice of pitching the joints of the coffins which were used to bury the dead.

The morbid appearances of the internal parts of the body, as they appear by dissection after death from the yellow fever, are different in different countries, and in the same countries in different years. I consider them all as effects only of a stimulus acting upon the whole system, and determined more or less by accidental circumstances to particular viscera. Perhaps the stimulus of the miasmata determines the fluids more violently in most cases to the liver, stomach, and bowels, and thereby disposes them more than other parts to inflammation and mortification, and to similar effusions and eruptions with those which take place on the skin. There can be no doubt of the miasmata acting upon the liver, and thereby altering the qualities of the bile. I transcribe, with great pleasure, the following account of the state of the bile in a female slave of forty years of age, from Dr. Mitchell's History of the Yellow Fever, as it prevailed in Virginia, in the years 1737 and 1741, inasmuch as it was part of that clue which led me to adopt one of the remedies on which much of the success of my practice depended.

“The gall bladder (says the doctor) appeared outwardly of a deep yellow, but within was full of a black ropy coagulated atrabilis, which sort of substance obstructed the pori biliarii, and ductus choledochus. This atrabilis was hardly fluid, but upon opening the gall bladder, it retained its form and shape, without being evacuated, being of the consistence of a thin extract, and, within, glutinous and ropy, like soap when boiling. This black matter seemed so much unlike bile, that I doubted if there were any bile in the gall bladder. It more resembled bruised or mortified blood, evacuated from the mortified parts of the liver, surrounding it, although it would stain a knife or probe thrust into it of a yellow colour, which, with its ropy consistence, seemed more peculiar to a bilious humour.”

The same appearance of the bile was discovered in several other subjects dissected by Dr. Mitchell.

The liver, in the above-mentioned slave, was turgid and plump on its outside, but on its concave surface, two thirds of it were of a deep black colour, and round the gall bladder it seemed to be mortified and corrupted.

The duodenum was lined on its inside, near the gall bladder, with a viscid ropy bile, like that which has been described. Its villous coat was lined with a thick fur or slime, which, when scraped or pealed off, the other vascular and muscular coats of the gut appeared red and inflamed.

The omentum was so much wasted, that nothing but its blood-vessels could be perceived.

The stomach was inflamed, both on its outside and inside. It contained a quantity of bile of the same consistence, but of a blacker colour than that which was found in the gall bladder. Its villous coat, like that of the duodenum, was covered with fuzzy and slimy matter. It moreover appeared to be distended or swelled. This peculiarity in the inner coat of the stomach was universal in all the bodies that were opened, of persons who died of this disease.

The lungs, instead of being collapsed, were inflated as in inspiration. They were all over full of black or livid spots. On these spots were to be seen small vesicles or blisters, like those of an erysipelas or gangrene, containing a yellow humour.

The blood-vessels in general seemed empty of blood, even the vena cava and its branches; but the vena portarum was full and distended as usual. The blood seemed collected in the viscera; for upon cutting the lungs or sound liver or spleen, they bled freely.

The brain was not opened in this body, but it was not affected in three others whose brains were examined.

Dr. Mackittrick, in his inaugural dissertation, published at Edinburgh in the year 1766, “De Febre Indiæ Occidentalis, Maligna Flava,” or upon the yellow fever of the West-Indies, says, that in some of the patients who died of it, he found the liver sphacelated, the gall bladder full of black bile, and the veins turgid with black fluid blood. In others he found the liver no ways enlarged, and its “texture only vitiated.” The stomach, the duodenum, and ilium, were remarkably inflamed in all cases. The pericardium contained a viscid yellow serum, and in a larger quantity than common. The urinary bladder was a little inflamed. The lungs were sound.

Dr. Hume, in describing the yellow fever of Jamaica, informs us, that in several dead bodies which he opened, he found the liver enlarged and turgid with bile, and of a pale yellow colour. In some he found the stomach and duodenum inflamed. In one case he discovered black spots in the stomach, of the size of a crown piece. To this account he adds, “that he had seen some subjects opened, on whose stomachs no marks of inflammation could be discovered; and yet these had excessive vomiting.”

Dr. Lind has furnished us with an account of the state of the body after death, in his short history of the yellow fever, which prevailed at Cadiz, in the year 1764. “The stomach (he says), mesentery, and intestines, were covered with gangrenous spots; there were ulcers on the orifice of the stomach, and the liver and lungs were of a putrid colour and texture[54].”

To these accounts of the morbid appearances of the body after death from the yellow fever I shall only add the account of several dissections, which was given to the public in Mr. Brown's Gazette, during the prevalence of this epidemic, by Dr. Physick and Dr. Cathrall.

“Being well assured of the great importance of dissections of morbid bodies in the investigation of the nature of diseases, we have thought it of consequence that some of those dead of the present prevailing malignant fever should be examined; and, without enlarging on our observations, it appears at present sufficient to state the following facts.

“1st. That the brain in all its parts has been found in a natural condition.

“2d. That the viscera of the thorax are perfectly sound. The blood, however, in the heart and veins is fluid, similar, in its consistence, to the blood of persons who have been hanged, or destroyed by electricity.

“3d. That the stomach, and beginning of the duodenum, are the parts that appear most diseased. In two persons who died of the disease on the 5th day, the villous membrane of the stomach, especially about its smaller end, was found highly inflamed; and this inflammation extended through the pylorus into the duodenum, some way. The inflammation here was exactly similar to that induced in the stomach by acrid poisons, as by arsenic, which we have once had an opportunity of seeing in a person destroyed by it.

“The bile in the gall-bladder was quite of its natural colour, though very viscid.

“In another person, who died on the 8th day of the disease, several spots of extravasation were discovered between the membranes, particularly about the smaller end of the stomach, the inflammation of which had considerably abated. Pus was seen in the beginning of the duodenum, and the villous membrane at this part was thickened.

“In two other persons, who died at a more advanced period of the disease, the stomach appeared spotted in many places with extravasations, and the inflammation disappeared. It contained, as did also the intestines, a black liquor, which had been vomited and purged before death. This black liquor appears clearly to be an altered secretion from the liver; for a fluid in all respects of the same qualities was found in the gall bladder. This liquor was so acrid, that it induced considerable inflammation and swelling on the operator's hands, which remained some days. The villous membrane of the intestines, in these last two bodies, was found inflamed in several places.

“The liver was of its natural appearance, excepting in one of the last persons, on the surface of which a very few distended veins were seen: all the other abdominal viscera were of a healthy appearance.

“The external surface of the stomach, as well as of the intestines, was quite free from inflammation; the veins being distended with blood, which appeared through the transparent peritonium, gave them a dark colour.

“The stomach of those who died early in the disease was always contracted; but in those who died at a more advanced period of it, where extravasations appeared, it was distended with air.

“P. S. PHYSICK, “J. CATHRALL.”

I have before remarked, that these dissections were made early in the disease, and that Dr. Annan attended a dissection of a body at Bush-hill, some time afterwards, in which an unusual turgescence appeared in the vessels of the brain.

Thus far have I delivered the history of the yellow fever, as it affected the human body with sickness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked, that the first reports of the existence of this fever were treated with neglect or contempt. A strange apathy pervaded all classes of people. While I bore my share of reproach for “terrifying our citizens with imaginary danger,” I answered it by lamenting “that they were not terrified enough.” The publication from the college of physicians soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, remote from the spot where it originated; although, for a while, in every instance, it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crowded with families flying in every direction for safety to the country. Business began to languish. Water-street, between Market and Race-streets, became a desert. The poor were the first victims of the fever. From the sudden interruption of business they suffered for a while from poverty as well as from disease. A large and airy house at Bush-hill, about a mile from the city, was opened for their reception. This house, after it became the charge of a committee appointed by the citizens on the 14th of September, was regulated and governed with the order and cleanliness of an old and established hospital. An American and French physician had the exclusive medical care of it after the 22d of September.

The disease, after the second week in September, spared no rank of citizens. Whole families were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians, from the desertion of some, and the sickness and death of others. At one time there were but three physicians who were able to do business out of their houses, and at this time there were probably not less than 6000 persons ill with the fever.

During the first three or four weeks of the prevalence of the disease I seldom went into a house the first time, without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlour, who came to ask for advice for their relations. Grief after a while descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends without shedding a tear, or manifesting any other of the common signs of grief.

A cheerful countenance was scarcely to be seen in the city for six weeks. I recollect once, in entering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear, upon my recovery, that the father and mother of this little creature died a few days after my last visit to them.

The streets every where discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city, at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night[55].

But a more serious source of the distress of the city arose from the dissentions of the physicians, about the nature and treatment of the fever. It was considered by some as a modification of the influenza, and by others as the jail fever. Its various grades and symptoms were considered as so many different diseases, all originating from different causes. There was the same contrariety in the practice of the physicians that there was in their principles. The newspapers conveyed accounts of both to the public, every day. The minds of the citizens were distracted by them, and hundreds suffered and died from the delays which were produced by an erroneous opinion of a plurality of diseases in the city, or by indecision in the choice, or a want of confidence in the remedies of their physician.

The science of medicine is related to every thing, and the philosopher as well as the christian will be gratified by knowing the effects of a great and mortal epidemic upon the morals of a people. It was some alleviation of the distress produced by it, to observe its influence upon the obligations of morality and religion. It was remarked during this time, by many people, that the name of the Supreme Being was seldom profaned, either in the streets, or in the intercourse of the citizens with each other. But two robberies, and those of a trifling nature, occurred in nearly two months, although many hundred houses were exposed to plunder, every hour of the day and night. Many of the religious societies met two or three times a week, and some of them every evening, to implore the interposition of Heaven to save the city from desolation. Humanity and charity kept pace with devotion. The public have already seen accounts of their benevolent exercises in other publications. It was my lot to witness the uncommon activity of those virtues upon a smaller scale. I saw little to blame, but much to admire and praise in persons of different professions, both sexes, and of all colours. It would be foreign to the design of this work to draw from the obscurity which they sought, the many acts of humanity and charity, of fortitude, patience, and perseverance, which came under my notice. They will be made public and applauded elsewhere.

But the virtues which were excited by our calamity were not confined to the city of Philadelphia. The United States wept for the distresses of their capital. In several of the states, and in many cities and villages, days of humiliation and prayer were set apart to supplicate the Father of Mercies in behalf of our afflicted city. Nor was this all. From nearly every state in the union the most liberal contributions of money, provisions, and fuel were poured in for the relief and support of such as had been reduced to want by the suspension of business, as well as by sickness and the death of friends.

The number of deaths between the 1st of August and the 9th of November amounted to four thousand and forty-four. I shall here insert a register of the number which occurred on each day, beginning on the 1st of August, and ending on the 9th of November. By comparing it with the register of the weather it will show the influence of the latter on the disease. Several of the deaths in August were from other acute diseases, and a few in the succeeding months were from such as were of a chronic nature.

died.

August 1 9

2 8

3 9

4 10

5 10

6 3

7 12

8 5

9 11

10 6

11 7

12 5

13 11

14 4

15 9

16 7

17 6

18 5

19 9

20 7

21 8

22 13

23 10

24 17

25 12

26 17

27 12

28 22

29 24

30 20

31 17

September 1 17

2 18

3 11

4 23

5 20

6 24

7 18

8 42

9 32

10 29

11 23

12 33

13 37

14 48

15 56

16 67

17 81

18 68

19 61

20 67

21 57

22 76

23 68

24 96

25 87

26 52

27 60

28 51

29 57

30 63

October 1 74

2 66

3 78

4 58

5 71

6 76

7 82

8 90

9 102

10 93

11 119

12 111

13 104

14 81

15 80

16 70

17 80

18 59

19 65

20 55

21 59

22 82

23 54

24 38

25 35

26 23

27 13

28 24

29 17

30 16

31 21

November 1 13

2 21

3 15

4 15

5 14

6 11

7 15

8 8

9 6

Total[56] 3881

From this table it appears that the principal mortality was in the second week of October. A general expectation had obtained, that cold weather was as fatal to this fever as heavy rains. The usual time for its arrival had come, but the weather was still not only moderate, but warm. In this awful situation, the stoutest hearts began to fail. Hope sickened, and despair succeeded distress in almost every countenance. On the fifteenth of October, it pleased God to alter the state of the air. The clouds at last dropped health in showers of rain, which continued during the whole day, and which were succeeded for several nights afterwards by cold and frost. The effects of this change in the weather appeared first in the sudden diminution of the sick, for the deaths continued for a week afterwards to be numerous, but they were of persons who had been confined before, or on the day in which the change had taken place in the weather.

The appearance of this rain was like a dove with an olive branch in its mouth to the whole city. Public notice was given of its beneficial effects, in a letter subscribed by the mayor of Philadelphia, who acted as president of the committee, to the mayor of New-York. I shall insert the whole of this letter. It contains, besides the above information, a record of the liberality of that city to the distressed inhabitants of Philadelphia.

“Sir,

“I am favoured with your letter of the 12th instant, which I have communicated to the committee for the relief of the poor and afflicted of this city.

“It is with peculiar satisfaction that I execute their request, by making, in their name, on behalf of our suffering fellow-citizens, the most grateful acknowledgements for the seasonable benevolence of the common council of the city of New-York. Their sympathy is balm to our wounds.

“We acknowledge the Divine interposition, whereby the hearts of so many around us have been touched with our distress, and have united in our relief.

“May the Almighty Disposer of all events be graciously pleased to protect your citizens from the dreadful calamity with which we are now visited; whilst we humbly kiss the rod, and improve by the dispensation.

“The part, sir, which you personally take in our afflictions, and which you have so pathetically expressed in your letter, excites in the breasts of the committee the warmest sensations of fraternal affection.

“The refreshing rain which fell the day before yesterday, though light, and the cool weather which hath succeeded, appear to have given a check to the prevalence of the disorder: of this we have satisfactory proofs, as well in the decrease of the funerals, as in the applications for removal to the hospital.

“I have, at your request, this day drawn upon you, at sight, in favour of the president and directors of the Bank of North America, for the sum of five thousand dollars, the benevolent donations of the common council of the city of New-York.

“With sentiments of the greatest esteem and regard,

“I am, sir, “Your most obedient humble servant, “MATTH. CLARKSON.

“Philadelphia, Oct. 17, 1793. “Richard Varick, mayor of the city of New-York.”

It is no new thing for bilious fevers, of every description, to be checked or subdued by wet and cold weather.

The yellow fever which raged in Philadelphia in 1699, and which is taken notice of by Thomas Story in his journal, ceased about the latter end of October, or the beginning of November. Of this there are satisfactory proofs, in the register of the interments in the friends' burying-ground, and in a letter, dated November 9th, old style, 1699, from Isaac Norris to one of his correspondents, which his grandson, Mr. Joseph P. Norris, politely put into my hands, with several others, which mention the disease, and all written in that memorable year in Philadelphia. The letter says, “It has pleased God to put a stop to our sore visitation, and town and country are now generally healthy.” The same disease was checked by wet and cold weather in the year 1741. Of this there is a proof in a letter from Dr. Franklin to one of his brothers, who stopped at Burlington, on his way from Boston to Philadelphia, on account of the fever, until he was assured by the doctor, that a thunder gust, which had cooled the air, had rendered it safe for him to come into the city[57]. Mr. Lynford Lardner, in a letter to one of his English friends, dated September 24, 1747, old style, after mentioning the prevalence of the fever in the city, says, “the weather is now much cooler, and those under the disorder revive. The symptoms are less violent, and the fever gradually abates.”

I have in vain attempted to procure an account of the time of the commencement of cold weather in the autumn of 1762. In the short history of the fever of that year, which I have inserted from my note book, I have said that it continued to prevail in the months of November and December. The register of the interments in the friends' burying-ground in those months confirms that account. They were nearly as numerous in November and December as in September and October, viz. in September 22, in October 27, in November 19, and in December 26.

The bilious remitting fever of 1780 yielded to cool weather, accompanied by rain and an easterly wind[58].

Sir John Pringle will furnish ample satisfaction to such of my readers as wish for more proofs of the efficacy of heavy rains, and cold weather, in checking the progress and violence of autumnal remitting fevers[59].

From the 15th of October the disease not only declined, but assumed more obvious inflammatory symptoms. It was, as in the beginning, more necessarily fatal where left to itself, but it yielded more certainly to art than it did a few weeks before. The duration of it was now more tedious than in the warmer weather.

There were a few cases of yellow fever in November and December, after the citizens who had retired to the country returned to the city.

I heard of but three persons who returned to the city being infected with the disease; so completely was its cause destroyed in the course of a few weeks.

In consequence of a proclamation by the governor, and a recommendation by the clergy of Philadelphia, the 12th of December was observed as a day of thanksgiving throughout the state, for the extinction of the disease in the city.

It was easy to distinguish, in walking the streets, the persons who had returned from the country to the city, from those who had remained in it during the prevalence of the fever. The former appeared ruddy and healthy, while the latter appeared of a pale or sallow colour.

It afforded a subject of equal surprise and joy to behold the suddenness with which the city recovered its former habits of business. In the course of six weeks after the disease had ceased, nothing but fresh graves, and the black dresses of many of the citizens, afforded a public trace of the distress which had so lately prevailed in the city.

The month of November, and all the winter months which followed the autumnal epidemic, were in general healthy. A catarrh affected a number of people in November. I suspected it to be the influenza which had revived from a dormant state, and which had not spent itself, when it yielded to the predominance of the yellow fever. This opinion derives some support from a curious fact related by the late Mr. Hunter of the revival of the small-pox in a patient, in whom it had been suspended for some time by the measles[60]. The few fevers which prevailed in the winter were highly inflammatory. The small-pox in the natural way was in several instances confluent; and in one or two fatal. I was prepared to expect this inflammatory diathesis in the fevers of the winter; for I had been taught by Dr. Sydenham, that the diseases which follow a great and mortal epidemic partake more or less of its general character. But the diseases of the winter had a peculiarity still more extraordinary; and that was, many of them had several of the symptoms of the yellow fever, particularly a puking of bile, dark-coloured stools, and a yellow eye. Mr. Samuel D. Alexander, a student of medicine from South-Carolina, who was seized with a pneumony about Christmas, had, with a yellow eye, a dilated pupil and a hard pulse, which beat only fifty strokes in a minute. His blood was such as I had frequently observed in the yellow fever. Dr. Griffitts informed me that he attended a patient on the 9th of January, in a pneumony, who had a universal yellowness on his skin. I met with a case of pneumony on the 20th of the same month, in which I observed the same degrees of redness in the eyes that were common in the yellow fever. My pupil, Mr. Coxe, lost blood in an inflammatory fever, on the 18th of February, which was dissolved. Mr. Innes, the brewer, had a deep yellow colour in his eyes, on the fourth day of a pneumony, on the 27th of the same month; and Mr. Magnus Miller had the same symptom of a similar disease on the 16th of March. None of these bilious and anomalous symptoms of the inflammatory fevers of the winter and spring surprised me. I had been early taught, by Dr. Sydenham, that the epidemics of autumn often insinuate some of their symptoms into the winter diseases which follow them. Dr. Cleghorn informs us, that “the pleurisies which succeeded the autumnal tertians in Minorca, were accompanied by a vomiting and purging of green or yellow bilious matters[61].”

It belongs to powerful epidemics to be followed by similar diseases after they disappear, as well as to run into others at their first appearance. In the former case it is occasioned by a peculiar state of the body, created by the epidemic constitution of the air, not having been changed by the weather which succeeded it.

The weather in March resembled that of May; while the weather in April resembled that of March in common years. A rash prevailed in many families, in April, accompanied in a few cases by a sore throat. It was attended with an itching, a redness of the eyes, and a slight fever in a few instances. The small-pox by inoculation in this month was more mortal than in former years. However unimportant these facts may appear at this time, future observations may perhaps connect them with a similar constitution of the air which produced the previous autumnal epidemic.

The appearance of bilious symptoms in the diseases of the winter, excited apprehensions in several instances of the revival of the yellow fever. The alarms, though false, served to produce vigilance and industry in the corporation, in airing and purifying such houses and articles of furniture as belonged to the poor; and which had been neglected in the autumn, after the ceasing of the disease.

The modes of purifying houses, beds, and clothes were various. Fumigations of nitre and aromatic substances were used by some people. Burying infected articles of furniture under ground, and baking them in ovens, were used by others. Some destroyed all their beds and clothing that had been infected, or threw them into the Delaware. Many white-washed their walls, and painted the wood-work of their house. I did not conceive the seeds of the disease required all, or any of those means to destroy it. I believed cold and water to be sufficient for that purpose. I therefore advised keeping the windows of infected rooms open night and day, for a few days; to have the floors and walls of houses well washed; and to expose beds and such articles of household furniture as might be injured by washing, upon the bare earth for a week or two, taking care to turn them every day. I used no other methods of destroying the accumulated miasmata in my house and furniture, and experience showed that they were sufficient.

It is possible a portion of the excretions of the sick may be retained in clothes or beds, so as to afford an exhalation that may in the course of a succeeding summer and autumn, or from accidental warmth at any time, create a solitary case of fever, but it cannot render it epidemic. A trunk full of clothes, the property of Mr. James Bingham, who died of the yellow fever in one of the West-India islands about 50 years ago, was opened, some months after they were received by his friends, by a young man who lived in his brother's family. This young man took the disease, and died; but without infecting any of the family; nor did the disease spread afterwards in the city. The father of Mr. Joseph Paschall was infected with the yellow fever of 1741, by the smell of a foul bed in passing through Norris's Alley, in the latter end of December, after the disease had left the city. He died on the 25th of the month, but without reviving the fever in the city, or even infecting his family.

The matter which produced the fever in both these cases, had nothing specific in it. It acted in the same manner that the exhalation from any other putrid matters would have done in a highly concentrated state.

In a letter from Dr. Senter of Newport, dated January 7th, 1794, I find the following fact, which I shall communicate in his own words. It is introduced to support the principle, that the yellow fever does not spread by contagion. “This place (says the doctor) has traded formerly very much to the West-India islands, and more or less of our people have died there every season, when the disease prevails in those parts. Clothes of these unfortunate people have been repeatedly brought home to their friends, without any accident happening to them.”

I feel with my reader the fatigue of this long detail of facts, and equal impatience with him to proceed to the history of the treatment of the fever; but I must beg leave to detain him a little longer from that part of the work, while I resume the subject of the origin of the fever. It is an interesting question, as it involves in it the means of preventing the return of the disease, and thereby of saving the lives of thousands of our citizens.

Soon after the fever left the city, the governor of the state addressed a letter to the college of physicians, requesting to know their opinion of its origin; if imported, from what place, at what time, and in what manner. The design of this inquiry was to procure such information as was proper to lay before the legislature, in order to improve the laws for preventing the importation or generation of infectious diseases, or to enact new ones, if necessary for that purpose. To the governor's letter the college of physicians sent the following answer:

”Sir,

”It has not been from a want of respect to yourself, nor from inattention to the subject, that your letter of the 30th ult. was not sooner answered; but the importance of the questions proposed has made it necessary for us to devote a considerable portion of time and attention to the subject, in order to arrive at a safe and just conclusion.

”No instance has ever occurred of the disease called the yellow fever having been generated in this city, or in any other parts of the United States, as far as we know; but there have been frequent instances of its having been imported, not only into this, but into other parts of North-America, and prevailing there for a certain period of time; and from the rise, progress, and nature of the malignant fever, which began to prevail here about the beginning of last August, and extended itself gradually over a great part of the city, we are of opinion that this disease was imported into Philadelphia, by some of the vessels which arrived in the port after the middle of July. This opinion we are further confirmed in by various accounts we have received from unquestionable authorities.

”Signed, by order of the college of physicians, ”JOHN REDMAN, President.

”November 26th, 1793. ”To the governor of Pennsylvania.”

Dr. Redman, the president of the college, Dr. Foulke, and Dr. Leib, dissented from the report contained in this letter. I have been necessarily led to continue it in the present edition of this work, not only because all the other members of that body still retain their belief of the importation of the fever, but as a reason for republishing the facts and arguments in support of its domestic origin.

I have asserted, in the introduction to the history of this fever, that I believed it to have been generated in our city; I shall now deliver my reasons for that belief.

1. The yellow fever in the West-Indies, and in all other countries where it is endemic, is the offspring of vegetable putrefaction. Heat, exercise, and intemperance in drinking (says Dr. Lind) dispose to this fever in hot climates, but they do not produce it without the concurrence of a remote cause. This remote cause exists at all times, in some spots of the islands, but in other parts even of the same islands, where there are no marsh exhalations, the disease is unknown. I shall not waste a moment in inquiring into the truth of Dr. Warren's account of the origin of this fever. It is fully refuted by Dr. Hillary, and it is treated as chimerical by Dr. Lind. They have very limited ideas of the history of this fever who suppose it to be peculiar to the East or West-Indies. It was admitted to have been generated in Cadiz after a hot and dry summer in 1764, and in Pensacola in 1765[62]. The tertian fever of Minorca, when it attacked Englishmen, put on the usual symptoms of the yellow fever[63]. In short, this disease appears, according to Dr. Lind, in all the southern parts of Europe, after hot and dry weather[64].

2. The same causes (under like circumstances) must always produce the same effects. There is nothing in the air of the West-Indies, above other hot countries, which disposes it to produce a yellow fever. Similar degrees of heat, acting upon dead and moist vegetable matters, are capable of producing it, together with all its various modifications, in every part of the world. In support of this opinion, I shall transcribe part of a letter from Dr. Miller, formerly of the Delaware state, and now of New-York.

“Dover, Nov. 5, 1793.

“Dear Sir,

“Since the middle of last July we have had a bilious colic epidemic in this neighbourhood, which exhibits phænomena very singular in this climate; and, so far as I am informed, unprecedented in the medical records, or popular traditions of this country. To avoid unnecessary details it will suffice at present to observe, that the disease, on this occasion, has assumed, not only all the essential characters, but likewise all the violence, obstinacy, and malignity described by the East and West-Indian practitioners. If any difference can be observed it seems here to manifest higher degrees of stubbornness and malignity than we usually meet in the histories of tropical writers. In the course of the disease, not only extreme constipation, frequent vomiting, and the most excruciating pains of the bowels and limbs, harass the unhappy patient; but to these succeed paralysis, convulsions, [**amp]c. and almost always uncommon muscular debility, oppression of the præcordia, [**amp]c. are the consequence of a severe attack. Bile discharged in enormous quantities constantly assumes the most corrupted and acrimonious appearances, commonly æruginous in a very high degree, and sometimes quite atrabilious.

“The inference I mean to draw from the phænomena of this disease, as it appears in this neighbourhood, and which I presume will also apply to your epidemic, is this, that from the uncommon protraction and intenseness of our summer and autumnal heats, but principally from the unusual drought, we have had, since the middle of July, a near approach to a tropical season, and that of consequence we ought not to be surprised if tropical diseases, even of the most malignant nature, are engendered amongst us.”

To the above information it may be added, that the dysentery which prevailed during the autumn of 1793, in several of the villages of Pennsylvania, was attended with a malignity and mortality unknown before in any part of the state. I need not pause to remark that this dysentery arose from putrid exhalation, and that it is, like the bilious colic, only a modification of bilious fever.

But further, a malignant fever, resembling that which was epidemic in our city, prevailed during the autumn in many parts of the United States, viz. at Lynn in Massachusetts, at Weatherfield and Coventry in Connecticut, at New-Galloway in the state of New-York, on Walkill and on Pensocken creeks in New-Jersey, at Harrisburgh and Hummelstown in Pennsylvania, in Caroline county in Maryland, on the south branch of the Potowmac in Hardie county, also in Lynchburgh and in Alexandria in Virginia, and in several counties in North-Carolina. In none of these places was there a suspicion of the disease being imported from abroad, or conveyed by an intercourse with the city of Philadelphia.

It is no objection to the inference which follows from these facts, that the common remitting fever was not known during the above period in the neighbourhood of this city, and in many other parts of the state, where it had usually appeared in the autumnal months. There is a certain combination of moisture with heat, which is essential to the production of the remote cause of a bilious fever. Where the heat is so intense, or of such long duration, as wholly to dissipate moisture, or when the rains are so great as totally to overflow the marshy ground, or to wash away putrid masses of matter, no fever can be produced.

Dr. Dazilles, in his treatise upon the diseases of the negroes in the West-Indies, informs us, that the rainy season is the most healthy at Cayenne, owing to the neighbouring morasses being deeply overflowed; whereas, at St. Domingo, a dry season is most productive of diseases, owing to its favouring those degrees of moisture which produce morbid exhalations. These facts will explain the reason why, in certain seasons, places which are naturally healthy in our country become sickly, while those places which are naturally sickly escape the prevailing epidemic. Previously to the dissipation of the moisture from the putrid masses of vegetable matters in our streets, and in the neighbourhood of the city, there were (as several practitioners can testify) many cases of mild remittents, but they all disappeared about the first week in September.

It is worthy of notice, that the yellow fever prevailed in Virginia in the year 1741, and in Charleston, in South-Carolina, in the year 1699, in both which years it prevailed in Philadelphia. Its prevalence in Charleston is taken notice of in a letter, dated November 18th, O. S. 1699, from Isaac Norris to one of his correspondents. The letter says, that “150 persons had died in Charleston in a few days,” that “the survivors fled into the country,” and that “the town was thinned to a very few people.” Is it not probable, from the prevalence of this fever twice in two places in the same years, that it was produced (as in 1793) by a general constitution of air, co-operating with miasmata, which favoured its generation in different parts of the continent? But again, such was the state of the air in the summer of 1793, that it predisposed other animals to diseases, besides the human species. In some parts of New-Jersey, a disease prevailed with great mortality among the horses, and in Virginia among the cows, during the autumn. The urine in both was yellow.—Large abscesses appeared in different parts of the body in the latter animals, which, when opened, discharged a yellow serous fluid. From the colour of these discharges, and of the urine, the disease got the name of the yellow water.

3. I have before remarked, that a quantity of damaged coffee was exposed at a time (July the 24th) and in a situation (on a wharf and in a dock) which favoured its putrefaction and exhalation. Its smell was highly putrid and offensive, insomuch that the inhabitants of the houses in Water and Front-streets, who were near it, were obliged, in the hottest weather, to exclude it by shutting their doors and windows. Even persons, who only walked along those streets, complained of an intolerable fœtor, which, upon inquiring, was constantly traced to the putrid coffee. It should not surprise us, that this seed, so inoffensive in its natural state, should produce, after its putrefaction, a violent fever. The records of medicine (to be mentioned hereafter) furnish instances of similar fevers being produced, by the putrefaction of many other vegetable substances.

4. The rapid progress of the fever from Water-street, and the courses through which it travelled into other parts of the city, afford a strong evidence that it was at first propagated by exhalation from the putrid coffee. It was observed that it passed first through those alleys and streets which were in the course of the winds that blew across the dock and wharf, where the coffee had been thrown in a state of putrefaction.

5. Many persons who had worked, or even visited, in the neighbourhood of the exhalation from the coffee, early in the month of August, were indisposed afterwards with sickness, puking, and yellow sweats, long before the air of Water-street was so much impregnated with the exhalation, as to produce such effects; and several patients, whom I attended in the yellow fever, declared to me, or to their friends, that their indispositions began exactly at the time they inhaled the offensive effluvia of the coffee.

6. The first cases of the yellow fever have been clearly traced to the sailors of the vessel who were first exposed to the effluvia of the coffee. Their sickness commenced with the day on which the coffee began to emit its putrid smell. The disease spread with the increase of the poisonous exhalation. A journeyman of Mr. Peter Brown's, who worked near the corner of Race and Water-streets, caught the disease on the 27th of July. Elizabeth Hill, the wife of a fisherman, was infected by only sailing near the pestilential wharf, about the 1st of August, and died at Kensington on the 14th of the same month. Many other names might be mentioned of persons who sickened during the last week in July or the first week in August, who ascribed their illnesses to the smell of the coffee.

7. It has been remarked that this fever did not spread in the country, when carried there by persons who were infected, and who afterwards died with it. During four times in which it prevailed in Charleston, in no one instance, according to Dr. Lining, was it propagated in any other part of the state.

8. In the histories of the disease which have been preserved in this country, it has six times appeared about the first or middle of August, and declined or ceased about the middle of October: viz. in 1732, 1739, 1745, and 1748 in Charleston, in 1791 in New-York, and in 1793 in Philadelphia. This frequent occurrence of the yellow fever at the usual period of our common bilious remittents, cannot be ascribed to accidental coincidence, but must be resolved, in most cases, into the combination of more active miasmata with the predisposition of a tropical season. In speaking of a tropical season, I include that kind of weather in which rains and heats are alternated with each other, as well as that which is uniformly warm.

9. Several circumstances attended this epidemic, which do not occur in the West-India yellow fever. It affected children as well as adults, in common with our annual bilious fevers. In the West-Indies, Dr. Hume tells us, it never attacked any person under puberty. It had, moreover, many peculiar symptoms (as I have already shown) which are not to be met with in any of the histories of the West India yellow fever.

10. Why should it surprise us to see a yellow fever generated amongst us? It is only a higher grade of a fever which prevails every year in our city, from vegetable putrefaction. It conforms, in the difference of its degrees of violence and danger, to season as well as climate, and in this respect it is upon a footing with the small-pox, the measles, the sore-throat, and several other diseases. There are few years pass, in which a plethoric habit, and more active but limited miasmata, do not produce sporadic cases of true yellow fever in Philadelphia. It is very common in South and North-Carolina and in Virginia, and there are facts which prove, that not only strangers, but native individuals, and, in one instance, a whole family, have been carried off by it in the state of Maryland. It proved fatal to one hundred persons in the city of New-York in the year of 1791, where it was evidently generated by putrid exhalation. The yellow colour of the skin has unfortunately too often been considered as the characteristic mark of this fever, otherwise many other instances of its prevalence might be discovered, I have no doubt, in every part of the United States. I wish, with Dr. Mosely, the term yellow could be abolished from the titles of this fever, for this colour is not only frequently absent, but sometimes occurs in the mildest bilious remittents. Dr. Haller, in his pathology, describes an epidemic of this kind in Switzerland, in which this colour generally attended, and I have once seen it almost universal in a common bilious fever, which prevailed in the American army, in the year 1776.

I cannot help taking notice, in this place, of an omission in the answer to the governor's letter, by the college of physicians. The governor requested to know whether it was imported; if it were, from what place, at what time, and in what manner. In the answer of the college of physicians to the governor's letter no notice was taken of any of those questions. In vain did Dr. Foulke call upon the college to be more definite in their answer to them. They had faithfully sought for the information required, but to no purpose. The character of their departed brother, Dr. Hutchinson, for capacity and vigilance in his office, as inspector of sickly vessels, was urged without effect as an argument against the probability of the disease being imported. Public report had derived it from several different islands; had chased it from ship to ship, and from shore to shore; and finally conveyed it at different times into the city, alternately by dead and living bodies; and from these tales, all of which, when investigated, were proved to be without foundation, the college of physicians composed their letter. It would seem, from this conduct of the college, as if medical superstition had changed its names, and that, in accounting for the origin of pestilential fevers, celestial, planetary, and demoniacal influence had only yielded to the term importation.

Let not the reader reject the opinion I have delivered because it is opposed by so great a majority of the physicians of Philadelphia. A single physician supported an opinion of the existence of the plague at Messina, in the year 1743, in opposition to all the physicians (33 in number) of that city. They denied the disease in question to exist, because it was not accompanied by glandular swellings. Time showed that they were all mistaken, and the plague, which might probably have been checked, at its first appearance, by their united efforts, was, by means of their ignorance, introduced with great mortality into every part of the city. This disposition of physicians to limit the symptoms of several other diseases, cannot be sufficiently lamented. The frequent absence of a yellow colour, in this epidemic, led to mistakes which cost the city of Philadelphia several hundred lives.

The letter of the college of physicians has served to confirm me in an opinion, that the plagues which occasionally desolated most of the countries of Europe, in former centuries, and which were always said to be of foreign extraction, were of domestic origin. Between the years 1006 and 1680, the plague was epidemic fifty-two times all over Europe. It prevailed fourteen times in the 14th century. The state of Europe, in this long period, is well known. Idleness, a deficiency of vegetable aliment, a camp life, from the frequency of wars, famine, an uncultivated and marshy soil, small cabins, and the want of cleanliness in dress, diet, and furniture, all concurred to generate pestilential diseases. The plagues which prevailed in London, every year from 1593 to 1611, and from 1636 to 1649, I believe were generated in that city. The diminution of plagues in Europe, more especially in London, appears to have been produced by the great change in the diet and manners of the people; also by the more commodious and airy forms of the houses of the poor, among whom the plague always makes its first appearance. It is true, these plagues were said by authors to have been imported, either directly or indirectly, from the Levant; but the proofs of such importation were as vague and deficient as they were of the West-India origin of our epidemic. The pestilential fevers which have been mentioned, have been described by authors by the generic name of the plague, but they appear to have originated from putrid vegetable exhalations, and to have resembled, in most of their symptoms, the West-India and North-American yellow fever.

I shall resume this interesting subject in another place, in which I shall mention a number of additional facts, not only in support of the domestic origin of the bilious yellow fever, but of its not spreading by contagion, and of course of its being impossible to import it. I shall at the same time enumerate all its different sources, and point out the means of destroying or removing them, and thus of exterminating the disease from our country.

With these observations I conclude the history of the epidemic fever of the year 1793. A few of its symptoms, which have been omitted in this history, will be included in the method of cure, for they were discovered or produced by the remedies which were given for that purpose.

☞ The following page begins an account of the states of the thermometer and weather, from the 1st of January to the 1st of August, and of the states of the barometer, thermometer, winds, and weather, from the 1st of August to the 9th of November, 1793. The times of observation, for the first three months are at 7 in the morning, and 2 in the afternoon; for the next five months they are at 6 in the morning, and 3 in the afternoon. From the 1st of October to the 9th of November, they are as in the first three months.

January, 1793. February, 1793.

Therm. Weather. Therm. Weather.

D. 7h 2h 7h 2h

1 27 30 Cloudy. 9 26 Fair, hazy.

2 30 41 Fair, cloudy. 25 34 Rain, ditto.

3 30 33 Cloudy, rain. 33 37 Cloudy, fair.

4 38 41 Rain, cloudy. 25 46 Cloudy, fair.

5 35 42 Fair, cloudy. 36 44 Cloudy, ditto.

6 33 47 Cloudy, fair. 35 46 Cloudy, rain.

7 38 51 Fair, fair. 36 40 Cloudy, fair.

8 32 49 Fair, ditto. 28 44 Cloudy, ditto.

9 33 48 Hazy, fair. 42 50 Rain, fair.

10 38 51 Fair, ditto. 38 40 Cloudy, fair.

11 35 48 Fair, clouds. 19 27 Fair, cloudy.

12 31 42 Fair, ditto. 20 28 Snow, cloudy.

13 28 42 Fair, ditto. 22 31 Cloudy, snow.

14 25 27 Hail, snow, sleet. 27 39 Cloudy, fair.

15 32 37 Clouds, mist. 18 40 Fair, ditto.

16 37 39 Rain, ditto. 29 42 Cloudy, ditto.

17 37 45 Rain, snow, fair. 44 48 Rain, ditto.

18 32 52 Fair, ditto. 39 49 Cloudy, fair.

19 37 48 Fair, ditto. 31 41 Cloudy, rain.

20 33 47 Hazy, cloudy. 52 53 Rain, rain.

21 36 47 Cloudy, fair. 37 49 Fair, ditto.

22 27 32 Fair, ditto. 29 34 Fair, ditto.

23 22 37 Fair, ditto. 22 34 Snow, cloudy.

24 30 39 Cloudy, ditto. 54 59 Rain, cloudy.

25 30 41 Fair, hazy. 34 35 Cloudy, ditto.

26 31 — Fair. 35 43 Rain, mist.

27 23 38 Fair, cloudy, snow. 43 43 Rain, cloudy.

28 35 45 Cloudy, fair. 14 26 Fair, ditto.

29 29 37 Fair, ditto.

30 22 23 Snow, hail.

31 25 32 Cloudy, fair.

March, 1793. April, 1793.

Therm. Weather. Therm. Weather.

D. 7h 2h 7h 2h

1 20 38 Fair, ditto. 45 70 Cloudy, fair.

2 31 51 Hazy, cloudy. 47 71 Fair, ditto.

3 48 63 Rain, fair. 56 80 Fair, ditto.

4 43 61 Hazy, ditto. 51 72 Cloudy, fair.

5 51 52 Rain, fair. 53 61 Cloudy, rain.

6 32 50 Fair, ditto. 60 76 Misty, fair.

7 36 62 Fair, ditto, clouds. 51 65 Fair, ditto.

8 54 60 Cloudy, rain. 46 74 Fair, ditto.

9 26 41 Fair, ditto. 55 71 Fair, cloudy.

10 29 51 Fair, ditto. 50 56 Fair, ditto.

11 43 55 Rain, ditto. 37 63 Fair, ditto.

12 40 43 Cloudy, ditto. 54 62 Cloudy, rain, fair.

13 38 39 Cloudy, fair. 49 62 Fair, ditto.

14 26 44 Fair, ditto. 50 70 Fair, ditto.

15 32 59 Fair, ditto. 45 55 Rain, cloudy.

16 52 62 Cloudy, fair. 46 62 Cloudy, fair.

17 51 72 Cloudy, fair. 48 67 Fair, clouds, fair.

18 58 69 Hazy, cloudy. 52 66 Cloudy, fair.

19 53 59 Fair, ditto. 52 75 Fair, ditto.

20 42 61 Fair, ditto. 52 49 Rain, cloudy.

21 41 43 Rain, cloudy. 44 47 Cloudy, ditto.

22 31 47 Fair, ditto. 43 46 Rain, cloudy.

23 35 57 Fair, ditto. 42 63 Fair, ditto.

24 37 50 Fair, ditto. 44 68 Fair, ditto.

25 35 59 Fair, ditto. 45 65 Cloudy, ditto.

26 47 54 Cloudy, rain. 53 57 Cloudy, rain.

27 43 51 Fair, cloudy. 47 46 Rain, ditto.

28 33 45 Fair, clouds, fair. 44 44 Rain, cloudy.

29 34 57 Fair, ditto. 40 59 Fair, ditto.

30 41 58 Cloudy, fair. 40 65 Fair, ditto.

31 42 61 Cloudy, fair.

May, 1793. June, 1793.

Therm. Weather. Therm. Weather.

D. 7h 2h 7h 2h

1 45 69 Foggy, cloudy. 53 61 Rain, showery.

2 52 73 Fog, clouds, fair. 54 64 Clouds, showers.

3 60 63 Rain, ditto. 55 62 Cloudy, rain, fair.

4 60 80 Fair, ditto. 54 60 Rain, do. cloudy.

5 55 56 Cloudy, ditto. 58 72 Cloudy, fair, rain.

6 47 58 Cloudy, fair. — 71 Cloudy, rain.

7 50 68 Cloudy, fair. 68 78 Fair, ditto.

8 59 78 Cloudy, fair. 65 — Fair, ditto.

9 61 79 Foggy, fair. 70 88 Fog, fair.

10 65 71 Rain, hazy. 74 90 Fair, ditto.

11 55 75 Cloudy, fair. 76 90 Fair, ditto.

12 61 76 Cloudy, rain. 75 88 Fair, showers.

13 57 78 Fair, ditto. 74 81 Cloudy, rain.

14 59 83 Fair, cloudy. 63 77 Fair, ditto.

15 60 71 Fair, ditto. 63 82 Fair, hazy.

16 50 69 Fair, ditto. 67 85 Fair, ditto.

17 48 74 Fair, ditto. 74 89 Fair, showers.

18 61 81 Cloudy, fair. 73 88 Fair, ditto.

19 65 85 Fair, rain. 77 91 Fair, ditto.

20 65 87 Fair, ditto. 79 88 Fair, rain, fair.

21 68 86 Fair, ditto, clouds. 75 85 Cloudy, rain.

22 72 80 Clouds, gusts. 58 78 Cloudy, fair.

23 94 79 Cloudy, fair. 58 78 Fair, ditto.

24 58 75 Fair, ditto. 60 79 Fair, ditto.

25 52 70 Fair, cloudy. 67 74 Cloudy, rain.

26 61 66 Rain, ditto. 66 69 Cloudy, rain.

27 68 84 Cloudy, fair. 68 80 Cloudy, fair.

28 70 68 Fair, clouds, rain. 71 85 Cloudy, fair.

29 57 62 Cloudy, rain, clouds. 77 88 Cloudy, ditto.

30 54 57 Cloudy, rain. 74 90 Fair, ditto.

31 54 60 Cloudy, ditto.

JULY, 1793.

Barom. Ther. Winds. Weather.

Days. 6 A. M. 3 P. M. 6 A. M. 3 P. M. 6 A. M. 3 P. M.

1 30 0 29 8 77 88 W W fair.

2 29 8 29 7 77 81 W fair, showers.

3 29 9 30 0 74 80 E E cloudy.

4 30 1 30 0 70 83 E SW cloudy, fair, rain.

5 30 0 29 9 76 90 NW SW fair, ditto.

6 29 9 30 0 78 91 SW SW cloudy, thunder.

7 29 9 30 0 73 88 NE NW fair, clouds.

8 30 1 30 1 72 85 E E cloudy, fair.

9 30 0 29 8 73 81 S SW cloudy, ditto.

10 30 0 30 0 70 84 W NW fair, ditto.

11 30 0 30 0 74 88 NW NW fair, clouds.

12 30 1 30 2 70 84 N N fair, ditto.

13 30 1 30 0 68 83 NW NW fair, ditto.

14 30 0 30 0 65 80 N Calm fair, hazy.

15 30 0 29 9 66 75 SW SW cloudy, ditto.

16 29 8 29 7 70 83 W W rain, fair.

17 29 8 29 9 68 81 NW NW fair, ditto.

18 30 0 30 0 66 86 W SW fair, ditto.

19 29 9 29 9 75 85 SW W fair, cloudy, rain.

20 30 0 30 0 72 87 W NW fair, ditto, shower.

21 30 1 30 1 70 86 NW NW fair, ditto.

22 30 0 30 0 72 87 SW SW fair, ditto.

23 30 0 30 0 73 91 SW SW fair, cloudy.

24 29 9 29 9 75 89 Calm W cloudy, fair.

25 30 1 30 1 71 83 NW NNW fair, ditto.

26 30 2 30 2 63 82 N NE fair, ditto.

27 30 2 30 1 64 81 S calm S fair, cloudy.

28 30 1 30 0 72 85 Calm NNE cloudy, fair.

29 30 1 30 1 74 85 SSE NE cloudy, ditto, rain.

30 30 1 30 0 73 86 S SW cloudy, fair.

31 29 9 29 8 76 80 SSW SW cloudy, rain, fair.

AUGUST, 1793.

Barom. Ther. Winds. Weather.

Days. 6 A. M. 3 P. M. 6 A. M. 3 P. M. 6 A. M. 3 P. M. 6 A. M. 3 P. M.

1 29 95 30 0 65 77 WNW NW cloudy, fair,

2 30 1 30 1 63 81 NW SW fair, fair,

3 30 6 29 95 62 82 N NNE fair, fair,

4 29 97 30 0 65 87 S SW fair, fair,

5 30 5 30 1 73 90 SSW SW fair, fair,

6 30 2 30 0 77 87 SW W cloudy, fair,

7 30 12 30 1 68 83 NW W fair, fair,

8 30 1 29 95 69 86 SSE SSE fair, rain,

9 29 8 29 75 75 85 SSW SW cloudy, fair,

10 29 9 29 9 67 82 W SW fair, fair,

11 30 0 30 0 70 84 SW WSW cloudy, cloudy,

12 30 0 30 0 70 87 W W fair, fair,

13 30 5 30 0 71 89 SW W fair, fair,

14 30 0 29 95 75 82 SW SW fair, rain,

15 30 0 30 1 72 75 NNE NE fair, cloudy,

16 30 1 30 1 70 83 NNE NE fair, fair,

17 30 1 30 0 71 86 SW SW fair, fair,

18 30 1 30 1 73 89 calm SW fair, fair,

19 30 1 30 0 72 82 N N fair, cloudy,

20 30 1 30 12 69 82 NNE NNE fair, fair,

21 30 15 30 25 62 83 N NNE fair, fair,

22 30 3 30 35 63 86 NE SE fair, fair,

23 30 25 30 15 63 85 calm S fair, fair,

24 30 1 30 1 73 81 calm calm cloudy, rain,

25 30 1 30 1 71 66 NE NE rain, gr. rain,

26 30 15 30 2 59 69 NE NE cloudy, cloudy,

27 30 2 30 2 65 73 NE NE cloudy, cloudy,

28 30 2 30 15 67 80 S calm cloudy, clearin.

29 30 16 30 15 72 86 calm SW cloudy, fair,

30 30 1 30 1 74 87 calm SW fair, fair,

31 30 0 30 0 74 84 SW NW rain, fair,

SEPTEMBER, 1793.

Barom. Ther. Winds. Weather.

Days. 6 A. M. 3 P. M. 6 A. M. 3 P. M. 6 A. M. 3 P. M. 6 A. M. 3 P. M.

1 30 0 29 30 71 86 calm SW fog, fair,

2 29 75 29 8 73 86 SW SW fair, fair,

3 30 0 60 NW N fair, fair,

4 30 15 30 15 55 75 W W fair, fair,

5 30 15 30 1 62 80 SE S fair, cloudy,

6 29 97 29 95 70 89 WSW W fair, cloudy,

7 30 0 30 0 65 77 WNW NW fair, fair,

8 30 1 30 1 64 70 calm calm cloudy, cloudy,

9 30 0 30 0 66 80 SE NW rain, fair,

10 30 0 30 0 64 72 N NNE fair, cloudy,

11 30 1 30 0 62 72 NNE N cloudy, fair,

12 29 96 29 9 58 76 NW NNW fair, fair,

13 29 95 30 0 57 72 NW N fair, fair,

14 30 0 30 5 58 79 NW NW fair, fair,

15 30 0 29 97 65 80 N S fair, fair,

16 29 9 29 70 84 S SW cloudy, fair,

17 29 8 29 85 66 67 N N cloudy, cloudy,

19 30 4 30 35 45 70 calm SW fair, fair,

20 30 3 30 15 54 69 calm SE hazy, hazy,

21 30 0 29 0 59 78 calm cloudy, fair,

22 30 0 30 0 63 83 calm cloudy, fair,

23 30 1 30 1 62 80 calm SE cloudy, cloudy,

24 30 2 30 2 65 70 NE ENE cloudy, fair,

25 30 15 30 0 61 68 NE NE cloudy, cloudy,

26 29 8 29 7 58 79 N N cloudy, fair,

27 29 7 64 NW NW cloudy, fair,

28 30 5 30 15 54 73 NW NW fair, fair,

29 30 3 30 3 56 74 NE ENE cloudy, fair,

30 30 35 30 3 57 75 calm SW foggy, fair,

OCTOBER, 1793.

Barom. Ther. Winds. Weather.

Days. 7 A. M. 2 P. M. 7 A. M. 2 P. M. 7 A. M. 2 P. M. 7 A. M. 2 P. M.

1 30 15 30 5 64 80 SW SW cloudy, fair,

2 29 9 30 5 70 72 W NNW cloudy, fair,

3 30 2 30 15 50 72 W SW fair, fair,

4 29 75 29 7 50 72 SW W cloudy, cloudy,

5 30 0 30 1 58 66 N N fair, fair,

6 30 3 30 3 43 66 NE W fair, fair,

7 30 45 46 calm fair,

8 30 6 30 6 53 68 N N fair, fair,

9 30 5 30 4 53 70 NW NW fair, fair,

10 30 2 30 2 49 74 E NW fair, fair,

11 30 0 29 85 51 74 W W fair, fair,

12 29 6 29 55 58 64 SW NW rain, rain,

13 29 85 29 9 49 69 NW NW fair, fair,

14 30 5 30 0 52 76 SW SW calm, fair,

15 29 75 29 8 56 54 SW N fair, rain,

16 30 0 30 0 37 53 NNW N fair, fair,

17 30 1 30 1 37 60 NE NE fair, fair,

18 30 1 30 1 41 62 NW NW fair, fair,

19 30 0 29 9 51 66 N N cloudy, fair,

20 30 0 30 0 44 54 NW N fair, fair,

21 30 0 30 2 49 59 N NW fair, fair,

22 29 6 29 5 51 65 NW NW fair, fair,

23 29 8 29 8 47 60 W W fair, fair,

24 30 3 30 4 36 59 W NW fair, fair,

25 30 4 30 3 46 71 S S cloudy, do. h-w.

26 30 2 30 2 60 72 calm SW cloudy, cloudy,

27 30 3 30 3 44 44 NNE NNE cloudy, cloudy,

28 30 2 30 1 34 37 N N cloudy, cloudy,

29 29 85 29 85 28 44 NNW NW fair, fair,

30 30 1 30 1 28 49 calm SW hazy, hazy,

31 30 15 30 2 42 45 calm NNE cloudy, rain,

NOVEMBER, 1793.

Barom. Ther. Winds. Weather.

Days. 7 A. M. 2 P. M. 7 A. M. 2 P. M. 7 A. M. 2 P. M. 7 A. M. 2 P. M.

1 30 1 30 1 40 41 NNE NE rain, cloudy,

2 30 3 30 25 32 49 NNE NE fair, fair,

3 30 1 30 0 43 56 calm SW cloudy, cloudy,

4 29 8 29 9 55 67 SW SW cloudy, fair,

5 30 15 30 1 50 64 NE NE rain, rain,

6 29 8 29 65 63 67 S S cloudy, cloudy,

7 29 8 29 8 44 64 calm SW fair, fair,

8 29 8 29 85 43 56 SSW SW fair, fair,

9 29 9 29 95 42 65 SW SW fair, fair,

OF THE METHOD OF CURE.

In the introduction to the history of the fever, I mentioned the remedies which I used with success, in several cases which occurred in the beginning of August. I had seen, and recorded in my note book, the efficacy of gentle purges in the yellow fever of 1762; but finding them unsuccessful after the 20th of August, and observing the disease to assume uncommon symptoms of great prostration of strength, I laid them aside, and had recourse to a gentle vomit of ipecacuanha, on the first day of the fever, and to the usual remedies for exciting the action of the sanguiferous system. I gave bark in all its usual forms of infusion, powder, and tincture. I joined wine, brandy, and aromatics with it. I applied blisters to the limbs, neck, and head. Finding them all ineffectual, I attempted to rouse the system by wrapping the whole body, agreeably to Dr. Hume's practice, in blankets dipped in warm vinegar. To these remedies I added one more: I rubbed the right side with mercurial ointment, with a view of exciting the action of the vessels in the whole system, through the medium of the liver, which I then supposed to be principally, though symptomatically, affected by the disease. None of these remedies appeared to be of any service; for although three out of thirteen recovered, of those to whom they were applied, yet I have reason to believe that they would have recovered much sooner had the cure been trusted to nature. Perplexed and distressed by my want of success in the treatment of this fever, I waited upon Dr. Stephens, an eminent and worthy physician from St. Croix, who happened then to be in our city, and asked for such advice and information upon the subject of the disease, as his extensive practice in the West-Indies would naturally suggest. He politely informed me, that he had long ago laid aside evacuations of all kinds in the yellow fever; that they had been found to be hurtful, and that the disease yielded more readily to bark, wine, and, above all, to the use of the cold bath. He advised the bark to be given in large quantities by way of glyster, as well as in the usual way; and he informed me of the manner in which the cold bath should be used, so as to derive the greatest benefit from it. This mode of treating the yellow fever appeared to be reasonable. I had used bark, in the manner he recommended it, in several cases of sporadic yellow fever, with success, in former years. I had, moreover, the authority of several other physicians of reputation in its favour. Dr. Cleghorn tells us, that “he sometimes gave the bark when the bowels were full of vicious humours. These humours (he says) are produced by the fault of the circulation. The bark, by bracing the solids, enables them to throw off the excrementitious fluids, by the proper emunctories[65].”

I began the use of each of Dr. Stevens's remedies the next day after my interview with him, with great confidence of their success. I prescribed bark in large quantities: in one case I ordered it to be injected into the bowels every four hours. I directed buckets full of cold water to be thrown frequently upon my patients. The bark was offensive to the stomach, or rejected by it, in every case in which I prescribed it. The cold bath was grateful, and produced relief in several cases, by inducing a moisture on the skin. For a while I had hopes of benefit to my patients from the use of these remedies, but, in a few days, I was distressed to find they were not more effectual than those I had previously used. Three out of four of my patients died, to whom the cold bath was administered, in addition to the tonic remedies before-mentioned.

Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other countries. The fever had a malignity and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality far beyond what it did in the year 1762. Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy. Under the impression of this belief I applied myself with fresh ardour to the investigation of the disease before me. I ransacked my library, and pored over every book that treated of the yellow fever. The result of my researches for a while was fruitless. The accounts of the symptoms and cure of the disease by the authors I consulted were contradictory, and none of them appeared altogether applicable to the prevailing epidemic. Before I desisted from the inquiry to which I had devoted myself, I recollected that I had, among some old papers, a manuscript account of the yellow fever as it prevailed in Virginia in the year 1741, which had been put into my hands by Dr. Franklin, a short time before his death. I had read it formerly, and made extracts from it into my lectures upon that disease. I now read it a second time. I paused upon every sentence; even words in some places arrested and fixed my attention. In reading the history of the method of cure I was much struck with the following passages.