Medical Inquiries and Observations, Vol. 4 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

2. In the construction of cities, narrow streets and alleys should be carefully avoided. Deep lots should be reserved for yards and gardens for all the houses, and subterraneous passages should be dug to convey, when practicable, to running water, the contents of privies, and the foul water of kitchens. In cities that are wholly supplied with fresh water by pipes from neighbouring springs or rivers, all the evils from privies might be prevented by digging them so deep as to connect them with water. Great advantages, it has been suggested, would arise in the construction of cities, from leaving open squares, equal in number and size to those which are covered with houses. The light and dark squares of a chequer-board might serve as models for the execution of such a plan. The city of London, which had been afflicted nearly every year for above half a century by the plague, has never been visited by it since the year 1666. In that memorable year, while the inhabitants were venting their execrations upon a harmless bale of silks imported from Holland, as the vehicle of the seeds of their late mortal epidemic, Heaven kindly pointed out, and removed its cause, by permitting a fire to destroy whole streets and lanes of small wooden buildings, which had been the reservoirs of filth for centuries, and thereby the sources of all the plagues of that city[22]. Those streets and lanes were to London, what Water-street and Farmer's-row are to Philadelphia, Fell's-point to Baltimore, the slips and docks to New-York, and Water-street to the town of Norfolk.

3. Where the different forms of summer and autumnal disease arise from marsh exhalations, they should be destroyed by drains, by wells communicating with their subterraneous springs, or by cultivating upon them certain grasses, which form a kind of mat over the soil, and, when none of these modes of destroying them is practicable, by overflowing them with water.

I have met with many excellent quotations from a work upon this part of our subject, by Tozzetti, an Italian physician, from which, I have no doubt, much useful information might be obtained. The Rev. Thomas Hall, to whom I made an unsuccessful application for this work, speaks of it, in his answer to my letter, in the following terms. “It is in such high estimation, that the late emperor Leopold, when grand duke of Tuscany, caused it to be re-printed at his own expence, and presented it to his friends. The consequence of this was, it influenced the owners of low marshy grounds, in the neighbourhood of the river Arno, to drain and cultivate them, and thereby rendered the abode of noxious air, and malignant fevers, a terrestrial paradise.”

4. The summer and autumnal diseases of our country have often followed the erection of mill-dams. They may easily be obviated by surrounding those receptacles of water with trees, which prevent the sun's acting upon their shores, so as to exhale miasmata from them. Trees planted upon the sides of creeks and rivers, near a house, serve the same salutary purpose.

5. It has often been observed, that families enjoy good health, for many years, in the swamps of Delaware and North-Carolina, while they are in their natural state, but that sickness always follows the action of the rays of the sun upon the moist surface of the earth, after they are cleared. For this reason, the cultivation of a country should always follow the cutting down of its timber, in order to prevent the new ground becoming, by its exhalations, a source of disease.

6. In commercial cities, no vessel that arrives with a cargo of putrescent articles should ever be suffered to approach a wharf, before the air that has been confined in her hold has been discharged. The same thing should be done after the arrival of a vessel from a distant or hot country, though her cargo be not capable of putrefaction, for air acquires a morbid quality by stagnating contiguous to wood, under circumstances formerly mentioned.

All these modes of removing the causes of malignant and yellow fevers, and of promoting strict and universal cleanliness, are of more consequence in the middle and northern states of America, than in countries uniformly warm, inasmuch as the disease may be taken as often as our inhabitants are exposed to its sources. In the West-Indies, a second attack of the yellow fever is prevented by the insensibility induced upon the system, by its being constantly exposed to the impressions of heat and exhalation. After a seasoning, as it is called, or a residence of two or three years in those islands, the miasmata affect the old settlers, as they do the natives, only with mild remittents. Nearly the same thing takes place at Madras, in the East-Indies, where, Dr. Clark says, the exhalations which bring on bilious fevers, colic, cholera, and spasmodic affections in new comers, produce a puking in the morning, only in old residents. But very different is the condition of the inhabitants of the middle and northern states of America, in whom the winters prevent the acquisition of habits of insensibility to the heat and exhalations of the previous summers, and thus place them every year in the condition of new comers in the West and East-Indies, or of persons who have spent two or three years in a cold climate. This circumstance increases the danger of depopulation from our malignant epidemics, and should produce corresponding exertions to prevent them.

In enumerating the various means of preventing and exterminating the malignant forms of fever, it may appear strange that I have said nothing of the efficacy of quarantines for that purpose. Did I believe these pages would be read only by the citizens of Pennsylvania, I would do homage to their prejudices, by passing over this subject by a respectful and melancholy silence; but as it is probable they will fall into the hands of physicians and citizens of other states, I feel myself under an obligation to declare, that I believe quarantines are of no efficacy in preventing the yellow fever, in any other way than by excluding the unwholesome air that is generated in the holds of ships, which may be done as easily in a single day, as in weeks or months. They originated in error, and have been kept up by a supine and traditional faith in the opinions and conduct of our ancestors in medicine. Millions of dollars have been wasted by them. From their influence, the commerce, agriculture, and manufactures of our country have suffered for many years. But this is not all. Thousands of lives have been sacrificed, by that faith in their efficacy, which has led to the neglect of domestic cleanliness. Distressing as these evils are, still greater have originated from them; for a belief in the contagious nature of the yellow fever, which is so solemnly enforced by the execution of quarantine laws, has demoralized our citizens. It has, in many instances, extinguished friendship, annihilated religion, and violated the sacraments of nature, by resisting even the loud and vehement cries of filial and parental blood.

While I thus deny the yellow fever to be the offspring of a specific contagion, and of course incapable of being imported so as to become an epidemic in any country, I shall admit presently, that the excretions of a patient in this disease may, by confinement, become so acrid as to produce, under circumstances to be mentioned hereafter, a similar disease in a person, but from this person it cannot be communicated, if he possess only the common advantages of pure air and cleanliness. To enforce a quarantine law, therefore, under such a contingent circumstance, and at the expence of such a profusion of blessings as have been mentioned, is to imitate the conduct of the man, who, in attempting to kill a fly upon his child's forehead, knocked out its brains.

From the detail that has been given of the sources of malignant fevers, and of the means of preventing them, it is evident that they do not exist by an unchangeable law of nature, and that Heaven has surrendered every part of the globe to man, in a state capable of being inhabited, and enjoyed. The facts that have been mentioned show further, the connection of health and longevity, with the reason and labour of man.