“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.
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.)
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. |
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. |