A Treatise on the Plague and Yellow Fever / With an Appendix, containing histories of the plague at Athens in the time of the Peloponnesian War; at Constantinople in the time of Justinian; at London in 1665; at Marseilles in 1720

by James Tytler

SECTION. II.

Symptoms of the Yellow Fever, as described by various authors.—Comparison between them and those of the Plague, with an inquiry into the Causes.—History of the Distemper as it has appeared in various parts of the United States since the year 1793.—A discussion of the question Whether the Yellow Fever is Contagious or not.

OF all those who have attempted to give an account of this fatal disease, none appear to have exceeded Dr. Moseley, either in his accuracy in enumeration, or perspicuity in description, of the symptoms. According to him the yellow fever is a species of the kausos of Hippocrates, Aretœus and Galen; that is, the febris ardens or causus, aggravated by climate, incidental only to the gross, inflammatory and plethoric at any season of the year, totally different from the remitting bilious fever to which all habits of body are subject in hot climates, particularly after rains, and in the fall of the year. The causus, seldom seen in the temperate climates of Europe, never appears there with the violent symptoms which attend it in hot climates. “Whether in the latitudes (says he) so mild as those of Spain, Greece, Italy and the Archipelagan islands, the causus has ever been attended with black vomiting, as in the West-Indies, I cannot tell. Lommius mentions the vomiting of blood, and voiding black liquid stools and black urine. Critical and symptomatical yellowness of the skin in the causus are enumerated by Hippocrates among its symptoms, and Lommius mentions the danger of that appearance before the seventh day. The affinity of the symptoms, progress and termination of a causus in Europe to those of the yellow fever in the West-Indies, excepting the black vomiting, leaves no room to doubt that the difference of climate constitutes all the difference that is found between them.”

For these reasons Dr. Moseley adopts the name of endemial causus; and he takes notice that many difficulties have arisen to young practitioners, and to strangers in the West-Indies, from the various names improperly given to it from its ultimate and not from its primary symptoms. Some call it a burning bilious fever; Warren, a putrid bilious fever; but, though they have disputed about their terms, Dr. Moseley thinks that neither of them have proved whether bile be the cause or the effect of the disease. To call it the black vomit or the yellow fever, he thinks also improper, as a stranger would not know the disease until some of these symptoms appear; both of which are generally fatal, and neither of them constant.

The West-India causus he says is no more putrid than the small-pox, or any other acute disease; which may, after it has passed its inflammatory state, change to putrefaction, and end in death with an extraordinary dissolution of the fluids. The disease is in truth an inflammatory one in the highest degree possible; accompanied with such symptoms in a greater extent as attend all inflammatory fevers, and most strikingly the reverse of any disease that is putrid, or of one exacerbation. It obeys no season of the year, and attacks such people, and under such circumstances, as are seldom the objects of putrid diseases, viz. all who are of an inflammatory diathesis, and do not perspire freely.

This distemper attacks sailors in the West-Indies more than any other set of men, even of new comers. For this the Dr. assigns as a reason, that they eat, drink, and sleep, so much at sea, use no exercise, and are always of gross habit of body. To this he adds the heat and dampness of harbours, generally in the neighbourhood of marshes, and their exposure to land winds at night; the labour they endure on board vessels in port, and the carelessness and excesses frequently committed by these people after long voyages.

When a stranger newly arrived feels a sudden loss of strength, with a continual desire of changing his position without finding rest in any, we may expert a causus. If he has exposed himself to any of the causes just mentioned, the probable consequences would be, that on the morrow he would feel an heaviness, lassitude, oppression and loss of appetite.[147] Next day, or perhaps within twelve hours from the first indisposition, the violence of the disease commences with faintness, generally giddiness of the head, with a small degree of chillness and horror, but never any rigor. These symptoms are succeeded by a high fever, great heat, and strong beatings of the arteries, particularly those of the temples and carotids; flushings of the face, gasping for cool air; tongue white tinged with yellow, after the retchings have commenced; excessive thirst; redness, heaviness, and sensations of burning in the eyes; heaviness and darting pains in the head, small of the back, and often down the thighs; the pulse generally full and strong, but sometimes quick, low, and vacillating; the skin hot and dry, though sometimes it has a partial and momentary moisture. There is a sickness of stomach from the beginning; retchings succeed immediately after any liquid is swallowed, which bring up bilious matter. There is an anxiety with stricture, soreness, and intense heat about the præcordia; great restlessness, heavy respiration, sighing, urine deep coloured and in small quantity.

Thus the fever goes on during its first stage, which constitutes the inflammatory period, and continues from twenty-four to sixty hours. The second, which our author calls the metaptosis, is comparatively mild, and is an intermediate state between the inflammatory and gangrenous stages. In this there is an abatement of many of the former symptoms, and a kind of deceitful tranquillity, accompanied, however, with a perturbation, if the patient should happen to sleep. There now appears a yellow tinge in the eyes, neck and breast; the heat subsides, sometimes accompanied with chillness, but never with that kind of rigor, which, when it happens, terminates the disease by sweat, or by copious bilious evacuations, upwards or downwards. The retchings increase and become porraceous: the pulse flags, but is sometimes high, and sometimes soft; the skin moist and clammy; urine of a dark saffron colour, and in small quantity; the tongue in some cases is dry, hard, and discoloured, in others furred and moist; the head is confused, sometimes with delirium, with a glossiness of the eyes. This stage of the disease continues sometimes only for a few hours, at others from twelve to forty-eight, seldom longer, and too frequently the disease hurries on rapidly from the first to the third stage, which is the gangrenous or fatal state. Now the pulse sinks, intermits, and becomes unequal, sometimes very quick; the vomiting becomes frequent with great straining and noise. The matter discharged is now in greater quantity, appearing like the grounds of coffee, or of a slate colour, and the stomach can retain nothing: the breathing is difficult, the tongue black, the sweats cold and clammy, the eyes yellow and sunk; there is a yellowness round the mouth and temples, and soon after over the whole body. The deepening of the yellow colour, with an aggravation of the other symptoms, is a forerunner of death. There is a deep respiration, subsultus tendinum, a convulsive kind of sighing; the urine is quite black, and sometimes totally suppressed. There is a death-like coldness of the hands, feet and legs, while the heat still remains about the stomach; the patient is delirious, and struggles to get up in bed; he trembles, his speech falters; blood oozes from the mouth and nostrils, sometimes from the corners of the eyes and ears; a black bloody cruor is discharged both by vomit and stool: livid spots appear on different parts of the body, particularly the præcordia; hiccup, muttering, coma, and death, follow in quick succession.

The affecting case of capt. Mawhood, who died on the fourth day of the disease, at Port-Royal in Jamaica, in the year 1780, exhibits a dreadful picture of this disease in its last stage. “When I entered the room, (says Dr. Moseley) he was vomiting a black, bloody cruor, and he was bleeding at the nose. A bloody ichor was oozing from the corners of his eyes, and from his mouth and gums. His face was besmeared with blood, and with the dullness of his eyes it presented a most distressing contrast to his natural visage. His abdomen was swelled and inflated most prodigiously. His body was all over of a deep yellow, interspersed with livid spots. His hands and feet were of a livid hue. Every part of him was cold, excepting about his heart. He had a deep, strong hiccup, but neither delirium nor coma; and was, at my first seeing him, as I thought, in his perfect senses. He looked at the changed appearance of his skin, and expressed, though he could not speak, by his sad countenance, that he knew life was soon to yield up her citadel, now abandoning the rest of his body. Exhausted with vomiting, he was at last suffocated with the blood he was endeavouring to bring up, and expired.”

The symptoms just now enumerated generally take place in those who die from the third to the seventh day of the disease. But in this, as in other fevers, the symptoms vary considerably according to the constitution of the patient, and habit of the body. In some it begins neither with chillness, faintness, nor flushings of the face. Sometimes the pulse is much depressed and not quick; and in sultry weather, and damp situations, where the inflammatory state has been only of a few hours duration, the metaptosis has been so rapid, that the black vomiting and the mortified state have unexpectedly appeared, and have ended the patient in 24, 36 or 48 hours. But our author says that he never saw or heard of an instance of what Lind says, that the black vomit may attack a man when newly arrived, without any previous complaint; or of that mentioned by the same author, viz. “an uneasy itching sensation, commonly in the legs; and upon pulling down the stockings, streams of thin-dissolved blood followed, and a ghastly yellow colour quickly diffused itself all over the body.”

In some cases the disease is much more mild. There are instances where it has been protracted to the eighth, ninth or tenth day; and others where it has never passed from the inflammatory stage; but being checked, though not extinguished, it has been lengthened out, and at last converted into a remittent of great duration, most difficult of cure, and tedious of recovery.

According to our author, the stomach seems to bear the principal burden of the disease, and accordingly, after death, appears to have been principally affected. Great heat is perceived near the præcordia during all the stages of the disease, and pain and uneasiness are complained of when those parts are pressed with the hand. After death, livid spots appear over the whole body, particularly about the præcordia. On dissection, the stomach, in some part or other, is generally found mortified, especially if the black vomiting has continued long, and the livid spots have appeared before death. Frequently the upper part of the duodenum is in a gangrenous state, and always bears the marks of inflammation, lest the disease have been of ever so short a duration.

Though both liver and gall-bladder must be very much affected in this disease, yet Dr. Moseley is of opinion that nothing can be depended upon from an inspection of them after death. Some symptoms there are in common with inflammations of the liver, but none of those which distinguish it from other diseases. It never terminates in suppuration of the liver as the hepatitis sometimes does, though it is frequently carried off by an enormous secretion of bile. “Dissections (says the Doctor) have never discovered any certain and uniform appearance in the liver of those who have died of this disease. In hot climates a sound state of the liver is never to be expected after death, whether the disease has been acute or chronical. Of the latter class of diseases it is almost always either the seat, or the origin.”

Dr. Lining, in a letter to Dr. Whytt at Edinburgh, published in the Physical and Literary Essays, defines the disease, to be “that fever, which continues two or three days, and terminates without any critical discharge by sweat, urine, stool, &c. leaving the patient excessively weak, with a small pulse, easily depressible by very little motion, or by an erect posture; and which is soon succeeded by an icteritious (jaundice) colour in the white of the eyes and the skin; vomiting, hæmorrhages, &c. and those without being accompanied with any degree of a febrile pulse and heat.”

In the four times in which he mentions it to have been epidemic at Charleston, our author says, that none of the years (excepting 1739, the summer and autumn of which had been remarkably rainy) were either warmer or more rainy (and some of them less so) than the summers and autumns were in several other years in which there was not one instance of any one being seized with it. The subjects were whites of both sexes, especially strangers lately arrived from cold climates, Indians, Mistees, Mulattoes of all ages, excepting young children, and of those only such as had formerly escaped the infection. Negroes were not liable to it.

Those affected with the fever, for a day or two previous to the attack generally complained of head-ach, pain in the loins and extremities, but principally in the knees and legs, debility and lassitude; but some were taken ill suddenly without any warning. The symptoms were, shivering; frequent, full, hard and strong pulse; though sometimes small and hard, and in others soft and small; but towards the end of the fever it became smaller, harder, and less frequent. Sometimes there was a remarkable throbbing in the hypochondria and carotids, the former causing in some a tremulous motion of the whole abdomen. The heat was about 102 of Fahrenheit, and nearly equal over the whole body; some had frequent returns of chilliness without any diminution of temperature of the body. “In a few there happened so great a remission of the heat for some hours, when at the same time the pulse was soft and less frequent, and the skin moist, that one from these circumstances might reasonably have hoped that the fever would only prove a remittent or intermittent. About the end of the second day the heat began to abate.” Here Dr. Moseley takes notice that when the fever abates, some, who have mistaken the bilious remittent for the causus, speak of remissions which do not happen in this fever. “This circumstance of the endemial causus (says he) I believe, has never been mentioned before.”

Dr. Lining goes on to inform us, that the skin was rarely dry in this disease, there being generally a propensity to sweat. “On the first day the sweating was commonly profuse and general, on the second it was more moderate; but on both those, there happened frequent and short remissions of the sweatings, at which times the febrile heat increased, and the patient became more uneasy. On the third day the disposition to sweat was so much abated that the skin was generally dry; only the forehead and backs of the hands continued moist.” A great despondency and prostration of strength took place from the first attack. On the first day they generally dozed much, but were afterwards very watchful. On the second day the pains in the head, loins, &c. of which they had complained before the attack, and which were sometimes very acute in the forehead, generally went off. Many on the first day were a little delirious, but afterwards not until the recess of the fever.

The blood had no inflammatory crust; in warm weather it was florid like arterial blood, and continued in one soft homogeneous like mass, without any separation of the serum after it was cold. When there was any separation, the crassamentum was of too loose a texture.

This disease was not attended with any remarkable thirst; but, on the third day, as the fever began to lessen, or rather, says the Doctor, as the fulness of the pulse, heat and disposition to sweat, began to abate, a nausea, vomiting, or frequent reachings to vomit, came on especially after the exhibition of either medicines or food. A very few had a vomiting, either bilious or phlegmatic, on the first day. The whole febrile state was attended with an obstinate costiveness.

These were the principal symptoms with which the febrile state was attended, and which generally went off on the third day, or in seventy-two hours from the first attack, without any salutary crisis, and was soon succeeded by the second stadium, as our author calls it; a state, though without a fever, much more terrible than the former. The symptoms now were,

1. The pulse, though hard and small, became less frequent; very little more so than in health. Soon after it became much slower, and very soft; this softness remaining while any pulse could be felt. In many it gradually subsided, till it became scarce perceptible; neither could it be supported by any of the ordinary means used for that purpose. After this the yellow suffusion, the vomiting, delirium, restlessness, &c. increased to a great degree. Sometimes the pulse would recover its strength, but only for a short time.

2. The heat did not exceed the natural, and was still farther diminished as the pulse sunk; the skin became cold, and the face, breast and extremities acquired something of a livid colour. There was no great thirst, though the sick had a great inclination for strong liquors.

3. The vomiting or reaching to vomit increased, and in some were so constant, that neither medicines nor aliment of any kind could be retained. Some vomited blood, others only what was last exhibited, mixed with phlegm, while others had what is called the black vomit. But this, though its general appearance is black, appears not to be entirely so, but owes its colour to a great number of black flakey substances. These are by our author supposed to be the bile mixed with the mucus of the stomach, or adhering to it. He founds his opinion upon observations from dissection, where the mucus of the stomach was always found abraded, and the bile in its cystis black, and sometimes very viscid. This change in the state of the bile he has always observed in such as died of this disease, and likewise that the blood was very fluid, and the vessels of the viscera much distended. In one case he found the bile of the consistence of turpentine, and carbuncles or gangrenous specks on the stomach.

The reaching to vomit continued a longer or shorter time, according to the state of the pulse; an increase of fulness of the pulse being attended with an abatement of the reaching, and the contrary.

In this state the patients were extremely unquiet, even their sleep being frequently attended with dejection of spirits and debility. This last symptom was so excessive that if the patient was only raised up in bed, or sometimes if the head was only raised from the pillow, while a little drink was given, the pulse sunk immediately, and became sometimes so small, that it could scarce be felt: they became cold, the skin became clammy, the delirium increased, their lips and skin, especially about the neck, face and extremities, as well as the nails, acquired a livid colour. The restlessness and tossing were so great, that it was sometimes scarce possible to keep the sick in bed, though, even in this state, they made no particular complaint, and if asked how they did, the reply was, Very well.

A yellowness in the eyes became now very observable, and this was soon diffused all over the body; but in some, this colour did not appear until a little before death, when it spread surprisingly quick, especially about the breast and neck. Along with this were a number of small spots of a scarlet, purple or livid colour. These appeared principally about the neck and breast.

Some were obstinately costive, others the contrary, with large, liquid and black stools, but others were relieved by moderate stools, even though black. In some they resembled tar, in smoothness, tenacity, colour and consistence.

In this disease there was such a putrid dissolution of the blood that hæmorrhages took place from almost all parts of the body. In women the menstrua flowed, sometimes in great quantity, even at irregular periods. Blood flowed also from the eyes, nose, mouth and ears, and from those parts where blisters had been laid on. “Nay, (says our author) in the year 1739 or 1745, there were one or two instances of an hæmorrhage from the skin, without any apparent puncture, or any loss of the scarf-skin.” The urine was pale while the patient was not yellow, but a deep saffron colour when the yellowness had come on. Sometimes it was turbid, at others bloody, and the quantity of blood was always in proportion to the state of the pulse; diminishing as the pulse became more full, and increasing as it became weaker.

In the third stage, which always terminated in death, the pulse was exceedingly small and unequal, though soft; the extremities were cold, clammy and livid; the face and lips in some flushed, in others they were of a livid colour; the livid specks increased so fast, that in some the whole breast and neck appeared livid; the heart palpitated strongly; the heat about the præcordia was greatly increased, respiration became difficult, with frequent sighing; the patient became anxious and extremely restless, the sweat flowed from the face, neck and breast, blood from the mouth or nose or ears, and in some from all together; the deglutition became difficult, hiccup and subsultus tendinum came on, the patient picked the bed-clothes, was comatous or constantly delirious. In this terrible state some continued eight, ten or twelve hours before they died, even after they had been so long speechless, and without any perceptible pulsation of the arteries and wrists; whereas in all other acute diseases, death follows immediately after the pulse in the wrists ceases. When the disease was very acute, violent convulsions seized the unhappy patient, and quickly brought this stadium to its fatal end. After death the livid blotches increased fast, especially about the face, neck and breast, and the putrefaction began very early, or rather increased very quickly. In hot weather, and when the symptoms at first were very violent, there was little difference to be observed between the stadia, the whole tragedy being completed in less than forty-eight hours.

On this disease in general Dr. Lining remarks, that the infection was increased by warm, and lessened by cold, weather. In hot days the violence of the symptoms were augmented to such a degree as sometimes to become fatal to those who, in moderate weather, seemed to be in no danger; while, on the other hand, in cold days, some who had been in great danger were apparently saved from the jaws of death. The disease was also more fatal to those who lay in small chambers without a proper ventilation, to such as were of an athletic and full habit, to strangers, natives of a cold climate, and to such as were most afraid of it, as well as to those who had previously overheated themselves by exercise in the sun, or by excessive drinking of strong liquors. It proved also most certainly fatal to valetudinarians, or to such as had been previously weakened by any disease.

Dr. Lind observes that “a yellow colour of the skin is observed not only in common agues, but likewise in other fevers; sometimes denoting, as in contagious fevers, their malignant nature, at other times, as in some West Indian fevers, an universal dissolution of the blood and humours; and frequently this symptom accompanies gentle discharges of the bile, and a diseased liver.” In speaking of the disease in the West Indies, he mentions some fevers, which he derives from stagnated air, “of such a malignant nature, that the people after being there a few days are suddenly seized with violent vomitings, head-achs, deliriums, &c. and in two or three days more the whole body putrefies, and the dissolved mass of blood issues from every pore. . . . On considering the yellow fever particularly he is of opinion that the remarkable dissolution of the blood, together with the tendency to putrefaction in the whole body, the black vomit, and other characteristic symptoms, are often accidental though fatal appearances in fevers of the West Indies. They proceed, according to him, in such as are newly arrived, sometimes from a gross habit of body, excessive drinking of spiritous liquors, and from being afterwards overheated in the sun; but the intense heat and unhealthfulness of the air does much more frequently produce all those symptoms. This fever was once supposed to have been first carried into the West Indies by a ship from Siam: an opinion truly chimerical; as similar diseases have made their appearance, not only in the East Indies, but in some of the southern parts of Europe, during a season when the air was intensely hot and unwholesome. This happened in the months of September and October 1764, when excessive heat and want of rain for some months gave rise to violent epidemic bilious diseases, resembling those of the West Indies, in the city of Cadiz in Spain, of which an hundred persons often died in a day. At this time the winds blew mostly from the south, and after sunset there fell an unusual and very heavy dew. The disease began with alternate heats and chills, nausea, pains of the head, back, and loins, and at the pit of the stomach, These symptoms were often followed, in less than 24 hours, with violent reachings, and a vomiting of green and yellow bile, the smell of which was very offensive. Some threw up an humour as black as ink, and died soon after, in violent convulsions and in a cold sweat. The pulse was sometimes sunk, sometimes quick, but often varying. After the first day, the surface of the body was generally either cold, or dry and parched. The head-ach and stupor often ended in a furious delirium, which quickly proved fatal. The dead bodies having been examined by order of the court of Madrid, the stomach, mesentery and intestines were found covered with gangrenous spots. The orifice of the stomach appeared to have been greatly affected, the spots upon it being ulcerated. The liver and lungs were both of a putrid colour and texture.

“The stomach contained a quantity of an atrabilious liquor, which, when poured on the ground, produced a sensible effervescence; but, when mixed with spirit of vitriol, a violent ebullition ensued. The dead bodies turned so quickly putrid, that at the end of six hours their stench was intolerable, and in some of them worms were already found lodged in the stomach. His Majesty’s ship the Tweed being at that time in Cadiz bay, several of her men were taken ill when on shore, but, by being carried on board, all of them recovered. Neither did the black vomit or any other deadly symptom of that fever make its appearance in any of the ships. The dread of this distemper forced many people of fashion to retire into the country, where they remained in perfect safety.”

Dr. Lind further remarks, that in the yellow fever it is a bad sign if the skin is very dry and rough; “and the longer it continues in this state, the greater is the danger, as such patients seldom recover, though the pulse may give hopes, and the other symptoms also be fluttering; for many have a good pulse in this fever a little before death.” He also quotes Dr. Bruce, an eminent physician of Barbadoes, whose account of the disease is to the same purpose. He says it may come on at any season of the year, but that the symptoms are most severe when there is great heat joined with moisture. The blood, even in the beginning of the disease, is of a florid red colour, and as it were rarefied; the crassamentum scarcely cohering; the serum of a clay-coloured yellow. It sometimes finishes its course in 24 hours.

The account given by Dr. Hillary corresponds also very much with that already given. The subjects of the disease are the same with those already mentioned. He has seen it at all seasons of the year, but it is worst in a hot season, especially if it was preceded by moist and warm weather. “Blood, taken even at the beginning of the disease, is often of an exceeding florid red colour, much rarefied and thin, and without the least appearance of fiziness; and the crassamentum, when it has stood till it is cold, will scarce cohere, but fluctuates; the serum is very yellow. . . . On the second or third day the blood is much more dissolved, the serum more yellow, and the crassamentum loose, scarcely cohering, but undulates like sizy water when shaken, and sometimes has dark, blackish spots on its surface, showing a strong gangrenescent diathesis. . . . In the latter stage of this fever the blood is so attenuated and dissolved, that we frequently see it flowing not only out of the nose and mouth, but from the eyes, and even through the very pores of the skin; also great quantities of black, half-baked, half-mortified blood is frequently voided, both by vomiting and stool, with great quantities of yellow and blackish putrid bile, by the same ways; and the urine, which was before of a high icteritious colour, is now almost black, and is frequently mixed with a quantity of half-dissolved blood. . . . Soon after death the body appears much fuller of livid, large, blackish, mortified spots, particularly about the præcordia and hypocondres, especially the right; which parts seem to be, even from the first seizure, the principal seat of this terrible disease. And upon opening the bodies of those who die of it, we generally find the gall-bladder and biliary ducts filled with a putrid blackish bile, and the liver and stomach, and adjoining parts, full of blackish and mortified spots, and sometimes gangrenes, in those, as also in several other parts of the body. And the whole corpse soon putrefies after death, and can be kept but a few hours above ground.”

Dr. Jackson, in describing the yellow fever of Jamaica, acknowledges the difficulty of characterising the disease, even though he is of opinion that it “possesses some characteristics of its own, different from those of any other.” In a note at the end of his work, he observes the impropriety of calling it the yellow fever; because that yellowness sometimes does not appear at all; and in no one case does it ordinarily show itself till the latter stages. “I know also (says he) that most of the practitioners of Jamaica consider it only as an aggravated species of the remittent, the common endemic of hot climates. It appeared to me, I must confess, in a different light. . . . It may not, however, be improper here to take notice of the opinion of Dr. Moseley, who has endeavoured to persuade us that it is no other than the kausos, or ardent fever, of the ancients. But the yellow fever of the West Indies is, by Dr. Moseley’s own confession, in some measure peculiar to strangers newly arrived in tropical climates. The kausos, we are informed, made its appearance in the islands of the Archipelago, and on the coasts of the contiguous continents, indiscriminately among men and women, natives and foreigners: in fact it has not, as far as I can perceive, any claim to be considered as a distinct disease. If I rightly understand Hippocrates, or the description of the still more accurate Aretæus, kausos in reality is only an accidental condition of the common endemic of the country, where the force of the fever is chiefly exerted upon the stomach and alimentary canal. In this manner it appears frequently in Jamaica, and in the southern provinces of America. In the hot months of summer, it appears occasionally in every climate; and is not necessarily accompanied with, nor does it depend upon, a general inflammatory diathesis of the system for its existence.”

The Doctor divides this disease into three species: 1. Where “signs of putrefaction are evident at a very early stage, which is generally rapid in its course, and which casually terminates in black vomiting. Yellowness seldom or never fails to make its appearance in the present instance; and perhaps it is the only one which, strictly speaking, can be called the yellow fever. 2. A form of fever which has either no remissions, or remissions which are scarcely perceptible; in which signs of nervous affection are more obvious than symptoms of putrescency; and in which yellowness and black vomiting are rare occurrences. 3. Another form, in which regular paroxysms and remissions cannot be traced, but in which there are marks of violent irritation, and appearances of inflammatory diathesis in the earlier stage, which give way, after a short continuance, to signs of debility and putrescency, to which yellowness frequently succeeds, or even sometimes the so much dreaded vomiting of matter of a dark colour. The disease in these three forms appears to be in reality one and the same. The difference of the symptoms probably arises from very trivial or very accidental causes. It is in some measure peculiar to strangers from colder regions soon after their arrival in the West Indies, and may generally be distinguished from the common endemic of the country, not only by a total want of paroxysms and remissions, but likewise by a certain expression of the eye and countenance, with something unusually disagreeable in the feelings, of which words convey only an imperfect idea.”

The symptoms enumerated by Dr. Jackson are in general the same with those already taken notice of. He mentions likewise a degree of confusion frequently joined with grimness, difficult to be described in words, but which a person acquainted with the appearances of the disease immediately recognises as one of its distinguishing marks. In the second stage he says, that no sweat or moisture was now observable on any part of the body: the state of the skin impressed the idea as if it were not pervious to any degree of perspiration, and heat gradually forsook the surface and extremities: the tongue became moist, and at the same time frequently clean about the edges: the gums became redder, more spongy, and showed a greater disposition to bleed: vomiting was troublesome: the matter thrown up was ropy, in large quantity, and abounding with villous or mucous flakes of a darker colour. The circulation in the extreme vessels became gradually more languid; the natural heat retired from the surface of the body, which was now dry and impervious; the pulse returned nearly to its ordinary state, or became slow, full and regular; the yellowness increased fast, so that the whole body was frequently yellow as an orange, or of as deep a colour as the skin of an American savage: anxiety was inexpressible; vomiting was irrestrainable, and the vomiting of a matter like the grounds of coffee at last made its appearance. This matter was often as black as soot, where the progress of the disease had been rapid; while it was not only less intensely black, but often tinged with green, where the disease had been more slow and gradual. The number of villous or mucous flakes, in the matter discharged by vomit, increased as the disease advanced, and with them were joined streaks of blood, which seemed principally to come from the throat and gums. As the disease advanced, the vomiting became more frequent, but was seldom accompanied with any violent retching. Quantities of liquor were discharged, so enormous that it was often difficult to imagine whence they came; after which the patient enjoyed some respite, till a similar collection was made. As soon as the matter discharged by vomit acquired this dark and sooty colour, the belly generally became loose, the stools being black, smooth, and not unlike tar or molasses; the tongue became clean, the gums putrid; hæmorrhages, or rather oozings of blood, were sometimes observed in different parts of the body, while livid blotches made their appearance on the belly and insides of the thighs. The pulse, which during the latter stages of the distemper could scarcely be distinguished from that of a person in health, became at last irregular, quick, or intermitting; soon after which coma or convulsions closed the scene. Sometimes the yellowness succeeded the black vomiting. In these the vomiting began unexpectedly, or without much previous affection of the stomach: the colour was commonly intensely black; the patient turned yellow almost in an instant, and died in a very short time. When any one recovered from this deplorable situation, of which there were some few instances, the termination was not by any regular crisis. The black vomiting ceased, sometimes apparently in consequence of treatment, sometimes evidently of its own accord: but a vomiting of a ropy, glutinous matter continued for a great length of time, together with an extreme irritability of the stomach, and a very peculiar state of the skin; which sometimes did not recover its natural smoothness and unctuosity for several weeks.

The disposition to faint, so common in the yellow fever, is supposed by Dr. Jackson to arise from a kind of torpor in the nervous system, rather than the usual causes of fainting. For this opinion he assigns as a reason, that “the patient was often able to stand upright for some time, and even to walk to a considerable distance; and, when at last overcome, was observed to fall down in a torpid, rather than a fainting, state.”

In dissections our author observed that the omentum and all its appendages were in a dry and parched state, and of an uncommon dark grey colour. But, along with this dark grey colour, and want of unctuosity and moisture, usually met with in the abdomen, the stomach and intestines had a dirty yellow appearance, were highly putrefied, and much distended with wind. The liver and spleen were generally enlarged in size; the former of a deeper yellow than any of the other abdominal viscera; while the texture of the spleen was often less firm than natural. The bile was usually black and thick, like tar or molasses; the blood-vessels of the liver bearing marks of uncommon distension. A quantity of black fluid, similar to that ejected by vomit, was found in the stomach, which fluid our author says positively derived its blackness from the bile, the flakes observed to float in it being parts of the villous coat of the stomach abraded. He denies that the black colour of the matter vomited is owing to blood, as many authors have supposed. He says that the passage of the bile might be easily traced from the gall-duct into the pylorus.

This being in the Doctor’s opinion the only true kind of yellow fever, we shall not follow him through the description of the other two species, but proceed to consider that remarkable and excessively fatal distemper which appeared in the year 1793, first in the West India islands, and then on the American continent. Dr. Chisholm, who has described the distemper very particularly, derives it from the coast of Africa, and gives the following account of its origin on the authority of a Mr. J. Paiba, “one of the adventurers in the Boullam scheme; and who, despairing of success, left the coast of Africa in a vessel called the Hankey. This vessel sailed from England in April 1792 with stores and adventurers for the intended colony at Boullam. The people were all in good health: that part of the coast of Africa on which they touched is remarkable for its healthiness; only it is destitute of water except what can be procured by digging temporary wells on the beach, and which is brackish, and consequently unwholesome. The ferocity of the negroes who inhabit that part of the continent prevented them from being accommodated on shore, so that they found themselves obliged to remain on board the Hankey for nine months. As the rainy season came on almost immediately after their arrival on the African coast, they attempted to shelter themselves by raising the sides of the vessel several feet, and covering it with a wooden roof.” Thus were upwards of two hundred persons, among whom were many women and children, confined in such a manner as must be supposed capable of producing fevers of a bad kind, if they could be produced by such causes. Accordingly a malignant fever did break out; the vessel was not ventilated, nor were the bed-clothes, &c. of the sick destroyed; from whence Dr. Chisholm concludes that the infection remained on board the vessel. The Doctor then proceeds to give the following account of the vessel after her departure from Boullam:[148] “Capt. Coxe, finding the water at Boullam unwholesome, proceeded with his ship to Bissao, where there is a Portuguese settlement, for a supply. The ship was navigated by about twelve seamen, most of whom had not experienced sickness, and had probably been procured from Sierra Leone: at any rate they were then taken on board for the first time. Of these, before the return of the Hankey to Boullam, nine died; and the remainder, with the captain, were reduced to a deplorable state. The time for which the Hankey was chartered being expired, Mr. Paiba, with his family, intended to return to England in her; but as no seamen could be procured they put to sea, having on board the captain, sick, and only the mate, Mr. Paiba and two seamen to navigate the ship. With much difficulty they arrived at St. Jago, where they fortunately found the Charon and Scorpion ships of war. Capt. Dodd of the former, humanely rendered them every service in his power, and on leaving them put two men of each ship on board the Hankey. With this aid they proceeded to the West Indies; a voyage to England being impracticable in their wretched state. On the third day after leaving St. Jago, the men they procured from the ships of war were seized with the fever, which had carried off three fourths of those on board the Hankey at Boullam; and, having no assistance, two of the four died: the remaining two were put on board here in the most wretched state possible. Capt. Dodd, on his arrival at Barbadoes from the coast of Africa, was ordered to convoy the homeward-bound fleet of merchantmen. In the execution of his orders he came to Grenada on the 27th of May, and, hearing of the mischief which the Hankey had been the cause of, mentioned that several of the Charon’s and Scorpion’s people were sent on board the Hankey at St. Jago, to repair her rigging, &c. that from this circumstance, and the communication which his barge’s crew had with that ship, the pestilence was brought on board both ships; and that of the Charon’s crew thirty died, and of the Scorpion’s, about fifteen. The Hankey arrived at the port of St. George’s (in Grenada) on the 19th of February, in the most distressed situation, and for a few days lay in the bay, but was afterwards brought into the careenage. From this period are we to date the commencement of a disease before, I believe, unknown in this country, and certainly unequalled in its destructive nature.”

This account of the introduction of the fever (which however is by Dr. Chisholm accounted very different from the yellow fever above described) is so clear and distinct, that, at first reading, it commands our belief. It hath not, however, met with universal approbation; and even the facts, for which both parties appeal to Mr. Paiba and capt. Dodd, vary from one another in a surprising manner. Dr. Trotter, in his Medicina Nautica, p. 328, gives the following account: “Dr. Chisholm tells us, that the ships of war on the African station, having sent men to assist the Hankey, after numbers had perished from the fever, received the infection by means of this communication, and that in the Charon thirty died, and fifteen in the Scorpion. Capt. Dodd, who at that time had his broad pendant in the Charon, now commands the Atlas of 98 guns in the fleet; Mr. Smithers, the surgeon, is at present in the Formidable, a second rate, also in the fleet; from them I have copied the following narrative of their transactions with the Hankey:

“When the squadron under commodore Dodd came to St. Jago in 1793, the Hankey lay there in great distress for want of hands; having buried above one hundred persons, men, women and children, from the time she had been at Bulam. The fever was now overcome: Mr. Smithers saw two men that had lately recovered. He left a quantity of bark. The Charon and Scorpion sent two men each to assist in navigating her to the West Indies. The Hankey at this port was cleaned, washed with vinegar, and fumigated. No fever appeared in either of the men of war, in consequence of this communication; they arrived at Grenada in perfect health, but did not go into the same part of the island to which the Hankey went. The Charon, at this harbour received some seamen from the merchant ships then taking in cargoes for England; she had afterwards fourteen cases of yellow fever, of which one died; but it is remarkable that the Scorpion did not bury a single man during the whole voyage.[149] It is probable from these facts, that the Hankey did not import the infection that produced the Grenada fever; for, after the disease was worn out, she had a passage to make to the West indies of many hundred leagues. It is also doubtful how the effects left in the Hankey could produce the fever, for the bedding was thrown away, and what clothing remained had been aired, and probably had scarcely been in contact with the body after being sick.”

The discordance between this and the foregoing account is abundantly evident. Dr. Chisholm’s account of the bedding, &c. is also very different. “Our lieutenant governor, Ninian Home, esq. some time after the disease became epidemic, informed me, that, in consequence of the information he had received of the clothes, &c. of the victims of the fever at Boullam being still on board the Hankey, he ordered Capt. Coxe to be brought before him and some gentlemen of the council. He then acknowledged, that all the effects of those who had died were then on board his ship, and said that he would not destroy them, unless he was indemnified for the loss he might sustain, should the heirs of the deceased call on him for those effects. Every argument was used to induce him to destroy the articles, but the only one which influences a man of this description, indemnification; and he of course carried the seminium of the disease to England.” It was this consideration which induced the governor to write to the secretary of state, and in consequence of his representation the vessel was obliged to perform quarantine in England, a circumstance which Dr. Trotter mentions without approbation.

Thus far the matter of fact seems to be very much obscured; and the more we investigate, the more we are involved in darkness. In the Medical Repository, vol. i, p. 484, we find the following severe censure passed upon Dr. Chisholm by the late Dr. Smith of New York: “It belongs to another part of this paper to assign the probable motives of Dr. Chisholm for maintaining that the fever was imported into Grenada: certain it is that he avowed a different opinion to Mr. Paiba, to whom he freely declared, that he could by no means trace the disease to the Hankey; and that he believed it to be of local origin, owing to the unhealthy condition of the careenage, and the particular prevailing winds: and, to confirm this notion, he informed Mr. Paiba that a similar disease, from the same cause, though in a less degree, had existed in St. George’s some years before.”

This was plainly giving Dr. Chisholm the lie; which, whatever might have been the consequence between the two parties, absolutely supersedes, to any impartial and unconcerned person, the evidence of both, at least as far as regards the origin of this disease. It is not, however, to be supposed that Dr. Chisholm would pass such a censure unnoticed. He did accordingly reply in a letter to Dr. Smith, who had sent him a copy of the Repository, with a letter inviting him to defend what he had said. Dr. Smith died before this letter reached him, but the principal part has appeared in the Medical Repository, vol. ii, p. 285. In this Dr. Chisholm retracts what he had said concerning the mortality on board the Charon and Scorpion ships of war. “I have lately received (says he) from a gentleman of the navy here, a log-book of the Charon, kept by one of her officers during the voyage in question. In this I find, that no sickness took place in either of these ships in consequence of this interview. A log-book is unquestionable evidence, and I therefore admit it.” As to the more serious part of the charge, viz. that Dr. Chisholm had wilfully misrepresented matters, the Doctor replies, that the narrative published by him was in general such as he had from Mr. Paiba; not indeed in manuscript, as Dr. Smith stated his to have been, but in conversation; and that this conversation took place expressly with a view to elucidate the cause of the fever, which he (Dr. Chisholm) could not account for by any reasoning from local causes, but heard it very generally ascribed to infection from the Hankey. Mr. Paiba was introduced to Dr. Chisholm at the request of the latter by the Hon. Samuel Mitchill now (the letter is dated Sept. 6th 1768 probably 1798) the senior member of the council of Grenada. “Mr. Mitchill (says the Doctor) brought Mr. Paiba to my house, and was present during the greatest part of the time the conversation continued. I found Mr. Paiba very willing to give me every information in his power relative to the state of the Bulama or Boulam colony, and of the ship Hankey; but I found him strongly disinclined to fall in with the universally received opinion, that that ship introduced the disease. The particulars I have given, are those Mr. Paiba related to me in this conversation; and, in order to be correct, I immediately, after Mr. Paiba left me, committed them to paper. Mr. Paiba promised to favour me with a written account; and in order to direct that gentleman’s attention to the points I considered as of most importance, I drew up a set of queries, and Mr. Mitchill charged himself with the delivery of it. A copy of these I have now in my possession, and a slight attention will exhibit my view in framing them, and show the doubts respecting the nature of the epidemic which suggested them. Although I repeatedly, through Mr. Mitchill and Mr. Palmer, the gentlemen with whom Mr. Paiba resided in the country, renewed my request to have this promise fulfilled, Mr. Paiba left the Island without gratifying it. If no other strong proof existed of something peculiar in the fever which at that time prevailed, the circumstance of my formally applying to Mr. Paiba for information relative to the state of the Hankey, and of taking the trouble to obtain an interview with him, presents an evidence as conclusive as can well be required by reasonable men. But the belief of the infection of the Hankey was universal, nor was it by any means confined to those whose interest might have been affected by the prosperity of an infant colony on the coast of Africa.”

Another charge against Dr. Chisholm is, that he falsifies the date of the Hankey’s arrival at Grenada; and which in Dr. Smith’s paper is brought forward in the following words: “In p. 91 the Doctor remarks, that, ‘in the short space of time from the beginning of March to the end of May, 200 of about 500 sailors, who manned the ships in the regular trade, died of this fever.’ By this it appears that the fever in question broke out as early as the beginning of March. The disingenuousness of this author is particularly evident from this quotation, if the period of the commencement of the disease be correctly assigned: and that it is so is probable from the difficulty of concealing the fact; as there must have been thousands of witnesses to the progress of the fever. When therefore it was thought proper to fix the odium of introducing the disease upon the Hankey (a project of which Dr. Chisholm seems originally to have had no idea) it became necessary for him to fix an earlier date to her arrival. Now, that the Hankey did not arrive till towards the latter end of March, is verified by the concurring testimony of Mr. and Mrs. Paiba, and of Mr. Bell, of this city (New York) who happened to be in Grenada about that time, and was personally acquainted with Mr. and Mrs. Paiba in that island.”

In answer to this Dr. Chisholm repeats his declaration that the Hankey arrived at Grenada on the 18th of February, and not on the 19th of March, as Dr. Smith (supposed on the authority of Mr. Paiba) had stated. In proof of this he produces an incontestible evidence, viz. an extract from the St. George’s Gazette in Grenada, of date 19th of February, which begins thus: “By the ship Hankey of London, arrived here yesterday from the island of Boulam on the coast of Africa, we are informed,” &c. The remainder of the extract contains an account of the excessive mortality on board the ships; which, as it may perhaps be exaggerated, it is needless to transcribe.

The next thing of consequence is the destruction of the bed-clothes and effects of the deceased; of which Dr. Smith says, “Before the Hankey put to sea, all the bedding of the sick was thrown overboard or destroyed; the ship was washed from stem to stern, both above and below, with salt water; and the purification was completed by fumigating her with tar, pitch and gun-powder. In this clean condition they bade farewel to Bulama on the 22d of November, 1792; but, in attempting to pass through the channel near to the entrance into the open sea, in a dark and foggy night, they got aground on a sand-bank, upon the north side of the island of Formosa or Warang, belonging to the Bijugas, who are represented as cannibals. The extreme terror excited by this accident was not calculated to improve the health of the people on board the Hankey; so that, when it became necessary to take measures for their security and deliverance, only four men were found in a condition to do duty, and all of these had intermittents. With them, however, and his lady, Mr. Paiba set off, in an open boat, for Bissao, to obtain assistance from the Portuguese settlement. Thither he arrived, rowing through rains and fogs, in a leaky boat, after being out two nights and a day; and having obtained such help as he could, returned to the Hankey, got her off, and carried her to Bissao. On the passage there eight persons died who belonged to this ship. At Bissao they refitted, and the Hankey was a second time purified as completely as she had been before leaving Bulama.”

In answer to all this Dr. Chisholm again declares, “that the bedding and effects of the deceased were preserved on board the Hankey, and constituted the seminium of the infection. Capt. William Liddle, of the ship General Mathew, saw them on board; and it was in consequence of that gentleman’s representation that the lieutenant governor, Mr. Home, entered into a strict investigation of the matter; the general result of which I have given; and the authenticity of it may be depended on. Capt. Liddle is now resident in London, and Mr. Byles, the governor’s secretary, is now resident commissary at Grenada; and these gentlemen will readily testify to the truth of my statement. The destructive articles I have mentioned were not thrown overboard till the Hankey arrived in Grenville Bay, when they were destroyed at the request of Mr. Prendfoot, the gentleman who chartered the ship for England.”

Dr. Chisholm is likewise charged with having mis-stated the case of a Capt. Remington, said to be the first who suffered by the fever in Grenada. The words in Dr. Chisholm’s Essay are, “A Capt. Remington, an intimate acquaintance of Capt. Coxe’s, was the first person who visited the Hankey after her arrival in St. George’s bay. This person went on board of her in the evening after she anchored, and remained three days; at the end of which time he left St. George’s, and proceeded in a drogher (a coasting vessel) to Grenville bay, where his ship, the Adventure lay. He was seized with the malignant pestilential fever on the passage; and the violence of the symptoms increased so rapidly, as, on the third day, to put an end to his existence.” In opposition to this Dr. Smith gives the following statement from Mr. Paiba: “He (Capt. Remington) had been all day and all night coming from Grenville bay, and had been wet through. He slept on board in his clothes; and went in an open boat the next day back to his ship: enough to kill any one in that climate.” Dr. Chisholm replies “that the above statement is not correct, nor founded on fact; Dr. Chisholm’s evidence for what he said was founded on the information of captains of vessels, who knew all the circumstances of his visit to the Hankey; and of Dr. Stewart, an eminent practitioner, who attended him at Grenville bay, when he landed there. Lastly, that the idea of his having returned to Grenville bay in an open boat, is absurd; nothing of the kind having been ever attempted.”

From this tedious account it is plain that the evidence relative to the importation of the fever into Grenada by the Hankey is quite contradictory, and subversive of itself, because we are unable to judge between the two disputants. A further consideration of it would lead us entirely from the subject of this treatise, into an endless dispute about which of the two parties had spoken the truth. Setting aside therefore the whole of the evidence on both sides as insufficient, we shall now proceed to give an account of the symptoms of the distemper as described by Dr. Chisholm, and to which description there has never been any objection made.

In the most violent kind of this fever, according to our author, “the patient, without any previous complaint, suddenly becomes giddy; he loses his eye-sight; every thing seems to move round him with inconceivable velocity; he falls down almost insensible, and in that state remains near half an hour, or upwards. During this paroxysm the body feels cold, and is over-spread with cold sweat, which issues from every pore in astonishing abundance. On his recovery the cold goes off, and is instantly succeeded by intense heat, and quick, small, hard pulse; the head achs dreadfully, particularly the fore part; generally accompanied with pain in the right side and at the præcordia. The last, however, has never been acute, and may rather be called oppression than pain. The eyes are much inflamed, watery, protruded, and wildly rolling; the face much flushed; much heat is felt at the pit of the stomach, and that organ seems to be considerably affected by the frequent retching and vomiting which then come on. The patient soon after complains of intolerable pains in the small of his back and in the calves of his legs; but the latter appears to be most violent. During twelve, eighteen, twenty-four or thirty-six hours, these symptoms continue increasing, except the quickness and hardness of the pulse, which does not change materially during that time; and are then succeeded by general coldness, cold sweat, a greater or less degree of coma and delirium, or a state very much resembling intoxication. Life in this state is lengthened out to sixty or ninety hours from the first attack. A short interval of reason then takes place; the patient considers himself better, and is, for a moment, flattered with the prospect of recovery: but a fit as sudden and unexpected as the first comes on, during which he foams at the mouth, rolls his eyes dreadfully, and throws out and pulls back his extremities in quick succession. In general the patient expires in this fit; but some have recovered from it, and continued rational for a few hours longer, when a second fit has carried them off.”

This, without much deviation, was the general progress of the worst kind of the fever. In some, however, a comatose disposition showed itself from the very first; in others the disease began with short convulsive fits in frequent succession, followed by constant delirium and cold clammy sweat, without any intervening heat. In a few cases the first symptoms were coldness and shivering, as in other fevers.

The distinguishing symptoms were the uncommonly sudden attack, the remarkably acute pain in the loins and calves of the legs, the watery, inflamed and rolling eye, flushing of the face, tendency to coma, the pain generally confined to the forehead, and the peculiar cast of the delirium, during which the looks and actions of the patient very much resembled those of a person intoxicated. It was never furious in any other way than by making efforts to get out of bed; and these in a few instances rose so high that the patients got up, dressed themselves, and walked out a considerable way before they could be overpowered. “The strength during the delirium is to appearance surprisingly great, for it is frequently necessary to use the united efforts of two or three men to keep the patient in bed. This is, however, no more than a spasmodic affection of the muscles; for in reality the powers of the sick in this disease are reduced to the extreme of debility, as is seen in the convalescent state.”

The most unequivocal characteristic of this disease, however, according to our author, is the appearance of a kind of petechiæ, but which look rather like red or livid patches than what is commonly understood by that word. They were always the forerunners of death. In a few very violent cases the body was almost of a livid or black colour, but they were generally seated on the neck, shoulders and breast. Vibices also, like those in the plague, described p. [258], sometimes made their appearance, and were also a fatal presage.

Hæmorrhage occurred much more frequent and profuse in this than in any other acute distemper our author had met with. “In several instances, the immensity of blood discharged has evidently been the more immediate cause of death. The robust, plethoric and gross habits have been the most subject to it. It has taken place from the nostrils, mouth, anus, and urethra; sometimes from the canthi (corners) of the eyes; but never, I believe, from the ears or pores of the skin. The most profuse discharge has been from the nostrils and anus, and has frequently, amounted to three or four pounds at a time; the stools having been on those occasions entirely composed of pure blood. Towards the close of life, the blood thus discharged has appeared granulous, or like ichor, with a sediment of a black gritty substance, and has been so extremely offensive as to oblige all the attendants to keep at a considerable distance till the hæmorrhage ceased. Hæmorrhage, however, has never been critical, nor has it in any instance permanently relieved the head-ach or pain in the breast or side. . . . Nearly about the period that these profuse discharges came on, a rawness was felt on the whole of the interior surface of the nose, and on several parts of it little ulcers formed; on others, small eschars, which were remarkably itchy, but on being touched, or an attempt made to detach them from the membrane of the nose, were very painful, and bled. These disappeared in proportion to the patient’s recovery; and I have reason to suspect, that, when the issue of the disease was fatal, these little eschars became gangrenous.”

In this distemper there was always a tendency to coma after the first two days; and after the third, it certainly came on. On examining the heads of two who died convulsed after having been comatose for some time, a great quantity of serum was found in the brain; and, on narrowly inspecting the eyes of those who were afterwards seized with coma, the pupil was found manifestly dilated.

A remarkable symptom unnoticed in any other fever is taken notice of by our author; viz. an affection of the testicles. “About the end of the second day the patient began to complain of a violent pain in these parts, accompanied with a contraction of the spermatic cord, and a drawing up of the testicles towards the abdominal ring. On examination they appear very much lessened in size, are drawn up considerably towards the abdomen, and the scrotum appears at the same time remarkably flaccid and empty. The surface of the scrotum becomes soon after very painful, and an excoriation takes place, chiefly at the most descending part, from which a considerable quantity of very offensive purulent matter issues: at the same time a similar discharge from the urethra takes place, which ceases with the disease when the event is favourable, or becomes ichorous and bloody, and insufferably fœtid when death is the consequence. In cases which terminate favourably, the whole of the scrotum, in a few days, is covered with a crust of hardened pus, which in the convalescent state, comes away very easily by means of a warm bath. The thickness of this coat may be about the fourth of a line; and, when separated, it much resembles moistened parchment. In fatal cases, this affection of the scrotum always terminates in gangrene a few hours before death.”

Another remarkable symptom is the change of voice to a shrill, soft and low sound when compared with the natural tone, at the same time that the syllables are more distinguished, and the words are strangely lengthened out in a drawling and whining manner. This change of voice affords a pretty certain prognostic; every alteration towards the natural tone being an almost certain sign of a favourable change, and the contrary if the voice becomes farther removed from it.

The pains felt in this fever were in a great measure peculiar to it, and seem to have been of a spasmodic nature. In the head the pain shot from the forehead, to which it was confined, invariably towards the bottom of the orbits, where it was generally exquisite. Sometimes it extended to the temples, where there was always a throbbing; but in no case did it extend to the back part, or over the whole head. This pain extended also to the balls of the eyes, which were protruded, and seemed ready to start from their orbits, with an inflammation externally, and a sensation of pain internally, rendering the admission of light intolerable. In the legs the pain had its seat at the top of the great tendon, immediately below the calf, and in the point where it was seated a gnawing sensation was felt, occasioning exquisite torture, with an involuntary contraction of the limb; so that, on the whole, our author concludes that this pain much resembles the cramp, differing only in being more permanent.

With regard to the pulse, our author observes, that in this disease “it never intermits. Even at the approach of death it has not intermitted, but has generally been remarkably tremulous, and so slow as to beat no more than thirty times in a minute. On the whole, it has not been found quicker than 130, or slower than 30, in a minute.” In violent cases the pulse was hard, quick and small, but sometimes full; and when it was so it was a good sign. It was however subject to excessive variations; and it frequently happened, “especially in the robust, that, after the first stage, flushing and chillness have often alternated in less than a minute; and that, although the skin felt considerably warm, the pulse has been no more than 52; but that, even when the low state came on, in which there was always a disagreeable coldness of the surface, it has been as quick, and nearly as full, as during the preceding febrile stage, although unaccompanied with thirst, or any other evident symptom of the existence of fever.”

In the state of delirium, Dr. Chisholm observes, that, whatever was the subject of the patient’s raving thoughts, he was always strongly under the impression of fear; and a word from the physician always reduced him to implicit obedience, however restless he might have been before. During this state he complained of no pain, even from blisters, nor was he sensible of the operation of laxative medicines. On being asked about his situation, he always answered that he was very well, and sensible of no pain, as in the yellow fever already described. It is observable, however, that the yellow colour, so remarkable in the former, seldom took place in the Boulam fever; but indeed this symptom, as has formerly been noticed, is by no means a characteristic either of the one disease or the other; but Dr. Chisholm observes “that in some protracted cases on shore, and in some among the sailors, which might have been a combination of the pestilential and yellow fevers, this symptom appeared about the 5th, 7th or 9th day.”

Besides the petechiæ and vibices, already mentioned, Dr. Chisholm takes notice of two other sorts of eruptions, which appeared about the lips: the one was such as frequently appears at the termination of the common remittents, and was favourable; the other resembling spots made by the fine black pencil of a painter, all round the mouth, but especially the upper lip, and certainly affording a fatal prognostic.

This disease was attended with a suppression of urine, a violent pain above the os pubis, a scalding in the urethra, a sense of fulness, without any visible swelling, a contraction and distortion of the penis; the urine generally of a deep red, sometimes brownish, green, very often bloody, and in a few cases much inclining to black, and of an oily consistence. Its smell was generally very offensive. All the excretions were exceedingly offensive, but the fæces most remarkably so towards the latter end of the disease; for in the beginning they had no remarkable fœtor. The sick were almost universally costive, which our author supposes to have arisen from a suspension of tone in the intestinal canal; for by exciting action in the fibres a large evacuation generally ensued. The colour of the fæces varied from yellow, or a yellowish white, to black; and from a considerable degree of thickness, to the exact appearance of coffee-grounds. The matter discharged by vomit also varied from porraceous to black, and resembling coffee badly boiled.

In this disease, as in the plague described by Thucydides, most other diseases degenerated into it, or partook of its nature. Dysenteries suddenly stopped, and were immediately succeeded by the symptoms of pestilential fever. A remarkable instance of this is given in twenty-seven recruits, who had been seized with dysentery, in consequence of being exposed to rain, receiving the infection in the hospital to which they were carried. The medicines exhibited with a view to cure the dysentery seemed to be attended with surprising effect; but in a short time symptoms of pestilential fever came on, even in a few hours after those of dysentery had disappeared. In like manner catarrhal complaints soon changed their nature. Convalescents from other diseases, such as laboured under chronical complaints, particularly rheumatism and inflammation of the liver, were particularly subject to it. “The puerperal fever became malignant, and of course fatal; and even among pregnant negro women, who might otherwise have had it in the usual mild degree peculiar to that description of people, many were reduced to a very dangerous situation by it. In short, every disease in which the patient was liable to infection, sooner or later assumed the appearance, and acquired the danger, of the pestilential fever.”

This fever was said to be propagated from Grenada to others of the West India islands, and to the United States, where in the same year, 1793, it raged with great violence in Philadelphia. Without entering into any inquiry at present concerning the truth of this report, or the origin of the fever itself, let us see whether from the symptoms enumerated by Dr. Rush, who hath written a very lengthy dissertation upon the disease, it was the same with the Boulam fever already described. According to him the fever in 1793 was frequently preceded by “costiveness, a dull pain in the right side, defect of appetite, flatulence, perverted taste, heat in the stomach, giddiness or pain in the head, a dull, watery, brilliant, yellow or red eye, dim and imperfect vision, hoarseness, or slight sore throat, low spirits, or unusual vivacity, a moisture on the hands, a disposition to sweat at nights, or after moderate exercise, or a sudden suppression of night sweats. . . . On entering a sick room the physician was first struck by the countenance of the patient. It was as much unlike that which is exhibited in the common bilious fever, as the face of a wild animal is unlike that of a domestic one. The eyes were sad, watery, and so inflamed in some cases as to resemble two balls of fire. Sometimes they had a most brilliant or ferocious appearance. The face was suffused with blood, or of a dusky colour, and the whole countenance was dusky and clouded. After the 10th of September, when the determination of blood to the brain became universal, there was a preternatural dilation of the pupil. Sighing attended in almost every case. The skin was dry, and frequently of its natural temperature. . . . The pulse at the beginning of the attack was sometimes full, tense and quick, but frequently weak; sometimes so low that it could not be perceived without pressing the wrists; and sometimes it had no preternatural quickness. In many it intermitted after the fourth or fifth, and sometimes after the fourteenth stroke. In some it was extremely slow; even as low as thirty strokes in a minute. The pulse was also tense and chorded. The slow intermitting pulse was observed more frequently in children than adults, and supposed to proceed from a collection of water in the brain. Impressed with this idea, I requested Mr. Coxe, one of my pupils, to assist me in examining the state of the eye. For two days we discovered no change in it; but on the third day after we began to inspect the eyes, we both perceived a preternatural dilatation of the pupils in different patients; and we seldom afterwards saw an eye in which it was wanting. In Dr. Say it was attended with squinting, a symptom which marks a high degree of a morbid affection of the brain. Had this slowness or intermission of the pulse occurred only after signs of inflammation or congestion had appeared in the brain, I should have supposed that it had been derived wholly from that cause; but I well recollect having felt it several days before I could discover the least change in the pupil of the eye. I am forced therefore to call in the operation of another cause, to assist in accounting for this state of the pulse, and this I take to be a spasmodic affection, accompanied with preternatural dilatation or contraction of the heart. Lieutaud mentions this species of pulse in several places, as occurring with an undue enlargement of this muscle. Dr. Ferriar describes a case, in which a low, irregular, intermitting and hardly perceptible pulse attended a morbid dilatation of the heart. . . . After the 10th of September this undescribable or sulky pulse became less observable, and, in proportion as the weather cooled, it disappeared. It was gradually succeeded by a pulse full, tense, quick, and as frequent as in pleurisy or rheumatism. It differed, however, from a pleuritic or rheumatic pulse, in imparting a very different sensation to the fingers. No two strokes seemed to be exactly alike. Its action was of a hobbling nature. . . . It was an alarming symptom. . . . The pulse most frequently lessened in its fulness, and became gradually weak, frequent and imperceptible before death; but I met with several cases in which it was full, active, and even tense, in the last hours of life.

“Hæmorrhages occurred in the beginning of the disorder, chiefly from the nose and uterus. Sometimes only a few drops of blood distilled from the nose. As the disease advanced, the discharges of blood became universal. They occurred from the gums, ears, stomach, bowels, and urinary passages. Drops of blood issued from the inner canthus of the left eye of Mr. Josiah Coates. Dr. Woodhouse attended a lady who bled from the holes of her ears which had been made for ear-rings. Many bled from the orifices which had been made in performing venesection, several days after they appeared to have been healed; and some from wounds in veins made in unsuccessful attempts to draw blood. These last were very troublesome, and in some cases precipitated death. . . .

“I was surprised to find so few marks of hepatic affection. I met with but two cases in which the patient could lie only on the right side. Many complained of a dull pain in the region of the liver, but very few complained of that soreness to the touch, about the pit of the stomach, which is taken notice of by authors, and which was universal in the yellow fever of 1762. In proportion as the cool weather advanced, a preternatural determination of the blood took place to the brain and lungs. Many were affected with pneumonic symptoms, and some appeared to die of sudden effusions of blood or serum in the lungs. . . . The disease seldom appeared without nausea or vomiting. In some cases they both occured for several days, or a week, before any fever took place. This was more frequently the case where the disease was taken by exhalation from the putrid coffee, than by contagion. The stomach was so extremely irritable as to reject drinks of every kind. Sometimes green or yellow bile was rejected on the first day of the disorder; but I much oftener saw it continue for two days without discharging any thing from the stomach, but the drinks which the patient had taken. If the fever in any case came on without vomiting, or if it had been checked by remedies that were ineffectual to remove it altogether, it generally appeared or returned on the 4th or 5th day of the disorder. I dreaded this symptom on those days; for, though it was not always the forerunner of death, yet it generally rendered the recovery more difficult and tedious. In some cases the vomiting was more or less constant from the beginning to the end of the disorder, whether it terminated in life or death. The vomiting which came on about the 4th or 5th day was accompanied with a burning pain in the region of the stomach. It produced great anxiety and tossing of the body from one part of the bed to another. In some cases this painful burning occured before any vomiting took place. Drinks were now rejected so suddenly as often to be discharged over the hand that lifted them to the head of the patient. The contents of the stomach were sometimes thrown up with a convulsive motion which propelled them in a stream to a great distance, and in some cases all over the clothes of the by-standers. . . . On the first and second days many puked from half a pint to nearly a quart of yellow or green bile. In four (three of whom recovered) the bile, even at this time, was black. On the 4th or 5th day a matter resembling coffee-grounds was discharged. . . . Many recovered in whom this symptom appeared. Towards the close of the disease there was a discharge of a deep or pale-coloured black matter, with flakey substances frequently swimming on the top of it.”

A quantity of grumous blood, dark coloured on the outside, was frequently discharged by vomit towards the end of the disease; and, along with all the discharges from the stomach, there was occasionally a large worm, and frequently large quantities of mucus and tough phlegm. Our author supposes the black blood and coffee-coloured matter to be different from that which constitutes the true black vomit. This last he supposes to arise in some cases from matter formed in consequence of a mortification of the stomach.

The bowels were generally costive, sometimes with extreme pain, tenesmus, and mucous and bloody discharges. Sometimes the disease came on with diarrhœa, principally in those who had weak bowels. Sometimes there was a tension of the abdomen, with pain in the lower part of it. Flatulency, chiefly in the stomach, was almost universal in the disorder throughout all its stages.

The colour and consistence of the fæces was various according to the mode of treatment the patient had undergone. Where they were spontaneous, or brought away only by gentle purgatives, their appearance was natural; but when the patient was strongly purged, they were dark-coloured, fœtid, and in large quantity. The colour was sometimes green, sometimes olive. Their fœtor was proportioned to the time they had been detained in the bowels. In one case, where tonics had been used, and the patient had no stool for several days, a purge produced such an excessively fœtid discharge, that the smell produced fainting in an old woman who attended. Their acrimony was so great that the rectum was excoriated, and an extensive inflammation sometimes produced round its extremity. In some cases the stools were as white as in the jaundice. Large round worms were frequently discharged with them.

The urine in this disease was sometimes plentiful and high-coloured, sometimes clear, and sometimes turbid; sometimes discharged with a burning pain, as in a gonorrhœa; sometimes it was suppressed; and in one case the patient voided several quarts of limpid urine just before he died.

Many were relieved on the first day by sweats, sometimes spontaneous, and sometimes produced by diluting drinks, or strong purges; sometimes of a yellow colour, and offensive smell. Sometimes they were cold, though the pulse was full at the same time. In general, however, the skin was dry, and there were but few instances of the disease terminating by sweat after the third day. In some there was a great discharge of mucus from the throat, occasioning an almost constant hawking and spitting; and those always recovered.

In this fever, as in that of Boullam, and in the true plague, people sometimes fell down suddenly in apoplexy, syncope or universal convulsions. Some had numbness and immobility of their limbs. Some had a coma (a continual sleepiness) or an obstinate wakefulness; the latter chiefly attended a state of convalescence. In some the distemper began with a violent cramp in the legs or arms. The last stage was attended with a strong hiccup, which was a very dangerous symptom, as indeed it is in all fevers. In some cases there was a deficiency of sensibility, in others too much, so that the mere motion of the limbs was attended with pain.

In this, as in the Boullam fever, the patient often manifested a considerable degree of strength, even without any delirium. One of Dr. Rush’s patients stood up before a looking-glass, and shaved himself, the day on which he died. A delirium, however, was common, alternating in some cases with the exacerbations and remissions of the fever, but in some continuing without intermission to a few hours before death. Some had maniacal symptoms, without any appearance of fever; but in many the understanding was not impaired throughout the whole course of the disease.

In this disease the pains in almost every part of the body were very distressing. In those cases, however, “where the system sunk under the violent impression of the contagion, there was little or no pain.” In other cases the patients were distressed with pains in their head, particularly affecting the eyeballs. Sometimes it extended from the back down the neck. A pain was felt in the ears, as if they were drawn together by strings. The sides, stomach, liver and bowels were all affected. A burning pain in the stomach was sometimes so excessive that the patient shrieked out violently. The back was often the seat of violent pain, which sometimes extended from the back to the thighs; and the arms and legs were sometimes affected in such a manner that one patient said his limbs felt as if scraped with a sharp instrument.

The thirst was generally moderate, but sometimes otherwise; and, when excessive thirst came on in the last stage of the disorder, it was a dangerous symptom. Water was preferred to all other drinks. The appetite for food returned much sooner in this than in other fevers, and was excessively keen. Coffee was relished in the remissions, in every stage of the disorder. Wine was disliked, but malt-liquors were agreeable. In some cases the recovery was attended with a great propensity to venery, as in the true plague, but in an inferior degree.

In some cases the disease was attended with buboes and glandular swellings. “I met with three cases (says our author) of swellings in the inguinal, two in the parotid, and one in the cervical glands: all these patients recovered without any suppuration of their swellings. They were extremely painful in one case, in which no redness or inflammation appeared. In the others there was considerable inflammation, and but little pain.

“Several cases of carbuncles, such as occur in the plague, came under my notice. They were large, hard swellings on the limbs, with a black apex, which, upon being opened, discharged a thin, dark-coloured, bloody matter. From one of these malignant sores an hæmorrhage took place, which precipitated the death of an amiable lady. A large and painful anthrax on the back succeeded a favourable issue of the fever in another patient. I met with a woman who showed me the marks of a number of small boils on her face and neck, which accompanied her fever. . . . Notwithstanding the disposition to cutaneous eruptions in this disorder, it was remarkable that blisters were much less disposed to mortify than in the common nervous fever. Such was the insensibility of the skin in some people, that blisters made no impression upon it. . . . In every case of this disorder which came under my notice, there were evident remissions or intermissions of the fever, or such symptoms as were substituted for fever.”

The yellow colour rarely appeared before the third day, and generally about the fifth or seventh day. The eyes were not always affected with this colour. Sometimes it appeared first on the neck and breast; and in one case it appeared behind the ears and on the crown of the head, which had been bald for some years. It varied in the deepness of the tint, and sometimes disappeared altogether; but, though some cases of great malignity and danger appeared without any yellowness, it was always a dangerous symptom when it appeared early. The cause of this yellowness is by our author supposed to be an absorption and mixture of the bile with the blood.

After death the body appeared of a deep yellow colour, sometimes a few minutes after death; sometimes it was purple or black; and in one case yellow above, and black below, the middle. In some it was pale, as in common diseases, and many died with a placid countenance as in natural sleep. In some the body grew cold soon after death, in others not till six hours afterwards, and in like manner stiffness occurred sometimes in one hour, in others not till six. Where evacuations had been procured, symptoms of putrescence were longer in making their appearance than in those who had used no medicines for that purpose. Many discharged large quantities of black matter from the bowels, others, of blood from the nose, mouth and bowels.

“The morbid appearances of the internal parts of the body (says the Doctor) as they appear by dissection after death, from the yellow fever, are different in different countries and in different years.” Dr. Mitchill, in his history of the yellow fever in Virginia, in 1737 and 1741, informs us, that, in a female slave of forty, the gall-bladder was outwardly of a deep yellow, but within, full of a black, ropy, coagulated atrabilis (black bile) obstructing the biliary ducts. It was so thick, that it retained its figure when the gall-bladder was opened. It more resembled bruised and mortified blood than bile, though it would stain a knife or probe of a yellow colour. Two thirds of the liver on its concave surface were of a deep black colour, and round the gall-bladder it seemed to be mortified and corrupted. A viscid bile, like that just described, was found in the duodenum near the gall-bladder. The villous coat being taken off, the other parts were found red and inflamed. The whole was lined with a thick fur or slime. The omentum was so much wasted, that nothing but its blood-vessels could be perceived. The stomach appeared to be distended or swelled, lined like the duodenum, containing a quantity of bile even blacker than that in the bladder. It was inflamed both on the outside and inside. The lungs were inflated and all full of black or livid spots; and on these spots were small blisters like those of an erysipelas or gangrene, containing a yellow humour. The blood-vessels in general were empty; only the vena portarum seemed full and distended as usual. On cutting the sound part of the liver, the lungs or the spleen, blood issued freely.

Dr. Mackittrick found the liver sphacelated, the gall-bladder full of black bile, and the veins tinged with a black fluid blood. In all cases the stomach, duodenum and ilium were remarkably inflamed. The pericardium contained a viscid yellow serum, and in larger quantity than usual. The urinary bladder a little inflamed; the lungs sound.

Dr. Hume, of Jamaica, found the liver enlarged and turgid with bile, and of a pale yellow colour; the stomach and duodenum sometimes inflamed; and, in one case, the former had black spots of the size of a crown-piece. He had seen some bodies in which there was no appearance of inflammation of the stomach, though the patients had been afflicted with excessive vomiting.

Dr. Lind’s account is given on p. [394].

Drs. Physic and Carthrall, of Philadelphia, found the brain in a natural state; the viscera of the thorax perfectly sound; the blood in the heart and veins fluid, similar in its consistence to the blood of persons who have been hanged, or destroyed by electricity. “The stomach and beginning of the duodenum are the parts that are 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 extremely 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 was of its natural colour, but very viscid.”

In others the stomach was spotted with extravasated blood; and it contained, as well as the intestines, a black liquor like that which had been vomited and purged before death. The gentlemen were of opinion that this must have been a secretion from the liver, as a fluid of the same kind was found in the gall-bladder, of such an acrid nature that it inflamed the operator’s hands, and the inflammation lasted some days. The liver was of its natural appearance, or nearly so. These dissections were made early in the season; and at that time Dr. Rush is of opinion that the disease was not attended with any congestion in the brain, though it was so afterwards; and accordingly we are informed that Dr. Annan attended a dissection at Bush-hill, in which the vessels of the brain were remarkably turgid. Dr. Rush, however, is likewise of opinion, that the morbid appearances in the brain may cease after death, as well as the suffusion of blood in the face disappears after the retreat of the blood from the extremities of the vessels in the last moments of life. “It is no new thing for morbid affections of the brain to leave either slender or no marks of disease after death. Dr. Quin has given a dissection of a child that died with all the symptoms of hydrocephalus internus, and yet nothing was distinguished in the brain but a slight turgescence of the blood-vessels. Dr. Girdlestone says, that no injury appeared in the brains of those persons who died of the symptomatic apoplexy which occurred in a spasmodic disease which he describes in the East Indies; and Mr. Clark informs us that the brain was in a natural state in every case of death from puerperal fever, notwithstanding it seemed to be affected in many cases soon after the attack of the disorder.”

With regard to the state of the blood in this distemper, Dr. Rush says, that when drawn from a vein, it was, “1. In the greatest number of cases, dense, and of a scarlet colour, without any separation into crassamentum and serum. 2. In many cases it did separate into crassamentum and yellow serum. 3. In a few cases the serum was of a natural colour. 4. There were many cases in which the blood was as sizy as in pneumony and rheumatism. 5. In some instances the blood was covered with a blue pellicle of sizy lymph, while the part which lay in the bottom of the bowl was dissolved. In two cases the lymph was mixed with green streaks. 6. It was in a few instances of a dark colour, and as fluid as molasses. Both this and the 5th kind of blood occurred chiefly where bleeding had been omitted altogether, or used too sparingly, in the beginning of the disorder. 7. In some patients the blood in the course of the disease exhibited nearly all the appearances which have been mentioned. They were varied by the time in which the blood was drawn, and by the nature and force of the remedies which had been used in the disorder.”

From this account of the different appearances of the blood, it appears to have varied at the very first attack from an healthy state, and to have gradually deviated from that state more and more, as the disease advanced. Dr. Rush says,[150] from Dr. Mitchill’s History of the Yellow Fever in Virginia, in 1741, that “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 contagion, who discovered no other symptom of the disease.” In p. 70 Dr. Rush gives his own opinion in the following words: “I shall say, hereafter, that the blood was seldom dissolved in this fever;” and p. 73, speaking particularly of the blood, he enters into an argumentation against the putrescency of that fluid. “It” (the blood) says he, “has been supposed to undergo a change from a healthy to a putrid state; and many of the symptoms which have been described, particularly the hæmorrhages and eruptions on the skin, have been ascribed to this supposed putrefaction of the blood. It would be easy to multiply arguments to prove that no such thing as putrefaction can take place in the blood; and that the symptoms which have been supposed to prove its existence are all effects of a sudden, violent and rapid inflammatory action, or pressure upon the blood-vessels; and hence the external and internal hæmorrhages. The petechiæ on the surface of the skin depend on the same cause. They are nothing but effusions of serum or red blood, from a rupture or preternatural dilatation of the capillary vessels. The smell emitted from persons affected with this disease was far from being of a putrid nature; and, if this had been the case, it would not have proved the existence of putrefaction in the blood; for a putrid smell is often discharged from the lungs, and from the pores in sweat, which is wholly unconnected with a putrid, or perhaps any other morbid, state of the blood. There are plants which discharge an odour which conveys to the nose a sensation like that of putrefaction; and yet these plants exist at the same time in a state of most healthy vegetation: nor does the early putrid smell of a body which perishes with this fever prove a putrid change to have taken place in the blood before death. All animals which die suddenly, and without loss of blood, are disposed to a speedy putrefaction. This has long been remarked in animals that have been killed after a chace, or by lightning. The poisonous air called samiel, which is described by Chardin, produces, when it destroys life, instant putrefaction. The bodies of men who die of violent passions, or after strong convulsions, or even after great muscular exertion, putrefy in a few hours after death. The healthy state of the body depends upon a certain state of arrangement in the fluids. A derangement of these fluids is the natural consequence of the violent and rapid motions, or of the undue pressure upon the solids, which have been mentioned. It occurs in every case of death from indirect debility, whether it be induced by the excessive stimulus of contagion, by the volatile vitriolic acid which is supposed to constitute the destructive samiel wind,[151] or by violent commotions excited in the body by external or internal causes. The practice among fishermen in some countries of breaking the heads of their fish as soon as they are taken out of the water, in order to retard their putrefaction, proves the truth of the explanation I have given of its cause soon after death. The sudden extinction of life in the fish prevents those convulsive or violent motions which induce sudden disorganization in their bodies. It was remarkable that putrefaction took place most speedily after death from the yellow fever, where the commotions of the system were not relieved by evacuations. In those cases where purges and bleeding had been used it was much slower. There is a fact mentioned by Dr. Ferriar, from Dr. Hamilton, late professor of anatomy at Glasgow, which may seem at first to militate against the facts I have mentioned. He says that he had observed that bodies which were brought into the dissecting room that had petechiæ on them were longer in putrefying than any others. The fevers of which the poor (the common subjects of dissection) die, are generally of the low nervous kind. Great direct debility is the characteristic of those fevers. The petechiæ which occur in them appear in the last stage of this direct debility. They are the effect, not of too much impetus in the blood, as in the yellow fever, but of a defect or total absence of it in the last hours of life. The slow progress of the body to putrefaction after death, in the instances mentioned by Dr. Hamilton, seems to depend upon the same cause as that to which I have ascribed it in those cases of death from the yellow fever in which evacuations had been used, viz. direct debility. In the former cases this slowness of putrefaction is induced by nature, in the latter by art. The effects of debility from both causes are, notwithstanding, the same.”

From this long detail, in which the author’s meaning seems rather involved in obscurity, we may gather that in the fever of 1793 the blood had no determinate appearance, but that, according to the action of the vascular system, it was sizy or otherwise. This position, which in my opinion is the meaning of the passage just now quoted, is not supported by any facts. It is mentioned indeed that the blood in some was sizy, in others quite fluid, but as the cases in which it was so are not particularly related, we do not know whether the action of the vessels was stronger in those where the blood was fluid than where it was not. Certain it is, that the blood may be made fluid by certain substances mixed with it, without any action of the vessels at all. The poison of the ticunas, as well as all other animal poisons, renders the blood fluid, yet this will kill instantaneously when injected into a vein, before the vessels have time to act in such a manner as could be supposed to change the texture of any of the fluids.[152] Or if this still will not satisfy, we are assured that the poison of serpents, as well as many other substances, which are not poisons, when mixed with the blood taken out of the body, will prevent it from coagulating. Granting, therefore, what hath not been proved, that the greater the action of the vessels, the more fluid the blood will be, yet we cannot know whether this fluidity be occasioned by the action of the vessels, or the action of the vessels by the tendency to fluidity in the blood. But it matters not which of the two is cause or effect: the question is, Whether in the yellow fever does the ultimate effort of the disease tend to produce any alteration in the texture of the blood to fluidity, or otherwise? This can be known only from considering the symptoms which take place in the last stage of the disorder, and from dissections. Now, from the concurrent testimonies of all the writers quoted in this treatise, it appears that towards the end of the disease there is such a tendency to dissolution, that the whole body seems ready to fall down into a putrid mass; or at least into what is commonly called so, whether with strict propriety of language or not, signifies little. In short, the difference between the plague and yellow fever seems to be entirely of the same kind with that taken notice of in this treatise, p.p. [269], 270, where the bile of a person dying of a malignant fever was injected into the veins of a dog. Here the blood was very fluid. In capt. Mawhood’s case (p. [385]) the blood flowed from his nose, eyes and gums, besides what he discharged by vomit. Dr. Lining (p. [389]) attests a similar tendency to dissolution in the blood in a most remarkable manner. See also Dr. Lind’s opinion to the same purpose, p. [393], Dr. Hillary’s, p. [395], Dr. Jackson’s account, p. [399], Dr. Chisholm’s, p. [411]; and lastly, Dr. Rush’s own testimony concerning the hæmorrhages from all parts, lately quoted.

As we have formerly seen, that in the plague there was no such tendency to dissolution, but rather to coagulation, in the blood, it was thence concluded that the immediate cause of the symptoms of plague is a tendency in the blood to throw out the latent heat it contains, by which means the parts on which these discharges fall, are burnt up to a kind of cinder. In the yellow fever the reverse takes place. The blood has a tendency to absorb heat, and if it does so it must of course become thinner, for this is the nature of all fluids, and indeed it is abundantly manifest that fluidity in all cases is an effect of the absorption of heat.[153] In consequence of this absorption, the body towards the latter end feels cold, the heat seems to retire from the extremities towards the vital parts, and the vessels contracting and losing their power by reason of the abstraction of sensible heat, the pulse ceases entirely some time before death. Dr. Huxham takes notice of this excessive coldness in the limbs taking place in a lady who died of a malignant fever, and likewise that an intolerable stench issued from her body for some time before her death, though kept clean with all possible care. As the plague therefore is the highest of all inflammatory diseases, so the yellow fever seems to be the highest of the malignant class.

It may be objected, however, that as hæmorrhages, petechiæ, black vomiting, and convulsions, sometimes take place in the plague, we cannot from the existence of similar symptoms in the yellow fever, conclude that they are different diseases. But, with regard to the first, it must be observed, that an hæmorrhage may ensue from a rupture of vessels as well as from an oozing of blood in consequence of an acrimonious thinness of blood. It is indeed to be questioned, except in cases where blood is discharged by the pores of the skin, whether any hæmorrhage takes place but by a rupture of vessels. In an healthy subject, hæmorrhages very frequently take place from the nose where the blood is of a very proper consistence; and Dr. Russel says that he had occasion to see hæmorrhages from the nose and uterus only; that in the advanced stages of the disease though the blood was paler and of a thinner consistence, the hæmorrhage was seldom profuse. It was, however, of very bad omen; most of the cases in which it appeared having terminated fatally.

That towards the end of this disease the blood should begin to absorb the heat which it had before thrown out, is not wonderful. A tendency to dissolution very probably does in all cases take place in a greater or lesser degree; but we have not any reason to suppose that in the true plague hæmorrhages ever are as frequent, violent, or attended with such an apparent tendency to putrefaction, as in the yellow fever, and consequently we must suppose that there is some specific difference between the state of the blood in the one disease and in the other.

Convulsions, though very frequent in the yellow fever, yet, according to Dr. Russel, were very rare attendants on the access of the pestilential fever. Even hiccup was seldom observed, and sneezing not once. However, he says that convulsive motions of the limbs were frequently observed in the course of the disease; but this is far from what Dr. Chisholm says of the Boullam fever, where the patient expired in a violent convulsive fit; or what Dr. Rush says of the fever of 1793, in which the patient sometimes fell down in universal convulsions. In short, the absence, or much less frequency, of nervous symptoms in the plague, seems to constitute another specific difference between the two.

With regard to black vomiting, it is neither peculiar to the plague nor yellow fever. Dr. Miller[154] has shown that it may be occasioned by almost any kind of acrid poison taken into the stomach. In proof of this he quotes from Sauvages the case of a man who died in consequence of taking a drachm of white arsenic instead of cream of tartar, in whose stomach was found, on dissection, a black liquor which deposited a sediment like powdered charcoal. The villous coat of the stomach was likewise abraded. For other cases of the same kind he refers to Wepfer de cicuta aquatica, Morgagni, &c. Another case of poison by arsenic occurred in New-York hospital, in which the patient had a black vomiting. In another case in which corrosive mercury was swallowed by mistake, the patient, after being to appearance in a fair way of recovery, began to vomit a dark-coloured matter, and died in a day or two. The agaricus clypeatus, a kind of poisonous mushroom, brought on bilious stools, locked jaw, vomiting, delirium, oppression of the breast, sighing, anxiety, great prostration of strength, yellowness on some parts of the skin, and death on the sixth day. On dissection the stomach was found to be inflamed, the duodenum distended with flatus, and the gall-bladder full of green and black bile.

But the principal distinctions between the plague and yellow fever seem to be the eruptive nature of the former, and the propensity in the latter to attack strangers newly arrived from colder climates; also in being more easily checked by cold than the plague. It has already been remarked from Dr. Russel, that of two thousand seven hundred patients, whose cases he noted, every one had buboes. These, however, were not all the cases he saw; for he mentions some that had no eruptions; but from this it is impossible to avoid drawing the conclusion, that eruptions are the true characteristics of the plague. Of these two thousand seven hundred, eighteen hundred and forty-one had buboes in one or both groins; five hundred and sixty-nine had them in the arm-pit; two hundred and thirty-one had parotids; four hundred and ninety, carbuncles; and seventy-four, spurious buboes. Now, in all the number of cases of fever which Dr. Rush attended in 1793, he had only two with buboes, and one parotid; and as to the carbuncles they do not answer the description of those in the former part of this work.[155] It is impossible therefore that any more clear line of distinction can be drawn between the plague and yellow fever. The following table, however, exhibiting at one view the symptoms of the plague, the yellow fever, fever of Boullam, and fever of 1793, will perhaps set this matter in a still clearer light.

From a mere inspection of the detail of symptoms in this table, the difference between the several distempers is obvious. It is evident that none of them can with any kind of propriety be called higher and lower degrees of the rest. The plague is essentially different from the other three, which seem indeed to be nearly allied; the Boullam fever being only attended with more violent and malignant symptoms. We ought now to enter into a particular inquiry concerning the origin and nature of these fevers; but, as a knowledge of this is in some measure dependent on the question, whether or not they are contagious, we shall in the first place present the reader with the following extract from a French treatise, in which the question seems to be handled in an agreeable and judicious manner, and then make another attempt, by an investigation of matter of fact, to determine whether the disease has ever been excited by imported contagion or not:

“A very important question is—whether this disease is contagious. The greater part of the American physicians are of opinion that it is, and are persuaded that it is brought from the West Indies, by the ships which arrive here in the beginning of every summer. It is even from that opinion, and on their vigorous representations, that quarantines have been established, which every vessel from the West Indies is obliged to perform during 10 and sometimes 20 days at Fort Mifflin, several miles distance from Philadelphia. This formality, so troublesome to navigation, was observed this year (1798) with more severity than ever it was; but without answering any good purpose for the vessels; for very few ships’ companies appeared taken with the yellow or putrid fever. Nevertheless the epidemic, whatever name it assumes, raged this year in Philadelphia with more fury than even in 1793. Besides, if the quarantine was a sure preservative, if almost all the ships’ crews coming from the West Indies brought the yellow fever with them, why should not Charleston, Norfolk, Alexandria, Baltimore, Boston and Salem, where no quarantines are performed, be affected with the contagion, as well as New York and Philadelphia? The American physicians are so convinced that the yellow fever is contagious, that they scrupulously prohibit persons in health from all communications with those diseased; they order frequent waterings in the streets and about the houses where the fever has manifested itself, and aromatic fumigations. They even order the clothes of those who have fallen by it to be burned, as is practised with respect to those who die with the plague. It must be confessed that their precautions, in this respect, have in some sort been justified, on seeing all the individuals of one family successively taken with it, and often at the same time, their neighbours, and so on, to a number of people who might be authorised to attribute their misfortunes only to their vicinage with the first victims.

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Characters and most remarkable Symptoms
of the
Plague, Yellow Fever, Fever of Boullam, and of Philadelphia in 1793.
(In this table the mark Do. refers to the column immediately preceding.)

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General Characters.

PLAGUE.	YELLOW FEVER.	FEVER of BOULLAM.	FEVER of PHILADELPHIA in 1793.
Known and described by ancient historians.	Not known to exist before the last century.	Supposed by Dr. Chisholm to be a kind of new disease originating in foul vessels on the coast of Africa in 1793.	Various opinions concerning it.
Attacks indiscriminately people of all nations.	Attacks principally those who change their climates, especially from cold to hot.	Do.	Attacks more generally than the common yellow fever.
Not brought on by intemperance. At least Dr. P. Russel never saw an instance.	Brought on not only by intemperance, but by slight errors in regimen.	Do.	Do.
Sometimes seems to spare the weakly and delicate, and to attack the robust.	Attacks the robust much more violently than those of a contrary description.	Attacks the intemperate and robust.	As in the yellow fever.
People sometimes struck dead as by a stroke of lightning. Sometimes fall down suddenly, but revive, and by proper management regain their health in a short time.	Not observed.	Those attacked by the disease fall down giddy and almost insensible with a profuse cold sweat.	Patient sometimes falls down in apoplexy, syncope or universal convulsions.
Death sometimes takes place without any fever or complaint; preceded only by momentary sickness, by eruptions of purple spots, or the breaking out of hard eschars in different parts of the body.	Death sometimes within twenty-four hours, but not without some previous complaints.	Do.	Do.
Irregular remissions and exacerbations.	No remission, but a cessation of one set of symptoms to make way for another.	Do.	Remissions and exacerbations.
Venereal appetite monstrously increased on recovery.	Not observed.	Do.	Venereal appetite increased but less than in the plague.

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Symptoms of the Disease in various parts of the Body, or over the whole System.

PLAGUE.	YELLOW FEVER.	FEVER of BOULLAM.	FEVER of PHILADELPHIA in 1793.
Infection sometimes begins with apparent intoxication.	Not commonly observed.	Do.	Do.
Sometimes is felt like an electric stroke.	Not observed.	Infection felt at the commencement of the disease, occasioning a nausea and rigor.	Do.
Fainting very frequent.	Do.	Do.	Do.
Convulsions rare at the beginning. Convulsive motions of the limbs not unfrequent throughout the disease.	Not commonly observed.	Convulsions sometimes very violent: the patient often expiring in a fit.	Tremors of the limbs uncommon.
Hiccup uncommon.	Hiccup extremely common.	Do.	Do.
Sudden loss of strength.	Do.	Excessive strength during the delirium.	A surprising degree of strength sometimes only a few hours before death.
Delirium at times.	Do.	Do. Sometimes constant.	Do.
Loss of speech, faltering and trembling of the tongue.	Not observed.	Do.	Do.
Coma very general.	Do.	Do.	Do.
Muddiness of the eyes, scarce to be described.	Grimness of countenance. Eyes red and heavy.	Eyes inflamed, watery, rolling and protruded.	Eyes watery, inflamed, or like balls of fire. Countenance wild and ferocious.
A solitary instance of the patient becoming green all over.	A deep yellow colour all over the body so common that the disease has one of its names from it.	The yellow colour scarcely met with.	Yellow colour very frequent.
Eruptions of the nature of eschars, sometimes small, and called tokens, pepper-corns, &c. sometimes larger, and called carbuncles, on many different parts of the body.	Never observed.	A kind of small eschars in the nose. Small black spots on the upper lip, but neither resembling the tokens or carbuncles in the plague. Carbuncles mentioned, but not described.	The carbuncles do not answer to any description of those in the plague.
Buboes in the inguinal, axillary and parotid glands exceedingly common.	Very rarely observed.	Sometimes observed, but only in fatal cases.	A very few instances.
Pulse extremely variable; disappearing entirely on pressure; often intermitting.	Pulse sometimes indistinguishable from that of a healthy person, even a short time before death. Otherwise of all possible varieties. Sometimes entirely gone a considerable time before death.	Pulse disappearing on pressure. Did not intermit even at the approach of death.	Pulse disappeared as in the plague and Boullam fever; otherwise as in the yellow fever.
Excessive uneasiness at the heart. One person died with violent palpitation.	Not observed. In the last stage the heart palpitates strongly.	Do.	Do.
Violent pain at the pit of the stomach, which could not bear the touch.	Universal in the yellow fever of 1762.	Very frequently observed.	Disease sometimes began with a pain in the stomach. A burning pain frequently accompanied the vomiting.
Hæmorrhages not very common, and only from the nose and uterus.	Hæmorrhages excessively common from every part of the body.	Do.	Do.
Vomiting of yellow, green and black matter.	Vomiting of matters of the same kind; also of matter resembling coffee grounds with flaky substances floating in it.	Do.	Do.
Stools less fœtid than in a common tertian. Dark coloured blood sometimes discharged.	Stools excessively fœtid, and in great quantity.	Do. Immense quantities of excessively fœtid blood discharged.	Stools extremely fœtid when strong evacuants had been used, otherwise the fœtor was less.
Sweats of various colours, and fœtid.	Not observed.	Not observed.	Yellow and fœtid sweats.
Sweat the natural crisis of the distemper.	No natural crisis.	Do.	Seldom terminated by sweat after the third day.

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Appearances on Dissection.

PLAGUE.	YELLOW FEVER.	FEVER of BOULLAM.	FEVER of PHILADELPHIA in 1793.
Bile of a black and greenish colour; turning quite black by the addition of spirit of nitre; a lasting grass green by adding spirit of vitriol; and of a yellow by the addition of alkalies. Heart of an extraordinary bigness; in seven cases stuffed with thick, black blood; in one, filled with a large polypus; in another the contents not mentioned. Lungs in five cases either purple, livid, or covered with spots of these colours. Liver greatly enlarged, with mortified spots in five cases. Stuffed also with thick blood. Mortifications in the brain, intestines, &c. Abscesses in two cases; one in the muscular integuments of the thorax, the other in the aorta.	Bile of a black colour, and very viscid. Stomach affected by gangrenous spots called carbuncles by Dr. Lining. Blood very fluid, and the vessels of the viscera much distended. Duodenum and other parts of the intestines mortified. Worms from putrefaction found in the stomach in six hours. Omentum and its appendages of a dark grey colour, and uncommonly dry. Liver and spleen enlarged.	Intestines mortified. Effusions of blood and serum in the brain. Liver sometimes shrunk up into half its natural size.	Bile very viscid. Congestion of blood in the brain. Blood in a fluid state. Stomach and intestines inflamed. Liver sometimes of its natural appearance.

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Fever of 1798.

Doctors Rand and Warren’s Dissections.

Case I. Patient died on the 6th day. Lungs filled with dark blood. Air vessels not distended. Large extravasation of firmly coagulated blood in the thorax. Fluid blood in the pericardium. Coronary veins extremely distended. Liver inflamed on both sides, and indurated as if boiled. Gall bladder contracted, and containing only about a quarter of an ounce of a substance resembling pitch. The secretion of bile had apparently ceased for some time. Stomach and intestines inflamed, and their veins distended. Omentum thickened and dark coloured from the swelling of its vessels. Spleen enlarged but without inflammation.

Case II. Death on the 12th day. Patient had been delirious since the 6th. Blood vessels of the brain greatly distended. An effusion of serum between the dura and pia mater. A band of coagulated lymph producing an adhesion between the two coverings of the brain, under the sagittal suture. Lungs adhered firmly to the pleura, and had several indurations of the size of a pigeon’s egg. Left lobe extremely diseased, and in a state of suppuration. Liver much enlarged and inflamed, the inside of the great lobe near the gall bladder appearing as if contused. Stomach covered on the inside with the matter of the black vomit, though the patient had no evacuation of that kind. Duodenum and small intestines much inflamed. Gall bladder full of bile, and ducts pervious. Bladder contracted to the size of a pullet’s egg, with a quantity of blood effused in it.

Case III. Death on the fourth day. Lungs inflamed on the fore part, and exceedingly stuffed with blood in the back parts. Liver inflamed, and of a very dense consistence. Gall bladder entirely obliterated; its coats forming a confused membranous substance by coalescence with the neighbouring parts. Stomach covered in the inside with the black vomit. Colon and part of the omentum inflamed. In the two cases where the gall bladder had been diseased, and the liver did not perform its functions, the patients became yellow; but not in the other, where the bile was in due quantity. In the second case the patient had previously had a pulmonary complaint.

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“Nevertheless, if this distemper was as contagious as certain physicians pretend, why should they not be the first to be taken with it; they who see, examine and touch many patients every day? Why should not those who nurse them day and night, who continually breathe those putrid miasmata; why should not those who attend the hospitals, those who daily carry 30 or 40 coffins to the grave, be taken with it? We do not hear, however, that the physicians, surgeons, nurses and sextons have enlarged the funeral list more than any other class of citizens. Some doubtless have fallen, and perhaps they owed their death to their frequent communications with the sick; but would the epidemic have spared them in any other condition, more than a number of unfortunate people who are neither physicians nor nurses?

“Another particular not less remarkable is, that the yellow fever seems hitherto to have spared the Frenchmen who have resided in the West India colonies, the greatest part of whom have nevertheless staid in New York and Philadelphia during the yellow fever, and have lived in the midst of the contagious air which proves so fatal to the Americans. The result of all this is, that, notwithstanding four years’ experience, notwithstanding the public and private researches and discussions which took place between the physicians and philosophers of the American continent, there is still much uncertainty on the nature of the distemper which so rapidly depopulates New York and Philadelphia. Every opinion, every system, presents palpable contradictions, and is liable to objections which it is difficult, not to say impossible, to answer in a satisfactory manner. If the disease be contagious, why are not the physicians, the nurses, the servants of the hospitals, taken sooner than persons who have no sort of communication with the sick?

“If it be not contagious, how happens it that the natives of every age and sex, many of which, the women and children especially, live in a pretty sober manner, and seldom drink any of those liquors so liable to inflame the blood, are taken with it, and fall, in spite of all the efforts of medicine? How happens it that the Europeans and Frenchmen who have never been in the colonies are attacked like the Americans, whilst the planters in the West Indies are spared?

“On the other hand, if, as the French physicians pretend, this is nothing else than the malignant putrid fever, often prevalent in Hispaniola, how happens it that those medicines and that mode of treatment which were so frequently successful in the colonies have no sort of success when administered to Americans, and seldom with Europeans? Why is this fever attended, in its very first stage, with vomitings of blood, bile, black spots, purples and other alarming symptoms, which they frequently have at Hispaniola? How comes it that the West India planters, who, while they resided in the colonies, had frequent attacks of putrid and often inflammatory fevers, enjoy the most blooming health ever since they have been on the American continent? And why are they not taken with those putrid and inflammatory fevers, at a time when those who have given them an asylum are the daily victims of it? Finally, if we must attribute the epidemic to no other cause than the immoderate heat of the summer, which is really greater here for two or three months than at Hispaniola, where a land and sea breeze tempers its violence, why does it not stop its ravages when the heat moderates? We have observed in the epidemics of New York and Philadelphia, that they were less destructive in the burning dog-days than in the months of September and October, when the mornings, evenings and nights begin to be cool, and even cold enough to allow people to go clothed as warmly as in winter.

“We have now a recent and striking example that it is not heat only which causes the epidemics; since there were only, in the month of September, three or four days of great heat. The rest were very cool. It may even be said that from the 22d it was cold, especially on the 28th and 29th, when a violent north wind obliged many people to have a fire. The number of deaths never were, however, so numerous as they have been since the 20th of September. The funeral list, which in July and August amounted to 40 per day, reached on the 20th of September to 78, the 22d, 68, the 23d, 71, the 24th, 63, the 25th, 80, the 26th, 77, the 27th, 96, the 28th, 106, the 29th, 76, and from the 29th at twelve o’clock, to the 1st of October, same hour, the number was 170; a number as prodigious as it is frightful: we could not therefore even flatter ourselves that the severest frosts of the end of October would dispel the epidemic, did not experience afford us that comforting hope.

“What then is the physical cause of this scourge, which all human prudence and science are unable to avert? The ministers of religion will not fail to ascribe it to celestial wrath, and to advise prayers, fast and charity to appease it. Those pious practices cannot assuredly do harm; but the philosophical observer, who does not conceive that Philadelphia and New York should have excited the Heavenly wrath more than those of other cities of the continent, will seek for more natural causes, and will examine whether they should not be attributed to some local and peculiar vice of those two unfortunate cities, and perhaps to the temperament, the diet, the mode of life, of their inhabitants. Respecting this, we do not find, in the localities of New York and Philadelphia sufficient reasons, nor in the constitutions or mode of life of their inhabitants sufficient variations, to mark them as the victims of the yellow fever, while the inhabitants [of other places] are free from it.

“I am however inclined to think that New York and Philadelphia, more than any other cities, contain causes of corruption or putridity, occasioned by their size and the extent of their commerce, which, added to the high mode of life of the Americans, may be the source of the calamity which now affects them.

“In effect, we observe that in these two cities the epidemic has constantly manifested itself in those parts which are not only the most commercial, but also where the common sinks of the city meet; where the houses, inhabited by the poorer class of people, being smaller, and more crowded together; where the stores contain most provisions liable to fermentation and putridity; where the shipping crowded in the wharfs render the water stagnant; where immense quantities of dirt and litter are brought from every quarter for the purpose of filling up new wharves and other places designed to be taken from the sea, to enlarge lands to build upon; finally, where the water used to drink does not reach the pumps of the lower part of the city until it has filtrated through the burying-grounds and privy-houses of the upper parts, most of which have no walls, and are never emptied.

“Let us add to all those causes of infection the dead dogs, cats, pigs, and rats, which are thrown into the common sinks and docks, the rotten fish, and the privies, which in several houses, especially at New York, are nothing but tubs, which are emptied weekly on the sea shore, and we shall have less reason to wonder at the putrid exhalations which issue on the eastern part of New York, and at Philadelphia on that part contiguous to the Delaware, and which are capable of infecting the whole atmosphere, and to impair the health of those who live in it. If the people who dwell in those parts are not scrupulously sober, if they frequently indulge in the use of spiritous liquors, if they feed on such food as is generally known to be unhealthy, is it to be wondered that, with such a mode of life, their blood should be more disposed to inflammation and to be dissolved and corrupted, in the midst of an air already corrupted and loaded with destructive miasmata?

“Now every man knows that those who live contiguous to the river at New York, and the Delaware at Philadelphia, mostly sailors, shipwrights, truckmen, labourers, tavernkeepers, &c. seldom trouble themselves about the quantity of their foods and drinks, but indulge copiously in the use of strong liquors, of which an astonishing consumption is made in those parts. They are not in other respects more careful as to cleanliness in their narrow and low houses. There, in a hole called a bedroom, and on a feather-bed half rotted, in a heap of rags half devoured by insects still more disgusting, two and sometimes three individuals, covered with sweat, often drunk, sleep, and still increase the filth by their shameful and dirty mode of life. Shall we find it strange that those infected haunts should shed forth in the morning a mephitic air, capable of suffocating the most robust and vigorous men? Shall we wonder that those who breathe this pestilential gaz are suddenly seized with a fever? in itself perhaps not very dangerous, if it were treated in a suitable manner. But what is their method of treating it? They do not even know the name of ptisan, still less the use of anodynes, nor that of salt of nitre, nor of camphor, so proper to prevent putridity. Punch, made with rum; water mixed with gin and molasses; a sort of soup made with Madeira wine; fish; raw oysters, &c. these are their first medicines. If their wives or friends go to consult the apothecary, he advises the castor-oil, or the famous calomel pills or powders, whose virtues the quacks extol for every disease. Finally, if the fever increases, the doctor is called, who administers a light puke of 12 or 15 grains of tartar emetic, a plenty of laudanum to procure sleep, and who, seeing the case desperate, withdraws, saying that he was called too late![156]

“Although the inhabitants of the other parts of the city who are in better circumstances follow a mode of life more regular, feed on more wholesome aliment, and are much more cleanly in their houses (except however feather-beds and lower bedrooms) it is nevertheless a fact that they are much inclined, the men especially, to eat salt meat, meat half cooked, green fruit, and still more to drink spiritous wines. Several of them allow themselves an immoderate use of the latter between dinner and tea-time, the strength of which, added to that of the high-spiced food, and liquors, must necessarily increase in their blood that fermentation already excited by the heat of the season. Now, shall we not concede that bodies thus predisposed ought to be more susceptible than others of the impression of the corrupted miasmata which are constantly exhaled from every thing that surrounds them; from the common sewers, the wharves or the docks; from the dirt and litter of the alleys and lanes; from the sulphureous bilge-water of ships; from the cellars and from the stores; in short, from those houses which contain sick, dying and dead persons?”

Here the author, after stating objections on both sides, seems at last to determine that the disease is produced by putrid effluvia. The dispute on this subject, however, hath continued so long, that we can by no means expect to settle it in this treatise. At first view one would think that nothing could be more easy than to determine whether the disease arose soon after the arrival of foreign vessels, or in places which had no connexion with maritime affairs. But when we come to particulars there is such a strange disagreement and contradiction concerning facts, that we are in every instance driven back into the wide field of theory and argumentation. One instance of this we have already had in the case of the Boullam fever said to be imported by the Hankey. Let us now try another. Dr. Currie of Philadelphia, in a letter to Mr. Wynkoop of date October 10th, 1797, says that the fever at New-York, of 1795, was proved “by unquestionable facts,” to have been introduced from Port au Prince by the brig Zephyr; and for a proof of this he refers to a letter of the health committee of New York to the governor, dated September 8th of that year. From this letter it appears that Dr. Treat visited this vessel on the 28th of July, where he found three men ill of what he called a bilious remitting fever, and the body of one who died that morning. Two days after, the Doctor was taken ill, and died in eight days, with unequivocal symptoms of yellow fever. On the 25th, four persons from on board the ship William, from Liverpool, which arrived several weeks before (the crew of which till this time had been healthy) were taken ill of fever, and died with similar symptoms in seven days. Nothing can be more direct than this evidence, yet it did not give satisfaction.

The fact was impugned by the late Dr. E. Smith, in a letter to Dr. Buel,[157] who produces such evidence as, in his opinion, “establishes it beyond a contradiction, that neither Dr. Treat nor any other person contracted a fever, such as prevailed in New York in 1795, from any sick or dead man, or any thing else connected with the vessel in question.”

The evidence brought forward is the declaration and deposition of capt. Bird. In a letter to Dr. Dingley, the captain “thinks it his duty to contradict the report” that Dr. Treat “caught the disease of which he died on board the Zephyr.” He contradicts it by a deposition, that “the mate and one mariner had the fever and ague seventeen days on shore, and came on board with the same disease; and the captain himself had a dysentery on his arrival in New York; and John Wheeler, aged 16 years, died on the day of the arrival of the brig in New York, by worms crawling up into his throat, and choking him. He was sewed up in a piece of canvass, and ready to be committed to the deep, when Dr. Treat came on board, who desired the captain to have the canvass opened, that he might inspect the body; and he only cut the canvass over the face, but did not make any other examination of the body.”

How far this proves captain Bird’s assertion, that Dr. Treat did not catch the disease on board the Zephyr, the reader will judge. It is, however, inconsistent with the plan of this treatise to enter into an examination of contradictory evidence concerning matters of fact. Accounting as nothing, therefore, all that has been said, by either party, concerning the brig Zephyr, let us proceed to other testimonies.

In a collection of facts and observations by the College of Physicians, published last year, we find the following remarkable accounts tending to prove that the disease was introduced by the ship Deborah, from Port au Prince and Jeremie in St. Domingo: 1. In a letter from Dr. Stevens to Dr. Griffiths it is stated, that “the yellow fever prevailed in almost all the sea-port towns in the French part of Hispaniola, particularly at Cape Nichola Mole, where it raged so violently that it obliged the British to abandon the post sooner than they intended. About the same time it appeared in the harbour of St. Thomas, and was so destructive to foreigners, that it obtained the name of the plague.” The Doctor saw several cases of it in St. Domingo, during the months of August and September, 1798, and “these were entirely confined to American seamen, while the native inhabitants of the city were totally exempt from it.” 2. From this very sickly coast arrived the Deborah on the eighth of July. 3. On the 12th of August John Lewis, mate of the Deborah, informed Dr. Currie, that the vessel had lost seven persons with fever on board during her passage, and one by accident; and that she had been employed as a transport in the British service previous to her taking in her cargo at Jeremie. 4. Mr. Thomas Town informed Dr. Wistar, that, on the first of August, 1798, he was told by Alexander Philips, of Water-street, that he (Mr. Philips) had brought up two or three sick people from the Deborah, in one or two boats. Some of them he had brought to his own house; and one was dead. Philips himself was sick at the same time, and died a day or two after. 5. Mr. Purdon informed Dr. Currie that he had a similar account from Mr. Philips, whom he saw on the first or second of August in apparent good health, and that he died on the Saturday following.

All this, and further evidence seemingly equally strong, was set aside with the greatest facility by bringing counter-evidence, particularly that of Mrs. Philips, who denied that there were any sick people in the house; and by bringing instances of the fever existing in town before the vessel arrived. It is needless therefore to trouble the reader with any further discussion of this evidence more than the rest. As the ancient Britons, in their letter to Aetius, lamented that the barbarians drove them to the sea, and the sea drove them back to the barbarians, so may we lament, in the present investigation, that the uncertainty of theory drives us to facts, and the uncertainty of supposed facts drives us to theory. Still, however, we shall not despair. The introduction of a disease into a large city is much more difficult to be traced than in a smaller one. In the year 1794 the disease appeared in the town of New Haven in Connecticut. Dr. Monson of that place informs us, that it appeared on the 10th of June, when Mrs. Gorham, residing on the Long wharf, was visited by Dr. Hotchkiss, who found her affected with symptoms of the yellow fever. In three days her complaints suddenly vanished, and she was supposed to be in a fair way of recovery, but the same evening she vomited matter resembling coffee-grounds, and died next day. On the same day that Mrs. Gorham died, Dr. Monson visited her niece, a girl of eight years of age, who had staid a week with her aunt, and was taken ill three days before. The day after the Doctor saw her she was suddenly relieved as her aunt had been, but in a few hours vomited matter like coffee-grounds, and died next day. These and some other similar cases having alarmed the select men, inquiry was made, when “it appeared, that, in the beginning of June, capt. Truman arrived from Martinico, in a sloop that was infected with the contagion of the yellow fever; that this vessel lay at the wharf, within a few rods of Mrs. Gorham’s residence; that she had on board a chest of clothes which had belonged to a mariner who died of the yellow fever in Martinico; and that his chest was carried into Mr. Austin’s store, and opened in presence of Capt. Truman, Mr. Austin, Henry Hubbard, and Polly Gorham: the three last died in a short time after their exposure to the contents of the chest. Hence it is highly probable that Mrs. Gorham caught the disease from the infected sloop or clothing. Mr. Austin’s store stands within three or four rods of Mr. Gorham’s house; and no person in town was known to have the yellow fever previous to capt. Truman’s arrival.”

In his further account of this fever Dr. Monson shows that it was contagious in the highest degree, and that Mr. Gorham’s house proved a kind of seminary from whence the disease spread itself. “June 26 (says he) Isaac Gorham lost an infant child with the yellow fever; and soon after his son and daughter were affected with it: the former died. Solomon Mudge died on the 30th; Jacob Thomson’s negro woman on the 1st of July; Archibald McNeil on the 9th; Polly Brown on the 3d of August; John Storer, jun. and John Hide, on the 8th; and widow Thomson on the 10th. Jacob Thomson’s negro woman, Solomon Mudge, John Storer, jun. and John Hide, had visited Mr. Gorham’s house a few days before their illness; Polly Brown and Mrs. Thomson nursed in Mr. Gorham’s family; and Archibald McNeil nursed Solomon Mudge. Elias Gill died on the 12th of August, and Samuel Griswold’s wife on the 7th: the former visited Mr. Gorham’s house, the latter nursed in his family.

“There were a number of persons who caught the disease at Mr. Gorham’s house, and recovered.

“Mrs. Thomson, on the first day of her illness, was moved half a mile from Mr. Gorham’s, into George-street. Luther Fitch caught the disease from Mrs. Thomson, and communicated it to his servant maid. Both recovered. Mr. Fitch lives in College-street, nearly three quarters of a mile distant from Mr. Gorham’s house. I could trace the disease throughout the town. No person had the yellow fever unless in consequence of attending the sick, or of being exposed by nurses, infected houses, clothing, or furniture.

“I have inquired of several aged persons in this town relative to the yellow fever, whether they knew of its having ever been here previous to June 1794, and there is but a single instance; the facts relating to which are these: In the year 1743 a transient person, by the name of Nevins, who came from the West Indies, lodged at the house of Nathaniel Brown, an inn-keeper in this city. The man was taken very sick in the night, and died shortly afterwards; and his body was very yellow after death. Mr. Brown’s wife sickened in a short time, and died of the same complaint, which was at that time supposed to be the yellow fever.

“I am credibly informed that several persons at Mill-river, in Fairfield county, and also at New London, died with the yellow fever in August and September, 1795. It was propagated there by infected persons from New York.

“Capt. John Smith died in this town, the 20th of August, 1795. He caught the disease in New York, and communicated it to one of his negro servants.”

On the whole, Dr. Monson concludes, “that the yellow fever is seldom or never generated in this country, and that it is always imported from abroad. An objection to the idea of its being generated in this country is, that it was never known in the interior of this state, or of the United States, so far as I can learn. Had it ever appeared in Connecticut before the year 1743, and June 1794, we should undoubtedly have had some record of the fact. There is no such record, and no person remembers to have heard of such a disease, but at these periods, prevailing in any part of the state. There are numbers of aged persons in New Haven who remember the putrid ulcerous sore throat, small pox, measles, dysentery, &c. raging here with great mortality, but have no recollection of any yellow fever. Hence we may rationally conclude that it never did appear in this state but in the years 1743 and 1794.

“It is evident, from facts before mentioned in this letter, that the yellow fever was propagated in no other way than by contagion, and that this is a specific contagion, and no more diversified, in its operation on the human system, than that of the small pox and measles.

“If the citizens of large commercial cities were attentive in tracing the origin of the yellow fever, on its first appearing among them, they would often find that the disease was imported. In some instances it would be extremely difficult to discover the origin. But the mischief lies in this; that the inhabitants of such cities, whenever a contagious disease makes its appearance among them, endeavour to suppress all rumour of it, from an apprehension of alarming the country, and injuring their commerce; unwilling to believe that there is evil in the city, till the disease spreads in every direction. Then, indeed, when it is too late, they are solicitous in the use of means to arrest its progress. As it extends itself slowly at first, seasonable exertion might both detect its source, and prevent its increase; but when it is diffused through a city, it spreads with rapidity, and it is no longer possible to discover where it began. But as, whenever the yellow fever has appeared in the United States, it has always been in sea-port towns, and originated near wharves, docks, and warehouses, there seems to be high probability that the disease is imported.”

The evidence here seems so strong, that no counter-evidence that can be brought appears likely to invalidate it. The coincidence of the commencement of the fever with the arrival of the ship hath not been denied, as in other cases; and, though it has been attempted to prove that a fever might have arisen from the quantity of putrid or putrescent matters at that time in the town, yet the circumstances of those who were present at the opening of the chest of clothes being taken with the fever, and those who were sick of it in so many cases infecting one another, cannot by any means be overthrown. But the fact is, that even those who contend most violently against importation, do yet allow that it may in some cases be so; but they contend that if proper care be taken it will not spread. Dr. Smith in his letter to Dr. Buel says, “that infection may be brought into any place from abroad; that, under certain circumstances of the place where it is introduced, it becomes very destructive; but that, when these circumstances do not exist, however the person immediately affected, if it be introduced by a sick person, may suffer, it is harmless so far as the general health of that place is concerned. If the subject were viewed in this light, as most assuredly it ought to be, the question of importation or non-importation would sink into its merited insignificance.” But, with due respect to the memory of Dr. Smith, this must surely be accounted a very inconsiderate mode of reasoning. In the instance he speaks of, that of the Zephyr lately mentioned, he allows that Dr. Treat might have caught the disease on board the vessel,[158] “but (says he) as no other person is known to have been infected by that vessel, and as the Doctor communicated it to no person, the advocates for importation would not be greatly benefited by the concession.” Surely we must look upon the life of Dr. Treat himself to have been a matter not entirely insignificant, and if he caught the fever by going on board, a number of others who went in full confidence of the impossibility of importation, might have done the same. As far therefore as the prevention of such accidents can be accounted a matter of importance, it is also of importance to believe the doctrine of imported contagion. It is true, Dr. Smith, in the passage just quoted, adds immediately after, that “no such concession (with regard to Dr. Treat) is necessary;” but, in p. [104], he does make an ample concession, as we have seen, viz. that the contagion may not only be imported, but, under certain circumstances, be very active and destructive. The question therefore rests here: Can we at all times promise that, with the utmost care that can be taken, the circumstances of a place may not be such as to give activity to an imported contagion? In the nature of things it is impossible that the docks, wharves, streets and alleys of a large town can be absolutely clean. It is equally impossible that all men can be advised to be temperate, cleanly, and neat in their lodgings; and we are unable to determine how far people may deviate from the rule of right in those respects without danger. Before any theory of this kind could be supported, it would be absolutely necessary to bring an unequivocal proof that yellow fever had been in one instance at least produced by local causes; but this cannot be done. Among the Hottentots, the dirtiest people in the world, no such disease exists. Among the peasants of Poland, who likewise live in a very dirty manner, their mode of life is said to produce not a fever, but a disease of the hair, called the plica Polonica. In the Medical Repository, vol. i, p. 276, Dr. Mitchill of New York describes a disease called elephantiasis, liktraa, or scurvy, occasioned by loathsome, putrefying diet, such as rotten fish, fish-livers and roe, fat and train of whales and sea-dogs, congealed sour milk, with little or no vegetable provisions, and by exposure to wet and cold. This disease prevails in Iceland, in the Ferro islands, in two districts of Sweden, and in Madeira; yet this disease is not the yellow fever, though it is said to make the person afflicted with it more like “a putrefying corpse than a living man.” The cold seems to be assigned as a reason why the disease does not assume a febrile form; but, however this may hold with Iceland, it cannot with Sweden, where the summer is so hot, that the sun has been said to set forests on fire. This is probably a fable; but we are assured by Pontoppiddan, in his Natural History of Norway, a country to the full as cold as Sweden, that in summer the heat is very great. His expression is, that it is enough to “make a raven gape.” As to Madeira, where the climate is warm, there can be no such objection. But a particularity of this disease is, that it is infectious. Supposing then that by any means it should be exalted into a fever, have we any reason to imagine that in such a case it would lay aside its infectious property? Surely not. If this then is the case with a disease produced by the same causes with the yellow fever, we have the very same reason to suppose that the latter is infectious, as that the former would be so if it could lay aside its present form, and assume that of fever. Another proof that mere dirtiness cannot at all times produce a distemper, or even propagate its infection, may be deduced from the sixth case quoted p. [355] from Dr. Russel, where he says that a poor Jewish family lived in a place such as he had always considered as one of the receptacles of contagion, yet only one in six of those who remained in it was taken with the plague. In all cases of plague, or of violent epidemic disorders, it has indeed been observed that the poor were more subject to an attack than the rich. This was so remarkable in the plague of London in 1665 that Dr. Hodges says it was called the poor’s plague; and Dr. Ferriar tells us from Diemerbroeck, that in some parts of Italy it was customary in the beginning of a pestilence to drive out the poor; and likewise that this cruel expedient was used at Marseilles. The bad success of the experiment at this last place, however, shows that people of any description, and in any circumstances, may be attacked. A very probable cause, entirely distinct from any mode of living, may be assigned in this case, viz. that the poor are more exposed to infection than others, both from their circumstances and their rashness; for it will be evident to those who converse with the most uninformed people of any country, that the Turkish notion of predestination is far from being confined to Mahometans. It is not, however, denied, that dirtiness, as well as other local causes, may do much hurt, and occasion the spreading of a disease which otherwise would not spread; because uncleanness of all kinds seems to be the proper vehicle of infection, in which it appears to delight to take up its abode. In the Medical Extracts, vol. ii, p. 174, we have from Goldsmith the following anecdote concerning the concentration of pestilential infection in the plague of London:

“A pious and learned schoolmaster, who ventured to stay in the city during the plague, and took upon himself the humane office of visiting the sick and dying who had been deserted by better physicians, averred, that, being once called to a poor woman, who had buried her children of the plague, he found the room where she lay so little, that it could scarce hold the bed on which she was stretched. However, in this wretched abode, beside her, in an open coffin, her husband lay, who had some time before died of the distemper, and whom she soon followed. What shewed the peculiar malignity of the air, thus suffering from human miasmata or effluvia, was, that the contagious steams had produced spots on the very wall of their wretched apartment. And Mr. Boyle’s own study, which was contiguous to a pest-house, was also spotted in the same frightful manner.” This shows not how infection may be produced, but how it may be concentrated in such miserable apartments. The appearance on the walls brings to remembrance what is said in the book of Leviticus concerning the appearance of the leprosy in walls and clothes.

But, supposing we should allow that dirtiness may bring on a yellow fever (and it is plain that this cannot be proved) we have, in the case of the Busbridge Indiaman, a demonstration that cleanliness cannot keep it off.[159] This vessel sailed from England for the East Indies, in the year 1792, much about the same time that the Hankey sailed for the coast of Africa. She had on board 264 people in all, viz. 109 belonging to the ship’s company, 130 recruits, and 25 passengers. She had very boisterous weather at first setting out, but crossed the equator on the 26th of May, where the weather was sultry, with heavy showers of rain. The disease now made its appearance first among the recruits, and in a fortnight spread among the ship’s company. It was common for six or seven to be attacked with it daily from the commencement; “and in the space of twelve weeks almost every person in the ship not only had laboured under it, but many had suffered repeated relapses.” For several weeks the weather was hot and sultry; but, when in the vicinity of the Cape of Good Hope, they experienced a reverse, and were driven by a storm as high as S. lat. 42. Here the thermometer indicated a temperature only 13° above frost, but no material change in the disease took place. Afterwards, when returning into the warm latitudes, they experienced the sultry heats of the Atlantic without any change either for the better or the worse, and this for no less a space than three months.

As to the origin of the disease, Mr. Bryce the surgeon, though inclined to ascribe it to contagion, could not trace it to any origin of that kind, as the vessel had been six weeks at sea before it appeared. It “could not be ascribed to want of air or cleanliness, as every possible attention had been used to preserve these: the different apartments were thoroughly cleaned and fumigated with wetted gun-powder; the decks were sprinkled with boiling vinegar; and the windsails were attentively kept in order at each hatchway. Mr. Bryce is inclined to conjecture that a peculiar combination in the circumstances of diet, situation, and state of the atmosphere, may have given rise to this calamity. But the same combination of circumstances so frequently takes place without any fever, that it appears much more probable the disease had its origin either from an imported fomes, or from a fomes generated in some individual in the ship, from whence it was afterwards propagated to others by contagion.” The disease produced on board the ship was not contagious to the people on board another vessel with whom they had communication, nor to the people ashore among whom the convalescents were put, nor to new passengers taken on board the vessel in the East Indies; circumstances certainly not a little surprising.

It doth not therefore appear, that, without the intervention of some other cause, mere dirtiness can produce the yellow fever. Let us next see what can be done by confinement, want of air, or, as it has been lately called, abstraction of oxygen. On this, however, we must observe, that in all cases where people are allowed to breathe, their lungs must be filled with the due quantity of some elastic fluid. If the fluid they breathe contains a smaller quantity of oxygen, it must contain a greater quantity of something else. If a disease therefore is produced, it must be occasioned by the presence of that other fluid, as well as by the absence of oxygen. Now, in confined air, we know that not only the oxygen is diminished, and consequently a larger proportion of azote or septon mixed with it, but in addition to this increased proportion of azote, there is also a positive augmentation of the deleterious part of the atmosphere by the effluvia from the bodies of those who are confined. These effluvia, as we have seen, p. [90], contain a great quantity of fixed air. Others have shown that they contain also azote; and it may be so; but still we are sure that the fixed air predominates. Besides this, from the breath we know that a great quantity of aqueous moisture proceeds. Experiments on the action of these different kinds of fluids are yet in an imperfect state, yet some important facts relating to them are known. 1. Oxygen breathed in great proportion produces an augmentation of heat, and proves an universal stimulant. See p. 118. By itself it quickens the pulse.[160] 2. Pure fixed air breathed by itself destroys life with the circumstances of increased heat, rarefaction of the blood, and rupture of the vessels. See p. [206]. 3. The circumstances attending death by breathing azote are not particularly recorded; but we know that by breathing an atmosphere lowered by it the consumptive fever is not increased, but diminished; and there is an account in the Medical Annals of a person who was perfectly cured of a consumption by the smell of the bilge-water of a ship. 4. It has formerly been shown, from Dr. Black’s experiments, that, when the vapour of water is condensed in the body, a great quantity of heat must be thus communicated to it. In confined air therefore there is a diminution of the oxygen which produces heat; but there is an augmentation of the fixed air and of the aqueous moisture which increases it; so that, on the whole, the balance must be considered as in favour of the augmentation of heat in the human body; not to mention the quantity of sensible heat continually added to the atmosphere by that which evaporates from the body. This position, however, doth not stand upon the uncertain ground of theory; it is confirmed by the following remarkable fact: Commodore Billings, who commanded a Russian expedition fitted out by the late empress, found, in his travels through the northeastern part of Asia, that the cold of the atmosphere exceeded not only what was known in other climates, but even what most people had been able to produce by freezing mixtures. Dr. Guthrie informs us that he was unable to produce a greater degree of cold than 36 below 0 of Reaumur, though assisted by 20 below 0 of natural cold, and the power of all the freezing mixtures he knew. “How much then (says he) was I surprised to hear Mr. Billings assert, that some spirit thermometers which he had with him, graduated according to Reaumur’s scale, were often as low as 40° below the freezing point of water, that is, 8 deg. below the freezing point of mercury. And once or twice he observed them at 42 deg. below the freezing point of quicksilver.[161]

“During this severe cold (probably 42 below 0 of Fahrenheit) the Nomade Tchutski (a wandering nation on the northeastern extremity of the Asiatic continent) who were conducting him along the coast of the Frozen ocean, in sledges drawn by rein-deer, encamped every night on the frozen snow in low tents, which they quickly formed with the skins of rein-deer, spreading some of them on the surface of the snow, on which they all slept; and he assured me, that, so far from suffering from cold during the night, the heat was so excessive in these fur tents, where from ten to fifteen slept together, according to its dimensions, that no one could bear even a shirt; but all lay in a violent perspiration, naked as they were born, till dawn of day, without the aid of fire, excepting a train-oil lamp, which lighted each tent.”

From this account it seems pretty evident, that, by the accumulation of animal effluvia, a heat may be communicated to the atmosphere greater than that of the human body. We cannot suppose the heat of the tent which put the people in a violent perspiration to have been less than 90° of Fahrenheit; and, supposing the temperature of the external atmosphere to have been at a medium 30° below 0, there must have been a generation of 120 degrees of heat; but the heat of the human body does not exceed 97 degrees, and it cannot communicate more heat than it has. But we must suppose the tents to have been capable, had they been filled to the top, of containing twice the number who did sleep in them. They could communicate to the air therefore only one half of 97 degrees, or 48 1/2°; the remaining 71 1/2° therefore must been derived from the breath and perspiration of the body.[162]

Let us now attend to the consequences which must naturally and undeniably follow from this fact. If, in such a violently cold climate, the effluvia of fifteen human bodies could produce a heat sufficient to induce a violent perspiration, what would they not have done had they been in a climate where the heat of the atmosphere was upwards of an hundred degrees greater, or between 70 and 80 above 0 of Fahrenheit? Perhaps this was never thoroughly tried except in the black hole at Calcutta. Here an hundred and forty-six men and one woman were enclosed in a dungeon only 18 feet square, and consequently affording scarce eighteen inches square to each. This happened in a very hot climate, in the month of June; so that we cannot suppose the temperature to have been less than 80° of Fahrenheit.

On being confined in this manner, the vital powers endeavoured, by a most profuse perspiration, to send off the superfluous quantity of heat thrown into the body. This was exactly what took place with Dr. Guthrie; but, in the case of the black hole, there was, besides the quantity of heat produced by the warmth and perspiration of the body, an hundred and ten degrees more to be added, on account of the natural heat of the atmosphere. For we cannot suppose the heat at Calcutta, in a sultry evening in the month of June, to have been less than 80, which added to –30, supposed to be the temperature among the Tchutski, makes 110°. The perspiration was extremely profuse, and was soon accompanied with excessive thirst; nature being unable to supply such a quantity of liquid, or this liquid to carry off the heat from the body. The want of pure air began then to be felt by a difficulty of breathing; and Mr. Holwell, having in despair retired from the window, found the difficulty of breathing increase, attended by a palpitation of the heart. Aroused by his sufferings, he returned and was relieved by drinking some water, and having air at the window. The difficulty of breathing diminished, and the palpitation ceased; but, finding the thirst not to be quenched by water, he sucked his shirt-sleeves, which were wet with sweat, and endeavoured as much as possible to catch all of it that he could. The taste was soft and agreeable. A pungent steam was now felt like spirit of hartshorn. A number had died, and Mr. Holwell, once more rendered desperate, retired from the window, and lay down upon a bench, where he soon lost all sense. Next morning only 23 survived, of whom Mr. Holwell was one. He revived on being brought out to the fresh air, but was instantly seized with a putrid fever, as well as all the rest of the survivors. In this situation they were obliged to walk, loaded with fetters, to the Indian camp; at night they were exposed to a severe rain, and the day following to a sultry sun; yet, notwithstanding this ill treatment, they all recovered; having an eruption of large and painful boils all over the body. Mr. Holwell, however, said that he never afterwards enjoyed good health.

Another melancholy proof of the bad consequences resulting from a want of fresh air we have in the evidence given by Dr. Trotter, when the question concerning the slave trade was agitated before the British House of Commons. He deposed that the slaves were confined 16 hours out of 24, and permitted no exercise while on deck. They were kept in rooms from 5 to 6 feet high, imperfectly aired by gratings above, and small scuttles in the sides of the ship, which could be of no use at sea. The temperature of these rooms was often above 96 of Fahrenheit, and the Doctor says that he never could breathe in them, unless just under the hatch-way. “I have often (says he) observed the slaves drawing their breath with all the laborious and anxious efforts for life which are observed in expiring animals subjected by experiment to foul air, or in the exhausted receiver of an air-pump. I have often seen them, when the tarpaulings have been inadvertently thrown over the gratings, attempting to heave them up, crying out, in their own language, ‘We are suffocated!’ Many I have seen dead, who, the night before, had shown no signs of indisposition; some also in a dying state, and, if not brought up quickly on the deck, irrecoverably lost. Hence, in one ship, before her arrival in the West Indies, out of 650 slaves, more than 50 had died, and about 300 were tainted with the sea scurvy.”

A third example of the effects of want of air, though conjoined with other causes, may be reckoned the case of the Hankey, formerly related. The people there were not indeed confined as much as in the black hole, but it is impossible to suppose that there could be a proper circulation of air, and the length of time the passengers were confined might be equivalent to the violence of the cause in the case of the black hole. In the latter, however, the disease produced was not the yellow fever, but seems to have been a kind of non-descript eruptive one, more resembling the small pox, or rather Job’s disease, than any other. From Dr. Chisholm’s account of the Boullam fever also, it seems to have been more of an eruptive nature than the common yellow fever; so much, that Dr. Chisholm is of opinion that it partook “in no small degree of the nature of the true plague.” He says that in it he “did not observe carbuncles on any who died; but that in many who recovered they were numerous, large, and very troublesome.” He considered them also as a critical discharge, and the only one in this fever; but in the plague they certainly are not; neither is it at all probable that they were of the same nature with the pestilential carbuncles.

In p. [207] of this treatise it is inferred, from some experiments of Dr. Davidson and Dr. Chisholm, that the fevers in warm climates are not owing to a deficiency of oxygen in the atmosphere; but in a treatise on the yellow fever in Dominica by Dr. Clarke, we have other experiments, which, if they can be depended upon, certainly overthrow that doctrine, or at least render it very dubious. Dr. Clarke endeavoured to ascertain the purity of the air by Mr. Scheele’s apparatus, and which was likewise used by Dr. Davidson, viz. filling gallipots with flowers of sulphur and iron filings well mixed and moistened, and putting these upon a stand under a glass vessel, which was placed on a stool in a pail of water. The glass vessel was marked and divided on the outside, and, allowance being made for the space occupied by the gallipot, the water rose only one fifth in the glass vessel, after standing 24 hours. When the disease abated, it rose near one fourth; and upon many trials afterwards it never rose above one fourth. When the emigrants fled towards the mountains, where the air is very pure, they always avoided an attack of fever, or soon recovered if in a convalescent state. This is similar to what is stated by Van Swieten concerning the plague at Oczakow, viz. that the atmosphere was so loaded with some kind of vapour, that in certain parts of the town polished sword-blades were turned black. This seems to have indicated a great prevalence of inflammable or hepatic air, or both, in the atmosphere; but it is extremely doubtful whether this could produce a fever, much less the true plague. In Dr. Clarke’s experiments it were to be wished that he had examined the nature of that part of the atmosphere which was left after the absorption of the oxygen. It is by no means probable that at any rate the addition of a fifth part of azote could have rendered the air so unwholesome; and besides, we are entirely at a loss whence to derive such an immense quantity; for certainly the quantity of air which surrounds us, even for a few miles extent, is so great, that any considerable alteration in its composition could not take place without a very evident cause. The probability therefore is, that the experiments did not give an accurate statement of the quantity of oxygen contained in the atmosphere. Experiments on this subject must always be uncertain; and of all the modes of trying the qualities of the air, perhaps that with sulphur and iron filings is most liable to variation. It may vary, from the nature of the sulphur,[163] from the cleanness or the impurity of the iron filings, or lastly from the accuracy of the mixture. It is also a misfortune in this case, that though a great absorption proves the existence of a large quantity of oxygen in the atmosphere, yet a small one does not prove the contrary; for it is more reasonable to suppose that we have failed in our experiment, than that the constitution of the atmosphere has changed. Dr. Clarke’s experiments therefore cannot prove any thing, until more accurate methods of investigating these things be found out.

We must now proceed to investigate a third cause assigned for the production of fever, and that is the putrefaction of animal and vegetable substances. This hath been very much insisted on. Dr. Rush ascribes the fever of 1793 to the exhalations of putrid coffee, but allows also the distemper to have been contagious, and says, that “for several weeks there were two sources of infection, viz. exhalation and contagion. The exhalation infected at the distance of three or four hundred yards, while the contagion infected only across the streets. The more narrow the street, the more certainly the contagion infected. Few escaped it in alleys. After the 15th of September the atmosphere of every street was loaded with contagion; and there were few citizens in apparent good health, who did not exhibit one or more of the following marks of it in their bodies: 1. Yellowness in the eyes, and sallow colour on the skin. 2. Preternatural quickness in the pulse. 3. Frequent and copious discharges by the skin of yellow sweats. 4. A scanty discharge of high-coloured or turbid urine. 5. A deficiency of appetite, or a preternatural increase of it. 6. Costiveness. 7. Wakefulness. 8, Head-Ach. 9. A preternatural dilatation of the pupils. . . . Many country people who spent but a few hours in the streets in the day, in attending the markets, caught the disease, and sickened and died after they returned home; and many 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.”

Thus, according to our author, the fever of 1793 began from putrid effluvia, and was continued by contagion. But many attempts have been made to prove that putrid effluvia alone both begin and continue it. The limits of this treatise would not allow (even were it but beginning) of a particular account of all that has been said upon the subject; neither indeed is it needful. A single well attested instance would decide the matter; but we have already seen the difficulty of procuring that instance on either side. Certain it is, that we have instances of the yellow fever arising where it is not pretended that there was any considerable collection of putrid matters. In the Medical Repository, vol. ii, p. 149, we find an account of the yellow fever appearing “in a country village, near a fresh river, on low marshy ground, seven miles from Portland, so that no suspicion could arise of the disease being imported. Several other cases of yellow fever occurred in different parts of the country.” This stands on the authority of Dr. Jeremiah Barker of Portland, so that there can be no doubt of its authenticity; and though it cannot prove that the yellow fever may not arise from putrid effluvia, yet it certainly shows that it may arise without them. It does the same with marsh effluvia; for though we may, in the case of the village, suppose that the marshy ground on which it stands occasioned the disease there, yet what shall we assign as the cause of its being dispersed in different parts of the country, where there were neither marshes nor rotten beef? The proofs indeed of animal effluvia being the cause of yellow fever are so equivocal, that Dr. Davidson[164] supposes putrid vegetable matters to be more active in this way than the former. For this supposition he gives as a reason, that Dr. Rush has observed, that butchers, and those who lived in the neighbourhood of shambles, scavengers, grave diggers, and others of similar employments, escaped the yellow fever in Philadelphia. These, the Doctor justly observes, were more exposed to what he calls the gazeous oxyd of azote, than any other class; and he likewise takes notice, that sailors, who during long voyages feed on putrescent food, which might be supposed to produce a great quantity of this acid, are thence subject to scurvy, a disease not only different from fever, but entirely opposite to it. This exemption of people conversant among the dead has been also taken notice of by Dr. Mitchill,[165] who brings as an argument against the contagious nature of the disease, that “seven men belonging to the alms-house of New York were employed, during the whole of the sickly season of 1798, in putting the persons dead of the plague (yellow fever) into coffins, and though they handled in the course of their service upwards of five hundred corpses, in different stages of putrefaction, and though they were much incommoded with the pestilential quality of the air in the rooms they entered, and frequently were obliged to vomit, not one of them was so much indisposed, during the whole season, as to discontinue his employment.” This is no doubt a very remarkable fact, but in the present instance it proves too much; for if, from it, we conclude that the disease is not contagious, we must also conclude that it cannot be produced by putrid animal substances. Yet in the very next sentence Dr. Mitchill assures Dr. Currie, “that exhalations from corrupting beef and fish have excited sickness as malignant, and as deadly, as any which has occurred.” If exhalations from putrefying beef and fish have produced this sickness, why did not exhalations from putrefying human bodies do the same? and if we are assured that the latter did not, we have as little reason to suppose that the former did; unless we establish a difference between the corrupting flesh of one animal and of another, which no experience hath countenanced in the least.

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 declare[167] (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]