Y-~t
--^V***
YELLOW  OR MALIGNANT BILIOUS FEVER
IN THE VICINITY OF
SOUTH STREET WHARF,
PHILADELPHIA, 1853.
[READ BEFORE THE COLLEGE OF PHYSICIANS AUG. % AND SEPT. 7,18SI.]
WITH AN  APPENDIX.
BY
          WILSON JEWELL, M.D.,
MEMBER OF TIIE AMERICAN MEDICAL ASSOCIATION; PENNSYLVANIA STATE MEDICAL SOCIETY; FELLOW OF THE
        COLLEGE OF PHYSICIANS; MEMBER OF THE BOARD OF HEALTH, ETC.
X°fT^
          PHILADELPHIA:
T. K. AND P. G. COLLINS, PRINTERS.
                1853. 
» 
YELLOW OR MALIGNANT  BILIOUS  FEVER

                     IN THE VICINITY OF

      SOUTH   STREET  ¥HARF.

         [Read before the College of Physicians Aug. §,1851]
  During the past month (July) our usually healthy city was
thrown into a state of great excitement, from a suspicion that yel-
low fever, with its fearful concomitants, threatened once more,
after an absence of the third of a century, to find a " local habita-
tion and a name" in our midst.
  A careful  investigation into the circumstances giving rise to
this alarm, has resulted in the development of the following racts,
having a direct bearing upon the origin and history of this much
dreaded visitation:—
  On the 25th of June last, the barque Mandarin, Capt. R. N.
Campbell, sailed from Cienfuegos, Cuba, for this  port, all in good
health, with a cargo  of  sugar,  molasses, and cigars.   Her crew
consisted of  twelve men.  On arriving at the Lazaretto, July 12,
after a passage of seventeen days, she was visited by the officers at
the station, and, on oath, the captain reported "cases of smallpox
and  fever" at Cienfuegos when he  left.   That he had lost  two
of his crew on  the passage with fever.   The statement of the
Lazaretto physician is, that " the crew, numbering ten souls, were
examined and proved to be in good health; notwithstanding this,
it was considered prudent that the barque should be detained
until thoroughly ventilated,  cleansed, and fumigated; the bedding
and  clothing of the deceased sailors were destroyed, the  vessel
whitewashed and fumigated in every part with  chloride of lime, 
4
the bedding of the crew aired, and their clothing washed; she was
detained an entire day;  and, before  being allowed to proceed  to
the city, all on board were separately and minutely examined; all
hands were on duty, and apparently free from disease.  The cap-
tain spent a portion of the day on shore, and before being per-
mitted  up, declared on  oath that 'all on board were in good
health,' and that no sickness, except that resulting in the death of
the two seamen, had occurred during the voyage."
   On the evening of the  13th, the Mandarin reached the city, and
came to at South Street Wharf.  On the 16th she was hauled
up to the lower side of the first pier below Lombard  Street, where
she  discharged  her cargo.  The  crew having  been  previously
discharged, the captain and mate remained  by her,  sleeping on
board.  On Wednesday morning, July 20, seven days after her
arrival,  she dropped down to the lower side of the first pier above
Almond Street  (her several  positions  being designated in the
accompanying diagram), where she remained until the 26th, when
she was  removed by order of the Board of Health to the cove
below the Navy Yard,  from whence, on  the 28th, she was  re-
manded  to the Lazaretto, in order to undergo a more  rigid and
thorough purification.
   There was  no development of disease of a malignant type in
the%icinity of where this  vessel lay, as far as has been ascertained
(and the strictest inquiry has been instituted by Dr. Gilbert, the
Port Physician,  to whose politeness we are indebted for many of
the facts here recorded), either before or during  the time of dis-
charging her cargo, and it is still  to be made known that any of
her sailors, or any of  the  laborers employed in removing her
cargo, have since been sick.
   There appears to have  been no cause for alarm until the cargo
was out of the vessel, when it was noticed that  a very offensive
smell proceeded from her hold.  After she dropped down to the
pier at Almond  Street Wharf, on  Wednesday morning, the 20th,
the stench became intolerable, especially whenever the pumps
agitated  the bilge-water,  contained under the limber planks or
flooring of the hold.
   The first case of suspicious fever which  occurred in the neigh-
borhood was on Tuesday, the 19th of July, the day bolbre the
Mandarin left her position at Lombard Street  for Almond Street 
5
wharf—Joseph Sharp, a young man, eighteen years of age, who
drove a furniture car, and whose stand was on the  upper side of
South  Street wharf.   This case proved fatal on the 26th, seven
days after the inception of the disease.  He died at the corner of
Almond  and Swanson Streets.
   The next case was that of Capt. George Robinson, of the British
brig Effort, which vessel  lay in the Lombard Street dock, next
above  the pier  where the Mandarin  discharged.  Capt. R. slept
on board his brig, but took his meals at the Champion House,
kept by Mr.  Charles Koehler, near the N. W. corner  of South
Street  and Delaware Avenue.  He sickened on Wednesday, the
20th, and died at the Champion House, on Saturday, the 23d, at
3  P.M.
   On the evening of the  same day, the 20th, Mr. Koehler's son,
aged nineteen, a ship-carpenter, who passed daily along the wharf
in going to and from his business, took sick, and died on the 27th,
at his father's, the Champion House, where he boarded.
   G. W. Kerkeslager, who kept the Red  Bank Ferry House, on
the S.  W. corner of South Street  and the Delaware or Wharf
Street, was the  next victim.  He was taken on the afternoon of
Wednesday, the 20th,  and died on  the  25th.  His wife, Mrs.
Kerkeslager, was taken on the  same evening, the  20th,  and died
on the 26th.
   Charles Burrows, the second mate of the barque Mazeppa, lying
on the north  side of the  pier first below Lombard Street, where
the Mandarin discharged her  cargo, sickened on Wednesday eve-
ning, the 20th,* was removed  to the  Pennsylvania Hospital on
the 22d,  and died the same night.
   Frederick H. Kellog, mate of the Mandarin, was taken sick on
Thursday, the 21st.  On  the  23d,  was removed to the Pennsyl-
vania Hospital, and died the following day.
   The next one attacked was  Fanny Martin, a maid-servant at
Mr. Koehler's, Champion House.  She sickened on Thursday, the
21st, and died on  the evening of Tuesday, the 26th.   On the
same  day, another son of Mr. Koehler,  aged  seventeen, and a
daughter, aged nine, both took sick of the fever, but recovered in
a few days.
  * The account given by Burrows, at the hospital, was that he sickened on the
17th, but the above date was procured by Dr. Gilbert at his boarding-house, and is
no doubt correct. 
'6
  Honora Stanton, residing at No. 16 Little Water Street, above
South, was taken sick on Friday, the 22d, and died on the 27th.
  Silas Green, a laboring man, at No. 21 Little Water Street, took
sick on Saturday, the 23d.   This man  came from the country on
Wednesday, where he had been for several weeks.  On Thursday
and Friday evenings he had visited the  avenue, and sat for an
hour or more on the wharf at Almond Street, where the Mandarin
lay.  He was not sensible of any bad smell.   Recovered.
  Capt. R. N. Campbell, of  the Mandarin, took sick on Friday,
the 23d,  and was removed  to  Mr. Clement's  Hotel, Delaware
Avenue, between South and  Lombard Streets.  Recovered.
  On the  25th, John Shellcott, steward, and John White, mate of
the brig Effort, already alluded to, were taken sick on board that
vessel, lying  at  Lombard  Street  dock.   On the 27th, they were
removed to the Pennsylvania Hospital, where John Shellcott died
on  the 30th;  but John White recovered.
  Capt. David Murray, of the brig Reform, lying on the north
side of the pier above Almond Street wharf, where the Mandarin
lay last (see diagram), was  taken sick on the 26th, and on  the
29th entered the Pennsylvania Hospital.  On the 1st inst. he was
doing well.   Recovered.
  James  Markley, another  of the crew  of the Effort, was taken
sick on the 27th, removed to the hospital on the 29th, and August
1 was reported doing well.   Recovered.
  A man about fifty years  of age died  on the night of the 27th
of  July, at No. 8 Little Water Street,  said to have been with yel-
low fever; but, upon strict  inquiry, there is not a doubt but that
his death was from  typhoid fever, caused by intemperance  and
exposure.
   Between the 19th and the 27th of the month  (July), there were
other cases of sickness in the neighborhood of South Street and
the avenue, but those above enumerated are all the deaths that
are known to have taken place, and all the  eases of  disease, as far
as  could be ascertained, that bore any resemblance  to fever of a
 malignant grade.
    The following are the pathognomonic symptoms exhibited in
 several of the cases of yellow fever and furnished to Dr. Gilbert
 and the writer by the physicians in attendance.
    Jos.  Sharp, a>t. 18, sickened 19th,  died 26th  July.   Fever 
7
 without remission until end of third day; then prostration, with-
 out reaction;  sallow skin and eye.
.   Capt. Geo. Robinson, of brig Effort, taken with fever 20th; died
 23d.  Fever without remission for thirty-six hours, then prostration
 without reaction; black vomit, hemorrhage from mucous surfaces,
 and bronzed color of skin.
   G. W. Kerkeslager,  sickened 20th, died 25th.   Excruciating
 pain in loins; fever without remission for three days, when pulse
 became natural and sank;  black vomit, and sallowness of con-
 junctiva.
   Wife of last  case, sickened  two  hours  after, and  died twenty
 hours after her husband.  Symptoms the  same, except no  black
 vomit.
   I.  D. Koehler,  aged 19, sickened 20th, died  27th.  Pain  in
 loins; no remission of fever until end of third day;  yellow skin,
 black vomit, hemorrhage  from mucous membranes.
   Fanny  Martin at Koehler's, sickened 22d, died 26th.  Symp-
 toms same as last case, except the yellow skin.
   J. M. G. Koehler, aged  17, taken 21st;  and Pauline, daughter,
 aged 9, taken same evening.  Febrile excitement of the same
 character as the others; abatement on third day,  followed by re-
 action and recovery.
   Case of Honora Stanton.  Could not discover any symptoms of
 yellow fever in the account of this case as given by the husband,
 family, and neighbors, nor did her  body after death present any
 symptoms favorable to  such a view.  The certificate of her phy-
 sician, Dr. Gegan, said bilious fever, although  the  doctor insisted
 upon it that she had black vomit.
   Silas Green, taken on the 23d.  Fever without intermission for
 several days, with vomiting of bilious  matter, and considerable
gastric distress;  intense pain in the head, back, and limbs;  fever
abated on the 26th, and recovery was rapid.
   Capt. R. N. Campbell was attacked on the 23d.  Symptoms were
accompanied by headache;  fever without  remission  for several
days;  nausea, without  vomiting;  was convalescent on the 27th.
   We are not advised that  the treatment in the above  cases
differed particularly from the usual  method pursued in our ordi-
nary bilious fevers, unless by the  early introduction of decided
doses of quinia in several  of them. 
8
  Of the cases treated in the hospital, Dr. Gerhard has furnished
the following very brief but emphatic report:—

  "Dear  Doctor: I inclose  you a  list  of cases of yellow fever '
admitted into the hospital; two of them were from vessels from
Cuba, the  others  were  from the English brig Effort, lying near
the Mandarin, and one from the Reform, lying in the same neigh-
borhood.
  "Two of the fatal  cases came into  the hospital dying; one had
black vomit, the other had  the same  black secretion contained in
his stomach.   The steward of the  Effort had  abundant black
vomit in the last twelve hours of his life.  These cases have all
been genuine yellow fever,  bearing no resemblance  to any other
variety of febrile diseases.
  " The examination after death, in the three cases, gave us nothing
but the usual lesions; that is, the peculiar yellowish hue of the
liver, coupled, generally, with a little gastritis and a slight enlarge-
ment of the spleen.
  "All of them had a yellowish hue, and one was exceedingly
jaundiced.  The treatment  we adopted was quinia in large doses,
together with cupping in some cases.
  "Striking out the  two cases that  came in  dying, we have lost
one out of four."

  Before  the arrival of the  Mandarin, and up to the  19th of
July, the day on which the first case of fever occurred, the vicinity
of South Street and the wharf, as well as the  entire city, enjoyed
its usual degree  of  health. Certain it is, that no epidemic was
prevalent.  For the week  ending  July 9, the deaths in the city
and liberties were 229, and only one  death from fever of a bilious
type.  For the week  ending July  16,  there were 206 deaths,
including one from intermittent fever. For the week ending July
23, there were 218 deaths, of which four were from  fever. Three
of these were in children; one was recorded fever, one bilious, one
congestive, and one remittent.
   As yet, no one with whom we have conversed has ventured to
intimate a doubt as to the agency of some uncommon and virulent
poison, diffused through the atmosphere, as the pestilential cause
of the  malignant or yellow fever, a few cases  of which have made
their appearance recently in the vicinity of South Street wharf. 
9
  The essential character and origin of this poison may afford an
opportunity for the speculative inquirer to  indulge anew, either
in an effort  to demolish some favorite, though long established,
yet not the less false theory of the origin of malaria;  or to build
upon the ruins of theories, once accredited as ingenious and popu-
lar, some more modern system of causation, which, as we advance
in medical  science, may be destined to meet the fate of those
which have preceded it, however elaborately and industriously they
may have been exemplified and sustained.
  But, while we  leave the discussion of this subject to others, it
will not, we conceive, be questioned, when all the facts are clearly
and minutely examined into, that this poison, whatever may be
the nature of its  character, must in part be  ascribed to a morbid
effluvia generated under  the limber planks in the hold  of the
barque Mandarin, from the putrescent  state  of her bilge-water.
   Upon the first glance at the  Mandarin, and the history of her
voyage previous to her arrival at Philadelphia, the advocates for
a contagious germ for yellow fever, or, in other words, a principle
emanating from the sick, and capable of being conveyed from one
person to another, as the focus for the fever  which has threatened
our city, may imagine they have discovered another  instance in
support of their favorite theory.   This, however, we are per-
suaded, can hardly be the case, although we are desirous that a
careful review of the  facts connected with this  ill-fated vessel
should speak for itself.
   The Mandarin left  Cienfuegos on  the 25th of June, with a
healthy crew.  No epidemic was prevailing there when she sailed,
although the captain, on oath, admits  that a "few cases of small-
pox and fever" did exist.  He states that his crew lived on board
the barque while in port, anchored off the town, were seldom on
shore, and, as far aPhis  knowledge extended, none of them had
visited among the sick.
   The captain admits that the hold of his  vessel had often been
in  a foul condition, as all vessels were that carried cargoes  of
sugar and molasses.  Eight days out from Cienfuegos, July  3, one
of the seamen sickened with fever, and died on the 7th.  On the
ninth day at  sea, July 4, another took sick with  fever, and died
 on the 9th, being the fifth day of his  illness.  This last man was
thrown overboard after  the vessel was within the capes of the
 Delaware. 
10
  On the 12th of July, seventeen days from the time of leaving
Cienfuegos, she hoisted a whiff on approaching the Lazaretto, for
a visit from the doctor.   She remained at the station one day, to
undergo a certain amount of cleansing, as a precautionary measure
only, there being at the time no sickness on board.
  On the 13th, she was permitted up, and at Lombard  Street
wharf proceeded to unload.  The seamen were discharged, and,
up to this date, we are yet to learn of any one of the eight having
had any  sickness; nor can we ascertain that any of those who
worked on board, during the time of her discharging cargo, have
either died or sickened.
  Not a case of fever, supposed to have had its origin from the
malaria arising out of the foul condition of the bilge-water of the
Mandarin, occurred  until the 19th of July, six days after  her
arrival, and not until subsequently to the cargo being discharged.
  All the cases of fever known to have taken  place  up  to  this
date, August 3, seventeen in  number, and in the vicinity of the
Mandarin, occurred between the 19th and 27th of July.  Of these
eleven, nearly  two-thirds, died.
  The poison appeared to be most active between the 19th  and
22d.  During  this interval, twelve cases were  reported,  and of
these ten died.
  Of the seventeen  cases recorded, we have no direct evidence of
the existence of black vomit but in eight, and all of these perished.
  On the  20th of  July, the Mandarin was warped down to
Almond Street wharf, below  South Street, about three hundred
yards from her berth at Lombard Street.
  All the cases that have occurred up to this date,  either resided
in, or did business in the vicinity of South Street wharf, nor  is it
known that any case originated  below, or south  of  where the
vessel had been last moored, nor has any cme  come within our
knowledge north of Lombard Street.
  The prevailing winds during the week ending the 27th, varied
from north-north-east to south-east and  south, while the average
gauge of the thermometer was 79£°.
  From all the facts above  recited, we may be warranted in draw-
ing the following conclusions:—
  1. That no disease of a malignant type was  prevailing in our
city previous to the arrival  of the Mandarin. 
11
  2. That none of the seamen  discharged from the Mandarin
have sickened.
  3. That none of the laborers employed  in unloading the Man-
darin have taken the disease.
  4. That the fever did not develop itself until after the cargo was
discharged;  when, it is believed, the noxious emanations which
had been latent in the  hold, under the limbers of the vessel, had
an opportunity (acted upon by certain exciting causes, as heat and
moisture) to disseminate itself, and,  coming into contact with other
elements of decomposition existing on  shore and in the docks,
soon  poisoned the atmosphere  of the immediate neighborhood
where the barque lay moored.
  5. That in no instance can  the  disease be traced to any indi-
vidual, except among those who either visited or resided in the
immediate vicinity of South and Lombard Street Wharves.
  6. In no case has the disease been communicated to any person
visiting, or engaged in attendance upon the sick.
  7. Up to this period, not  a single instance  can be met with,
having its origin to the south of where the Mandarin lay last.
                     [Read September 7,185!.]

  Since our communication of August 3, read before the College,
on  the subject of yellow fever in this city, we have  come into
possession of some additional particulars, and a number  of new
cases that are well authenticated, and beg leave to submit them
for  your consideration.
  On the  26th of July, as already stated  in our first communica-
tion, the barque Mandarin, by order of the Board of Health, was
taken in  charge by the health  officer,  Wm. McGlensey,  Esq.,
who put  on  board of her a crew of five men,  including the
watchman.  These men remained on  board from the  26th up to
the 29th of July, when she was safely anchored inside the island
of Little Tinicum, opposite  the Lazaretto, and placed in charge
of the quarantine master.  Neither the health officer  nor any of
his  men, nor did the watchman who remained on board until after
her purification and return to the city, experience an hour's sick-
ness. 
12
  While at the Lazaretto, where she remained from  the 29th of
July to the 2d of August, several of her limber planks were re-
moved, but no mud or other collection of filth was  found con-
cealed there.   She was then scuttled and filled with water, which
remained in her twenty-four hours.   The holes were then plugged
up, and  the water pumped out.  After  this operation, she was
thoroughly whitewashed, and in every  part of her  chloride of
lime was freely distributed.  During this process, the quarantine
master, with several of the  barge-men at the station, were on
board and at work in the hold, cabin, and other parts of the ves-
sel for several hours during each day—the weather  excessively
hot, without any inconvenience to their health.
  On her return to the city, the 3d of August, she was moored
at Noble Street wharf, Northern Liberties, where she remained
until near the close of the month; then was removed to the screw:
dock, Kensington, for repairs;  and, on the 6th  of the present'
month, was taking in cargo between Arch and Race Streets, pre-
paratory to a voyage for New Orleans.
  No sickness whatever has followed in her track, since she left
Almond Street wharf on the 26th of last July.
  The population within the district where the disease first ap-
peared, and where it seems to have  been almost  altogether  con-
fined, is by no means crowded.  Many  of the  houses,  however,
were  filthy in the extreme, with dirty yards, and full and foul.
privies.
  The docks  along  the Delaware line, between Lombard  and
Almond Streets, as usual, contain large accumulations of offen-
sive mud and other filth.
  Upon the authority of a highly respectable shipwright, who, in
his official capacity, very  carefully  examined the Mandarin, we
learn that her pumps are so constructed as to render it impossible
to remove all the water in  her hold.  Being  a  tight vessel, the
bilge-water remaining in her will smell in a very few days after
pumping her clean.   His language is: "If you draw those pumps
every five minutes in the day, there must remain in her twelve
inches of water.  My opinion is, that the pumps do not go down
low enough;  they do not  go down within twelve  inches of the
keel, whereas  they ought to be at least eight inches lower."
   We present this fact in evidence of the impure state of the hold 
13
 of  the Mandarin, six days after she was  pumped clean at the
 Lazaretto.
   In addition, however, to the  prevalence  of the morbific atmo-
 sphere which we have clearly  shown developed itself on board
 the Mandarin—but not until  her  cargo  was discharged—and
 which so sensibly affected  individuals on approaching her when
 she lay at Almond Street wharf, we must not for a moment con-
 ceal the  existing causes in the immediate vicinity of South Street
 wharf, sufficient to  justify the supposition of their agency, in the
 development of  disease of a malignant type, when subjected to
 the high thermometrical  influence which  prevailed throughout
 the months of June and July.   Not the least mischievous of these
 causes in the production of an unhealthy atmosphere,  was the
 outlet of the sewer into the dock at  South Street ferry, belching
 forth continually putrid masses of animal and vegetable filth,
 accumulating around its mouth, and exposed at low water to the
 rays of the sun, exhaling streams of unwholesome and poisonous
 gases into the  surrounding air.  Besides this  agent, there was a
 most foul wharf at the upper side of South Street; a filthy avenue,
 between Lombard and South Streets, without any properly-con-
 structed surface drainage; numerous damp and confined cellars
 subject to an occasional overflow by the ebbing and flowing of
 the tide-water  of the  Delaware; and various minor causes  that
 might properly be  added  to the above category, fruitful in the
 production of atmospherical changes injurious to health.
   In summing up, however, there is one prominent feature in the
 chain of our narrative that must not be passed  by without notice,
 viz.:—
  No yellow fever existed in  our city until six days after the
 arrival of the Mandarin; that it broke out immediately abreast of
 the wharf where she  first hauled to, and, although there were
 existing  causes in the vicinity—on shore—for the production of
 disease, there were  "plague  spots" in other parts of our  city, re-
 mote from  South Street wharf, where, had the question been
 asked, we should have unhesitatingly located the first appearance
 of fever  of a malignant type, independent of the suspected exist-
 ence of a foreign focus of infection, competent to exercise its mor-
bific influence on an atmosphere already tainted.
  In presenting the above, it is proper  to  say that we are influ- 
14
enced solely by a desire to arrive at the true cause for the origin
of the yellow fever in our city.  That we are no blind adherent
to any favorite theory for the spontaneous or domestic origin of
yellow fever, nor yet an uncompromising opponent of those who
advocate the doctrine of a contagious principle, capable of being
carried about from place to place, and, under a train of favorable
circumstances, productive  of disease.  An honest inquirer after
truth, we would  disguise no fact, that might tend in any way to
elucidate a question so intricate, that for years it has been contro-
verted by the  ablest pens in our profession, and yet  remains a
mystery.
  In our first account of this disease, we narrated briefly the his-
tory of seventeen cases, bringing them down to July 27, and gave
the pathognomonic symptoms of several of  them as far as they
could be obtained.  Since then,  we have collected twenty-seven
additional cases, that may be relied upon, and presenting, in all
respects, the evidences of genuine yellow fever.
  The accompanying table embraces the entire list, in their nu-
merical  order, since July 19, including the name, age,  sex, place
of birth, where the  disease was  contracted,  the  date of attack,
where attended, by whom, the duration  of the disease, those that
were  accompanied with black vomit, those  that  died, and those
that recovered.
  From  this table we  learn that 9 of the cases were  under 20
years of age; 18 between 20 and 30; 10 between 30 and 40; and
7 over 40.
  Twenty-five were  males and nineteen females.  Of  the whole
number, twenty were born in Ireland, four in  Germany, five in
England, and fifteen in the United States.
  Thirty-seven of these cases may be traced directly to  the in-
fected district.  In four, the  origin is doubtful,  and in  three, no
clew could be had as to where the disease was contracted.
  Of the forty-four cases, thirty-four died.   The mean duration
of the disease in those who died was  four days; not  including,
however, Dr. Jackson's  case, No. 23, and that of James Genton,
No. 30.  The former was protracted  until the fourteenth, and the
latter to the twelfth day.
  In  twenty-six of the  forty-four cases  recorded, there occurred
the peculiar dark-colored  "coffee-grounds'1 ejection  from the sto- 
15
mach, known  as black  vomit*  This  substance,  when placed
within  the  field of the microscope, exhibited the true blood-cor-
puscles, denoting its  sanguineous character, with the exception
of that in  Ellen Parr's case, No. 35, examined by  Prof. Gilbert,
whose  testimony disproves its  identity with  blood,  and conse-
quently throws  a doubt  on  the genuineness of the  case.   This
patient recovered, and was one  of the two instances of recovery
where the black vomit was said  to have occurred.
   In eleven of the thirty-four deaths a post-mortem was made; in
all of which the yellow or  ochre-colored liver was  detected in
whole or in part.  In all of them the " coffee-grounds" fluid, or
melsenic blood, was found, either in the stomach  or intestines, with
other evidences of a pernicious form of fever.
   The mortality, according to the table, has been fearful; equal to
80 per  cent., or 5 to 1 of recoveries.!
   The sixteenth case in the table;}: was Rosanna  McKean, a native
of Ireland,  a patient of Dr. William  H. Hooper, and  residing at
No. 172J South Second Street.   From her own account, she had
made a visit on Monday, three days previous to Dr.  Hooper's see-
ing  her, to  the corner of South  and Water Streets,  next door to
where two persons had died with yellow fever.   We are indebted
to Dr. H. for the following symptoms of this as well as those in
several other cases,  which he kindly furnished for our use:—
   " Called to see her at 4 P. M.,  July 24, 1853; had  been ill three
days with fever and severe pain  in the head and back; found the
eyes  injected, intense  epigastric  uneasiness, with great tenderness
on pressure; pulse feeble; face dark and suffused; intense pain in
the back of neck; tongue perfectly natural in  color  and to the
touch.
   "29th. Great prostration; vomited during the night a large quan-
tity of a brownish fluid, containing a sediment  resembling coffee-
grounds. 12 M. Rejected  everything taken into  the  stomach.
Resisted  all stimulants,  gulping up  everything by mouthfuls.

  * In the seventh case, there was no black vomit before death, but it was found in
the stomach at the post-mortem.
  | By a reference to the accompanying  diagram of the infected locality, the pre-
cise situation of each case  recorded is indicated, corresponding to the number in
the table.
  J The previous cases having been already described. 
16
Intense thirst; the eye at this stage assuming a peculiar pinkish
hue; tongue remaining clean.
   "30///.  Sinking.   Skin  cold and system collapsed.  Died at 3
P. M.   Before death  the eye  became jaundiced  and  the skin
bronzed in appearance."
   The nineteenth case was James Clements, who attended bar for
his father,  at Clements's  Hotel,  on Delaware Avenue  between
Lombard and  South  Streets, immediately in front of the wharf
where the Mandarin discharged her cargo.  He was taken ill on
Friday, July 29, and went to his residence, No. 93 Prime Street. Dr.
Wm. Klapp, his physician, saw him for the first time on Sunday,
31st, when he was rapidly sinking, and died on Monday, August
1, at 2 A. M. Dr. K.  could  not  obtain any connected account of
his symptoms  previous to his visit on Sunday, but from the in-
jected  eye,  deep yellow tinge of the  skin  universally,  and the
fatally rapid progress of the case, identified it as  one similar  to
those of  yellow fever he  had witnessed in the vicinity of South
Street Wharf*
   Mrs. Mullen, residing at No. 4 Swanson Street, a patient of Dr.
John Gegan, was attacked with malignant symptoms on the 29th
of July;  the next day had black  vomit.  Prof. S. Jackson saw
this case.  On the 3d  of August, the  vomiting had ceased under
the use of a powerfully stimulating acid mixture, and hopes were
entertained that she might recover; but during the following day
she began to sink, and died on the 5th, at 4 P. M.  Skin became
very yellow after death.
   Mary Bulger, residing  at No. 12 Swanson   Street  (a continua-
tion of Little Water Street) below  South, west side,  attended  by
Dr. Gegan,  was taken ill on the 30th of July, and died on the 3d
of August, with black vomit.  This, according to the doctor's  ac-
count, was a highly malignant case.  The  premises where she died
were in a very  filthy  condition.
   About this time John Ilaslett, a drayman, whose stand was at

   * Dr. (iilbert, the Port Physician, says of this case: "His father informed me
that his son had been in delicate health for years.  On the 19th of July he had  a
slight diiirrhu'ii, which continued until  the li'.Uh, when he was  attacked with pain
in the lieiul, hack,  and limbs;  had very little fever: was  sensible  throughout: ex-
pectorated a little blood before his death, which  took place on the 1st of August."
   This account would seem to strengthen the impressions of Dr. W. Klapp. 
17
 Chestnut Street wharf, was taken ill at his  residence Christian
 Street above Eleventh.  He  was  attended by Dr. W. Keating.
 We are not in possession of particular symptoms, farther than that
 he had black vomit, and died at St. Joseph's  Hospital in three
 hours after his admission on the 2d of August.
   There has been some doubt as to the origin of this case  of yel-
 low fever, unless we consent to the proposition, that the influence
 of the poison had extended  its march along the river front to
 Chestnut Street, and there communicated the disease to Haslett.
 But as no other case has manifested itself in that vicinity, up to
 this date, we must either consider it isolated, or endeavor to trace
 the infection to a location nearer the contaminated district.  We
 have  taken  some pains to trace out the history of Haslett's sick-
 ness,  and within a few days learned from  his employer, Mr.
 Christian Ferry, that for several weeks preceding his last illness
 he had not  been well, complaining of his head, and was very
 drowsy, but  did not lay by.   Mr. Ferry's drays had  not  hauled
 any loads into or from the neighborhood of Lombard or South
 Street wharf since the 13th of July.  But, on reflection, and on
 reference to  his book account, recollected having sent repeatedly
 one or the other of his men to South Street ferry, on business,
 during the week previous to Haslett's sickness, and believes that
 John had been there more than once.  He stated farther, that his
 men  were every day hauling loads into Southwark, and  that
 vicinity, from Chestnut Street wharf, and thinks it not unlikely
 Haslett may have entered the infected district in that way.
   Another interesting  case, occurring beyond the borders of the
 infected locality, but which may be clearly traced to an immediate
 exposure to atmospheric infection, was that of Ann Jane Stewart,
 residence Tenth  Street  near  Shippen, under the care of Prof. S.
 Jackson,  to  whom we  are indebted for the following particu-
 lars :—
   " Miss S. was in good  health previous to Sunday, the 30th  of
July.  On the afternoon of the preceding Wednesday, the 26th,
she made a visit to Swanson  Street near  South on business, and
remained  there for some time.  Returning home, she continued
well until the 30th, when she complained of intense pain  in the
head  and limbs,  great  distress over  the  epigastrium, oppression
and nausea,  with fever,  continuing  without  intermission until
       2 
18
Wednesday evening, the 3d of August, when  the  fever abated.
From that time up to the period of her death, on the 13th of
August,  fourteen  days,  there  was  no sensible  reaction.  The
nausea, sense of oppression about the heart, and extreme tender-
ness over the  epigastrium continued unabated until  she died,
accompanied with  a purging of yellow and bloody fluid.  Her
pulse remained  about  130 throughout, while her skin, from  the
commencement of the attack, was of a dark yellowish hue.  The
extreme heat of the weather, during the three last days of her life,
tended greatly to prostrate her already enfeebled system, and, in
my estimation, hastened her death."
  It deserves a passing notice, that from the date of the last case,
July 30th, there was a temporary cessation of the disease for  the
space of  seven days.  No new case occurred again  until the  6th
of August, when the evidence was clear, that the epidemic influ-
ence not  only lingered among us, but that it was occupying more
territory, and taking a wider range than was at first supposed to
exist.  From  this  date, August 6th, it  will be perceived as we
proceed, that a number of genuine cases of yellow fever happened
a short distance beyond the limits of the first twenty-two cases,
as embracing the infected district.
  Mary Williams, the next case, an Irish woman, aged twenty-two
years, was also  taken ill away from the locality of the infection,
and doubts arose as to the source of her sickness.   An accidental
occurrence, however, shed the clearest light upon  its origin, and
satisfied us that she had fairly contracted her disease in  Swranson
Street below South.
   Mary boarded for a number of weeks with Mrs. Mary Bulger,
at No. 12 Swanson Street, who  died of yellow fever on the 4th of
August.   On the 3d, the day before Mrs. B.  died, Mary Williams
left the house, returning the next day, the 4th, for her clothes,  but
refused to see the body of  Mary Bulger.  From hence  she went
to No. 338 North Front Street above Noble.   Dr. A. C. Bournon-
ville, who was called in, has politely furnished us with the follow-
ing statement:  "She came to  this place  on Thursday evening,
'as well,' according to the language of her room-mate, 'as  she
ever knew her  to  be.'  She first  complained on Saturday, after
dinner;  I did not  see her until  Monday.   Found  her  laboring
under fever, with  great suffering  from distress over the epigas- 
19
trium, cramps in legs, pain in head and back, eyes injected, red,
face flushed, tongue coated white,  and her body covered with
a petechial eruption.  Her symptoms not improving, on Tuesday
she was admitted into St. Joseph's Hospital."
  On Wednesday, as we learned  at the hospital, her fever gave
way to prostration.  On Thursday, her skin became very yellow,
accompanied with  extreme sensibility on the slightest touch, the
petechia increasing.  On Friday, the 12th, she began to throw up
a peculiar dark-colored fluid, in large quantities, which left the
"coffee-grounds"  sediment on the clothes; and at 10J P. M. she
died, six days from the date of her attack.
  The post-mortem, made twelve hours  after death, revealed the
peculiar " box-wood" colored liver, congested appearance of other
viscera of the abdomen; extreme yellowness of the adipose matter;
softening of the mucous membrane of the stomach, and a deposition
thereon of a dark,  muddy-looking substance.  A slight  puncture
of the stomach, made accidentally during the dissection, deprived
us  of the  opportunity of examining its fluid contents.   Neither
the brain  nor lungs were examined.
  The next case occurred at No. 37 Almond Street, between Front
and Second, on the 9th of August, in the person of John S. Wil-
liams.   A brief statement has been kindly furnished by  our friend
Prof. Mitchell, and is, in substance, as follows:—
  John S.  Williams, aged  twenty and a half years,  native  of
Chester, Pa., trade, carpenter.  Returned from a short visit  to
Port Deposit, Md. (which  place he represented as  unusually
healthy),  on the  18th of July,  in  good health;  continued well
until the night between the 8th and 9th of August.  About 4 A.M.
on  the 9th, felt a severe headache, pain in the lumbar region, legs,
and in the finger and toe-joints.  At 8 A. M. had a chill, followed
by  fever.   About  6 J P. M. vomited, at first what he had recently
swallowed, then frothy matter, but no bile; vomited again about
7 P. M.  Took Epsom salts  at noon on the 9th, which purged
him twice during the afternoon and twice at night.
  Dr. J. V. Herriott saw him for the first time on the 9th, about
8 P. M.; describes his pulse one hundred  and twenty-nine, and
regular;  headache, backache, and general soreness; eyes injected,
and patient very restless; began to be yellow on Wednesday, the
10th; considerable prostration; pulse one hundred  and  six; 
20
showed  delirium at 9 P. M.  Thursday, the 11th, pulse ninety-
two ; sallowness increased, and extended to the abdomen; vomited
coffee-grounds in appearance at 2| P. M., and in half an hour
again.   Died at twenty minutes after 4 P. M., on Friday, 12th of
August, having been sick exactly three and a half days, or eighty-
four hours.
  Dr. Mitchell says: "I saw him on Friday the 12th, at 11 A. M.
Yellow  skin, most conspicuous on breast and neck; eyes of deli-
cate pink color, slightly streaked with yellow; tongue large, soft,
white in middle, with red edges and tips; pulse one hundred  and
eight, soft and regular;  mind muddy;  answered correctly when
questioned;  very tender over the epigastrium and the right iliac
fossa.  When in articuh mortis, the evacuations from his bowels
were liquid, and of a darker color than the matter vomited."
  Young  Williams stated  to Dr. Mitchell, that on Monday, the
8th, the day preceding his attack, he  had  walked from No. 37
Almond Street to Schuylkill  Eighth  and  Market Streets,  and
returned.  On the same  day, to and  from Apple Street, running
north from  Brown Street,  between Fourth  and Fifth Streets,
Northern Liberties.  In the evening, as was his custom, he re-
sorted to Almond Street wharf, for cool river air.  From thence
walked with a friend to the  Commissioners' Hall, Southwark;
made no complaint, had an excellent appetite, and retired to bed
apparently well.
   He had, on several occasions during the two weeks preceding
his sickness, been along the wharves  from Almond to Walnut
Street, but had not been on board  any vessel, nor had he seen or
been in the house with  any person sick in any form.  No post-
mortem could be obtained.
   The  two following cases were  in Krider's Court, Southwark,
a small place  running east from  Front Street, south of Almond
Street,  as delineated on the diagram.  An exceedingly filthy and
ill-ventilated court; the houses are old, confined, and  the passage-
 way is  deficient in drainage.  On the  13th  of August, a woman
 died in this court from dysentery, after five days' illness.  Within
 a few days, also, a child, from cholera infantum.
   Betsey Stephens, aged eighteen, unmarried, was unwell a few
 days from suppressed menstruation, about the 29th of last month
 (July).  On the 8th of August, was well enough to walk a long 
21
distance into "the Neck."  On the 9th, her father had an attack
of cramp, and Betsey went in  great haste for  a  physician a dis-
tance of five or six squares.  This over-exertion and excitement
brought on violent fever the same evening.  Her physician, Dr.
J. Heritage, has furnished us with the following synopsis of her
case:—
   " My first visit to Miss  Stephens was  on the 9th of August.
She  complained of severe pain in the head, back, and inferior
extremities; tongue coated and dry, presenting a brownish appear-
ance;  skin hot and dry; pulse about one hundred,full and tense;
bowels costive.
   " I saw her again on the 10th, at 9 A. M.  All the  preceding
symptoms were much aggravated, with the addition of pain in the
epigastrium, which was increased by pressure; pulse one hundred
and twenty, full and tense; face flushed; conjunctivas red, and
slightly tinged with brown; respiration hurried.  At 4 P. M., much
worse, tongue darkish-brown, and much dryer; pulse more fre-
quent, but not so full; face flushed, and expressive of the greatest
anxiety;  stomach exceedingly irritable, ejecting everything, even
ice-water; thirst intense.
   " At 9  P. M., the  only noticeable change was  in  the  matter
 ejected from the  stomach, which now resembled  in  appearance
 coffee-grounds.
   " At 9 A. M., on the 11th, learned  that she had passed a very
 restless  night, vomiting continually.  Pulse  more feeble; dark
 fluid  discharges,  tinged with  blood, from the bowels;  great
 prostration.  From this time she continued to sink, despite the
 sulphate of quinia and milk punch, until the 13th, when she died."
   Ellen  Boland  was the companion of Betsey Stephens.   She
 formerly resided at No. 405 South Front Street, near Catharine.
 About two weeks previous to  her  last illness, had an attack of
 erysipelas, from which she recovered.   On or  about  the  4th of
 August, went to board  in Krider's Court, in the house with Betsey
 Stephens.  Here  she was taken ill with fever on the 10th, from
 whence  she was removed to St. Joseph's Hospital on the 13th,
 and died on the 15th, with the symptoms of yellow fever, accom-
 panied by black vomit.
   The above cases occurred in  the immediate vicinity  of  the
 infected  district, as originally presented, nor could it be ascer- 
22
tained positively, that either of them had been east of Front Street
between Almond and Pine Streets; an evidence that the influence
of the poison had extended south of Almond Street.
  We are indebted to  the notes of Dr. John Gegan for the sub-
joined account of a case occurring beyond the infected neighbor-
hood :—•
  " James Riley, aged twenty-four years, by trade  a chairmaker,
residing back of No. 25 Union Street, near Second, of temperate
habits, worked in  Race Street;  had no communication with the
infected district.  Was taken sick  on Saturday,  August 13th,
with chill,  followed by fever; pulse  one hundred and  twenty,
strong and active; considerable tenderness over the epigastrium;
severe pain in the  head; cramps in the legs; eyes injected; tongue
furred and soft; stomach irritable;  bowels constipated.  All the
symptoms were  relieved within twenty-four hours, by venesection,
calomel, and neutral mixture.
  " On the 14th, the pulse was one hundred; head relieved of pain;
skin yellow universally;  tongue  thickly  coated,  white;  com-
menced ejecting black vomit from  stomach without  effort;  the
evacuations from  the  bowels were of a  dark-colored matter;
epistaxis of dark blood; urine very dark in color; constant thirst.
  " Eight P. M., increased yellowness of skin; tongue continued
furred;  conjunctivae injected red; vomiting ceased, followed by
an abatement of all the symptoms.  At midnight  the epistaxis
returned, with rapid prostration,  and he died at  4J A. M. on the
15th, in forty-eight hours.
  "Thirty  hours after death  the body  became quite black in
color."
  The three subjoined  cases possess more than ordinary interest,
because of  the  difficulty in establishing  a direct intercourse be-
tween them and the infected  location, and from the circumstance
of their having been sailors belonging to the same vessel, lying
at a remote point from the district where the fever first made its
appearance.
  Oliver Pitcher, seaman, aged twenty-three, from Waldoborough,
Maine,  and James  Genton, seaman, aged nineteen, from Waldo-
borough, Maine, entered the  Pennsylvania Hospital August 15,
laboring under  yellow fever.  The former  died  on the  18th,
while the latter  lingered until the 27th. 
23
  John Brennock, seaman, aged twenty-eight, from Portland, Maine,
entered the hospital on the 18th, and died on the 19th with yellow
fever.  In two of these cases there was black vomit.
  The history of the above cases, as far as we have been able to
obtain it, is as follows:—
  They were seamen belonging to the  schooner Canary, Captain
Winchenpaugh, which arrived here on the 9th of August, freighted
with lumber from Calais, Maine.  She discharged her cargo at the
fourth wharf above the Navy Yard, full a quarter of a mile below
South Street.  About the 12th or 13th, she was taken  up to the
coal wharves at Richmond, and  on the 15th, two of the sailors
referred to above sickened, and were taken to the hospital.  The
third  man, John Brennock, who was received on the 18th, did not
come directly from the Canary, but from Moyamensing Prison, to
which place  he had been committed  four days previously, on
account of a drunken spree.
  If these men  died from yellow fever, where did they contract
it ?   It is evident that there had not been any yellow fever atmo-
sphere either at  Richmond or near the Navy Yard.   Nor is there
any evidence that the disease could have originated on board the
schooner Canary.  She was a new northern vessel, four years old,
had never been in a southern port, and had no bilge-water  in her
hold.   This testimony is derived from  James Genton, one of the
men who was at the hospital.  Not willing, however, to suppress
a single known fact that can shed a ray of light on its causation,
we  would state  that John Brennock, one of the men, arrived in
Philadelphia on  the 21st  of June last, in the schooner Splendid,
from Cardenas, Cuba, where yellow fever prevails every year. He
returned to  his  home in Portland, Maine, shipped  on board the
schooner Canary, and arrived in Philadelphia  as already stated.
Query—Could the opening of his chest of sea-clothes, and turning
out in the presence of his shipmates, Genton and Pitcher, some
unwashed and confined garment that  he had worn last in Car-
denas, on the hypothesis that it may be portable in the form of a
tropical germ,  and which exotic  became  reproductive in  our
atmosphere, furnish the foci for the disease in these  sailors ?
  A much more rational theory, however, than its foreign im-
portation, in these  cases, is at hand, inasmuch as we must  resort
to inferential evidence to account for their infection.  When the 
24
Canary was discharging cargo, at the fourth wharf above the Navy
Yard, the crew, on their way up town, being " 'long shore men,"
would  naturally keep  near  the river,  and would have to pass
through the district  of South and Water  Street,  or  may have
visited among  the sailor boarding-houses or  taverns  in that
vicinity, and there imbibed the disease of which they died.   This,
however, is all speculation,  and must  be taken for what it is
worth in making out the case.
  The  next on record is the case of Thomas E. Crowell, Esq., aged
thirty-eight, a lawyer  by profession, residence No. 266  Front
Street,  below South.  We learn from Dr. John Gegan, his physi-
cian, that he was taken ill on Tuesday, August 16, with a severe
chill, followed by fever, intense pain in  the head, extreme tender-
ness over the epigastrium, tongue clean.  On Wednesday, the 17th,
he was ejecting black vomit,  and had  slight delirium.   On Thurs-
day, all his  symptoms  grew worse, and on Friday, the 19th,  he
was attacked with convulsions, and died the same day.  He had
an injected eye and yellowness of skin throughout his sickness.
  The  three following cases were at  No. 76, Penn Street, below
South,  in the practice  of Dr. Jos. Huckel.  The house was old,
contracted, badly  ventilated, and exceedingly filthy, as were  all
the families, three in number, occupying the  premises.  Samuel
Morrison had died in the same room where these cases lay sick,
about two weeks previously, and reported in  Dr. Gegan's certifi-
cate as bilious fever.
  Dr. Huckel informed us that Mary  Carrigan, aged seventy, was
taken ill on Wednesday, the 17th, with  severe pain in the head,
violent fever,  intense  thirst, tenderness  all over the abdomen,
extreme restlessness and moaning, tongue unusually white, vomited
a watery fluid, bowels constipated, red, spots over her extremities.
This woman died  on Friday A. M., the 19th, in forty-eight hours.
Appearance six hours  after  death—skin very yellow, vibices  on
the extremities, very dark in color.
  Her  daughter, Mary Carrigan, aged  eighteen, sickened same day
as the  mother, and lay in the same  bed.  Her symptoms were
fever, pain in the head, white tongue,  thirst,  vomiting of dark-
colored watery fluid.   On Friday, at 1 P.  M., was pulseless,  sink-
ing rapidly; mind clear; tongue intensely red, dry, and protruded
with difficulty; extreme tenderness over the epigastrium; eyes 
25
injected,  and of a pinkish hue;  skin over body yellow; had
vomited  a very dark fluid, but not examined by her  physician.
She died on the morning of the 20th, 3 A. M.
  Edward Carrigan, brother to the above, aged twenty-six, resi-
ding in the same room, sickened on the 19th, and died on the 22d.
Symptoms similar to those of his mother and sister. Skin yellow,
but no black vomit.
  No post-mortem could be obtained in these cases.
  For an account of the next case we are indebted to  the polite-
ness of Dr. W. H. Hooper,  the physician in attendance.  The
origin of it, as in that of Riley's, is involved in obscurity, unless
the infected atmosphere extended as far west as Third  Street.
  " 8th Month 19, '53.   Called to see Mary Turner, set. twenty-
five  years, at No. 1 Loxley's  Court.  Found the eye red and in-
jected; great epigastric uneasiness, tenderness on pressure; pulse
full  and  tense,  ranging  one  hundred and ten.   Complained of
great pain in back of head and neck; continual vomiting of glairy
mucus;  bowels loose, moved four times  during the  day.   She
informed me that she was living with Mr. West, as a  servant, at
No.  82  Lombard Street, between Third and Fourth,  where she
sickened; had been  sick two days, and had taken a  drachm of
magnesia.
   " 20th. Pulse feeble; skin cold and clammy; vomiting had not
been arrested during the night; continually sighing and tossing
in bed.  At 1 \ P. M., same condition; pulse more feeble; intellect
clear; peculiar pinkish hue of the eye.  Numerous small spots,
injected of a deep red color, made their appearance upon the neck,
breast, and arms, as it were  in  clusters.  At 6 P. M.  died.  The
eye  and skin before death were  slightly tinged of a yellow hue.
The matter vomited on the night of the 20th was of  a brownish
hue, containing a blackish sediment  resembling coffee-grounds."
   This woman declared  to us, at noon on  the day she died, that
she had not been at  any one time for weeks past in the vicinity
of the district  of South and Lombard Streets,  east of Second
Street.  Had no acquaintances in that neighborhood.
   The case of Ellen Parr is one of doubtful character, and yet
possesses interest from several circumstances.
   According to the statement of her physician, Dr. Hooper, she
had " black vomit," and recovered.   She took in  three days two 
26
hundred and forty grains sulphate of quinia, eighty grains daily,
without unpleasant symptoms.  Lastly,  she resided  in Gray's
Alley, running from Front to Second Street, between Walnut and
Chestnut Streets, and no evidence could be obtained of her having
visited the infected district, or its immediate vicinity.
  We furnish the history, with treatment, as presented by Dr. H.,
together with a short statement from Dr. Gilbert, the Port Physi-
cian, who visited her after the symptoms began to yield, and who
examined the matter thrown from her stomach.
  "8ih Mo. 19, 1853. Ellen  Parr, aet. 20 years, native of Ireland,
residence back of No. 13 Gray's Alley.
  "Found pulse 115, full and  tense;  tongue whitish;  great  epi-
gastric uneasiness; vomiting continually; countenance suffused;
eyes red and fiery; complained of great pain in the back of
the head and back; had  been sick only one day.   Ordered  five
grains of sulphate of quinia in solution every two hours, a blister
three by four over the epigastrium.
  "20th, at 8£ A. M. Found the pulse 80, somewhat feeble; vomit-
ed during the night a brownish fluid containing a small quantity
of brownish sediment.   Continued  the quinia, with an ounce of
essence  of beef every hour, and one ounce of brandy made into
punch every other hour.  12 A. M.,  found the vomiting had con-
tinued,  but  only of a yellowish hue.  Treatment same.  At 5
P. M., vomiting only at intervals, mucus, with a  slight deposi-
tion of fine powder resembling soot.  Treatment continued, with
the addition of  one ounce of lemon-juice every hour.
  "21s/, 8^ A.M. No vomiting during the night; she said  she
derived instant  relief from the nausea by the first draught of the
lemon-juice; pulse 80, more full; tongue whitish, and red at  the
edges.   Treatment continued; brandy discontinued at 1  P. M.
No vomiting; pulse better.
  "Monday.  Same condition; treatment continued.
  "At 5 P. M. complained of intense pain and buzzing in the ears.
Reduced the quinia to two and a half grains every two hours.
  " Tuesday. Still improving.
  " Wednesday.  The injected eye entirely gone; tongue clean  and
moist.   Quinia one grain every two hours.  Essence of beef  and
lemonade ordered.
  " Thursday. Convalescent. 
27
  " One fact worthy of note was the immense doses of quinia taken
for the first three days, viz., two hundred and forty grains in all,
without any  ill  effect.  Another, was  the injected eye clearing
and furred tongue cleaning,  in one night."
  Dr. Gilbert, who visited her on the 21st, says: "Her case does
not appear to me to have been yellow fever.   The only symptom
which is at all suspicious is the dark matter vomited.   This is of
a lead  color, not  black or  reddish-black, as  in genuine yellow
fever.   I examined some of its deposit with the microscope, and
the peculiar black pigment, as well as blood-corpuscles, found in
black vomit of yellow fever, are wanting.  There is no yellowness
of skin, no hemorrhage, and her mind has been clear throughout
the attack.   The eyes are natural."

  There have been three cases of yellow fever in the Blockley
Hospital.   Two  died and the third recovered.   The two  that
died had black vomit; the one that recovered had no  black vomit
in the house, but profuse epistaxis.  No history could be obtained
of two  of these  cases, prior to their  admission, owing to their
feeble and exhausted condition when  received, except that  pre.
sented  in the permit, viz.,  that one came from  Shippen Lane,
Moyamensing, and the other from Front Street below South, in
the infected district.
  We  are indebted to Dr. J. D. Stewart, the principal physician
of the hospital, for the accompanying statement.
  Cath. Handson, Irish, aged  forty, was admitted  from Shippen
Lane, Moyamensing, August 1.  I have been  unable to procure
any information  respecting her prior  to  admission.   When re-
ceived  she was in a state of muttering delirium;  general yellow
hue of  the skin  and conjunctiva.  A few hours  after admission
she commenced  vomiting a blackish fluid; this continued until
death, which occurred the day following her reception, August 2.
  A post-mortem  was  made.  There appeared to be  a general
jaundiced hue of the body; the stomach contained a  similar fluid
to that she had been ejecting; the mucous membrane was softened,
and appeared entirely removed from  portions of the  stomach;
there seemed to  be general  injection of the organs of  digestion;
the liver the color of rhubarb; the brain was not examined'; the 
28
fluid contained in the stomach was submitted to the microscope,
and was found to contain blood-corpuscles.
  Mary Fortner, Irish, aged twenty-eight, was  brought into the
house last evening, August 19, from Front Street, between Ship-
pen and  South; she died  this morning, evidently of malignant
fever.
  A post-mortem examination was made to-day.   When admitted,
her brain appeared to be unaffected, answering questions intelli-
gently, although with difficulty;  her prostration was extreme.
When admitted, she had been sick five days; her greatest complaint
was extreme tenderness over  the epigastric  region;  previous to
death she vomited a dark fluid; upon examination, the stomach
was found to contain similar fluid; it was very much injected, but
it did not appear to have sustained the same amount of injury as
the previous  case; the  liver  was of  a bright  yellow color; the
skin was also  yellow.  In both of the cases the lungs were en-
tirely healthy.  The brain of the last case was examined, although
somewhat injected, not to  any important extent.  We have ex-
amined with the microscope the fluid  found in the stomach of the
last case, and discovered the blood-corpuscles.
  The third case was John Reehil, Irish, aged twenty-three, ad-
mitted August 22, from No. 145 South Front Street, above Dock,
where he had been under the  care of  Dr. W. H. Hooper, who has
offered the annexed history of symptoms.
  "Saw John on Friday, August 19, at 5 P. M.; found him in the
second stage.  The  eye  red, injected,  and yellow;  complained of
great epigastric uneasiness;  tenderness on  pressure; continual
vomiting and retching.  From  what I could learn, he had  been
suffering from a high fever for two days past.
  "12 P. M.  Great debility; pulse sinking; slight delirium.
  "20//*, 7 A. M. Skin  and eye completely yellow;  the  blister,
which had been applied over the epigastrium, on being cut, stained
his linen of a yellow hue ;  greater debility  manifest; delirium in-
creased;  vomiting at intervals, the matter vomited during the
night resembling coffee-grounds, or the lees of porter (to  use the
nurse's language).
  " 5 P. M. In the  same condition. Vomiting more frequent, but
the matter contained nothing  abnormal.
  "21s/, 7 A. M. Reaction had taken place;  pulse full and tense. 
29
  " 1 P. M. In the same condition.  Vomiting had ceased.
  "22c?, 9 A. M.  Pulse more feeble, 78 per minute.  Informed by
the nurse vomiting  had returned during the night, but it con-
tained nothing abnormal;  he was delirious during the night; has
hemorrhage from  the nostrils this morning.  Sent at 3 P. M. to
Blockley.  Continued delirious during the day."
  Dr. Gilbert visited this  patient, and confirms the statement of
Dr. Hooper in every particular, and  does not hesitate in pro-
nouncing it genuine yellow fever.
  The treatment by  Dr. H. was with five-grain  doses of quinia
every hour, beef-tea and brandy, with stimulating frictions over
the body.
  We  have been  informed  by Dr. Stewart, chief resident physi-
cian of Blockley Hospital, that no quinia was employed  in  any
of these cases while in the house.  In that of Reehil, cups were
freely used to back of neck and over the abdomen, together with
calomel  pushed to salivation.   This patient  had no  vomiting
from the time he entered the house; that he lost about twenty
ounces  of  blood by  epistaxis and the  application of the cups,
which relieved his gastric tenderness; his stools  were gray until
ptyalism was effected.
  On Saturday  last, September 3, we visited Reehil  at the hos-
pital, and found him  convalescent, walking about the ward, with
a good  appetite, but  unable  to indulge it as he labored under
ptyalism.  The surface of his body was universally yellow, while
the conjunctiva exhibited a yerj deep-yellow tint.
  Questioned  him minutely in order to learn the origin of his
disease, and found that he came to this city very  much exhausted
from hard work, on Monday afternoon,  August  15, from Jersey
City, where he  had resided  for  six  weeks, on  the  wharf near
North  Point.  A  stranger, he  was  taken by  a  boy to  the Ex-
change, from whence, in an omnibus, to one John  Smith's Tavern,
near the Schuylkill, he  thinks.   Here he stopped all night, and
in the morning went to  No. 145 Front Street, near Dock, where
he took boarding.  All  that day, Tuesday, he was strolling along
the wharves, as far down as the saw-mills near  the Navy Yard,
looking for work.  On Wednesday he was out again  in the same
direction, or, as  he expressed  himself, "a long way below Dock
Street,  on the wharf," and, on his  return, was taken with violent 
30
cramps in his legs, felt very bad, and had  difficulty in reaching
his boarding-house.
  From this  statement the inference is natural, if not conclusive,
that John Reehil contracted the fever  during Tuesday and Wed-
nesday, while passing through the infected  neighborhood on  his
way to the saw-mills.  His system exhausted, and predisposed to
disease, more readily received the poison, which, from the same
cause, developed itself in a few hours  in the form of a malignant
type of fever.
  Bridget Tibley, aged thirty-three years, Irish, died at St. Joseph's
Hospital, of yellow fever, on the 22d of August.  She resided at
Third and Catharine Streets, and spent Friday and Saturday,  the
12th and 13th, at No. 221  South Front Street, between Lombard
and South, east or Delaware side of the street.  On Sunday,  the
14th, had a chill.   On Wednesday, the 17th, went to the hospital,
and died on the 22d, the eighth day of her disease.
   Joel Sauteir, aged thirty-six, was admitted into the Pennsylvania
Hospital, from  a  sailor boarding-house  in  Shippen Street, near
Front, on the 20th of August.   He had been sick  a  number of
days, and his last voyage was from Cuba. His case presented  the
usual symptoms of yellow fever, without the black vomit.  This
man recovered with his skin and eyes jaundiced.
   The annexed case was treated in the City Hospital, on  Bush
Hill, by Dr. J. F. Bird, the physician to that institution, who kindly
furnished the notes of symptoms and  treatment.
   The name of the patient was Mary  Gibson, Irish, aged twenty-
two years.  Resided at the corner of  Lombard and  Penn Streets,
and was  sent to the hospital, Wednesday, the  24th of August, the
day on which she sickened.
   "Wednesday. Pulse one hundred and ten; headache; tongue
slightly furred, soft, and without tremor; no epigastric tenderness.
Gave an emetic of ipecac, grs. 20, followed by calomel, grs. 20, in
two powders; in  four hours took half an ounce of castor-oil—has
acted three times.
   " Thursday, 10 o'clock. Better.  Pulse one hundred ; eyes slightly
injected,  is to take  every two  hours  four grains of calomel, with
one-fourth  grain  of opium.   There is no  eruption over  the
abdomen. 
31
  "4| o'clock P. M.  Pulse one hundred.  Continue treatment  of
morning.
  "Friday, 12 o'clock M.  Pulse eighty.  Has had several bilious
evacuations;  capillary circulation very languid; constant nausea.
Will take  a  pill every two hours, consisting of  three grains of
calomel. Diet—toast water, gum water, weak tea, and arrowroot.
  "5  o'clock P. M.  Pulse eighty.  Apparently better.  Continue
treatment of morning.
  "Saturday, 12 o'clock M.  Pulse eighty; some petechia about the
chest; eyes injected; some nausea; no alvine evacuations.   Has
taken three  grains  of calomel and  two of  quinia  four times.
R.  Calomel,  five grains, every two hours.  Blister over region of
liver.
   " Sunday, 28th, 9 o'clock. Pulse eighty-eight;  capillary circulation
very  torpid; purplish tint over face and upper extremities; very
little  epigastric tenderness;  eyes injected.  Has been vomiting a
dark-colored fluid, described by the nurse as  being the  " color of
laudanum.1'  Tongue  cleaning a little.  Blister did not vesicate.
 R.  Renew the blister,  and give five grains of quinia and three of
calomel every  hour  for four hours.
   "5 o'clock P.M.  Pulse one hundred, and feeble; eyes still
injected, and left one discharging purulent  matter; capillary cir-
 culation better.   R. Quinia, twenty  grains;  water, two ounces;
 give  a teaspoonful  every hour.  Continue calomel, three grains
 every  two hours.  Bowels  have not been moved;  ordered  an
 enema.  Weak brandy punch and chicken tea. Pains in her limbs
 much less severe.  Intellect perfectly clear, and has  been during
 her sickness.  For  her  eye, apply cloths wet with a solution of
 sulphate  of zinc, two grains,  and  sulphate of  morphia,  three
 grains, in  four ounces of water.
   "Monday morning, 9 o'clock.  Pulse one hundred; vomits a dark-
 colored fluid;  bowels moved by enema yesterday ; eyes injected;
 capillary circulation bad; catamenia have appeared.  R.  Continue
quinia and diet.   Blister the extremities, and administer another
enema.  Discontinue calomel this forenoon.
   "Monday  afternoon, 5 o'clock.  Pulse one hundred; vomiting as
before; no mental aberration. Withdraw calomel; continue diet,
stimulants, and quinia.
   " Tuesday, 30th, 10 o'clock.   Pulse scarcely  perceptible; carotid 
32
beats one hundred and twenty per  minute; muscular tremors;
jaundiced hue continues, also the vomiting of dark fluid like coffee-
grounds ;  intellect still clear.  Continue stimulants and quinia.
   "Strong convulsions came on  about 3 P. M., and at 4 P. M. the
patient expired.  Post-mortem, sixteen hours after death."
   The following is a correct narrative of the evidences revealed,
as taken down at the time by Dr. Remington:—
   Post-mortem examination  of Mary Gibson, made by Dr. Riley,
8th Mo. 31, 1853, 8 A. M., in the presence of  Drs. Jewell, Bird,
and Remington, sixteen hours after death.
   External aspect uniformly yellow; no emaciation; vibices  on
the inferior extremities, with general purple suffusion principally
on the inferior surface of the trunk and extremities; conjunctiva
yellow, and that of the left eye remaining ecchymosed or injected
with blood.  On opening the cavity of the abdomen, found the
adipose matter  somewhat  abundant and deeply tinged with bile;
muscular fibre of a deep red color.  The stomach containing about
four ounces of black vomit, its villi enlarged and corrugated; the
mucous surface stained by its  contents, and  covered  with red
points, especially at its cardiac extremity, with patches of redness
interspersed throughout.
   The liver was  rather firm in  texture, and in color closely re-
sembling  yellow ochre; gall-bladder distended with inspissated,
dark green bile.   The duodenum containing bilious secretions,
with spots of inflammation diffused over its surface; the jejunum
was a deep red, with softening and destruction of its mucous sur-
face.  The contents of the ileum, caecum, colon, and rectum con-
sisted of dark grumous blood, entirely devoid of fecal odor, which
smell, by repeated, close, and accurate examinations made by  all
present, could not be detected in any part  of the intestinal canal
or its contents.
   The cavities of the heart  nearly empty, without coagula; and,
like the aorta, containing a small amount of dark fluid blood.
   The brain and its investing membranes healthy  in appearance,
though slightly softened.
   The last case on record, is that of Edward Strieker, aged eighteen,
a  native of Germany, a  seaman on board the brig Starts Von
Brock, lying at a wharf first above Mead  Alley, and below Al-
mond Street.  He came to the  Pennsylvania Hospital on Wed- 
33
nesday,  the  31st of August, and died on Saturday, the 3d of
September.  This was a well-marked case of yellow fever, fully
confirmed by the post-mortem*
   On board the above vessel, the captain (Brcedhering) died on the
4th inst., after an illness of four days.  His physician, Dr. Blom,
informed us that he died from bilious fever.  Three of the crew
are now sick with similar symptoms.  This vessel  arrived from
Leghorn on the 13th of August, and has been up to this  time at
Mead Alley wharf.
   It may not be unpardonable to name the fact, that there is at
present  a  vessel riding quarantine at our Lazaretto from New
Orleans.
   The  Caledonia Brander, Rowland, Master, left New  Orleans,
August 7, with a crew of eighteen men and  eleven passengers;
all well.   On  the  first  day out, a seaman, Charles  Tyrrell, was
taken  sick with yellow fever,  and died on  the 9th, forty-eight
hours  ill.  On  the  8th, two  more of the crew sickened,  and re-
turned  to duty on  the  23d; fifteen  days  ill.   On the 10th, the
second  mate was attacked with chills and fever. On the 11th,
another of the crew was taken  sick with chill and headache, but
returned to duty in two days.   On the 13th, A. Witrnore, seaman,
took ill with yellow fever, and died on the 17th,  ninety-six hours.
On the 19th, the carpenter sickened with Chagres fever.   On the
26th, William Green was taken ill with yellow fever, and on the
31st was received into the hospital at the Lazaretto, where  he died
on the 1st instant.
   As this last  case was undoubtedly one  of yellow fever, con-
tracted  on board a vessel direct from New Orleans, where  the
disease  has raged  with almost unprecedented  violence, it  will
be interesting to present the following account, politely sent us by
Dr. T. J. P.  Stokes, the  Lazaretto physician, together  with  the
post-mortem examination, for the purpose of showing  its patholo-
gical resemblance to those cases of fever which have occurred in
Philadelphia.

  * As a minute account of the pathology and treatment, together with the morbid
appearances exhibited after death, of all the cases that were treated in the Penn-
sylvania Hospital is in course of preparation, and will be published, we deem it
unnecessary to enlarge.
       3 
34
                    Case of William Green.
  " William Green, American,  aged about forty, a printer, had
worked in  the Delta office, New Orleans, all  summer;  left New
Orleans on  the 7th of August.  Was visited  on board the ship
Caledonia Brander, August 31,  9 A. M.  His  skin was  of a deep
yellow; eyes injected, of a deep yellow, without redness; pulse
90; weakness moderate; sat up in bed  and answered  questions
coherently; has had no vomiting for sixteen hours; tongue reddish-
brown, with white edges; mouth moist, and skin slightly warmer
than natural; bowels free, has had two passages this morning.
  "11 A. M. Brought into hospital.  In the boat, on the way to
the hospital, had a slight convulsion, and another a  few minutes
after he was placed in bed.  Pulse feeble and small, 86.
  "12 M. Found him pulseless, without sense or motion, and died
at 1 P. M., without convulsion or struggle.
  "The captain gave the following account of  his case:  " He was
taken on the 26th of August, with chill,  headache, and fever; had
no vomiting until  second day, then vomited a grayish fluid mixed
with blood; the next day, 29th of August, vomited black matter;
did not vomit afterwards.  The  yellowness came on the  third day
of his sickness."
  "Autopsy, five hours after death.
  "Externally.—Skin a deep yellow; deep yellow stripes, mottled
with purple, down the back; lower extremities less yellow than
trunk, arms, and head; much emaciated.
  "Head.—Not examined.
  " Chest.—Lungs natural;  heart natural in size and appearance.
  "Stomach.—Contained a pint  of fluid, blackish-gray, with green
tinge; after standing twelve hours in a  glass, had a pale reddish
appearance on its  edges; patches of thickened  mucous membrane,
thinly filmed with bright red blood;  mucous membrane ridged
longitudinally, the ridges  from an inch  to two inches  apart, and
elevated from  one-eighth to one-fourth of an inch above the  sur-
face;  the surface of the mucous membrane stained with  the black
liquid, which I found it difficult to wash off with warm water and
soap; the stomach was (except the above) of the natural size and
consistence. 
35
   " Liver.—Pale yellow color in its right lobe; natural in left lobe,
except yellow patches in its substance of half an inch in diameter.
   " Gall-Bladder.—Filled with the  blackish secretion similar to
that found in the stomach.
   "Spleen.—Perfectly natural.
   " Duodenum.—Yellow externally;  mouth full of the blackish-
green secretion; the  mucous membrane corrugated  and ridged,
patches of apparently inflamed mucous membrane.
   " Small Intestines and Mesentery.—Bloodvessels of mesentery in-
jected with dark red blood, and deeply tinged with yellow; small
intestines contained a small portion of blackish fluid in their whole
length,  and were externally of a yellow  and violet color; mucous
membrane slightly ridged;  glands of Peyer natural.
   " Large Intestine.—Contained some of the blackish liquid; more
fluid and watery, and less deeply-colored yellow tinge; in other
respects natural.
   "Pancreas.—Enlarged, and injected with blood.
   " Kidneys.—Natural.
   "Bladder.—Smaller than usual;  contained a tablespoonful of
dark yellow  urine.
  " Lazaretto, September 1, 1853."

   We have but little information to record of a precise character,
as regards the treatment in the above cases.  It has not been so
much our object  to furnish remarks on the therapeutics of the
disease, as to present a detailed account of its outbreak, and exhibit
as nearly as  possible its local  origin and spread.
   In the first stage of the fever, the treatment in general has been
by bloodletting from the arm and by cups to the back and abdo-
men, emetics,  mercurial  purges,  diaphoretics,  &c.  During the
second  stage, or as soon as  a remission took  place, which  was
generally about the third or fourth  day from the attack, calomel
as a sialogogue was administered in  some cases; in others quinia,
in three or  five-grain doses, every  one or two hours.  In the
event  of no speedy  reaction, brandy  or wine  internally,  and
local  stimulating  applications by blisters  and  rubefacients were
resorted to.
  Quinia in full doses, on the first intimation of a remission from
fever, appears to have been a favorite remedy.  In some cases, 
36
over seventy grains were administered daily for several days, and,
as far as we could learn, without  any annoyance  to the brain or
other organ, but with advantage.  It will  be remembered, how-
ever, that the cases at  the Blockley Almshouse  Hospital were
treated  without quinia   in any stage  of the disease.  Calomel,
pushed  to salivation, was the principal remedy employed.
   We have already alluded to the fact, that there have been other
cases of disease assuming  a malignant type of fever in our city
since the 19th of July, in the immediate vicinity of  the  infected
district, which we were  not able to secure.
   Again,  there were others that resembled, in many  of their fea-
tures, the cases recorded  as yellow fever.   These, however, we
have designedly omitted, because they could  not be strictly iden-
tified, although it is not altogether improbable, if yellow fever had
existed as an epidemic, they would have been reported as  genuine
cases.
   Among the latter, and we allude to them particularly, because
they may be noticed elsewhere, were those of Samuel Morrison,
No. 76 Penn  Street, below  South;  Joseph  Roberts, one of the
inspectors of vessels for the Board of Health; J. R. Davis, No. 3
Benton Street (West Market Street); Mrs. Horner, Second  and
South  Streets; Catherine Dougherty, No. 85 Penn Street; a ser-
vant girl at No. 24 Union Street; ----Jones, in Water Street,
above  Almond Street; Christopher Ruff,  Front Street, below
Mead Alley.
   The  certificates in these instances read, remittent, bilious, and
typhus fevers.  Nor were  the physicians in either of these  cases
willing to pronounce them yellow fever.
   The  case of S. Morrison, which we had an opportunity of in-
 specting,  was an  aggravated attack of bilious remittent, under
 which  he sunk at the  expiration of ten days, although he  died
 in the  same room where the Carrigan family perished about two
 weeks  subsequently.
   Joseph Roberts may have died of fever of a malignant type,
 but there were  circumstances in his case which would lead  to a
 different  conclusion.  His physician, Dr. C. W. Hornor, was not
 prepared to confirm the  general impression that it was yellow
 fever.
    Mrs. Homer died of bibous fever, after six days*  illness.   Ac- 
37
cording  to the evidence of one of her physicians, Dr. J. Wilson
Moore, there was  a hemorrhagic tendency in her case, and she
became quite yellow before death.
   The case of Davis was peculiar.  Dr. Gilbert, in writing to us,
says of it: "I had a case of malignant fever in my own practice,
which presented striking features  of yellow fever; but, on post-
mortem examination, proved to be malignant  bilious, complicated
with inflammation of the bowels."
   This patient sickened on Monday evening, the 15th of July, and
died on the following Thursday morning, in about sixty hours.
   The other  cases referred to, presented nothing remarkable, and
were reported as bilious and as  typhus fevers.
   It would have  added very much to the interest of this docu-
ment if we could have secured the entire list of cases of fever that
have occurred since the irruption of the disease on the 19th of
July, in the immediate vicinity of the infected district.   Some few
have undoubtedly escaped our notice; owing, in a great measure,
to the  fact, that the Board of Health has not  required the physi-
cians,  by any special resolution, to report their cases of malignant
or yellow  fever*  A law  of the legislature, however, makes it
binding on physicians to do so.   The Board of Health, no doubt,
judged wisely in the matter, inasmuch as the fever has not ap-
peared in an epidemic  form throughout  our city.  By this deci-
sion, and the hesitation on the part of many practitioners to make
their cases known, we never can arrive at a complete  account of
all of  them, with their date and locality.
   Enough certainly has been  accumulated to establish the pre-
mises,  that yellow fever has existed in our city since July 19, con-
fining  its ravages to a particular  locality, bordering on the wharves
and  docks of the Delaware, which were a favorite resort for the
malignant  fevers  that prevailed at similar  seasons in  Philadel-
phia, near the close of the last and at the beginning of the present
century.

  * Since the above was written, the Board of Health passed a resolution requiring
physicians to report their cases of malignant fever. 
Table of Yellow Fever  Cases in Philadelphia, from July 19 to August 31, 1853, in the numerical order, &c. &c,
                                            in which they occurred.
t3	Name.	aj	Sex.	Nativity.	Where contracted.	Date of	Where attended.	By whom.	£>*	Black vomit.	Died.	Kecovered.
fc		< lp"				attack.			3fi C			
1	Joseph Sharp		M.	U. States	South Street wharf	July 19	Corner Almond and Penn Dr. E. S. Hickard.-		7		July 20	
2	George Robinson	50	M.	England	Wharf between South and Lombard	" 20	Champion House	•' W. Klapp	3	Black vomit		
3	Thomas D. Koehler	19	M.	U. States	South Street wharf	" 20	"	u ..	7		" 27	
4	G. W. Kerkeslager	4l ■	M.	Germany	"	" 20	Red Bank Ferry House	" Jos. Klapp	5	«	" 25	
5	Mrs. Kerkeslager	3S	F.	"	it	" 20	" "	IC u	6		" 26	
6	Charles Burrows	2t	M.	U. States	Wharf between South and Lombard	" 20	Pennsylvania Hospital	" W.Gerhard	5	a	" 22	
7	Frederick H. Kellog	2(	M.	"	Barque Mandarin	" 21	« «	;i t.	3	It*	" 23	
8	Fanny Martin	2k	F.	Ireland	South Street wharf	« 21	Champion House	" W. Klapp	5	If	" 20	
e	J. M. G. Koehler	17	M.	U. States	"	« 21	"	u it				Kecovered.
10	Pauline Koehler	9	F.	"	"	" 21	"	h «				
n	Honora Stanton	35	F.	Ireland	Little Water Street	" 22	12 Little Water Street	" J. Gegan	5	If	" 27	
12	Silas Green	40	M.	U. States	Almond Street wharf	« 23	21 " "	" S. Stewart				u
13	R. N. Campbell	35	M.	"	Barque Mandarin	" 23	Clement's Hotel	" W. Klapp				a
14	John Shellcott	23	M.	England	Wharf between South and Lombard	" 25	Pennsylvania Hospital	" W.Gerhard	5	II	" 30	
15	John White	22	M.	"	" "	" 25	" tt	it tt				«
16	Rosanna McKean	24	F.	Ireland	South and Water Streets	" 25	172 South Second Street	" W. II. Hooper	5	u	" 30	
17	David Murray	ib	M.	England	Wharf between Almond and South	" 26	Pennsylvania Hospital	" W. Uerhard				u
18	James Markley	21	M.		Wharf between South and Lombard	« 27	" »	n u				ii
19	James Clements	42	M.	U. States	" "	« 29	Prime Street	" W. Klapp	2		Aug. 1 " 2	
20	John Haslett	]<J	M.	Ireland	Doubtful	" 29	Eleventh and Christian	" W. Keating	3	if		
21	Mrs. Mullen	35	F.	"	4 Swanson Street	" 29	4 Swanson Street	" J. Gegan	6	It	" 5	
22	Mary Bulger	25	F.	"	12 Swanson Street	" 30	12 Swanson Street		4	tt	" 3	
23	Ann Jane Stewart	31	F.	U. States	Swanson and South Streets	" 30	South Tenth Street	" S. Jackson	14		" 13	
24	Mary Williams	22	F.	Ireland	12 Swanson Street	Aug. 6	St. Joseph's Hospital	" F. G. Smith	6	(I	« 12	
25	John S. Williams	2c	M.	U. States	Almond St. Wharf	" 9	36 Almond Street	" J. V. Ilerriott	3	It	" 12	
26	Betsey Stephens	If	F.	Ireland	Front Street below Almond	" 9	Krider's Court	" J. Heritage	4	If	'« 13	
27	Kllen Boland	22	F.	"	(I 11	" 10	St. Joseph's Hospital	" F. G. Smith	5	If	" 15	
2H	James Riley	34	M.	"	Unknown	" 13	25 Union Street	" J. Gegan	2	ff	" 15	
29	Oliver Pitcher	23	M.	U. States	Doubtful	" 15	Pennsylvania Hospital	" W. Gerhard	3	ft	" 18	
30	James Genton	19	M.	"	"	•' 15	« <•	II it	12		" 27	
31	Thomas E. Crowell	3S	M.	u	South and Front Streets	" 16	Front Street below South	" J. Gegan	3	f<	" 19	
82	Mary Carrigan	71	F.	Ireland	76 Penn Street	" 17	76 Penn Street	" J. Huckel	2		" 19	
83	Mary Carrigan (D.)	IS	F.	"	"	" 17	"		3		" 20	
34	John Reehil	20	M.	"	Wharf below Lombard Street	" 17	Blockley Hospital	" J. Stewart		If		it
35	Ellen Parr	20	V	"	Unknown	" 18	13 Gray's Alley	" W.H. Hooper		;;t		
30	Mary Turner	35	V.	"	82 Lombard Street	" 18	Loxley's Court		2		" 20	
37	John Brennock	24	M	D. States	Doubtful	" 18	Pennsylvania Hospital	" W. Gerhard	1	tt	" 19	
38	Edward Carrigan	2.1	M.	Ireland	76 Penn Street	" 19	76 Penn Street	" W. Sharp " J. Stewart	3		" 22	
39	Catharine Handson	40	F.	"	Unknown •	" 1	Blockley Hospital			tt	" 2	
40	Mary Fortner	2s	V.	"	Front Street below South	" 14	" "		7	u	« 21	
41	Bridget Tibley	33	V.	«	221 Front Street	« ]4	St. Joseph's Hospital	" F G. Smith	8	ti	" 22	
42	Joel Sauter	31	M.	Germany	Shippen and Front Streets	" 20	Penusvlvania Hospital	" W. Gerhard				«
43	Mary Gibson	2'J	F.	Ireland	Penn and Lombard Streets	" 24	City Hospital	" J. F. Bird	6	it	" sn	
44	Edward Strieker	IS	M.	Germany	Wharf below Almond Street	" 31	Pennsylvania Hospital	" W.Gerhard	3	8ept.l		
CO
00
* In stomach after death.     f Doubtful. 
 
APPENDIX.
   In* addition to the forty-four cases of yellow fever, enumerated
in the preceding articles, as read before the College of Physicians,
we have, after considerable labor, gathered the statistics of one
hundred and twenty-six more; bringing the report up to October
7, 1853, the date of the occurrence of the last case.  Thus making
in all one hundred and seventy cases of yellow fever in Philadel-
phia, from  July  19 to October  7,  inclusive, a period  of eighty
days.
   Of these, one hundred and twenty-eight died;  equivalent to 1
in every 1.42 hundredths, or 75 per cent.
   One hundred and forty-seven of all the cases may be traced to
a direct intercourse with the infected  locality.   Twenty-two  are
of doubtful or unknown origin;  and one was contracted at  the
Lazaretto, while at work on board  the ship Caledonia Brander,
from New Orleans*
   One hundred and  eighteen  were treated  in private practice,
twenty-four at  the Pennsylvania  Hospital, eighteen at the Block-
ley Hospital, seven at the Bush  Hill or  City Hospital, and three
at St. Joseph's.
   Ninety, equal to 53 per  cent,  of the cases, were accompanied
with black vomit; all of which died, with the exception of four.
The genuineness of the discharge in one of these four cases has
been doubted,  as stated on  page  27.  As the discharge of black
vomit from  the stomach of a yellow fever patient has generally
been considered a fatal symptom, we should always be inclined
to question  the character of the  matter  vomited where patients
recover, who are said to  have had  black vomit, no matter how
high the  authority from which they emanate, unless it had  first
undergone a careful examination  under the microscope, and then
found to contain blood-corpuscles.
  The greatest number of cases that occurred in any one day was
ten; this happened on the 11th and also on the 19th of September.
  The duration of the cases that proved fatal was from two  to
twenty-four days; the mean period was a fraction less than six days.
  Ninety-three of all  the cases  that occurred were among males,
and seventy-seven in females.  That period of life which appeared
most susceptible of the fever was between twenty and thirty; one-
third of all the  cases happened in  this decade.
* This vessel had yellow fever on board when she arrived. 
,  40
  Out of the wdiole number of cases  recorded, sixty-eight were
born in the United States, sixty-two in Ireland, nineteen in Ger-
many, eighteen in England, one in  Scotland, one in France, and
one in Spain.
  In no instance  have we learned that the fever has been  com-
municated to others, by those laboring under the disease. At the
Pennsylvania Hospital the yellow fever cases were placed in the
wards, promiscuously, with other patients, without any attempt
to prevent intercourse between  them; and  not an individual,
either among  the patients, nurses, or visitors, contracted the dis-
ease.  The same  immunity was observed at the  Blockley, St.
Joseph's, and City Hospitals.  In private practice, although  many
of the cases were treated away from the infected locality, where
they contracted the fever, we have  not been able to hear, after
the strictest inquiry, that the  disease spread itself in any case be-
yond  the individuals infected, although there  was unrestrained
intercourse between them and their friends.  An  evidence of the
non-contagiousness of yellow fever;  or, in  other  words, that the
poison which produces yellow fever is incapable of being  gene-
rated in the body of the sick, so as to produce a similar disease in
those attending upon them.
  We have  been unable to calculate the proportion of cases, or
even  of deaths, to the population, from yellow fever, in the in-
fected  district.  The  information required to make an accurate
estimate not being reliable, all we can offer on this subject  is,
that the population involved was by no means a crowded one.  The
number of resident inhabitants in that locality, where the first
nineteen cases  happened, bounded by the south side  of  South
Street, the west  side  of Little Water Street,  Lombard Street,
and the  Delaware front, did not exceed one hundred.   The re-
maining portion of the infected district to which the fever seemed
to be confined, and to which we have  ascribed limits, extending
from  Union Street on the North, to Queen Street on the South,
Second Street  on the west,  and the Delaware front on the east,
did not  by any  means contain an excess of  population.  The
inference, therefore, is, not only, as we have already shown, that
the deaths to cases have been large, but that the cases  to the
population, as well as the deaths to the population residing  within
the above limits,  have been proportionately large.
   While  the  fever in general has been  confined to the  limits
above named, it  is  evident  that  a few cases of genuine yellow
fever have appeared beyond these boundaries, between which and
the infected  locality, no direct communication could be traced.
Showing either that isolated cases of malignant fever may occur
in our city when the mean of the thermometer is above 76°, or
that an epidemic influence was extending its treacherous  march
to remote and varied sections of our metropolis.