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

by Benjamin Rush

It has been said, exultingly, that the opinion of the importation of the yellow fever is of great antiquity in our country, and that it has lately been admitted by the most respectable physicians in Britain and France, and sanctioned by the laws of several of the governments in Europe. Had antiquity, numbers, rank, and power been just arguments in favour of existing opinions, a thousand truths would have perished in their birth, which have diffused light and happiness over every part of our globe. In favour of the ancient and general belief of the importation of the yellow fever, there are several obvious reasons. The idea is produced by a single act of the mind. It requires neither comparison nor reasoning to adopt it, and therefore accords with the natural indolence of man. It, moreover, flatters his avarice and pride, by throwing the origin of a mortal disease from his property and country. The principle of thus referring the origin of the evils of life from ourselves to others is universal. It began in paradise, and has ever since been an essential feature in the character of our species. It has constantly led individuals and nations to consider loathsome and dangerous diseases as of foreign extraction. The venereal disease and the leprosy have no native country, if we believe all the authors who have written upon them. Prosper Alpinus derives the plagues of Cairo from Syria, and the physicians of Alexandria import them from Smyrna or Constantinople. The yellow fever is said to have been first brought from Siam (where there are proofs it never existed) to the West-Indies, whence it is believed to be imported into the cities of the United States. From them, Frenchmen and Spaniards say it has been re-shipped, directly or indirectly, to St. Domingo, Havanna, Malaga, Cadiz, and other parts of the world. Weak and absurd credulity! the causes of the ferocious and mortal disease which we thus thrust from our respective ports, like the sin of Cain, “lie exclusively at our own doors.”

Lastly, it has been asserted, if we admit the yellow fever to be an indigenous disease of our cities, we shall destroy their commerce, and the value of property in them, by disseminating a belief, that the cause of our disease is fixed in our climate, and that it is out of the power of human means to remove it. The reverse of this supposition is true. If it be an imported disease, our case is without a remedy; for if, with all the advantages of quarantine laws enforced by severe penalties, and executed in the most despotic manner, the disease has existed annually, in most of our cities, as an epidemic, or in sporadic cases, ever since the year 1791, it will be in vain to expect, from similar measures, a future exemption from it. Nothing but a belief in its domestic origin, and the adoption of means founded upon that belief, can restore the character of our climate, and save our commercial cities from destruction. Those means are cheap, practicable, and certain. They have succeeded, as I shall say presently, in other countries.

From the account that has been given of the different ways in which this disease is communicated from one person to another, and from the facts which establish its propagation exclusively through the medium of the atmosphere, when it becomes epidemic, we may explain several things which belong to its history, that are inexplicable upon the principle of its specific contagion.

1. We learn the reason why, in some instances, the fever does not spread from a person who sickens or dies at sea, who had carried the seeds of it in his body from a sickly shore. It is because no febrile miasmata exist in the bodies of the rest of the crew to be excited into action by any peculiar smell from the disease, or by fear or fatigue, and because no morbid excretions are generated by the person who dies. The fever which prevailed on board the Nottingham East-Indiaman, in the year 1766, affected those forty men only, who had slept on shore on the island of Joanna twenty days before. Had the whole crew been on shore, the disease would probably have affected them all, and been ascribed to contagion generated by the first persons who were confined by it[45]. A Danish ship, in the year 1768, sent twelve of her crew on shore for water. They were all seized after their return to the ship with malignant fever, and died without infecting any person on board, and from the same causes which preserved the crew of the Nottingham Indiaman[46].

2. We learn the reason why the disease sometimes spreads through a whole ship's crew, apparently from one or more affected persons. It is either because they have been confined to small and close berths by bad weather, or because the fever has been protracted to a typhus or chronic state, or because the bodies of the whole crew are impregnated with morbid miasmata, and thus predisposed to have the disease excited in the manner that has been mentioned. In the last way it was excited in most of the crew of the United States frigate, in the Delaware, opposite to the city of Philadelphia, in the year 1797. It appears to have spread, from a similar cause, from a few sailors, on board the Grenville Indiaman, after touching at Batavia. The whole crew had been predisposed to the disease by inhaling the noxious air of that island.

The same reasons account for the fever expiring in a healthy village or country; also for its spreading when carried to those towns which are seated upon creeks or rivers, and in the neighbourhood of marsh exhalations. It has uniformly perished in the high and healthy village of Germantown, when carried from Philadelphia, and has three times appeared to be contagious near the muddy shores of the creeks which flow through Wilmington and Chester.

3. From the facts that have been mentioned, we are taught to disbelieve the possibility of the disease being imported in the masts and sails of a ship, by a contagious matter secreted by a sailor who may have sickened or died on board her, on a passage from a West-India island. The death in most of the cases supposed to be imported, in this way, occurs within a few days after the ship leaves her West-India port, or within a few days after her arrival. In the former case, the disease is derived from West-India miasmata; in the latter, it is derived, as was before remarked, either from the foul air of the hold of the ship, or of the dock or wharf to which the ship is moored.

Many other facts might be adduced to show the yellow fever not to be an imported disease. It has often prevailed among the Indians remote from the sea coast, and many hundred cases of it have occurred, since the year 1793, on the inland waters of the United States, from the Hudson and Susquehannah, to the rivers of the Mississippi. In South-America, Baron Humboldt assured me, it is every where believed to be an endemic of that country.

These simple and connected facts, in which all the physicians in the United States who derive the yellow fever from domestic causes have agreed, will receive fresh support by comparing them with the different and contrary opinions of the physicians who maintain its importation. Some of them have asserted it to be a specific disease, and derived it from the East and West-Indies; others derive it from Beulam, on the coast of Africa; a third sect have called it a ship fever; a fourth have ascribed it to a mixture of imported contagion with the foul air of our cities; while a fifth, who believed it to be imported in 1793, have supposed it to be the offspring of a contagion left by the disease of that year, revived by the heat of our summers, and disseminated, ever since, through the different cities of our country. The number of these opinions, clearly proves, that no one of them is tenable.