AN
ACCOUNT
OF THE
Bilious remitting Yellow Fever,
AS
IT APPEARED
IN THE
CITY OF PHILADELPHIA,
IN THE YEAR I793.
By Benjamin Rush, M. D.
PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDICINE
IN THE UNIVERSITY OF PENNSYLVANIA.
SECOND EDITION. 
PHILADELPHIA,
PRINTED BY THOMAS DOBSON,
AT THE STONE HOUSE, N° 41, SOUTH SECOND-STREET.
MDCCXCIV. 



THE PREFACE.
THE delay of the following publi-
cation has been occasioned by the want of health
to prepare it for the press, during the winter
months. It now goes forward, under the great
disadvantages, of having been hastily copied
from my notes, amidst frequent professional in-
terruptions. Its imperfections I hope will be
overlooked, when it is considered, that my only
design in publishing thus prematurely, was to
obviate as much as possible, the danger of the
disease, should it unhappily appear in our city
in the course of the present season.
In the history of the fever, I have introduced
an account of the symptoms and prognosis, in
such places as they occurred most naturally,
without a strict regard to the artificial order of
the schools.
In the detail of the symptoms, I have divid-
ed the body into different systems. This divi-
sion I have found to accord more easily with the
principles                                    

iv THE PREFACE.
principles of medicine which I have adopted,
than the common method of describing them, as
they appear in the animal, natural, and vital
functions.
In republishing an account of the controver-
sies between the physicians of Philadelphia, my
motives were, to prevent the revival of certain
opinions and modes of practice, by bringing
them forward under the patronage of respecta-
ble names, and to justify in a great measure,
from their influence, the want of universal suc-
cess, by the only safe, and proper mode of treat-
ing the yellow fever. I hope I shall be excus-
ed for this part of the following work, when it
is perceived, that I have been more minute in
relating my own mistakes, than those of other
Physicians; and that I have connected no names
with the opinions and modes of practice which I
have opposed, but such as were given to the
public by their authors, during the prevalence
of the fever.
BENJAMIN RUSH.
Philadelphia,
June 14th, 1794. 


CONTENTS.
PAGE                                                 
AN account of the diseases which preceded the
yellow fever - 1                                  
Of the first cases of it - 8              
Correspondence between Dr. Hutchinson and the
Author, upon the subject of the fever 16, 17
Proceedings and publication of the College of Phy-
cians - 21
Predisposing and exciting causes of the fever - 29
Premonitory signs of an attack of the fever - 36
History of its symptoms - 39
As they appeared in the blood vessels - 40
- in the liver and brain - 47
- in the stomach and bowels, - 51
- in the secretions and excretions 54
- in the nervous system - 61
- in the senses and appetites - 66
- in the lymphatic and glandular
system - 68
- on the skin - 69
- in the blood - 73
Anomalous circumstances belongings to the history
of the fever, - 78
Its banishment of, or mixture with, other fevers 84
b Account 


viii CONTENTS.
Account of persons, most subject to the disease, 95
- of those who escaped it, - 1Ol
Signs of the universal prevalence of the exhalation,
and contagion in the city, - 104
State of the atmosphere during  the prevalence of
the fever, - 108
Proofs of reinfection, - 112
State of the body after death, - 113
Appearances of the dead body exhibited by dissection, 115
State of the City during the prevalence of the fever,
Amount of deaths, and the number on each day
from the 1st of August to the 9th of Novem-
ber, - 128, 129
The causes which checked the disorder, - 131
The diseases which succeeded the yellow fever, 138
The means used to purify houses and clothes, 141
Sporadic cases of yellow fever in 1763, - 144
Of the origin of the fever, - 145
Symptoms, and circumstances, of agreement and
disagreement, between the yellow fever and the
plague, - 169        
- of the yellow and jail fever, 175
Different grades or states of bilious fever, 178
Premonitory signs of great and mortal epidemics,
or of a sickly autumn, - 179 
Register of the weather from the 1st of January to
the 9th of November, 1793 - 185
Of the Method of Cure, - 193
Of the remedies for the fever, - 203
Origin of the dissentions among the physicians, 207
Four modes of treating the fever, - 243
I. Of purging, - 245
Objections to it answered, - 248
Of                                                      

ix CONTENTS. 
Of blood-letting, - 258      
The appearances of the blood, - 261            
Objections to blood-letting answered, - 274 
Advantages of obtaining evacuations in a gradual
manner in certain cases, - 277
Of Cool and fresh air, - 284 
Of the drinks and diet used in the first stage of the
fever, - 285, 286
Of the application of cold water to the body, 287
Of the advantages of a salivation in the cure of the
fever, - 291, 292
Of blisters, - 290       
Of the drinks and diet in the second stage of the fever
Of the remedies which were used to relieve painful
or distressing symptoms, - 292
Symptoms which attended the convalescence, 295
Of the benefits of bleeding, purging, and low diet in
preventing or mitigating the disease, - 295
II. Observations on the use of bark, in the fever, 289
- of wine, - 299
- of laudanum, 299
- of the cold bath, 300
III. Observations on the combined use of evacuations,
and tonic medicines, - 302
IV. Observations on the use of the French remedies, 302
Inquiry into the comparative success of each of the
four modes of practice, which have been mentioned, 303
Of the tonic method - 308
Of the antiphlogistic method, - 308
Of the combination of the tonic and antiphlogistic
methods, and of the French practice, 319, 320
2 observations 


x CONTENTS.
Observations on the success of the antiphlogistic
remedies, in the hands of persons not educated
to the profession of physic - 320
Inferences from their success, and from other consi-
derations, in favour of teaching the people at
large to cure themselves of the yellow fever,
and of all other pestilential fevers - 325
Narrative of the state of the Author's body and
mind during the prevalence of the fever 339
AN 

AN
ACCOUNT
OF THE
Bilious remitting Yellow Fever,
AS IT APPEARED IN
PHILADELPHIA,
IN THE YEAR 1793.
B 



AN
ACCOUNT, &c.		
BEFORE I proceed to describe the fever
which is to be the subject of the following history,
it will be proper to give a short account of the
diseases which preceded it.
The state of the weather during the first seven
months of the year, and during the time in which
the fever prevailed in the city, as recorded by Mr.
Rittenhouse, will be inserted immediately after the
history of the disease.
The MUMPS which made their appearance in
December 1792, continued to prevail during the
month of January 1793. Besides this disorder,
there were many cases of catarrh in the city,
B2 brought                  


4 AN ACCOUNT OF THE
brought on chiefly by the inhabitants exposing
themselves for several hours on the damp ground
in viewing the aerial voyage of Mr. Blanchard on
the 9th day of the month.
The weather which had been moderate in De-
cember and January became cold in February.
The mumps continued to prevail during this month
with symptoms so inflammatory, as to require in
some cases two bleedings. Many people com-
plained this month of pains and swellings in the
jaws. A few had the scarlatina anginosa.
The mumps, pains in the jaws, and scarlatina
continued throughout the month of March. I was
called to two cases of pleurisy in this month, which
terminated in a temporary mania. One of them
was in a woman of ninety years of age, who re-
covered. The blood drawn in the other case,
(a gentleman from Maryland) was dissolved. The
continuance of a tense pulse, induced me notwith-
standing to repeat the bleeding. The blood was
now sizy. A third bleeding was prescribed, and
my patient recovered several cases of obstinate
erysipelas succeeded inoculation in children during
this, and the next month, one of which proved
fatal.                                        
Blossoms 

5 BILIOUS YELLOW FEVER.
Blossoms were universal on the fruit-trees, in
the gardens of Philadelphia, on the first day of
April. The scarlatina anginosa continued to be
the reigning epidemic in this month.
There were several warm days in May, but the
city was in general healthy. The birds appeared
two weeks sooner this spring than usual.
The register of the weather shews, that there
were many warm days in June. The scarlatina
continued to maintain its empire during this
month.
The weather was uniformly warm in July. The
scarlatina continued during the beginning of this
month, with symptoms of great violence. A son
of Mr. James Sharswood, aged seven years, had with
the common symptoms of this disorder, great
pains and swellings in his limbs, accompanied with
a tense pulse. I attempted in vain to relieve him
by vomits and purges. On the 10th day of the
month, I ordered six ounces of blood to be drawn
from his arm, which I observed afterwards to be
very sizy. The next day he was nearly well. Be-
tween the 22d and the  24th days of the month,
there died three persons whose respective ages
were 80, 92, 96. The weather at this time
B3 was                     

6 AN ACCOUNT OF THE
was extremely warm. I have elsewhere taken no-
tice of the fatal influence of extreme heat, as well
as cold, upon human life in old people. A few
bilious remitting fevers appeared towards the close
of this month. One of them under my care,
ended in a tedious typhus mitior, from which the
patient was recovered with great difficulty. It
was the son of Dr Hutchins of the island of Bar-
badoes.
The weather for the first two or three weeks in
August was temperate, and pleasant. The colera
morbus, and remitting fevers were now common.
The latter were attended with some inflammatory
action in the pulse, and a determination to the
breast. Several dysenteries appeared at this time,
both in the city and in its neighbourhood. During
the latter part of July, and the beginning of this
month, a number of the distressed inhabitants of
St Domingo, who had escaped the desolation of
fire and sword, arrived in the city. Soon after
their arrival, the influenza made its appearance,
and spread rapidly among our citizens. The scar-
latina still kept up a feeble existence among chil-
dren. The above diseases were universal, but
they were not attended with much mortality. They
prevailed in different parts of the city, and each
seemed to appear occasionally to be the ruling
epidemic.                                      


7 BILIOUS YELLOW FEVER.
epidemic. The weather continued to be warm
and dry. There was a heavy rain on the 25th of
the month, which was remembered by the citi-
zens of Philadelphia as the last that fell, for many
weeks afterwards.
There was something in the heat and drought
of the summer months, which was uncommon
in their influence upon the human body. La-
bourers every where gave out (to use the coun-
try phrase) in harvest, and frequently too when
the mercury in Fahrenheit's thermometer was un-
der 84°. It was ascribed by the country people
to the calmness of the weather, which left the
sweat produced by heat and labour, to dry slowly
upon the body.
The crops of grain and grass were impaired by
the drought. The summer fruits were as plentiful
as usual, particularly the melons, which were of an
excellent quality. The influence of the weather
upon the autumnal fruits, and upon vegetation in
general, shall be mentioned hereafter.
I beg pardon for the length of this introduction.
Some parts of it, I hope, will not appear useless
in the sequel of this work.
B4 I now 

8 AN ACCOUNT OF THE
I now enter upon a detail of some solitary cases
of the epidemic, which soon afterwards spread
distress through our city, and terror throughout
the United States.
On the 5th of August, I was requested by Dr
Hodge to visit his child. I found it ill with a fever
of the bilious kind, which terminated (with a
yellow skin) in death on the 7th of the same
month.
On the 6th of August, I was called to Mrs.
Bradford, the wife of Mr. Thomas Bradford. She
had all the symptoms of a bilious remittent, but
they were so acute, as to require two bleedings,
and several successive doses of physic. The last
purge she took was a dose of calomel, which ope-
rated plentifully. For several days after her re-
covery, her eyes and face were of a yellow
colour.
On the same day, I was called to the son of
Mrs. M'Nair, who had been seized violently
with all the usual symptoms of a bilious fever.
I purged him plentifully with salts and creamor
tartar, and took ten or twelve ounces, of blood
from his arm. His symptoms appeared to yield
to these remedies; but on the 10th of the month
an                                            

9 BILIOUS YELLOW FEVER.
an hæmorrhage from the nose came on, and on
the morning of the 12th he died.
On the 7th of this month I was called to visit
Richard Palmer, a son of Mrs. Palmer in Ches-
nut-street. He had been indisposed for seve-
ral days with a sick stomach and vomiting after
eating. He now complained of a fever and head-
ach. I gave him the usual remedies for the bilious
fever, and he recovered in a few days. On the
15th day of the same month, I was sent for to visit
his brother William, who was seized with all the
symptoms of the same disorder. On the 5th day
his head-ach became extremely acute, and his
pulse fell to sixty strokes in a minute. I suspected
congestion to have taken place in his brain, and
ordered him to lose eight ounces of blood. His
pulse became more frequent, and less tense after
bleeding, and he recovered in a day or two after-
wards.
On the 14th day of this month I was sent for to
visit Mrs. Learning, the wife of Mr. Thomas Lea-
ming. I suspected at first that she had the influ-
enza, but in a day or two, her fever put on bili-
ous symptoms. She was affected with an uncom-
mon disposition to faint. Her pulse was languid,
but tense. I took a few ounces of blood from her,
and                                          

10 AN ACCOUNT OF THE
and purged her with salts, and calomel. I after-
wards gave her a small dose of laudanum which
disagreed with her. In my note book, I find
I have recorded, that "she was the worse for it."
I was led to make this remark by its being so very
uncommon, for a person who had been properly
bled and purged, to take laudanum in a common
bilious fever, without being benefited by it. She
recovered however slowly, and was yellow for
many days afterwards.
On the morning of the 18th of this month, I
was requested to visit Peter Alton, in Vine-street,
in consultation with Dr Say. I found him in the
3d day of a most acute bilious fever. His eyes
were inflamed, and his face flushed with a deep
red colour. His pulse seemed to forbid evacua-
tions. We prescribed the strongest cordials; but
to no purpose. We found him at 6 o'clock in
the evening, sitting upon the side of his bed, per-
fectly sensible, but without a pulse, with cold clam-
my hands, and his face of a yellowish colour. He
died a few hours after we left him.
None of the cases which I have mentioned,
excited the least apprehension of the existence of a
yellow fever in our city; for I had frequently seen
sporadic cases in which the common bilious fever
of                                           


11 BILIOUS YELLOW FEVER.
of Philadelphia, had put on symptoms of great ma-
lignity, and terminated fatally in a few days, and
now and then with a yellow colour on the skin,
before, or immediately after death.
On the 19th of this month I was requested to
visit the wife of Mr. Peter Le Maigre, in Water-
street, between Arch and Race streets, in consul-
tation with Dr Foulke and Dr Hodge. I found
her in the last stage of a highly bilious fever. She
vomited constantly, and complained of great heat
and burning in her stomach. The most powerful
cordials, and tonics were prescribed, but to no pur-
pose. She died on the evening of the next day.
Upon coming out of Mrs. Le Maigre's room,
I remarked to Dr Foulke and Dr Hodge, that I
had seen an unusual number of bilious fevers, ac-
companied with symptoms of uncommon malig-
nity, and that I suspected all was not right in our
city. Dr Hodge immediately replied, that a fever
of a most malignant kind had carried off four or
five persons within sight of Mr. Le Maigre's door,
and that one of them had died in twelve hours af-
ter the attack of the disorder. This information
satisfied me that my apprehensions were well found-
ed. The origin of this fever was discovered to
me                                           
 

12 AN ACCOUNT OF THE
me at the same time, from the account which Dr
Foulke gave me of a quantity of damaged coffee
which had been thrown upon Mr. Ball's wharf,
and in the adjoining dock, on the 24th of July,
nearly in a line with Mr. Le Maigre's house, and
which had putrefied there to the great annoyance
of the whole neighbourhood.
After this consultation I was soon able to trace
all the cases of fever which I have mentioned to
this source. Dr Hodge lived a few doors above
Mr. Le Maigre's, where his child had been expo-
sed to the exhalation from the coffee for several
days.  Mrs. Bradford had spent an afternoon in a
house directly opposite to the wharf and dock on
which the putrid coffee had emitted its noxious
effluvia, a few days before her sickness, and had
been much incommoded by it.  Her sister Mrs.
Leaming had visited her during her illness, and
probably caught the fever from her, for she per-
fectly recollected perceiving a peculiar smell unlike
to any thing she had been accustomed to in a sick
room, as soon as she entered the chamber where
her sister lay. Young Mr. M'Nair and  Mrs. Pal-
mer's two sons had spent whole days in a compting
house, near where the coffee was exposed, and
each of them had complained of having been made
sick                                         

13 BILIOUS YELLOW FEVER.      
sick by its offensive smell, and Mr. Aston had fre-
quently been in Water-street near the source of
the exhalation.
This discovery of the malignity-extent-and
origin of a fever which I knew to be highly con-
tagious, as well as mortal, gave me great pain.
I did not hesitate to name it, the Bilious remitting
Yellow Fever. I had once seen it epidemic in
Philadelphia, in the year 1762. Its symptoms
were among the first impressions which diseases
made upon my mind. I had recorded some of
these symptoms. I had likewise recorded its mor-
tality. I shall here introduce a short account of
it from a note book which I kept during my ap-
prenticeship.
"In the year 1762, in the months of August,
"September, October, November and December,
"the bilious yellow fever prevailed in Philadel-
"phia, after a very hot summer, and spread like a
"plague, carrying off daily for some time, upwards
"of twenty persons.
"The patients were generally seized with ri-
"gors, which were succeeded with a violent fever,
"and pains in the head and back. The pulse was
"full, and sometimes irregular. The eyes were
"inflamed,                                     

14 AN ACCOUNT OF THE
"inflamed, and had a yellowish cast, and a vomit-
"ing almost always attended.
"The 3d, 5th, and 7th days were mostly criti-
"cal, and the disease generally terminated on one
"of them, in life or death.
"An eruption on the 3d or 7th day over the
"body, proved salutary.
"An excessive heat, and burning about the
"tended death to be at hand."
I have taken notice in my note book, of the
principal remedy which was prescribed in this
fever by my preceptor in medicine, Dr Redman;
but this shall be mentioned hereafter.
Upon my leaving Mrs. Le Maigre's, I expressed
my distress at what I had discovered, to several of
my fellow-citizens. The report of a malignant
and contagious fever  being in  town, spread in
every direction, but it did not gain universal cre-
dit. Some of those physicians who had not seen
patients in it, denied that any such fever existed,
and asserted (though its mortality was not denied)
that it was nothing but the common annual re-
mittent                                     

15 BILIOUS YELLOW FEVER.       
mittent of the city. Many of the citizens, joined
the physicians in endeavouring to discredit the ac-
count I had given of this fever, and for a while,
it was treated with ridicule or contempt. Indig-
nation in some instances was excited against me,
and one of  my friends whom I advised in this
early stage of the disorder, to leave the city, has
since told me that for that advice, "he had hated
me."
My lot in having thus disturbed the repose of
the public mind, upon the subject of general
health, was not a singular one. There are many
instances upon record, of physicians who have ren-
dered themselves unpopular, and even odious to
their fellow citizens, by giving the first notice of
the existence of malignant and mortal diseases. A
physician who asserted that the plague was in Mes-
sina in the year 1743, excited so much rage in the
minds of his fellow citizens against him, as to ren-
der it necessary for him to save his life, by retreat-
ing to one of the churches of that city.
In spite, however, of all opposition, the report
of the existence of a malignant and contagious fe-
ver in the city, gained so much ground, that the
governor of the state directed Dr Hutchinson, the
inspector of sickly vessels, to inquire into the truth
of                                            


16 AN ACCOUNT OF THE
of it, and into the nature of the disease. In con-
sequence of this order, I received the following
letter from Dr Hutchinson.
DEAR SIR,
A CONSIDERABLE alarm has taken place,
in consequence of the appearance of an infectious
disorder in this city; from which the governor has
been induced to direct me to make enquiries rela-
tive to the existence and nature of such disorder.
In executing this duty, I must rely on the assistance
of such of my medical brethren as may have been
called to attend any of the persons supposed to
have been infected: as I understand you have had
several of them under your care, I would be much
obliged to you to communicate to me (as speedily
as can be done with convenience to yourself) such
facts as you have been able to ascertain relative to
the existence of such disorder; in what part of the
city it prevails; when it was introduced; and what
was the probable cause of it.
I am, Sir,
With the greatest respect,
AUGUST 24th, Your obedient servant,
1793.                         
J. HUTCHINSON.
Dr Benjamin Rush.
2 To

17 BILIOUS YELLOW FEVER.    
To this letter I wrote the following answer a
few hours after it came to hand.
DEAR SIR,
A MALIGNANT fever has lately ap-
peared in our city, originating I believe from some
damaged coffee, which putrefied on a wharf near
Arch-street. The fever was confined for a while
to Water-street, between Race and Arch-streets;
but I have lately met with it in Second-street, and
in Kensington; but whether propagated by conta-
gion, or by the original exhalation, I cannot tell.
The disease puts on all the intermediate forms of a
mild remittent, and a typhus gravior. I have not
seen a fever of so much malignity, so general, since
the year 1762.
From, dear sir,
August 24th, Yours sincerely,
1793.
BENJ. RUSH.
A FEW days afterwards, the following publica-
tion, by Dr Hutchinson, appeared in the Ameri-
can Daily Advertiser of August 28th.
C THE

18 AN ACCOUNT OF THE
THE governor having directed an inquiry to ascertain
the facts, respecting the existence of a contagious fever
in the city, and the probable means of removing it, Dr
Hutchinson, the physician of the port, has made the
following statement upon the subject, in a letter to
Nathaniel Falconer, Esq. health-officer of the port of
Philadelphia.
DEAR SIR,
IMMEDIATELY on the receipt of your
letter, with the enclosure from the governor, sta-
ting that a considerable alarm had taken place, in
consequence of the appearance of an infectious dis-
order in this city, I endeavoured to take measures
to ascertain the facts, relative to the existence of
such disease: for this purpose, I wrote to such of
my medical brethren, who had been called on to
attend persons supposed to have been infected; and
from their answers, as well as from my own obser-
vations, I am convinced that a malignant fever has
lately made its appearance in Water-street and in
Kensington; principally in Water-street between
Arch and Race-streets. This part of the city I
examined personally on Thursday and Friday last,
and found that east of Front-street, and between
Arch and Race-streets, sixty-seven persons were
diseased, many with the malignant fever. Thir-
teen of them are since dead, and numbers remain
ill. For a while this fever was confined to the
above-                                        


19 BILIOUS YELLOW FEVER.
abovementioned part of the city, but the disorder
is spreading, and now appears in other places, so
that several are affected in other parts of  Water-
street, some in Second-street, some in Vine-street,
some in Carter's-alley, some in other streets; but,
in most cases the contagion can be traced to Wa-
ter-street. Dr Say, who has attended more in this
disease than any other physician, informs me, that
he first observed it in Kensington, on the fifth or
sixth of this month; that he did not perceive it in
Water-street, until about the twelfth or fifteenth,
but that on its appearance in the latter place, the
whole neighbourhood was soon affected-He fur-
ther informs me, that he has at this time upwards
of 40 patients, which he supposes to be infected;
and that he has lost about 20 patients in this dis-
ease since its first appearance. As far as I have
been able to ascertain, the number of persons who
have died altogether of this fever, amounts to 40
or thereabouts*.
The general opinion both of the medical gentle-
men, and of the inhabitants of Water-street is, that
the contagion originated from some damaged cof-
fee, or other putrefied vegetable and animal mat-
* The register of the deaths shows that it amounted at
that time to upwards of 150.
C2 ters; 


20 AN ACCOUNT OF THE
ters; and on enquiry, it appears, that on a few
wharfs above Arch-street, there was not only a
quantity of damaged coffee, which was extremely
offensive, exposed for some time, but also some
putrid hides, and other putrid animal and vegetable
substances. Should, however, Dr Say's opinion be
well founded, that he observed the disease in Ken-
sington previously to its appearance in Water-street,
this cannot be the original cause of the contagion.
It does not appear to be an imported disease;
for I have heard of no foreigners or sailors that
have hitherto been infected; nor has it been found
in any lodging houses; but it is, on the contrary,
principally confined to the inhabitants of Water-
street, and such as have done business, or had con-
siderable intercourse, with that part of the city.
The Dispensary physicians tell me, that out of the
large number of sick, now under the care of that
charitable institution, they have had but one per-
son afflicted with this fever. In the Pennsylvania
Hospital, the disorder does not exist.
The disease appears differently in different per-
sons; it puts on all the intermediate forms between
a mild remittent and the worst species of Typhus
Gravior.
I en- 

21 BILIOUS YELLOW FEVER.
I enclose you a copy of the proceedings of the
college of physicians, which contains their recom-
mendation of the means for preventing the future
progress of the disease.
I am, with the greatest respect,
Your most obedient servant,
PHILADELPHIA,
August 27th, 1793. J. HUTCHINSON.
The disease continued to spread, and with a
degree of mortality that had long been unknown
by common fevers.
On the 25th of the month, the college of physi-
cians was summoned by their president to meet, in
order to consult about the best methods of treating
this fever, and of checking its progress in the city.
After some consideration upon the nature of the
disease, a committee was appointed to draw up
some directions for those purposes; and the next
day the following were presented to the college,
and adopted unanimously by them. They were
afterwards published in most of the news papers.
Philadelphia, August 26, 1793.
The college of physicians having taken into
consideration the malignant and contagious fever
C3 that


22 AN ACCOUNT OF THE
that now prevails in this city, have agreed to
recommend to their fellow citizens the following
means of preventing its progress.
1st. That all unnecessary intercourse should be
avoided with such persons as are infected by it.
2d. To place a mark upon the door or window
of such houses as have any infected persons in it.
3d. To place the persons infected in the centre
of large and airy rooms, in beds without curtains,
and to pay the strictest regard to cleanliness, by
frequently changing their body and bed linen, also
by removing, as speedily as possible, all offensive
matters from their rooms.
4th. To provide a large and airy hospital, in
the neighbourhood of the city, for the reception
of such poor persons as cannot be accommodated
with the above advantages in private houses.
5th. To put a stop to the tolling of the bells.
6th. To bury such persons as die of this fever
in carriages, and in as private a manner as possible.
7th. To 

23 BILIOUS YELLOW FEVER.
7th. To keep the streets and wharfs of the city
as clean as possible.-As the contagion of the dis-
ease may be taken into the body and pass out of
it, without producing the fever, unless it be ren-
dered active by some occasional cause, the following
means should be attended to, to prevent the con-
tagion being excited into action in the body.
8th. To avoid all fatigue of body and mind.
9th. To avoid standing or sitting in the sun;
also in a current of air, or in the evening air.
10th. To accommodate the dress to the wea-
ther; and to exceed rather in warm than in cool
clothing.
11th. To avoid intemperance, but to use fer-
mented liquors, such as wine, beer, and cyder, in
moderation.
The college conceive fires to be very ineffectual,
if not dangerous means of checking the progress
of this fever. They have reason to place more
dependence upon the burning of gun-powder. The
benefits of vinegar and camphor, are confined chiefly
to infected rooms, and they cannot be used too fre-
quently upon handkerchiefs, or in smelling-bottles,
C4 by                    


24 AN ACCOUNT OF THE
by persons whose duty calls them to visit or attend
the sick.
Signed by order of the college,
WILLIAM SHIPPEN, Jun.
Vice President.
SAMUEL P. GRIFFITTS,
Secretary.
From a conviction that the disease originated in
the putrid exhalations from the damaged coffee, I
published in the American Daily Advertiser of
August 29th, the following short address to the
citizens of Philadelphia, with a view of directing
the public attention to the spot where the coffee
lay, and thereby of checking the progress of the
fever as far as it was continued by the original
cause.
"Mr. DUNLAP,
"A doubt has been expressed by Dr
Hutchinson, in his letter to the health-officer, whe-
ther the malignant fever which now prevails in our
city, originated in an exhalation from Some putrid
coffee on a wharf, between Arch and Race-streets,
because it made its first appearance at Kensington.
Upon                                        

25 BILIOUS YELLOW FEVER.         
Upon enquiry, it appears that the first persons who
died with this fever, about the 5th of the month,
in that village, had been previously exposed to the
atmosphere of the wharf, and that three of the
crew of the Danish ship, who are now ill with
it at Kensington, received the seeds of the disease
on board their ship, while she lay at or near Race-
street wharf. If these facts could not be ascer-
tained, it does not follow, that the disease was not
generated by the putrid coffee; for, morbid exha-
lations, it is well known, produce fevers at the dis-
tance of two and three miles, where they are not
opposed by houses, woods, or a hilly country.
This is obvious to all the farmers who live in the
neighbourhood of mill-ponds.
"It is no new thing for the effluvia of putrid
vegetables to produce malignant fevers. Cab-
bage, onions, black pepper, and even the mild
potatoes, when in a state of putrefaction, have all
been the remote causes of malignant fevers. The
noxious quality of the effluvia from  mill-ponds, is
derived wholly from a mixture of the putrefied
leaves and bark of trees, with water.
"It is much less common for the effluvia of
putrid animal matters to produce fevers. How
seldom do we hear of them in the neighbourhood
of                                           


26 AN ACCOUNT OF THE
slaughter-houses, or of the work-shops of skinners
or curriers?
"These observations are intended to serve two
purposes: 1st, To support the opinion of Dr
Hutchinson, that the malignant fever, which has
excited so general and so just an alarm in our city,
is not an imported disease; and, 2dly, To direct the
attention of our citizens to the spot from whence
this severe malady has been derived. It will be
impossible to check it during the continuance of
warm and dry weather, while any of the impure
matter which produced it, remains upon the pesti-
lential wharf.
R."                                       
This publication had no other effect, than to
produce fresh clamours against the author; for the
citizens as well as most of the physicians of Phila-
delphia had adopted a traditional opinion, that the
yellow fever could exist among us, only by impor-
tation from the West Indies.
In consequence, however, of a letter from Dr
Foulke to the Mayor of the city, in which he had
decided, in a positive manner, in favour of the
generation of the fever from the putrid coffee; the
mayor gave orders for the removal of the coffee,
and                                      

27 BILIOUS YELLOW FEVER. 
and the cleaning of the Wharf and dock. It was
said that measures were taken for this purpose;
but Dr Foulke, who visited the place where the
coffee lay, has repeatedly assured me, that they
were so far from being effectual, that an offensive
smell was exhaled from it many days afterwards.
I shall pass over for the present, the facts and
arguments on which I ground my assertion of the
generation of this fever in our city. They will
come in more properly in the close of the history
of the disease.
The seeds of the fever, whether received into
the body, from the putrid effluvia of the coffee, or
by contagion, generally excited the disease in a
few days. I met with several cases in which it
acted, so as to produce a fever on the same day, in
which it was received into the system, and I heard
of two cases in which it excited sickness, fainting,
and fever, within one hour after the persons were
exposed to it. I met with no instance in which
there was a longer interval than sixteen days, be-
tween the contagion being received into the body,
and the production of the disease.
This poison acted differently in different consti-
tutions, according to previous habits, to the de-
grees                                         

28 AN ACCOUNT OF THE
grees of predisposing debility, or to the quantity
and concentration of the contagion which was ap-
plied to the body.
In some constitutions the contagion was at once
a remote, a predisposing, and an exciting cause of
the disease; hence some persons were affected by
it, who had not departed in any instance from their
ordinary habits of living, as to diet, dress, and ex-
ercise. But it was more frequently brought on
by some predisposing, or exciting cause. I shall
briefly enumerate each of them.
Whatever be the specific quality of the matter
which produced the fever, it is certain, that it
acted as a stimulus upon the whole system. In a
moderate degree, it produced only a quickness
and fullness of the pulse, but when it was more
active, it induced that species of debility which
has been happily called indirect. It is the reverse
of direct debility, which is produced by the ab-
straction of natural, and usual stimuli from the
body. When the contagion acted with so much
force, as to induce indirect debility, a fever some-
times followed without the aid of an exciting
cause, but this was seldom the case. In ninety-
nine cases out of an hundred, which came under
my notice, I could distinctly trace the formation
of                                             

29 BILIOUS YELLOW FEVER.
of the disease to some of the following causes, act-
ing separately, or in greater or less combination,
and inducing indirect or direct debility upon the
system. The causes which induced indirect debi-
lity were,
1. FATIGUE of body or mind, induced by labour,
by walking, riding, watching, or the like. It was
labour which excited the disease so universally
among the lower class of people. A long walk often
induced it. Few escaped it after a day, or even a
few hours spent in gunning. A hard trotting
horse brought it on two of my patients. Perhaps,
riding on horseback, and in the sun, was the ex-
citing cause of the disease in most of the citizens
and strangers who were affected by it in their
flight from the city. A fall excited it in a girl,
and a stroke upon the head excited it in a young
man who came under my care. Many people were
seized with the disorder in consequence of their
exertions on the night of the 7th of September,
in extinguishing the fire which consumed Mr.
Dobson's printing-office, and even the less violent
exercise of working the fire engines for the pur-
pose of laying the dust in the streets, added fre-
quently to the number of the sick.
2. HEAT, 

30 AN ACCOUNT OF THE
2. HEAT, from every cause, but more especially
the heat of the sun, was a very common exciting
cause of the disorder. It aided the stimulus of the
contagion in bringing on indirect debility. The re-
gister of the weather during the latter end of Au-
gust-the whole of September, and the first two
weeks in October, will shew how much the heat
of the sun must have contributed to excite the dis-
ease, more especially among labouring people.
The heat of common fires, likewise became a fre-
quent cause of the activity of the contagion, where
it had been received into the body; hence the
greater mortality of the disease among bakers,
blacksmiths, and hatters, than among any other
class of people.
3. INTEMPERANCE in eating or drinking. A
plentiful meal, and a few extra-glasses of wine, sel-
dom failed of exciting the fever. But where the
body was strongly impregnated with the contagion,
even the smallest deviation from the customary
stimulus of diet, in respect to quality or quantity,
roused the contagion into action. A supper of
twelve oysters in one, and of three, in another
of my patients, produced the disease. Half an
ounce of meat rendered the contagion active in
a lady, who had lived by my advice for two
weeks                                      

31 BILIOUS YELLOW FEVER.      
weeks upon milk and vegetables. A supper of
salad dressed after the French fashion, excited it
in one of Dr Mease's patients. It is because
men are more predisposed by their constitution,
and employments, to indirect debility than wo-
men, and that young and middle aged persons
are more predisposed to this species of debility
than old people; that more men than women, and
more young than old people, were affected by the
disorder.
There were several exciting causes of the disease,
which acted by inducing direct debility upon the
system. It may appear difficult at first fight to ex-
plain, how causes so opposite in their nature, as in-
direct and direct debility should produce exactly
the same effect. The difficulty vanishes when we
reflect, that the abstraction of one stimulus, by
accumulating the excitability of the system, en-
creases the force of those which remain. The
contagion when received into the body, was fre-
quently innocent, until it was aided by the addi-
tion of a new, or by the abstraction of a customary
stimulus. The causes which acted in the latter
way were,
1. FEAR. This passion debilitates, only be-
cause it abstracts its antagonist passion of courage.
In many people the disease was excited by a sud-
den                                           

32 AN ACCOUNT OF THE
den paroxysm of fear; but I saw some remarkable
instances where timid people escaped the disease,
although they were constantly exposed to it. Per-
haps a moderate degree of fear served to balance
the tendency of the system to indirect debility from
the excessive stimulus of the contagion, and there-
by to preserve it in a state of healthy equilibrium.
I am certain that moderate fear did no harm, after
the disease was formed, in those cases where a mor-
bid excess of action, or prostration of the moving
powers from excess of stimulus, had taken place.
It was an early discovery of this fact which led me
not to conceal from my patients the true name of
this fever, when I was called to them on the day
of their being attacked by it. The fear, co-ope-
rated with some of my remedies (to be mention-
ed hereafter) in reducing the morbid excitement
of the arterial system. A total absence of fear, in
many cases that came under my notice, did not pre-
vent an attack of the fever.
2. GRIEF. It was remarkable that the great-
est concentration of the contagion did not pro-
duce the disease in many instances in the atten-
dants upon the sick, while there was a hope of
their recovery. The grief which followed the
extinction of hope, by death, frequently produ-
ced the disease within a day or two afterwards
and that, not in one person only, but often in most
I of        

33 BILIOUS YELLOW FEVER.
of the near relations of the deceased. But the dis-
ease was also produced by a change in the state of
the mind directly opposite to that which has been
mentioned. Many persons that attended patients
who recovered, were seized with the disorder a
day or two after they were relieved from the toils
and anxiety of nursing. The collapse of the mind
from the abstraction of the stimulus of hope and
desire, by their ample gratification, probably pro-
duced that debility, and loss of the equilibrium
in the system, which favoured the activity of the
contagion.
The effects of both the states of mind which
have been described, have been happily illustrated
by two facts which are recorded by Dr Jackson.*
He tells us that the garrisons of Savannah and
York Town, were both healthy during the siege
of those towns, but that the former became sick-
ly as soon as the French and American armies re-
treated from before it, and the latter, immediately
after its capitulation.
3. COLD. It will not be necessary to pause
here, to prove that cold is a negative quality, and
produced only by the absence of heat. Its action
* Treatise on the Fevers of Jamaica, page 298.
D in                     


34 AN ACCOUNT OF THE
in exciting the disease, depended upon the dimi-
nution of the necessary and natural heat of the bo-
dy, and thereby so far destroying the equilibrium
of the system, as to enable the contagion to pro-
duce excessive or convulsive motions in the blood
vessels. The night air, even in the warm month
of September, was often so cool as to excite the
disease where the dress and bed clothes were not
accommodated to it. It was excited in one case
by a person's only wetting his feet in the month
of October, and neglecting afterwards to change
his shoes and stockings. Every change in the
weather, that was short of producing frost, evi-
dently encreased the number of sick people. This
was obvious after the 18th and 19th of September,
when the mercury fell to 44°, and 45°. The
hopes of the city received a severe disappointment
upon this occasion, for I well recollect there was a
general expectation that this change in the weather
would have checked the disorder. The same en-
crease of the number of sick, was observed to fol-
low the cool weather which succeeded the 6th and
7th of October, on which days the mercury fell
to 43° and 46°.
It was observed that those persons who were
habitually exposed to the cool air, were less liable
to the disease than others. I ascribe it to the ha-
bitual                                        

35 BILIOUS YELLOW FEVER.
bitual impression of the cool night air upon the
bodies of the city watchmen, that only four or
five of them out of 25 were affected by the dis-
order.
After the body had been heated by violent ex-
ercise, a breeze of cool air sometimes excited the
disease in those cases where there had been no
change in the temperature of the weather.
4. SLEEP. A great proportion of all who were
affected by this fever, were attacked in the night.
Sleep induced direct debility, and thereby dispo-
sed the contagion which floated in the blood, to
act with such force upon the system as to destroy
its equilibrium, and thus to excite a fever. The
influence of sleep as a predisposing, and exciting
cause was often assisted by the want of bed cloathes,
suited to the midnight or morning coolness of the
air.
5. IMMODERATE EVACUATIONS. The efficacy
of moderate purging and bleeding in preventing
the disease, led some people to use those remedies
in an excess, which both predisposed to the dis-
ease, and excited it. The morbid effects of these
evacuations, were much aided by fear, for it was
this passion which perverted the judgment in such
D2 a man-                  
 

36 AN ACCOUNT OF THE
a manner, as to lead to the excessive use of reme-
dies, which to be effectual, should only be used
in moderate quantities.
The disease appeared with different symptoms,
and in different degrees, in different people. They
both varied likewise with the weather. In describ-
ing the disease I shall take notice of the changes
in the symptoms, which were produced by changes
in the temperature of the air.
The precursors, or premonitory signs of this
fever were, costiveness, a dull pain in the right
side, defect of appetite, flatulency, perverted taste,
heat in the stomach, giddiness, or pain in the
head, a dull-watery-brilliant, yellow or red
eye, dim and imperfect vision, a hoarseness, or
slight sore throat, low spirits, or unusual vivacity,
a moisture on the hands, a disposition to sweat at
nights, or after moderate exercise, or a sudden
suppression of night sweats. The dull eye, and
the lowness of spirits appeared to be the effects of
such an excess in the stimulus of the contagion as
to induce indirect debility, while the brilliant eye,
and the unusual vivacity, seemed to have been
produced by a less quantity of the contagion act-
ing as a cordial upon the system. More or less of
these symptoms, frequently continued for two or
three                                       

37 BILIOUS YELLOW FEVER.  
three days before the patients were confined to
their beds, and in some people they continued du-
ring the whole time of its prevalence in the city,
without producing the disease. I wish these symp-
toms to be remembered by the reader. They will
form the corner stone of a system which I hope
will either eradicate the disorder altogether, or
render it as safe as a common intermittent, or as the
small-pox when it is received by inoculation.
Frequent as these precursors of the fever were,
they were not universal. Many went to bed in
good health, and awoke in the night with a chilly
fit. Many rose in the morning after regular and
natural sleep, and were seized at their work, or
after a walk with a sudden and unexpected attack
of the fever. In most of these cases the disease
came on with a chilly fit, which afforded by its
violence or long duration a tolerable presage of the
favourable issue of the disorder.
Upon entering a sick room where a patient was
confined by this fever, the first thing which struck
the eye of a physician, was the countenance. It
was as much unlike that which is exhibited in the
common bilious fever, as the face of a wild, is
unlike the face of a mild domestic animal. The
eyes were sad, watery, and so inflamed in some
D3 cases 

38 AN ACCOUNT OF THE
cases as to resemble two balls of fire. Some-
times they had a most brilliant or ferocious ap-
pearance. A redness or yellowness in them, was
nearly universal: but I saw a few violent cases in
which no change could be discovered in the colour
of the eyes. The face was suffused with blood,
or of a dusky colour, and the whole countenance
was downcast and clouded. After the 10th of
September, when a determination of blood to the
brain became universal, there was a preternatural
dilatation of the pupil. Sighing attended in almost:
every case. The skin was dry, and frequently of
its natural temperature. These were the principal
symptoms which discovered themselves to the eye,
and hand of a physician. The answers to the first
questions proposed upon visiting a patient, were
calculated to produce a belief in the mind of a
physician, that the disease under which the patient
laboured, was not the prevailing malignant epi-
demic. I did not for many weeks meet with a
dozen patients, who acknowledged that they had
any other indisposition than a common cold, or a
slight remitting, or intermitting fever. I was
particularly struck with this self-deception in many
persons who had nursed relations that had died
with the yellow fever, or who had been exposed
to its contagion in families, or neighbourhoods,
where it had prevailed for days and even weeks
with                                         

39 BILIOUS YELLOW FEVER.
with great mortality. I shall hereafter trace a part
of this disposition in the sick to deceive themselves,
to the influence of certain publications which ap-
peared soon after the disease became epidemic in
the city.
In the further history of this fever, I shall de-
scribe its symptoms as they appeared.
I. In the sanguiferous system.
II. In the liver, lungs, and brain.
III. In the alimentary canal; in which I include
the stomach as well as the bowels.
IV. In the secretions and excretions.
V. In the nervous system.
VI. In the senses and appetites.
VII. In the lymphatic and glandular system.
VIII. Upon the skin.
IX. In the blood.
D4 After 
 

40 AN ACCOUNT OF THE
After having finished this detail, I shall mention
some general characters of the disease, and after-
wards subdivide it into classes, according to its de-
grees and duration.
I. THE BLOOD VESSELS (and not the stomach
and bowels according to Dr Warren) are the
"seat and throne" of this as well as of all other
fevers. I have publicly taught for several years,
that a fever is occasioned by a convulsion in the
arterial system. When the epidemic, which we
are now considering, came on with a full, tense,
and quick pulse, this convulsion was very percep-
tible; but it frequently came on with a weak
pulse; often without any preternatural frequency
or quickness, and sometimes so low as not to be
perceived without pressing the artery at the wrists.
In many cases the pulse intermitted after the 4th,
in some after the 5th, and in others after the 14th,
stroke. These intermissions occurred in several per-
sons who were infected, but who were not confined
by the fever. They likewise continued in several
of my patients for many days after their recovery.
This was the case in particular in Mrs. Clymer,
Mrs. Palmer's son William, and in a son of Mr.
William Compton. In some there was a preter-
natural slowness of the pulse. It beat 44 strokes
in a minute in Mr. B. W. Morris-48 in Mr. Thos.
Wharton,                                      


41 BILIOUS YELLOW FEVER.
Wharton, jun. and 64 in Mr. William Sansom,
at a time when they were in the most imminent
danger. Dr Physick informed me that in one of his
patients the pulse was reduced in frequency to 30
strokes in a minute. All these different states of
the pulse have been taken notice of by authors
who have described pestilential fevers.* They
have been improperly ascribed to the absence of
fever: I would rather suppose that they are occa-
sioned by the stimulus of the contagion acting,
upon the arteries with too much force to admit of
their being excited into quick and convulsive mo-
tions. The remedy which removed it (to be men-
tioned hereafter) will render this explanation of its
cause still more probable. Milton describes a dark-
ness, from an excess of light. In like manner, we
observe in this small intermitting and slow pulse, a
deficiency of strength from an excess of force ap-
plied to it. In every case of it which came under
my notice, it was likewise tense or chorded. This
species of pulse occurred chiefly in the month of
August, and in the first ten days in September. I
had met with it formerly in a sporadic case of yel-
* Vergasca, Sorbait, and Boate in Haller's Bibliotheca,
Medicinæ, Vol. iii. also by Dr Stubbs in the Philosophi-
cal Transactions, and Riverius in his treatise de febre pesti-
lenti.
low                                           

42 AN ACCOUNT OF THE
low fever. It was new to all of my pupils. One
of them, Mr. Washington, gave it the name of the
"indescribable pulse." It aided in determining
the specific nature of this fever before the common
bilious remittent disappeared in the city. For a
while, I ascribed this peculiarity in the pulse, more
especially its slowness, to an affection of the brain
only, and suspected that it was produced by what
I have taken the liberty elsewhere to call the phre-
nicula, or inflammatory state of the internal dropsy
of the brain, and which I have remarked to be an
occasional symptom and consequence of remitting
fever*. I was the more disposed to adopt this
opinion, from perceiving this slow and intermitting
pulse more frequently in children than in adults.
Impressed with this idea, I requested Mr. Coxe, one
of my pupils, to assist me in examining the state
of the eye. For two days we discovered no change
in it, but on the third day after we began to in-
spect the eyes, we both perceived a preternatural
dilatation of the pupils in different patients; and
we seldom afterwards saw an eye in which it was
absent. In Dr Say it was attended by a squinting,
a symptom which marks a high degree of a mor-
bid affection of the brain. Had this slowness or
intermission in the pulse occurred only after signs
* Medical Inquiries and Observations, Vol. ii.
of                                           


43 BILIOUS YELLOW FEVER.  
of inflammation or congestion had appeared in the
brain, I should have supposed that it had been de-
rived wholly from that cause; but I well recollect
having felt it several days before I could discover
the least change in the pupil of the eye. I am
forced therefore to call in the operation of another
cause, to assist in accounting for this state of the
pulse, and this I take to be a spasmodic affection,
accompanied with preternatural dilatation or con-
traction of the heart. Lieutaud mentions this spe-
cies of pulse in several places, as occurring with an
undue enlargement of that muscle*.  Dr Ferriar
describes a case, in which a low, irregular, inter-
mitting and hardly perceptible pulse, attended a
morbid dilatation of the heart†. In a letter I
lately received from Mr. Hugh Ferguson, a student
of medicine in the college of Edinburgh, written
from Dublin, during the time of a visit to his fa-
ther, and dated September 30th, 1793, I find a
fact which throws additional light upon this sub-
ject. "A case (says my young correspondent)
where a remarkable intermission of pulse was ob-
served, occurred in this city last year. A gentle-
man of the medical profession, middle aged, of a
* Historia Anatomica Medica, Vol. ii. Obs. 405. 418.
423. 510.
† Medical Histories and Reflections, p. 150.
delicate                                         
 

44 AN ACCOUNT OF THE
delicate habit of body, and who had formerly suf-
fered phthisical attacks was attacked with the
acute rheumatism. Some days after he was taken
ill, he complained of uncommon fullness, and a very
peculiar kind of sensation about the præcordia,
which it was judged proper to relieve by copious
blood-letting. This being done, the uneasiness
went off. It returned however three or four
times, and was as often relieved by bleeding. Du-
ring each of his fits (if I may call them so), the
patient experienced an almost total remission of his
pains in his limbs; but they returned with equal
or greater violence after blood-letting. During
the fit there was an intermission of the pulse (the
first time) of no less than thirteen strokes. It was
when beating full, strong, and slow. The third
intermission was of nine strokes. The gentleman
soon recovered, and has enjoyed good health for
ten months past. The opinion of some of his phy-
sicians was, that the heart was affected as a mus-
cle, by the rheumatism, and alternated with the
limbs."
I am the more inclined to believe the peculi-
arity in the pulse which has been mentioned in the
yellow-fever, arose in part from a spasmodic affec-
tion of the heart, from the frequency of an uncom-
mon palpitation of this muscle, which I discovered
in 

45 BILIOUS YELLOW FEVER. 
in this disorder, more especially in old people.
The disposition likewise to syncope and sighing,
which so often occurred, can be explained upon
no other principle than inflammation, spasm, dila-
tation, or congestion in the heart. After the 10th
of September this indescribable or sulky pulse (for
by the latter epithet I sometimes called it) became
less observable; and in proportion as the weather
became cool, it totally disappeared. It was gra-
dually succeeded by a pulse, full, tense, quick,
and as frequent as in pleurisy or rheumatism. It
differed however from a pleuritic or rheumatic
pulse, in imparting a very different sensation to the
fingers. No two strokes seemed to be exactly
alike. Its action was of a hobbling nature. It was
at this time so familiar to me, that I think I could
have distinguished the disease by it, without seeing
the patient. It was remarkable, that this pulse at-
tended the yellow fever even when it appeared in
the mild form of an intermittent, and in those cases
where the patients were able to walk about, or go
abroad. It was nearly as tense in the remissions
and intermissions of the fever, as it was in the ex-
acerbations. It was an alarming symptom, and
when the only remedy which was effectual to re-
move it, was neglected, such a change in the sys-
tem was induced, as frequently brought on death
in a few days.
This

46 AN ACCOUNT OF THE
This change in the pulse, from extreme low-
ness, to fullness and activity, appeared to be owing
to the diminution of the heat of the weather,
which by its stimulus, added to that of the conta-
gion, had induced those symptoms of indirect de-
bility in the pulse, which have been mentioned.
The pulse most frequently lessened in its fullness,
and became gradually weak, frequent, and imper-
ceptible before death; but I met with several cases
in which it was full, active, and even tense in the
last hours of life.
HEMORRHAGIES belong to the symptoms of
this fever as they appeared in the sanguineous sys-
tem. They occurred in the beginning of the dis-
order chiefly from the nose and uterus. Some-
times but a few drops of blood distilled from the
nose. The menses were unusual in their quantity,
when they appeared at their stated periods, but
they often came on a week or two before the usual
time of their appearance. I saw one case of an
hemorrhage from the lungs on the first day of the
fever, which was mistaken for a common hemop-
tysis. As the disease advanced, the discharges of
blood became more universal. They occurred from
the gums, ears, stomach, bowels, and urinary pas- 
sages. Drops of blood issued from the inner Can-
thus                                         


47 BILIOUS YELLOW FEVER.
thus of the left eye of Mr. Josiah Coates. Dr
Woodhouse attended a lady who bled from the
holes in her ears, which had been made by ear
rings. Many bled from the orifices which had
been made by bleeding, several days after they
appeared to have been healed, and some from
wounds which had been made in veins in unsuc-
cessful attempts to draw blood. These last hemor-
rhages were very troublesome, and in some cases
precipitated death.
II. I come now to mention the symptoms of
this fever as they appeared in the LIVER, the
LUNGS, and the BRAIN. From the histories which
I had read of this disorder, I was early led to ex-
amine the state of the LIVER, but I was surprised
to find so few marks of hepatic affection. I met
with but two cases in which the patient could lie
only on the right side. Many complained of a
dull pain in the region of the liver, but very few
complained of that soreness to the touch, about
the pit of the stomach which is taken notice of by
authors, and which was universal in the yellow
fever in 1762. In proportion as the cool weather
advanced, a preternatural determination of the
blood took place chiefly to the lungs and brain.
Many were affected with pneumonic symptoms,
2 and            

48 AN ACCOUNT OF THE
and some appeared to die of sudden effusions of
blood or serum in the lungs. It was an unex-
pected effusion of this kind which put an end to
the life of Mrs. Keppele after she had exhibited
hopeful signs of a recovery.
I saw one person who recovered from an affec-
tion of the lungs, by means of a copious expecto-
ration of yellow phlegm and mucus. But the
BRAIN was principally affected with morbid con-
gestion in this disorder. It was indicated by the
suffusion of blood in the face, by the redness of
the eyes, by a dilatation of the pupils, by the pain
in the head, by the hemorrhages from the nose
and ears, by the sickness, or vomiting, and by an
almost universal costive state of the bowels. I wish
to impress the reader with these facts, for they
formed one of the strongest indications for the use
of the remedies which I adopted for the cure of
this disorder. It is difficult to determine the exact
state of these viscera in every case of bilious and yel-
low fever. Inflammation certainly takes place in some
cases, and internal hemorrhages in others; but I
believe the most frequent affection of these viscera
consists in a certain morbid accumulation of blood in
them, which has been happily called by Dr. Clark
an engorgement or choaking of the blood vessels. I
I believe 

49 BILIOUS YELLOW FEVER. 
believe further with Dr Clark* and Dr Balfour†,
that death in most cases in bilious fevers is the
effect of these morbid congestions, and wholly
unconnected with direct debility or a supposed
putrefaction in the blood. It is true the dissec-
tions of Dr. Physick and Dr. Cathrall discovered
no morbid appearances in either of the viscera
which have been mentioned, but it should be re-
membered, that these dissections were made early
in the disorder. Dr. Annan attended the dissection
of a brain of a patient who died at Bush-hill some
days afterwards, and observed the blood-vessels to
be unusually turgid. In those cases where con-
gestion only takes place, it is as easy to conceive
that all morbid appearances in the brain may cease
after death, as that the suffusion of blood in the
face should disappear after the retreat of the blood
from the extremities of the vessels in the last mo-
ments of life. It is no new thing for morbid af-
fections of the brain to leave either slender, or no
marks of disease after death. Dr. Quin has given
a dissection of the brain of a child that died with
all the symptoms of hydrocephalus internus, and
yet nothing was discovered in the brain but a
slight turgescence of its blood vessels. Dr. Gir-
* Vol. i. p. 168.
† Treatise on the Intestinal remitting Fever, p. 125.
E dlestone                     

50 AN ACCOUNT OF THE
dlestone says, no injury appeared in the brains of
those persons who died of the symptomatic apo-
plexy, which occurred in a spasmodic disease which
he describes in the East Indies; and Mr. Clark in- 
forms us, that the brain was in a natural state in
every case of death from puerperal fever, notwith-
standing it seemed to be affected in many cases soon
after the attack of that disorder*.
I wish it to be remembered here, that the yel-
low fever like all other diseases is influenced by cli-
mate and season. The determination of the fluids
is seldom the same in different years, and I am sure
it varied with the weather in the disease which I
am now describing. Dr. Jackson speaks of the
head being most affected in the West India fevers
in dry situations. Dr. Hillary says, that there was
an unusual determination of the blood towards the
brain after a hot and dry season in the fevers of
Barbados in the year 1753, and Dr. Ferriar in
his account of an epidemic jail fever in Manchester
in 1789, 1790, informs us, that as soon as frost set
in, a delirium became a more frequent symptom of
that disorder, than it had been in more temperate
weather.
* Essay on the Epidemic Disease of Lying in Women,
of the years 1787 and 1788. p. 34.
III.                                            

51 BILIOUS YELLOW FEVER. 
III. The STOMACH and BOWELS were affected
in many ways in this fever. The disease seldom
appeared without nausea or vomiting. In some
cases, they both occurred for several days, or a
week before they were accompanied by any fever.
This was more frequently the case, where the dis-
ease was taken by exhalation from the putrid
coffee, than by contagion. Sometimes a pain,
known by the name of gastrodynia, ushered in the
disease. The stomach was so extremely irritable
as to reject drinks of every kind. Sometimes
green or yellow bile was rejected on the first day
of the disorder, by vomiting; but I much oftener
saw it continue for two days without discharging
any thing from the stomach, but the drinks which
were taken by the patient. If the fever in any
case came on without vomiting, or if it had been
checked by remedies that were ineffectual, to re-
move it altogether, it generally appeared, or re-
turned, on the 4th or 5th day of the disorder. I
dreaded this symptom on those days, for although
it was not always the forerunner of death, yet it
generally rendered the recovery more difficult and
tedious. In some cases the vomiting was more
or less constant from the beginning to the end
of the disorder, whether it terminated in life or
death.
E2 The

52 AN ACCOUNT OF THE
The vomiting which came on about the 4th or
5th day, was accompanied with a burning pain in
the region of the stomach. It produced great
anxiety and tossing of the body from one part of
the bed to another. In some cases this painful
burning occurred before any vomiting had taken
place. Drinks were now rejected from the sto-
mach so suddenly as often to be discharged over
the hand that lifted them to the head of the pa-
tient. The contents of the stomach (to be men-
tioned hereafter) were sometimes thrown up with
a convulsive motion, that propelled them in a
stream to a great distance, and in some cases all
over, the clothes of the by-standers.
Flatulency was an almost universal symptom in
every stage of this disorder. It was very distres-
sing in many cases. It occurred chiefly in the
stomach.
The BOWELS were generally costive, and in
some patients, as obstinately so as in the dry
gripes. In some-cases there was all the pain and
distress of a bilious colic, and in others, the tenes-
mus, and mucous and bloody discharges of a true
dysentery. A diarrhœa introduced the disease in
a few persons, but it was chiefly in those who had
been previously indisposed with weak bowels. A
pain-                                         

53 BILIOUS YELLOW FEVER.
painful tension of the abdomen took place in
many, accompanied in some instances by a dull,
and in others, by an acute pain in the lower part
of the belly.
The vomiting and costiveness in the first stage
of this fever, I believe were occasioned chiefly by
the morbid state of the brain. But the vomiting
and burning in the stomach, and the pain in the
bowels which occurred on the 4th and 5th days,
appeared to be the effects of inflammation induced
in part by the effusion of acrid bile into the alimen-
tary canal, and in part by a change in the action
of the coats of the stomach and bowels, induced
by effusions of serum or red blood, similar to those
which take place on the skin in malignant fevers,
and which are known by the name of petechiæ.
I am the more disposed to ascribe a large portion
of the inflammation, erosions, and mortifications,
which have been observed after death in the sto-
mach and bowels in this fever, to the latter cause,
from the discovery which has been made of pe-
techiæ and carbuncles in the bowels in the plague,
exactly similar to those which are found on the ex-
ternal parts of the body in that disorder*.
* Haller's Biliotheca Medicinæ, vol. iv. p. 375.
E3 IV. I

54 AN ACCOUNT OF THE
IV. I come now to describe the state of the
SECRETIONS and EXCRETIONS, as they appeared
in different stages of this fever.
There appeared to be a preternatural secretion
and excretion of bile. It was discharged from the
stomach and bowels in large quantities, and of
very different qualities and colours.
1. On the first and second days of the disorder,
many patients puked from half a pint to nearly a
quart of green or yellow bile. This was gene-
rally a favourable sign, as it shewed the biliary
ducts to be open. Four cases came under my no-
tice in which black bile was discharged on the first
day. Three of these patients recovered. I ascribed
their recovery, to the bile not having as yet ac-
quired acrimony enough to inflame, or corrode
the stomach.
2. There was frequently on the 4th or 5th day,
a discharge of matter from the stomach, resembling
coffee impregnated with its grounds. This was
always an alarming symptom. I believe it at first
to be a modification of vitiated bile, but I was led
afterwards by its resemblance to the urine (to be
described hereafter) to suspect that it was produced
by a morbid secretion in the liver, and effused
from                       


55 BILIOUS YELLOW FEVER.
from it into the stomach. Many recovered who
discharged this coffee-coloured matter.
3. Towards the close of the disease, there was a
discharge of matter of a deep black or pale colour,
from the stomach. Flakey substances frequently
floated in the basin or chamber-pot upon the sur-
face of this matter. It appeared to be bile in a
highly acrid state. That the bile may become ex-
tremely acrid in this stage of the disorder is evident
from several observations and experiments. Dr
Physick's hand was inflamed in consequence of its
being wetted by bile in this state, in differing a
dead body. Dr Arthaud examined the body of a
soldier who died of the yellow fever at the French
Cape on the 16th of May 1789, whose bile im-
parted a green colour*, to the tincture of radishes.
I am not certain that the black matter, which was
discharged in the last stage of the disorder, was
always vitiated or acrid bile. It was probably in
some cases, the matter which was formed in con-
sequence of the mortification of the stomach. The
matter which was discharged from carbuncles on
the skin, as I shall say hereafter, was always of a
dark colour. Several dissections of persons who
have died of the yellow fever, have shewn abscesses
in the stomach, not unlike external carbuncles.
* Rosier's Journal for Jan. 1790. vol. xxxvi. p. 380.
May                                          


56 AN ACCOUNT OF THE
May not the black matter in some cases be derived
from these internal carbuncle-like abscesses?
4. There was frequently discharged from the
stomach in the close of the disease, a large quan-
tity of grumous blood, which exhibited a dark
colour on its outside, resembling that of some of
the matters which have been described, and which
I believe was frequently mistaken for what is com-
monly known by the name of the black vomiting.
Several of my patients did me the honour to
say, I had cured them, after that symptom of
approaching dissolution had made its appearance;
but I am inclined to believe, dark-coloured blood
only, or the coffee coloured matter, was mistaken
for the matters which constitute the fatal black
vomiting. I accept here the black discharge
before mentioned, which took place in three cases
on the first day of the disorder. This I have no
doubt was bile, but it had not acquired its greatest
acrimony, and it was discharged before mortifica-
tion, or even inflammation could have taken place
in the stomach. Several persons died without a
black vomiting of any kind.
Along with all the discharges from the stomach
which have been described, there was occasionally
a large worm, and frequently large quantities of
mucus and tough phlegm.
The                                        

57 BILIOUS YELLOW FEVER.
The colour, quality, and quantity, of the fæces
depended very much upon the treatment of the
disease. Where active purges had been given, the
stools were copious, fœtid, and of a black or dark
colour. Where they were spontaneous, or excited
by weak purges, they had a more natural ap-
pearance. In both cases, they were sometimes of
a green, and sometimes of an olive colour. Their
smell was more or less fœtid, according to the time
in which they had been detained in the bowels. I
visited a lady who had passed several days without
a stool, and who had been treated with tonic
remedies. I gave her a purge, which in a few
hours procured a discharge of fæces so extremely
fœtid, that they produced fainting in an old woman
who attended her. The acrimony of the fæces
was such as to excoriate the rectum, and sometimes
to produce an extensive inflammation all around
its external termination. The quantity of the
stools produced by a single purge was in many
cases very great. They could be accounted for
only by calling in the constant, and rapid forma-
tion of them, by preternatural effusions of bile
into the bowels. 
I attended one person, and heard of two others,
in whom the stools were as white as in the jaun-
dice. I suspected in these cases, the bile to be so
impacted                                      

58 AN ACCOUNT OF THE
impacted in the gall bladder, or in its ducts, as
not to be discharged in a sufficient quantity to co-
lour the fœces. Large round worms were fre-
quently discharged with the stools.
The urine was in some cases plentiful, and of a
high colour. It was at times clear, and at other
times turbid. About the 4th or 5th day it some-
times assumed a dark colour, and resembled strong
coffee. This colour continued in one instance for
several days after the patient recovered. In seve-
ral cases, the urine had a fœtid smell. In some,
the discharge was accompanied by a burning pain
resembling that which takes place in a gonorrhœa.
I met with one case in which this burning came
on only in the evening, with the exacerbation of
the fever, and went off with its remission in the
morning.
A total deficiency of the urine took place in
many people for a day or two, without pain.  Dr
Sydenham takes notice of the same symptom in
the highly inflammatory small pox*. It generally
accompanied, or portended great danger. I sus-
pected that it was connected in this disease, as in
the hydrocephalus internus, with a morbid state
* Wallis's Edition. Vol. i. p. 197.
of                                          

59 BILIOUS YELLOW FEVER.
of the brain. I heard of one case in which there  
was a suppression of urine, which could not be
relieved without the use of the catheter.
A young man was attended by Mr. Fisher, one
of my pupils, who discharged several quarts of
limpid urine just before he died.
Dr. Arthaud informs us in the history of the
dissection before quoted, that the urine after death
imparted a green colour to the tincture of ra-
dishes.                               
Many people were relieved by copious sweats
on the first day of the disorder. They were in
some instances spontaneous, and in others, they
were excited by diluting drinks, or by strong
purges. These sweats were often of a yellow co-
lour, and sometimes had an offensive smell. They
were in some cases cold, and attended at the same
time with a full pulse. In general, the skin was
dry in the beginning as well as in the subsequent
stages of the disorder. I saw but few instances of
the disease terminating like common fevers, by
sweat after the third day. I wish this fact to be
remembered by the reader, for it laid part of the
foundation of my method of curing this fever.
There                                      

60 AN ACCOUNT OF THE
There was in some cases a preternatural secre-
tion and excretion of mucus from the glands of
the throat. It was discharged by an almost con-
stant hawking and spitting. All who had this
symptom recovered.
The Tongue was in every case moist, and of a
white colour on the first and second days of the
fever. As the disease advanced, it assumed a red
colour, and a smooth shining appearance. It was
not quite dry in this state. Towards the close of
the fever, a dry black streak appeared in its mid-
dle, which gradually extended to every part of it.
Few recovered after this appearance on the tongue
took place.
V. In the NERVOUS SYSTEM the symptoms of
the fever were different according as it affected
the brain-the muscles-the nerves-or the mind.
The sudden and violent action of the contagion,
induced apoplexy in several people. In some, it
brought on syncope, and in others, convulsions
in every part of the body. The apoplectic cases
generally proved fatal, for they fell chiefly upon
hard drinkers. Persons affected by syncope, or
convulsions, sometimes fell down in the streets.
Two cases of this kind happened near my house.
One                                          

61 BILIOUS YELLOW FEVER.
One of them came under my notice. He was
supposed by the bystanders to be drunken, but
his countenance, and convulsive motions, soon
convinced me that this was not the case.
A coma was observed in some people, or an
obstinate wakefulness in every stage of the disorder.
The latter symptom most frequently attended the
convalescence. Many were affected with immobi-
lity, or numbness in their limbs.
These symptoms were constant, or temporary,
according to the nature of the remedies which were
made use of, to remove them. They extended to
all the limbs, in some cases, and only to a part of
them in others. In some, a violent cramp both in
the arms, and legs attended the first attack of the
fever. I met with one case in which there was a
difficulty of swallowing from a spasmodic affection
of the throat, such as occurs in the locked-jaw. I
met with two cases of palsy in the limbs, which
continued for many months, after the disease left
the city.
A hiccup attended the last stage of this disorder,
but I think less frequently than the last stage of the
common bilious fever. I saw only five cases of
recovery where this symptom took place.
There 

62 AN ACCOUNT OF THE
There was in some instances a deficiency of sen-
sibility, but in others a degree of it, extending to
every part of the body, which rendered the appli-
cation of common rum to the skin, and even the
least motion of the limbs painful.
I was surprised to observe the last stage of this
fever to exhibit so few of the symptoms of the
common typhus or nervous never. Tremors of the
limbs and twitchings of the tendons were uncom-
mon. They occurred only in those cases in which
there was a predisposition to nervous diseases, and
chiefly in the convalescent state of the disorder.
While the muscles and nerves in many cases ex-
hibited so many marks of preternatural weakness,
in some, they appeared to be affected with preter-
natural excitement. Hence patients in the close of
the disorder often rose from their beds, walked
across their rooms, or came down stairs, with as
much ease as if they had been in perfect health. I
lost a patient in whom this state of morbid strength
occurred to such a degree, that he stood up before
his glass, and shaved himself on the day in which
he died.
The mind suffered with the morbid states of the
brain and nerves. A delirium was a common
symptom. It alternated in some cases with the
exacerbations                                  

63 BILIOUS YELLOW FEVER.
exacerbations and remissions of the fever. In
some, it continued without a remission, until a few
hours before death. Many, however, passed
through the whole course of the disease without
the least derangement in their ideas, even where
there were evident signs of a morbid congestion in
the brain. Some were seized with maniacal symp-
toms. In these, there was an apparent absence of
fever. Such was the degree of this mania in one
man, that he stripped of his shirt, left his bed, and
ran through the streets with no other covering
than a napkin on his head, at 8 o'clock at night,
to the great terror of all who met him. The
symptoms of mania occurred most frequently to-
wards the close of the disease, and sometimes con-
tinued for many days, and weeks, after all the fe-
brile symptoms had disappeared.
The temper was much affected in this fever.
There were few, in whom it did not produce great
depression of spirits. This was the case in many,
in whom pious habits, had subdued the fear of
death. In some the temper became very irritable.
Two cases of this kind came under my notice, in
persons who in good health, were distinguished for
uncommon sweetness of disposition and manners.
I observed in several persons the operations of
the understanding to be unimpaired, throughout
the                                          

64 AN ACCOUNT OF THE
the whole course of the fever, who retained no
remembrance of any thing that passed in their sick-
ness. My pupil Mr. Fisher furnished a remarkable
example of this correctness of understanding with
a suspension of memory. He neither said, nor
did any thing during his illness, that indicated the
least derangement of mind, and yet he recollected
nothing that passed in his room, except my visits to
him. His memory awakened upon my taking him
by the hand on the morning of the 6th day of his
disorder, and congratulating him upon his escape
from the grave.
In some, there was a weakness, or total defect
of memory for several weeks after their recovery,
Dr Woodhouse informed me that he had met with
a woman who after she had recovered, could not
recollect her own name.
Perhaps it would be proper to rank that self-
deception with respect to the nature and danger
of the disease which was so universal, among the
instances of derangement of mind.
The pain which attended the disorder was dif-
ferent according as the system was affected by
direct or indirect debility. In those cases in which
the system sunk under the violent impression of
the contagion, there was little or no pain. In
2 proportion                            

65 BILIOUS YELLOW FEVER.
proportion as the system was relieved from this
oppression it recovered its sensibility. The pain in
the head, was acute and distressing. It affected
the eye balls in a peculiar manner. A pain ex-
tended in some cases from the back of the head,
down the neck. The ears were affected in several
persons with a painful sensation, which they com-
pared to a string drawing their two ears together
through the brain. The sides, and the regions of
the stomach, liver and bowels, were all, in differ-
ent people, the seats of either dull or acute pains.
The stomach towards the close of the disorder was
affected with a burning or spasmodic pain of the
most distressing nature. It produced in some cases
great anguish of body and mind. In others it pro-
duced cries and shrieks which were often heard on
the opposite side of the streets to where the patients
lay. The back suffered very much in this disorder.
An acute pain extended in some cases from the
back, to one or both thighs. The arms and legs
sympathized with every other part of the body.
One of my patients, upon whose limbs the disease
fell, with its principal force, said that his legs felt as
if they had been scraped with a sharp instrument.
The sympathy of friends with the distresses of the
sick, extended to a small part of their misery, when
it did not include their sufferings from pain. One
F of


66 AN ACCOUNT OF THE
of the dearest friends I ever lost by death, declared
in the height of her illness, that "no one knew the
pains of a yellow fever, but those who felt them."
VI. The senses and appetites exhibited several
marks of the universal ravages of this fever upon
the body. A deafness attended in many cases, but
it was not often as in the nervous fever, a favour-
able symptom. A dimness of sight, was very com-
mon in the beginning of the disease. Many were
affected with temporary blindness. In some there
was a loss of sight in consequence of gutta serena,
or a total destruction of the substance of the eye.
There was in many persons a soreness to the touch,
which extended all over the body. I have often
observed this symptom to be the fore-runner of a
favourable issue of a nervous fever, but it was less
frequently the case in this disorder.
The thirst was moderate or absent in some cases,
but it occurred in the greatest number of persons
whom I saw in this fever. Sometimes it was
very intense. One of my patients who suffered
by an excessive draught of cold  water, declared
just before he died, that "he could drink up the
Delaware." It was always an alarming symptom,
when the thirst came on in this extravagant de-
gree                                          


67 BILIOUS YELLOW FEVER.
gree in the last stage of the disorder. In the be-
ginning of the fever, it generally abated upon the
appearance of a moist skin. Water, was preferred
to all other drinks.
The appetite for food was impaired in this, as
in all other fevers, but it returned much sooner
than is common after the patient began to recover.
Coffee was relished in the remissions of the fever,
in every stage of the disorder. So keen was the
appetite for solid, and more especially for animal
food, after the solution of the fever, that many
suffered from eating aliment that was improper
from its quality or quantity. There was a general
disrelish for wine, but malt liquors were frequently
grateful to the appetite.
Many people retained a relish for tobacco much
longer after they were attacked by this fever, and
acquired a relish for it much sooner after they
began to recover, than are common in any other
febrile disease. I met with one case in which my
patient, who was so ill as to require two bleedings,
continued to chew tobacco through every stage of
his fever.
The convalescence from this disorder was mark-
ed in some instances, by a sudden revival of the
F2 venereal                                  

68 AN ACCOUNT OF THE
venereal appetite. Several weddings took place
in the city between persons who had recovered from
the fever. Twelve took place among the con-
valescents in the hospital at Bush-hill. I wish I
could add, that the passion of the sexes for each
other, among those subjects of public charity, was
always gratified only in a lawful way. Delicacy
forbids a detail of the scenes of debauchery which
were practiced near the hospital in some of the
tents, which had been appropriated for the recep-
tion of convalescents. It is not peculiar to the
yellow fever to produce this  morbid excitability
of the venereal appetite. It was produced in a
much higher degree by the plague which raged in
Messina in the year 1743.
VII. The lymphatic and and glandular system did
not escape without some signs of the infection of
this disease. I met with three cases of swellings
in the inguinal, two in the parotid, and one in the
cervical glands: all these patients recovered without
a suppuration of their swellings. They were ex-
tremely painful in one case in which no redness
or inflammation appeared. In the others, there
was considerable inflammation, and but little pain.
In one of the cases of inguinal buboes, the whole
force of the disease seemed to be collected into the
lymphatic                                      

69 BILIOUS YELLOW FEVER. 
lymphatic system. The patient walked about, and
had no fever nor pain in any part of his body,
except in his groin. In another case which came
under my care, a swelling and pain extended from
the groin along the spermatic cord into one of the
testicles. These glandular swellings were not pe-
culiar to our late epidemic. They occurred in
the yellow fever of Jamaica as described by Dr.
Williams, and always with a happy issue of the dis-
order*.  A similar concentration of the contagion
of the plague in the lymphatic glands, is taken
notice of by Dr Patrick Russel.
VIII. The SKIN exhibited many marks of this
fever. It was preternaturally warm in some cases,
but it was often preternaturally cool. In some
there was a distressing coldness in the limbs for
two or three days. The yellow colour from which
this fever has derived its name, was not universal.
It seldom appeared where purges had been given
in sufficient doses. The yellowness rarely appeared
before the third, and generally about the fifth or
seventh day of the fever. Its early appearance
always denoted great danger. It sometimes appear-
ed first on the neck and breast, instead of the eyes.
In one of my patients it discovered itself first be-
hind one of his ears, and on the crown of his head,
* Essay on the Bilious or Yellow Fever, p. 35.
F3 which                  


70 AN ACCOUNT OF THE
which had been bald for several years. The re-
missions and exacerbations of the fever seemed to
have an influence upon this colour, for it appeared
and disappeared altogether, or with fainter or deep-
er shades of yellow, two or three times in the course
of the disorder. The eyes seldom escaped a yellow
tinge; and yet I saw a number of cases in which
the disease appeared with uncommon malignity and
danger, without the presence of this symptom.
Two very different causes have been supposed to
produce this yellow colour of the skin. By some
it has been attributed to the dissolution of the blood;
but I shall say hereafter, that the blood was seldom
dissolved in this fever. The yellow colour, more-
over, occurred in those cases where the blood ex-
hibited an inflammatory crust, and it continued in
many persons for five or six weeks after their re-
covery. It was likewise absent in some cases in
which the blood was dissolved. From these facts
it is probable, that the yellowness was the effect
of an absorption and mixture of bile with the
blood.
There was a clay-coloured appearance in the face
in some cases, which was very different from the
yellow colour which has been described. It occur-
red in the last stage of the fever, and in no instance
did I see a recovery after it.
There 

71 BILIOUS YELLOW FEVER.
There were eruptions of various kinds on the
skin, each of which I shall briefly describe.
1. I met with two cases of an eruption on the
skin, resembling that which occurs in the scarlet
fever. Dr Hume says, pimples often appear on
the pit of the stomach in the yellow fever of Ja-
maica. I examined the external region of the
stomach in many of my patients, without discover-
ing this symptom.
2. I met with one case, in which there was an
eruption of watery blisters, which after bursting,
ended in deep, black sores.
3. There was an eruption about the mouth in
many people, which ended in scabs, similar to
those which take place in the common bilious fever.
They always afforded a prospect of a favourable
issue of the disease.
4. Many persons had eruptions which resem-
bled mosquito bites. They were red and circum-
scribed. They appeared chiefly on the arms, but
they sometimes extended to the breast. Like the
yellow colour of the skin, they appeared and dis-
appeared two or three times in the course of the
disorder.
F4 5. Pe-

72 AN ACCOUNT OF THE
5. Petechiæ were common in the latter stage of
the fever. They sometimes came on in large, and
at other times in small red blotches; but they
soon acquired a dark colour. In most cases they
were the harbingers of death.
6. Several cases of carbuncles, such as occur in
the plague, came under my notice. They were
large and hard swellings on the limbs, with a black
apex, which upon being opened, discharged a thin,
dark-coloured, bloody matter. From one of these
malignant sores, an hemorrhage took place, which
precipitated the death of the amiable widow of
Dr John Morris.
7. A large and painful anthrax on the back, suc-
ceeded a favourable issue of the fever in the Rev.
Dr Blackwell.
8. I met with a woman who shewed me the
marks of a number of small boils on her face and
neck, which had accompanied her fever.
9. In one of my female patients, the cuticle
peeled from her arms and breast after her re-
covery. It was remarkable in this case, that the
skin discovered no yellowness except in those parts
which had been denudated of the cuticle.
Notwithstanding                                

73 BILIOUS YELLOW FEVER.
Notwithstanding this disposition to cutaneous
eruptions in this disorder, it was observed that
blisters were much less disposed to mortify than in
the common nervous fever. I met with only one
case in which a deep-seated ulcer followed the ap-
plication of blisters to the legs. Such was the in-
sensibility of the skin in some people, that blisters
made no impression upon it.
IX. How far the blood may be considered as the
vehicle of the contagion, it is not my business at
present to inquire; nor shall I in this place men-
tion the different appearances it exhibited when
drawn from a vein. It has been supposed to un-
dergo a change from a healthy to a putrid state;
and many of the symptoms of the fever which
have been described, particularly the hemorrhages
and eruptions on the skin, have been ascribed to
this supposed putrefaction of the blood. It would
be easy to multiply arguments to prove, that no
such thing as putrefaction can take place in the
blood; and that the symptoms which have been
supposed to prove its existence, are all effects of a
sudden, violent, and rapid inflammatory action, or
pressure upon the blood-vessels; and hence the ex-
ternal and internal hæmorrhages. The petechiæ
on the surface of the skin depend upon the same
cause. They are nothing but effusions of serum
or red blood, from a rupture or preternatural dila-
tation                                         
 

74 AN ACCOUNT OF THE
tation of the capillary vessels*. The smell emitted
from persons affected by this disease was far from
being of a putrid nature; and if this had been the
case, it would not have proved the existence of
putrefaction in the blood; for a putrid smell is
often discharged from the lungs, and from the
pores in sweat, which is wholly unconnected with
a putrid, or perhaps any other morbid state of the
blood. There are plants which discharge an
odor, which conveys to the nose a sensation like
that of putrefaction; and yet these plants exist at
the same time, in a state of the most healthy vege-
tation: nor does the early putrid smell of a body
which perishes with this fever, prove a putrid
change to have taken place in the blood before
death. All animals which die suddenly, and with-
out loss of blood, are disposed to a speedy putre-
faction. This has long been remarked in animals
that have been killed after a chance, or by light-
ning. The poisonous air called samiel, which is
described by Chardin, produces, when it destroys
life, instant putrefaction. The bodies of men who
die of violent passions, or after strong convulsions,
* See Wallis's edition of Sydenham, Vol. i. p. 165. Vol.
ii. p. 52, 94, 98, 350. De Haen's Ratio Medendi, Vol.
ii. p. 162. Vol. iv. p. 172.  Gaubii Pathologia, § 498, and
Dr. Sybert's inaugural dissertation, entitled "An Attempt
to Disprove the Doctrine of the Putrefaction of the Blood
in Living Animals," published in Philadelphia in 1793.
or                                            

75 BILIOUS YELLOW FEVER.
or even after great muscular exertion, putrefy in
a few hours after death. The healthy state of
the body depends upon a certain state of arrange-
ment in the fluids. A derangement of these fluids
is the natural consequence of the violent and ra-
pid motions, or of the undue pressure upon the
solids, which have been mentioned. It occurs in
every case of death from indirect debility, whe-
ther it be induced by the excessive stimulus of con-
tagion, by the volatile vitriolic acid which is sup-
posed to constitute the destructive samiel wind, or
by violent commotions excited in the body by ex-
ternal or internal causes. The practice among
fishermen in some countries, of breaking the heads
of their fish as soon as they are taken out of the
water, in order to retard their putrefaction, proves
the truth of the explanation I have given of its
cause, soon after death. The sudden extinction of
life in the fish, prevents those convulsive or violent
motions which induce sudden disorganization in
their bodies. It was remarkable that putrefaction
took place most speedily after death from the yel-
low fever, where the commotions of the system
were not relieved by evacuations. In those cases
where purges and bleeding had been used, putre-
faction did not take place sooner after death than
is common in any other febrile disease, under
equal circumstances of heat and air.
There                                       


76 AN ACCOUNT OF THE
There is a fact mentioned by Dr. Ferriar, from
Dr. Hamilton, late professor of anatomy at Glas-
gow, which may seem at first sight to militate
against the facts I have mentioned. He says that
he had observed bodies which were brought into
the dissecting room, that had petechiæ on them,
were longer in putrefying than any others. The
fevers of which the poor (the common subjects of
dissection) die, are generally of the low nervous
kind. Great direct debility is the characteristic
of these fevers. The petechiæ which occur in
them, appear in the last stage of this direct debi-
lity. They are the effect, not of too much impe-
tus in the blood, as in the yellow fever, but of a
defect or total absence of it in the last hours of
life. The slow progress of the body to putrefac-
tion after death in the instances mentioned by Dr.
Hamilton, seems to depend upon the same cause as
that to which I have ascribed it in those cases of
death from the yellow fever, in which evacuations
had been used, viz. direct debility. In the former
cases this slowness of putrefaction is induced by na-
ture-in the latter by art. The effects of debility
from both causes are, notwithstanding, the same.
Thus have I described the symptoms of this
fever. From the history I have given, it appears
that it counterfeited nearly all the acute and
chronic                                       

77 BILIOUS YELLOW FEVER.
chronic diseases to which the human body is sub-
ject. An epitome, both of its symptoms and its
theory, is happily delivered by Dr. Sydenham in
the following words. After describing the epide-
mic cough, pleurisy, and parapneumonic of 1675,
he adds, "But in other epidemics, the symptoms
are so slight from the disturbance raised in the
blood by the morbific particles contained in the
mass, that nature being in a manner oppressed, is
rendered unable to produce regular symptoms that
are suitable to the disease; and almost all the phæ-
nomena that happen are irregular, by reason of
the entire subversion of the animal œconomy; in
which case the fever is often depressed, which of
its own nature, would be very high. Sometimes
also fewer signs of a fever appear than the nature
of the disease requires, from a translation of the
malignant cause, either to the nervous system, to
some other parts of the body, or to some of the
juices not contained in the blood; whilst the mor-
bific matter is yet turgid*."
The disease ended in death in various ways. In
some it was sudden; in others it came on by gra-
dual approaches. In some the last hours of life
were marked with great pain, and strong convul-
sions; but in many more, death seemed to insinu-
* Wallis's edition, Vol, i. p. 344.
ate

78 AN ACCOUNT OF THE
ate itself into the system, with all the gentleness of
natural sleep. Mr. Powel expired with a smile
on his countenance. Dr. Griffitts informed me
that Dr. Johnson exhibited the same symptom in
the last hours of his life. This placid appearance
of the countenance, in the act of dying, was not
new to me. It frequently occurs in diseases which
affect the brain and nerves. I lost a patient three
years ago in the gout, who not only smiled, but
laughed, a few minutes before he expired.
I proceed now to mention some peculiarities of
the fever which could not be brought in under any
of the foregoing heads.
In every case of this disorder which came under
my notice, there were evident remissions, or inter-
missions of the fever, or of such symptoms as were
substituted for fever. I have long considered with
Mr. Senac, a tertian as the only original type of
all fevers. The bilious yellow fever indicated its
descent from this parent disorder. I met with
many cases of regular tertians in which the pa-
tients were so well on the intermediate days as to
go abroad. It appeared in this form in Mr. Van
Berkel the minister of the United Netherlands.
Nor was this mild form of the fever devoid of
danger. Many died who neglected it as a trifling
2 disorder,                                 

79 BILIOUS YELLOW FEVER.
disorder, or who took the common remedies for
intermittents to cure it. It generally ended in a
remittent before it destroyed the patient. The
tertian type discovered itself in some people after
the more violent symptoms of the fever had been
subdued, and continued in them for several weeks.
It changed from a tertian to a quartan type in Mr.
Thomas Willing, nearly a month after his reco-
very from the more acute and inflammatory symp-
toms of the disorder.
It is nothing new for a malignant fever to ap-
pear in the form of a tertian. It is frequently the
garb of the plague. Riverius describes a tertian
fever which proved fatal on the third day, which
was evidently derived from the same exhalation
which produced a continual malignant fever*.
The remissions were more evident in this, than
in the common bilious fever. They generally oc-
curred in the forenoon. It was my misfortune to
be deprived by the great number of my patients,
of that command of time which was necessary to
watch the exacerbations of this fever under all
their various changes, as to time, force, and dura-
* De Febre Pestilenti, Vol. xi. p. 93.
tion. 

80 AN ACCOUNT OF THE
tion. From all the observations that were sug-
gested by visits, at hours that were seldom left to
my choice, I was led to conclude, that the fever
exhibited in different people all that variety of
forms which has been described by Dr. Cleghorn
in his account of the tertian fever of Minorca. A
violent exacerbation on even days was evidently
attended with more danger than on odd days. The
same thing was observed by Dr. Mitchell in the
Yellow Fever of Virginia in the year 1741. "If
"(says he) the exacerbations were on equal days,
"they generally died in the third paroxysm, or
"the 6th day, but if on unequal days, they reco-
"vered on the 7th."
The deaths which occurred on the 3d, 5th, and
7th days, appeared frequently to be the effects
of the commotions or depression, produced in the
system on the 2nd, 4th, and 6th days.
The remission on the third day, was frequently
such as to beget a belief that the disease had run
its course and that all danger was over. A vio-
lent attack of the fever on the 4th day removed
this deception, and if a relaxation had taken place
in the use of proper remedies on the 3d day, death
frequently occurred on the 5th or the seventh.
The 

81 BILIOUS YELLOW FEVER.
The termination of this fever in life, and death,
was much more frequent on the 3d, 5th, 7th, 9th
and 11th days, than is common in the mild remit-
ting fever. Where death occurred on the even
days, it seemed to be the effect of a violent pa-
roxysm of the fever, or of great vigour of consti-
tution, or of the force of medicines which pro-
tracted some of the motions of life beyond the
close of the odd days which have been mentioned.
I think I observed the fever to terminate on the
third day more frequently in August, and during
the first ten days in September, than it did after
the weather became cool. In this, it resembled
the common bilious remittents of our city, also the
simple tertians described by Dr. Cleghorn*. The
danger seemed to be in proportion to the tendency
of the disease to a speedy crisis, hence more died
in August in proportion to the number who were
affected than in September or October, when the
disease was left to itself. But, however strange
after this remark it may appear, the disease
yielded to the remedies which finally subdued it,
more speedily and certainly upon its first appear-
ance in the city, than it did two or three weeks
afterwards.
* Diseases of Minorea, p. 185.
G The                    


82 AN ACCOUNT OF THE
The fever continued for fifteen, twenty, and
even thirty days in some people. Its duration was
much influenced by the weather, and by the use
or neglect of certain remedies (to be mentioned
hereafter) in the first stage of the disorder.
It has been common with authors to divide the
symptoms of this fever into three different stages.
The order I have pursued in the history of those
symptoms, will render this division unnecessary. It
will, I hope, be more useful to divide the patients
affected with the disorder into three classes.
The first includes those in whom the stimulus of
the contagion, produced the symptoms of indirect
debility, such as coma, languor, sighing, a disposi-
tion to syncope, and a weak, or flow pulse.
The second includes those in whom the conta-
gion acted with less force, producing great pain
in the head, and other parts of the body; delirium,
vomiting, heat, thirst, and a quick, tense, or full
pulse, with obvious remissions or intermissions of
the fever.
The third class includes all those persons in
whom the stimulus of the contagion acted so fee-
bly as not to confine them to their beds or houses.
This                                       

83 BILIOUS YELLOW FEVER. 
This class of persons affected by the yellow fever,
was very numerous. Many of them recovered
without medical aid, or by the use of domestic
prescriptions; many of them recovered in conse-
quence of a spontaneous diarrhœa, or plentiful
sweats; many were saved by moderate bleeding,
and purging; while some died, who conceived
their complaints to be occasioned by a common
cold, and neglected to take proper care of them-
selves, or to use the necessary means for their re-
covery. It is not peculiar to the contagion of the
yellow fever to produce this feeble operation up-
on the system. It has been observed in the south-
ern states of America, that in those seasons in
which the common bilious fever is epidemic "no
body is quite well," and that what are called in
those states "inward severs" are universal. The
small-pox even in the natural way, does not always
confine the patient; and thousands pass through
the plague without being confined to their beds
or houses. Dr. Hodges prescribed for this class
of patients in his parlour in London in the year
1665, and Dr. Patrick Russel did the same from
a chamber window fifteen feet above the level of
the street at Aleppo. Notwithstanding the mild
form the plague put on in these cases, it often
proved fatal according to Dr. Russel. I have in-
troduced these facts chiefly with a view of prepa-
G2 ring                    

84 AN ACCOUNT OF THE
ring the reader to reject the opinion that we had
two species of fever in the city at the same time;
and to shew that the yellow fever appears in a
more simple form than with "strongly marked"
characters; or in other words, with a yellow skin,
and a black vomiting.
It was remarkable that this fever always found
out the weak part of every constitution it attacked.
The head, the lungs, the stomach, the bowels,
and the limbs, suffered more or less, according as
they were more or less debilitated by previous in-
flammatory, or nervous diseases, or by a mixture
of both, as in the gout.
I have before remarked, that the influenza, the
scarlatina, and a mild bilious remittent, prevailed
in the city, before the yellow fever made its ap-
pearance. In the course of a few weeks they all
disappeared, or appeared with symptoms of the
yellow fever; so that after the first week of Sep-
tember, it was the solitary epidemic of the city.
The only case like influenza which I saw after
the 5th of September, was in a girl of 14 years of
age, on the 13th of the month. It came on with
a sneezing and cough. I was called to her on
the third day of her disorder. The instant I felt
her                                          

85 BILIOUS YELLOW FEVER.
her pulse, I pronounced her disease to be the yellow
fever. Her father was offended with this opinion,
although he lived in a highly infected neighbour-
hood, and objected to the remedies I prescribed for
her. In a few days she died. In the course of
ten days, her father and sister were infected, and
both died I was informed, with the usual symptoms
of the yellow fever.
It has been an axiom in medicine, time imme-
morial, that no two contagious fevers of unequal
force can exist long together in the same place.
As this axiom seems to have been forgotten by
many of the physicians of Philadelphia, and as
the ignorance or neglect of it, led to that contra-
riety of opinion and practice, which unhappily
took place in the treatment of the disorder, I hope
I shall be excused by those physicians to whom this
fact is as familiar as the most simple law of nature,
if I fill a few pages with proofs of it, from practical
writers.
Thucydides long ago remarked that the plague
chased all other diseases from Athens, or obliged
them to change their nature, by assuming some of
its symptoms.
G3 Dr
 

86 AN ACCOUNT OF THE
Dr Sydenham makes the same remark upon the
plague in London in 1665. Dr Hodges in his ac-
count of the same plague, says that "at the rise of
the plague all other distempers, went into it, but at
its declension, that it degenerated into others, as in-
flammations, headache, quincies, dysenteries, small-
pox, measles, fevers, and hectics, wherein the
plague yet predominated*."
During the prevalence of the plague in Grand
Cairo, no sporadic disease of any kind makes its
appearance. The same observation is made by
Sauvage in his account of the plague at Alias in
the province of Languedoc†.
The small-pox though a disease of less force than
the plague, has often chased it from Constantino-
ple, probably from its infecting at a greater distance
than the plague. But this exclusive prevalence
of a single epidemic is not confined to the plague
and small-pox. Dr Sydenham's writings are full
of proofs of the dominion of febrile diseases over
each other: Hence after treating, upon a sympto-
* Dr Hodges Account of the Plague in London, p. 26.
† Sed hoc observatu dignum fuit, omnes alios morbos
acutos, durante peste siluisse, et omnes morbos acutos e pes-
tis genere fuissed. Nosologia Methodica, vol. i. p. 416.
matic                                          

87 BILIOUS YELLOW FEVER.
matic pleurisy, which sometimes accompanied a
slow fever in the year 1675, and which had pro-
bably been injudiciously treated by some of those
physicians who prescribe for the name of a disease,
he delivers the following aphorism, "whoever in
the cure of fevers, hath not always in view, the
constitution of the year, inasmuch as it tends to
produce some particular epidemic disease, and
likewise to reduce all the cotemporary diseases to
its own form and likeness, proceeds in an uncer-
tain and fallacious way*." It appears further
from the writings of this excellent physician, that
where the monarchy of a single disease was not
immediately acknowledged, by a sudden retreat
of all cotemporary diseases, they were forced to
do homage to it, by wearing its livery. It would
be easy to multiply proofs of this assertion, from
the numerous histories of epidemics which are to
be found in his works. I shall mention only one
or two of them. A continual fever accompanied
by a dry skin, had prevailed for some time in the
city of London. During the continuance of this
fever, the regular small-pox made its appearance.
It is peculiar to the small-pox when of a distinct
nature, to be attended by irregular sweats before
the eruption of the pock. The continued fever
Vol. i. p. 340.
G4 now                 

88 AN ACCOUNT OF THE
now put on a new symptom. It was attended by
sweats in its first stage, exactly like those which
attended the eruptive fever of the small-pox*. This
despotism of a powerful epidemic, extended it-
self to the most trifling indispositions. It even
blended itself, Dr Sydenham tells us, with the
commotions excited in the system by the suppres-
sion of the lochia, as well as with the common
puerperal fever†. Dr. Morton, has left testimo-
nies behind him in different parts of his works,
which establish, in the most ample manner, the
truth of Dr. Sydenham's observations. Dr. Hux-
sham describes the small-pox as blending some of
its symptoms with those of a slow fever at Ply-
mouth in the year 1729 ‡. Dr. Cleghorn mentions
a constitution of the air at Minorca, so highly in-
flammatory, "that not only tertian fevers, but
even a common hurt or bruise, required more
plentiful evacuations than ordinary."§  Riverius
informs us in his history of a pestilential fever that
prevailed in France, that "it united itself with
phrenitis, angina, pleurisy, peripneumonia, hepa-
titis, dysentery, and many other diseases‖."
* Vol. i. p. 352.
† Vol. ii. p. 164. see also p. 1. p. 109, 122, 204, 212,
233, 274, 355, 358-9, and 436.
‡ De Aere et morb. epidem. p. 33, 34.
§ Page 285. ‖ De Febre Pestilenti, vol. ii. p. 95.
The                                             

89 BILIOUS YELLOW FEVER.
The bilious remitting fever which prevailed in
Philadelphia in 1780, chased away every other
febrile disease; and the scarlatina anginosa which
prevailed in our city in 1783 and 1784, furnished
a striking proof of the influence of epidemics over
each other. In the account which I published of
this disease, in the year 1789, there are the follow-
ing remarks. "The intermitting fever which
made its appearance in August, was not lost du-
ring the month of September. It continued to
prevail, but with several peculiar symptoms. In
many persons it was accompanied by an eruption
on the skin, and a swelling of the hands and feet.
In some it was attended with sore throat, and
pains behind the ears. Indeed such was the pre-
valence of the contagion which produced the scar-
latina anginosa, that many hundred people com-
plained of sore throats, without any other symp-
tom of indisposition. The slightest exciting cause,
and particularly cold, seldom failed of producing
the disorder*."
I shall mention only one more authority in fa-
vour of the influence of a single epidemic upon
diseases. It is taken from Mr. Clark's essay on
the epidemic disease of lying-in women, of the
* Medical Inquiries and observations, Lond. edit. Vol. i.
p. 122. 
years                                          

90 AN ACCOUNT OF THE
years 1787 and 1788. "There does not appear
(says he) to be anything in a parturient state, which
can prevent women from being affected by the
general causes of disease at that time; and should
they become ill, their complaints will probably par-
take of the nature of the reigning epidemic*." I
have said that the fever sometimes put on the symp-
toms of a dysentery, pleurisy, rheumatism, colic,
palsy, and even of the locked jaw. That these
were not original diseases, but symptomatic af-
fections only of the reigning epidemic, will appear
from other histories of bilious fevers. Dr. Bal-
four tells us in his account of the intestinal remit-
ting fever of Bengal†, that it often appeared with
symptoms of dysentery, rheumatism, and pleurisy.
Dr. Cleghorn and Dr. Lind mention many cases
of the bilious fever appearing in the form of a
dysentery. Dr. Clarke ascribes the dysentery, the
diarrhœa, the colic, and even the palsy, to the
same contagion which produced the bilious fever
in the East Indies‡; and Dr. Hunter, in his trea-
tise upon the diseases of Jamaica, mentions the
locked jaw as one of its occasional symptoms.
* Page 28.
† Page 132.
‡ Observations on the Diseases in long voyages to the
East Indies, Vol. i. p. 13, 14, 48, 151. Vol. ii. p. 99, 318.
and 320.
Even

91 BILIOUS YELLOW FEVER. 
Even the different grades of this fever, from the
mildest intermittent to the most acute continual fe-
ver, have been distinctly traced by Lancissi to the
same marsh exhalation*.
However irrefragably these numerous facts and
authorities establish the assertion of the prevalence
of but one powerful epidemic at a time, the pro-
position will receive fresh support, from attending
to the effects of two impressions of unequal force
made upon the system at the same time: only one
of them is felt: hence the gout is said to cure all
other diseases. By its superior pain it destroys
sensations of a less painful nature. The small-pox
and measles have sometimes existed together in the
body; but this has, I believe, never occurred,
where one of them has not been the predominating
disease†. In this respect, this combination of epi-
demics only conforms to the general law which
has been mentioned.
I beg pardon for the length of this digression. I
did not introduce it to expose the mistakes of those
physicians who found as many diseases in our city,
* Lib. ii. Cap. V.
† Hunter on the Venereal Disease, introduction, p. 3.
as                                            

92 AN ACCOUNT OF THE
as the yellow fever had symptoms, but to vindicate
myself from the charge of innovation, in having
uniformly and unequivocally asserted, after the first
week in September, that the yellow fever was the
only febrile disease which prevailed in the city. I
shall hereafter mention some facts upon the subject
of the extent of the contagion, which will add such
weight to the assertion, as to render the disbelief
of it, as much a mark of a deficiency of reason, as
it is of reading and observation.            
Science has much to deplore from the multipli-
cation of diseases. It is as repugnant to truth in
medicine, as polytheism is to truth in religion.
The physician who considers every different affec-
tion of the different systems in the body, or every
affection of different parts of the same system, as
distinct diseases, when they arise from one cause,
resembles the Indian or African savage, who con-
siders water, dew, ice, frost, and snow, as distinct
essences: while the physician who considers the
morbid affections of every part of the body, (how-
ever diversified they may be in their form or de-
grees) as derived from one cause, resembles the
philosopher, who considers dew, ice, frost, and
snow as different modifications of water, and as
derived simply from the absence of heat.
Humanity

93 BILIOUS YELLOW FEVER
Humanity has likewise much to deplore from
this paganism in medicine. The sword will pro-
bably be sheathed for ever, as an instrument of
death, before physicians will cease to add to the
mortality of mankind, by prescribing for the names
of diseases.
The facts I have delivered upon this subject will
admit of a very important application to the cure,
not only of the yellow fever, but of all other
acute and dangerous epidemics. I shall hereafter
assign a final cause for the law of epidemics which
has been mentioned, which will discover an union
of the goodness of the Supreme Being with one of
the greatest calamities of human life.
All ages were affected by this fever, but per-
sons between fourteen, and forty years of age,
were most subject to it. Many old people had it,
but it was not so fatal to them,  as to  robust per-
sons in middle life. It affected children of all ages.
I met with a violent case of the disorder, in a child
of four months, and a moderate case of it, in a child
of only ten weeks old. The latter had caught it
from its mother. It had a deep yellow skin. Both
these children recovered.
The 

94 AN ACCOUNT OF THE
The proportion of children who suffered by this
fever may be conceived from a single fact. Seventy
five persons were buried in the grave-yard of the
Swedish Church in the months of August, Sep-
tember, and October, twenty four of whom were
children. They were buried chiefly in September
and October; months, in which children, gene-
rally enjoy good health in our city.
Men were more subject to the disease than wo-
men. Pregnancy seemed to expose women to it.
The refugees from the French West-Indies,
universally escaped it. This was not the case with
the natives of France, who had been settled in the
city.
It is nothing new, for epidemics to affect per-
sons of one nation, and to pass by persons of other
nations in the same city or country. At Nimu-
guen in the year 1736, Deigner informs us that
the French people, (two old men excepted), and
the Jews, escaped a dysentery which was univer-
sal among persons of all other nations. Ramazini
tells us that the Jews at Modena, escaped a tertian
fever which affected nearly all the other inhabi-
tants of the town. Shenkius says that the Dutch
and                                          

95 BILIOUS YELLOW FEVER
and Italians escaped a plague which prevailed for
two years in one of the towns of Switzerland,
and Dr. Bell, in an inaugural dissertation published
at Edinburgh in 1779, remarks that the jail fever
which attacked the soldiers of the Duke of Buc-
cleugh's regiment, spared the French prisoners who
were guarded by them. It is difficult to account
for these facts. However numerous their causes
may be, a difference in diet which is as much a
distinguishing mark of nations as dress, or man-
ners, will probably be found to be one of them.
From the accounts of the yellow fever which
had been published by many writers, I was led to
believe that the negroes in our city would escape
it. In consequence of this belief, I published the
following extract from Dr. Linings's history of
the yellow fever as it had four times appeared in
Charleston in South-Carolina.
For the American Daily Advertiser.
"IT has been remarked, that the black
people have in no one instance been infected with
the malignant fever which now prevails in our
city. The late Dr. Lining, of South Carolina,
long ago made the same remark. "There is
something 

96 AN ACCOUNT OF THE
something very singular (says the Doctor) in the
constitution of the Negroes which renders them
not liable to this fever; for though many of them
were as much exposed as the nurses to the infec-
tion, yet I never knew of one instance of this fever
among them, though they are equally subject with
the white people to the bilious fever*."
"The only design of this remark is, to suggest
to our citizens the safety and propriety of employ-
ing black people to nurse and attend persons in-
fected by this fever; also to hint to the black
people, that a noble opportunity is now put into
their hands, of manifesting their gratitude to the
inhabitants of that city which first planned their
emancipation from slavery, and who have since
afforded them so much protection and support, as
to place them, in point of civil and religious privi-
leges, upon a footing with themselves."
A day or two after this publication, the follow-
ing letter from the Mayor of the city, to Mr. Clay-
poole the printer of the  Mail, appeared in his
paper.
* Essays and Observations, Physical and Literary. Vol.
xi. page 409. 
2 "SIR, 

97 BOLIOUS YELLOW FEVER.
"SIR,
"IT is with peculiar satisfaction that I
communicate to the public, through your paper,
that the AFRICAN SOCIETY, touched with the
distresses which arise from the present dangerous
disorder, have voluntarily undertaken to furnish
nurses to attend the afflicted: and that by applying
to ABSALOM JONES and WILLIAM GRAY, both
members of that society, they may be supplied.
September 6th, 
1973           
MATTH. CLARKSON,
Mayor."
It was not long after these worthy Africans
undertook the execution of their humane offer of
services to the sick, before I was convinced I had
been mistaken. They took the disease, in common
with the white people, and many of them died
with it. I think I observed the greatest number
of them to sicken after the mornings and evenings
became cool. A large number of them were my
patients. The disease was lighter in them, than in
white people. I met with no case of hemorrhage
in a black patient.
The tobacconists, and persons who used tobacco
did not escape the disease. I observed snuff-takers
to be more devoted to their boxes than usual,
during the prevalence of the fever.
H I have 

98 AN ACCOUNT OF THE
I have remarked formerly that servant maids
suffered much by the disease. They were the only
patients I lost in several large families. I ascribe
their deaths to the following causes:
1st. To the great indirect debility induced upon
their systems by fatigue in attending their masters
and mistresses, or their children. Indirect debi-
lity, according to its degrees and duration seems to
have had the same effect upon the mortality of this
fever, that it has upon the mortality of an inflam-
mation of the lungs. When it is moderate and
of short duration, it predisposes only to a common
pneumonia, but when it is violent and protracted,
in its degrees and duration, it predisposes to a pul-
monary consumption.
2dly. To their receiving large quantities of con-
tagion into their bodies, and in a most concen-
trated state by being obliged to perform the most
menial offices for the sick, and by washing, as well
as removing infected linen, and the like.
3dly. To their being left more alone in con-
fined or distant rooms, and thereby suffering from
depression of spirits, or the want, of a punctual
supply of food and medicines.
There 

99 BILIOUS YELLOW FEVER.
There did not appear to be any advantage from
smelling vinegar, tar, camphor, or volatile salts, in
preventing the disorder. Bark and wine were
equally ineffectual for that purpose. I was called
to many hundred people who were infected after
using one or more of them. Nor did the white-
washing of walls secure families from the action of
the contagion. I am disposed to believe garlick
was the only substance that was in any degree use-
ful, in preventing the disorder. I met with seve-
ral persons who chewed it constantly, and who
were much exposed to the contagion, without
being infected. All other substances seemed to
do harm by begetting a false confidence in the
mind, to the exclusion of more rational preserva-
tives. I have suspected further, that such of them
as were of a volatile nature, helped to spread the
disease by affording a vehicle for the contagion
through the air.
There was great mortality in all those families
who lived in wooden houses. Whether this arose
from the small size of these houses, or from the
want of cleanliness of the people who occupied
them, or from the contagion becoming more ac-
cumulated, by adhering to the wood, I am unable
to determine. Perhaps it was the effect of the co-
operation of all three of those causes.
H2 I have 

100 AN ACCOUNT OF THE
I have said formerly that intemperance in drink-
ing predisposed to the disease; but there were se-
veral instances of persons having escaped it who
were constantly under the influence of strong drink.
The stimulus of ardent spirits, probably predomi-
nated over the stimulus of the contagion, and thus
excited an artificial fever which defended the sys-
tem from that which was epidemic.
I heard of some sea-faring people who lived on
board their vessels who escaped the disease. The
smell of the tar was supposed to have preserved
them; but from its being ineffectual in other cases,
I was led to ascribe their escape to the infected
air of the city being diluted by a mixture with
the pure air that came from the water.
Many people who were infected in the city,
were attacked by the disease in the country, but
they propagated it in very few instances, even
to persons who slept in the same room with
them.
Dr. Lind informs us that many persons escaped
the yellow-fever which prevailed in Pensacola in
the year 1765, by retiring to the ships which lay
in the harbour, and that when the disease had
been taken, the pure air of the water changed it
into                                          

101 BILIOUS YELLOW FEVER.
into an intermitting fever*. The same changes
have frequently been produced in malignant fevers,
by sending patients infected with them from the
foul air of a city, into the pure air of the country.
Persons confined in the House of Employment,
in the Hospital, and in the Jail, were preserved
from the fever. The airy and remote situation
of those buildings, was probably the chief means
of their preservation. Perhaps they derived addi-
tional security from their simple diet, their exemp-
tion from hard labour, and from being constantly
sheltered from heat and cold.
Several families who shut up their front and
back doors and windows, and avoided going out
of their houses except to procure provisions, es-
caped the disorder.
I have taken some pains to ascertain whether
any class of tradesmen escaped the fever, or whe-
ther there was any species of labour which pro-
tected from it. The result of my inquiries is as
follows: Three butchers only out of nearly one
hundred who remained in the city, died with the
disorder. Many of them attended the markets
* Diseases of Warm Climates, p. 169.
H3 every                     

102 AN ACCOUNT OF THE
every day. Two painters, who worked at their
business during the whole time of the prevalence
of the fever, and in exposed situations, escaped it.
Out of forty scavengers who were employed in
collecting and carrying away the dirt of the streets,
only one caught the fever and died. Very few
grave-diggers, compared with the number who
were employed in that business, were infected; and
it is well known, that scarcely an instance was
heard of persons taking the disease, who were con-
stantly employed in digging cellars. The fact is
not new that grave-diggers escape the contagion
of malignant fevers. It is taken notice of by Dr.
Clark. There seems to be something in the fresh
earth which attracts or destroys by mixture, con-
tagion of every kind. Clothes infected by the
small-pox are more certainly purified by being bu-
ried under ground, than in any other way. Even
poisons are rendered inert, by the action of the
earth upon them. Dogs have long ago established
this fact, by scratching a hole in the ground, and
burying their limbs or noses in it, when bitten by
poisonous snakes. The practice I have been told,
has been imitated with success by the settlers upon
new lands in several parts of the United States.
It was said by some physicians in the public pa-
pers, that the neighbourhood of the grave-yards
was                                          

103 BILIOUS YELLOW FEVER.     
was more infected than other parts of the city.
The reverse of this assertion was true in several
cases, owing probably to the line of communica-
tion of the contagion being broken by the absence
of houses, and to its being diluted and weakened
by its mixture with the air of the grave-yards; for
this air was pure, compared with that which stag-
nated in the streets.
It was said further that the disease was propa-
gated by the inhabitants assembling on Sundays
for public worship; and as a proof of this asser-
tion, it was reported, that the deaths were more
numerous on Sundays than on other days; occa-
sioned by the contagion received on one Sunday,
producing death on the succeeding first day of the
week. The register of the deaths shews that this
was not the case. I am disposed to believe that
fewer people sickened on Sundays, than on any
other day of the week; owing to the general rest
from labour, which I have before said was one of
the exciting causes of the disease. From some facts
to be mentioned presently, it will appear probable,
that places of public worship, in consequence of
their size, as well as of their being shut up during
the greatest part of the week, were the freest from
contagion of any houses in the city. It is agree-
able to discover in this, as well as in all other cases
H4 of                    
 

104 AN ACCOUNT OF THE
of public and private duty, that the means of
health, and moral happiness are in no one instance
opposed to each other.
There were for several weeks two sources of
infection, viz. exhalation, and contagion. The ex-
halation infected at the distance of three and four
hundred yards; while the contagion infected only
across the streets. The more narrow the street,
the more certainly the contagion infected. Few
escaped it in alleys. After the 12th of Septem-
ber, the atmosphere of every street in the city was
loaded with contagion; and there were few citi-
zens in apparent good health, who did not ex-
hibit one or more of the following marks of its
presence in their bodies.
1. A yellowness in the eyes, and a sallow colour
upon the skin.
2. A preternatural quickness in the pulse. I
found but two exceptions to this remark, out of a
great number of persons whose pulses I examined.
In one of them it discovered several preternatural
intermissions in the course of a minute. This
quickness of pulse occurred in the negroes, as
well as in the white people. I met with it in a
woman who had the yellow fever in 1762.
In

105 BILIOUS YELLOW FEVER. 
In two women, and in one man above 70, the pulse
beat upwards of 90 strokes in a minute. This
preternatural state of the pulse during the preva-
lence of a pestilential fever in persons in health, is
taken notice of by Riverius*.
3. Frequent and copious discharges by the skin
of yellow sweats. In persons who were much ex-
posed to the contagion, these sweats sometimes had
an offensive smell, resembling that of the warnings
of a gun.
4. A scanty discharge of high coloured or tur-
bid urine.
5. A deficiency of appetite, or a greater degree
of it than was natural.
6. Costiveness.
7. Wakefulness.
8. Head-ach.
9. A preternatural dilatation of the pupils-
This was universal. I was much struck in observ-
* "Pulsus sanorum pulsibus similes admodum, pericu-
losi." De Febre Pestilenti, p. 114
ing                                           

106 AN ACCOUNT OF THE
ing the pupil in one of the eyes of a young man
who called upon me for advice, to be of an oblong
figure. Whether it was natural, or the effect of
the contagion acting on his brain, I could not de-
termine.
It will be thought less strange, that the conta-
gion should produce those changes in the systems
of persons who resided constantly in the city,
when I add, that many country people who spent
but a few hours in the streets in the day, in at-
tending the markets, caught the disease, and sick-
ened and died after they returned home; and that
others, whom business compelled to spend a day
or two in the city during the prevalence of the fe-
ver, but who escaped an attack of it, declared that
they were indisposed during the whole time, with
languor or head-ach.
I was led to observe and record the above ef-
fects of the contagion upon persons in apparent
good health, by a fact I met with in Dr. Mitchell's
history of the yellow fever in Virginia in the year
1741. In that fever, blood drawn from a vein
was always dissolved. The same state of the blood
was observed in many persons who had been ex-
posed to the contagion, who discovered no other
symptom of the disease.
A wo-                                    


107 BILIOUS YELLOW FEVER.
A woman whom I had formerly cured of a ma-
nia, who lived in an infected neighbourhood, had
a fresh attack of that disorder, accompanied by an
unusual menstrual flux. I ascribed both these
complaints to the action of the contagion upon her
system.
Citizens thus impregnated with the contagion,
communicated it in several instances to their coun-
try friends. The disease produced in this way was
very light, amounting in all the cases that came
under my notice, to little more than a sickness at
stomach or vomiting.
The smell of the contagion, as emitted from a
patient in a clean room, was like that of the small-
pox, but in most cases of a less disagreeable nature.
Putrid smells in sick rooms were the effects of a
mixture of the contagion with some filthy matters.
In small rooms, crowded in some instances with
four or five sick people, there was an effluvia that
produced giddiness, sickness at stomach, a weak-
ness of the limbs, faintness, and in some cases a
diarrhœa. I met with a fetid breath in one
patient, which was not the effect of that medicine
which sometimes produces it.
The contagion adhered to all kinds of clothing,
and seemed to be propagated by them. It was
in                                            

108 AN ACCOUNT OF THE
in no instance communicated by means of paper;
a circumstance which contributed both to lessen
and encrease the distress produced by the disease,
by enabling the citizens to keep up an intercourse
by letters with their country friends.
The state of the atmosphere during the whole
month of September, and the first two weeks in
October, favoured the accumulation of the conta-
gion in the city.
The register of the weather, shews how little
the air was agitated by winds during the above
time. In vain were changes in the moon ex-
pected to alter the state of the air. The light
of the morning, mocked the hopes that were
raised by a cloudy sky in the evening. The sun
ceased to be viewed with pleasure. Hundreds
sickened every day beneath the influence of his
rays; and even where they did not excite the
disease, they produced a languor in the body
unknown to the oldest inhabitant of the city at
the same season of the year.
A meteor was seen at two o'clock in the morn-
ing on or about the twelfth of September. It fell
between Third-street and the Hospital, nearly in
a line with Pine-street. Mosquitoes (the usual
attendants of a sickly autumn) were uncommonly
numerous.                                     

109 BILIOUS YELLOW FEVER.
numerous. Here and there a dead cat added to
the impurity of the air of the streets; for many
of those animals perished with hunger in the city,
in consequence of so many houses being deserted
by the inhabitants who had fled into the country.
It appears further, from the register of the wea-
ther, that there was no rain between the 25th of
August and the 15th of October, except a few
drops, hardly enough to lay the dust of the streets
on the 9th of September, and the 12th of Octo-
ber. In consequence of this drought, the springs
and wells failed in many parts of the country.
The dust in some places extended two feet below
the surface of the ground. The pastures were
deficient, or burnt up. There was a scarcity of
autumnal fruits in the neighbourhood of the city.
But while vegetation drooped or died from the
want of moisture in some places, it revived with
preternatural vigor from unusual heat in others.
Cherry-trees blossomed, and apple, pear, and
plum-trees bore young fruit in several gardens
in Trenton, thirty miles from Philadelphia, in the
month of October.
However inoffensive uniform heat, when agita-
ted by gentle breezes may be, there is, I believe
no record of a dry, warm and stagnating air,
having                                       

110 AN ACCOUNT OF THE
having existed for any length of time without pro-
ducing diseases. Hippocrates in describing a pes-
tilential fever, says the year in which it prevailed,
was without a breeze of wind*. The same state
of the atmosphere for six weeks, is mentioned in
many of the histories of the plague which pre-
vailed in London in 1665. Even the sea air itself
becomes unwholesome by stagnating; hence Dr.
Clark informs us, that sailors become sickly after
long calms in East India voyages†. Sir John
Pringle delivers the following aphorism from a
number of similar observations upon this subject.
"When the heats come on soon and continue
throughout autumn, not moderated by winds, or
rains, the season proves sickly, distempers appear
early, and are dangerous‡."
Who can review this account of the universal
diffusion of the contagion of this disease, its uni-
versal effects upon persons apparently in good
health,  and its accumulation and concentration,
in consequence of the calmness of the air, and be-
lieve, that it was possible for a febrile disease to
* "Sine aura, usque annus suit." Epid. 3.
† Vol. i. 5.
‡ Diseases of the Army, p. 5. of the 7th London
Edition.
exist                                          


111 BILIOUS YELLOW FEVER. 
exist at that time in our city that was not derived
from this contagion?
The West India writers upon the yellow fever
have said, that it is seldom taken twice, except by
persons who have spent some years in Europe or
America in the interval between its first and second
attack. I directed my inquiries to this question,
and I now proceed to mention the result of them.
I met with five persons during the prevalence of
the disease, who had it formerly; two of them
in the year 1741, and three in 1762, who escaped
it in 1793, although they were all more or less
exposed to the contagion. One of them felt a
constant pain in her head while the disease was in
her family. Four of them were aged, and of
course less liable to be acted upon by the conta-
gion, than persons in early or middle life. Mr.
Thomas Shields furnished an unequivocal proof
that the disease could be taken after an interval
of many years. He had it in the year 1762, and
narrowly escaped from a violent attack of it last
year.  Cases of re-infection, or more properly, of
re-excitement were very common during the pre-
valence of this fever. They occurred most fre-
quently, where the first attack had been light.
But they succeeded attacks that were severe in
Dr.                                           

112 AN ACCOUNT OF THE
Dr. Griffitts, Dr. Mease, my pupil Mr. Coxe, and
several others, whose cases came under my notice.
I have before remarked, that the contagion
sometimes excited a fever as soon as it was taken
into the body, but that it often lay there from one
to sixteen days, before it produced the disease.
How long it existed in the body after a recovery
from the fever, I could not tell, for persons who
recovered were in most cases exposed to the action
of the contagion from external sources. The pre-
ternatural dilatation of the pupils was a certain
mark of the continuance of some portion of the
contagion in the system. In one person who was
attacked with the fever on the night of the 9th
of October, the pupils did not contract to their
natural dimensions, until the 7th of November.
Having described the effects of the contagion
upon the body, I proceed now to mention the
changes induced upon it by death.
Let us first take a view of it as it appeared soon
after death. Some new light may perhaps be
thrown upon the proximate cause of the disease,
by this mode of examining the body.
I
My 

113 BILIOUS YELLOW FEVER.
My information upon this subject was derived
from the attendants upon the sick, and from the
two African citizens who were employed in bury-
ing the dead, viz. Richard Allen and Absalom
Jones. The coincidence of the information I re-
ceived from different persons, satisfied me that
all that I shall here relate, is both accurate and
jut.
A deep yellow colour appeared in many cases
within a few minutes after death. In some, the
skin became purple, and in others black. I heard
of one case in which the body was yellow above,
and black below its middle. In some, the skin
was as pale, as it is in persons who die of common
fevers. A placid countenance was observed in
many, resembling that which occurs in an easy and
healthful sleep.
Some were stiff within one hour after death.
Others were not so, for six hours afterwards. This
sudden stiffness after death, Dr. Valli informs us,
occurred in persons who died of the plague in
Smyrna in the year 1784*.
Some grew cold soon after death, while others
retained a considerable degree of heat for six hours,
more especially on their backs.
* Experiments on Animal Electricity, p. 90.
I A stream                     
 

114 AN ACCOUNT OF THE
A stream of tears appeared on the cheeks of a
young woman, which seemed to have flowed after
her death.
Some putrefied in a short time after their disso-
lution, but others had no smell for twelve, eigh-
teen and twenty hours afterwards. This absence
of smell, occurred in those cases in which evacua-
tions had been used without success, in the treat-
ment of the disease.
Many discharged large quantities of black mat-
ter from the bowels, and others blood from the
nose, mouth and bowels after death. The fre-
quency of these discharges, gave rise to the prac-
tice of pitching the joints of the coffins, which
were used to bury the dead.
The morbid appearances of the internal parts
of the body as they appear by dissection after
death, from the yellow fever, are different in dif-
ferent countries, and in the same countries in dif-
ferent years. I consider them all as effects only
of a stimulus acting upon the whole system, and
determined more or less by accidental circumstan-
ces, to particular viscera. Perhaps the stimulus
of the contagion determines the fluids more vio-
lently in most cases to the liver, stomach, and bow-
els, and thereby disposes them more than other
parts                                        

115 BILIOUS YELLOW FEVER.
parts to inflammation and mortification, and to
similar effusions and eruptions with those which
take place on the skin. There can be no doubt
of the contagion acting specifically upon the liver,
and thereby altering the qualities of the bile. I
transcribe with great pleasure the following ac-
count of the state of the bile in a female slave of
forty years of age from Dr. Mitchell's history of
the yellow fever, as it prevailed in Virginia in the
years 1737 and 1741, inasmuch as it was part of
that clue which led me to adopt one of the reme-
dies on which much of the success of my practice
depended.
"The gall bladder (says the Doctor) appeared
outwardly of a deep yellow, but  within was full
of a black ropy coagulated atrabilis, which sort
of substance obstructed the pori biliarii, and duc-
tus choledochus. This atrabilis was hardly fluid,
but upon opening the gall bladder, it retained its
form, and shape, without being evacuated, being
of the consistence of a thin extract, and within,
glutinous and ropy, like soap when boiling. This
black matter seemed so much unlike bile, that I
doubted if there were any bile in the gall-bladder.
It more resembled bruised or mortified blood, eva-
cuated from the mortified parts of the liver, sur-
rounding it, although it would stain a knife or
probe thrust into it of a yellow colour, which with
I2 its

116 AN ACCOUNT OF THE
its ropy consistence, seemed more peculiar to a bi-
lious humour."
The same appearance of the bile was disco-
vered in several other subjects dissected by Dr
Mitchell.
The liver in the abovementioned slave, was tur-
gid and plump on its outside, but on its concave
surface, two thirds of it were of a deep black co-
lour, and round the gall-bladder, it seemed to be
mortified and corrupted.
The duodenum was lined on its inside near the
gall bladder with a viscid ropy bile, like that which
has been described. Its villous coat was lined
with a thick fur or slime, which when scraped or
peeled off the other vascular and muscular coats of
the gut, appeared red and inflamed.
The omentum was so much wasted, that nothing
but its blood-vessels could be perceived.
The stomach was inflamed both on its outside
and inside. It contained a quantity of bile of the
same consistence, but of a blacker colour than that
which was found in the gall bladder. Its vilous
coat like that of the duodenum, was covered with
fuzzy and slimy matter. It moreover appeared to
be                                          

117 BILIOUS YELLOW FEVER.
be distended or swelled. This peculiarity in the
inner coat of the stomach was universal in all the
bodies that were opened, of persons who died of
this disease.
The lungs instead of being collapsed, were in-
flated as in inspiration. They were all over full
of black or livid spots. On these spots were to
be seen small vesicles of blisters, like those of an
erysipelas or gangrene, containing a yellow hu-
mour.
The blood-vessels in general seemed empty of
blood, even the vena cava and its branches; but
the vena portarum was full and distended as usual.
The blood seemed collected in the viscera; for up-
on cutting the lungs or sound liver or spleen, they
bled freely.
The brain was not opened in this body, but it
was not affected in three others whose brains were
examined.
Dr. Mackittrick, in his inaugural dissertation
published at Edinburgh in the year 1766 "De fe-
bre Indiæ occidentalis, Maligna Flava," or upon
the yellow fever of the West Indies, says, that in
some of the patients who died of it, he found the
I3 liver 


118 AN ACCOUNT OF THE
liver sphacelate, the gall bladder full of black
bile, and the veins turged with black fluid blood.
In others he found the liver no ways enlarged,
and its "texture only vitiated." The stomach,
the duodenum, and ilium, were remarkably infla-
med in all cases. The pericardium contained a
viscid yellow serum, and in a larger quantity than
common. The urinary bladder was a little inflamed.
The lungs were found.
Dr. Hume in describing the yellow fever of Ja-
maica, informs us, that in several dead bodies
which he opened, he found the liver enlarged and
turged with bile, and of a pale yellow colour. In
some he found the stomach and duodenum infla-
med. In one case he discovered black spots in
the stomach, of the size of a crown piece. To
this account he adds, "that he had seen some sub-
jects opened, on whose stomachs no marks of in-
flammation could be discovered; and yet these had
excessive vomiting."
Dr. Lind has furnished us with an account of
the state of the body after death in his short histo-
ry of the yellow fever, which prevailed at Cadiz
in the year 1764. "The stomach, (he says) me-
sentery, and intestines were covered with grangre-
nous spots; there were ulcers on the orifice of the
stomach,          

119 BILIOUS YELLOW FEVER.
stomach, and the liver and lungs were of a putrid
colour and texture*."
To these accounts of the morbid appearances
of the body after death from the yellow fever, I
shall only add the account of several dissections
which was given to the public in Mr. Brown's
Gazette, during the prevalence of our late epide-
mic, by Dr. Physick and Dr. Cathrall.
"BEING well assured of the great importance
of dissections of morbid bodies in the investigation
of the nature of  diseases, we have thought it of
consequence that some of those, dead of the present
prevailing malignant fever, should be examined;
and without enlarging on our observations, it ap-
pears at present sufficient to state the following facts.
"1st. That the brain in all its parts has been
found in a natural condition.
"2d. That the viscera of the thorax are per-
fectly found. The blood, however, in the heart
and veins is fluid, similar in its consistence, to the
blood of persons who have been hanged, or de-
stroyed by electricity.
* Diseases of Warm Climates, p. 125.
"3d.                                         


120 AN ACCOUNT OF THE            
"3d. That the stomach, and beginning of the
duodenum are the parts that appear most diseased.
In two persons who died of the disease on the 5th
day, the villous membrane of the stomach, espe-
cially about its smaller end, was found highly in-
flamed; and this inflammation extended through
the pylorus into the duodenum, some way.--The
inflammation here, was exactly similar to that
induced into the stomach by acrid poisons, as by
arsenic, which we have once had an opportunity
of seeing in a person destroyed by it.
"The bile in the gall-bladder was quite of its
natural colour, though very viscid.
"In another person who died on the 8th day
of the disease, several spots of extravasation were
discovered between the membranes, particularly
about the smaller end of the stomach, the inflam-
mation of which had considerably abated. Pus
was seen in the beginning of the duodenum, and
the villous membrane at this part was thickened.
"In two other persons who died at a more ad-
vanced period of the disease, the stomach appeared
spotted in many places with extravasations, and
the inflammation disappeared. It contained, as did
also the intestines, a black liquor, which had been
vomited                                       

121 BILIOUS YELLOW FEVER. 
vomited and purged before death. This black
liquor appears clearly to be an altered secretion
from the liver; for a fluid in all respects of the
same qualities was found in the gall-bladder. This
liquor was so acrid, that it induced considerable in-
flammation and swelling on the operator's hands,
which remained some days. The villous mem-
brane of the intestines in these last two bodies was
found inflamed in several places.
"The liver was of its natural appearance, ex-
cepting in one of the last persons, on the surface
of which a very few distended veins were seen:
all the other abdominal viscera were of a healthy
appearance.
"The external surface of the stomach as well
as of the intestines, was quite free from inflamma-
tion; the veins being distended with blood, which
appeared through the transparent peritoneum,
gave them a dark colour.
"The stomach of those who died early in the
disease was always contracted; but in those who
died at a more advanced period of it, where extra-
vasations appeared, it was distended with air.
P. S. PHYSICK,
J. CATHRALL."
I have                                        

122 AN ACCOUNT OF THE
I have before remarked that these dissections
were made early in the disorder, and that Dr.
Annan attended a dissection of a body at Bush-
hill some time afterwards, in which an unu-
sual turgescence appeared in the vessels of the
brain.
Thus far have I delivered the history of the
yellow fever as it affected the human body with
sickness and death. I shall now mention a few of
those circumstances of public and private distress
which attended it. I have before remarked, that
the first reports of the existence of this fever were
treated with neglect or contempt. A strange apa-
thy pervaded all classes of people. While I bore
my share of reproach for "terrifying our citizens
with imaginary danger," I answered it by lament-
ing "that they were not terrified enough." The
publication from the College of Physicians soon
dissipated this indifference and incredulity. Fear
or terror now sat upon every countenance. The
disease appeared in many parts of the town, re-
mote from the spot where it originated; although
in every instance it was easily traced to it. This
set the city in motion. The streets and roads
leading from the city were crowded with families
flying in every direction for safety to the country.
Business began to languish. Water-street be-
tween Market and Race-streets became a desert.
The                                         

123 BILIOUS YELLOW FEVER. 
The poor were the first victims of the fever.
From the sudden interruption of business, they
suffered for a while from poverty, as well as dis-
ease. A large and airy house at Bush-hill about a
mile from the city, was opened for their reception.
This house, after it became the charge of a com-
mittee appointed by the citizens on the 14th of
September, was regulated and governed with the
order and cleanliness of an old and established hos-
pital. An American and French physician had
the exclusive medical care of it after the 22d of
September.
The contagion after the second week in Sep-
tember, spared no rank of citizens. Whole fa-
milies were confined by it. There was a deficiency
of nurses for the sick, and many of those who
were employed were unqualified for their business.
There was likewise a great deficiency of physi-
cians from the desertion of some, and the sickness
and death of others. At one time, there were
only three physicians who were able to do busi-
ness out of their houses, and at this time, there
were probably not less than 6,000 persons ill with
the fever.
During the first three or four weeks of the
prevalence of the disorder, I seldom went into a
house                                         

124 AN ACCOUNT OF THE
house the first time, without meeting the parents
or children of the sick in tears. Many wept aloud
in my entry, or parlour, who came to ask for ad-
vice for their relations. Grief, after a while de-
scended below weeping, and I was much struck
in observing that many persons submitted to the
loss of relations and friends, without shedding a
tear, or manifesting any other of the common
signs of grief.
A cheerful countenance was scarcely to  be seen
in the city for six weeks. I recollect once in en-
tering the house of a poor man, to have met a
child of two years old that smiled in my face. I
was strangely affected with this sight (so discordant
to my feelings and the state of the city) before I
recollected the age and ignorance of the child. I
was confined the next day by an attack of the
fever, and was sorry to hear upon my recovery,
that the father and mother of this little creature
died, a few days after my last visit to them.
The streets every where discovered marks of the
distress that pervaded the city. More than one
half the houses were shut up, although not more
than one third of the inhabitants had fled into the
country. In walking for many hundred yards, few
persons were met, except such as were in quest of
a physi-                                       

125 BILIOUS YELLOW FEVER.
a physician, a nurse, a bleeder, or the men who
buried the dead. The hearse alone kept up the
remembrance of the noise of carriages or carts in
the streets. Funeral processions were laid aside.
A black man, leading or driving a horse, with a
corpse on a pair of chair  wheels, with now and
then half a dozen relations or friends following at
a distance from it, met the eye in most of the
streets of the city at every hour of the day, while
the noise of the same  wheels passing slowly over
the pavements, kept alive anguish and fear in the
sick and well, every hour of the night*.
* In the life of Thomas Story a celebrated preacher
among the Friends, there is an account of the distress of
the city in its infant state, from the prevalence of the yel-
low fever in the autumn of 1699, nearly like that which
has been described. I shall insert the account in his own
words. "Great was the fear that fell on all flesh. I saw
no lofty or airy countenance, nor heard any vain jesting to
move men to laughter. Every face gathered paleness, and
many hearts were humbled, and countenances fallen, and
sunk, as such that waited every moment to be summoned to
the bar, and numbered to the grave." The same author
adds that six, seven, and sometimes eight died of this fever
in a day for several weeks. His fellow traveller and com-
panion in the ministry Roger Gill, discovered upon this oc-
casion an extraordinary degree of Christian philanthropy.
He publicly offered himself in one of the meetings of the
Society as a sacrifice for the people, and prayed that "God
would                                             

126 AN ACCOUNT OF THE
But a more serious source of the distress of the
city arose from the dissentions of the physicians,
about the nature and treatment of the fever. It
was considered by some as a modification of the
influenza, and by others as the Jail fever. Its va-
rious grades, and symptoms were considered as so
many different diseases, all originating from differ-
ent causes. There was the same contrariety in
the practice of the physicians that there was in
their principles. The newspapers conveyed ac-
counts of both to the public every day. The
minds of the citizens were distracted by them, and
hundreds suffered and died from the delays which
were produced by an erroneous opinion of a plu-
rality of diseases in the city, or by indecision in the
choice, or a want of confidence in the remedies of
their physician.
The science of medicine is related to every
thing, and the philosopher as well as the Chris-
tian will be gratified by knowing the effects of a
great and mortal epidemic upon the morals of a
people. It was some alleviation of the distress
would please to accept of his life for them, that a stop might
be put to the contagion." He died of the fever a few days
afterwards.
produced

127 BILIOUS YELLOW FEVER.
produced by it, to observe its influence upon the
obligations of morality and religion. It was re-
marked during this time, by many people that the
name of the Supreme Being was seldom profaned
either in the streets, or in the intercourse of the
citizens with each other. Two robberies only,
and those of a trifling nature, occurred in nearly
two months, although many hundred houses were
exposed to plunder, every hour of the day and
night. Many of the religious societies met two or
three times a week, and some of them every even-
ing, to implore the interposition of heaven to save
the city from desolation. Humanity and charity
kept pace with devotion. The public have already
seen accounts of their benevolent exercises in other
publications. It was my lot to witness the uncom-
mon activity of those virtues upon a smaller scale.
I saw little to blame, but much to admire and
praise in persons of different professions, both sexes,
and of all colours. It would be foreign to the
design of this  work,  to draw from the obscurity
which they sought, the many acts of humanity and
charity, of fortitude, patience, and perseverance
which came under my notice. They will be made
public and applauded elsewhere.
But the virtues which were excited by our ca-
lamity, were not confined to the city of Philadel-
phia.                                        

128 AN ACCOUNT OF THE
phia. The United States wept for the distresses
of their capital. In several of the states, and in
many cities, and villages, days of humiliation and
prayer were set apart to supplicate the Father of
mercies in behalf of our afflicted city. Nor was
this all. From nearly every state in the Union,
the most liberal contributions of money, provi-
sions, and fuel, were poured in for the relief and
support of such persons as had been reduced to
want by the suspension of business, as well as by
sickness, and the death of friends.
The number of deaths between the first of
August and the ninth of November, amounted to
four thousand and forty four. I shall here insert
a register of the number which occurred on each
day, beginning on the first of August and ending
on the ninth of November. By comparing it
with the register of the weather, it will shew the
influence of the latter on the disease. Several of
the deaths in August were from other acute dis-
orders, and a few in the succeeding months were
from such as were of a chronic nature.
4 August


129 BILIOUS YELLOW FEVER.		
died
August 1 9
  -   2 8
  -   3 9
  -   4 10
  -   5 10
  -   6 3
  -   7 12
  -   8 5
  -   9 11
  -  10 6
  -  11 7
  -  12 5
  -  13 11
  -  14 4
  -  15 9
  -  16 7
  -  17 6
  -  18 5
  -  19 9
  -  20 7
  -  21 8
  -  22 13
  -  23 10
  -  24 17
  -  25 12
  -  26 17
  -  27 12
  -  28 22
  -  29 24
  -  30 20
  -  31 17
September  1 17
    -     2 18
    -     3 11
    -     4 23
    -     5 20
    -     6 24
    -     7 18
            456
K			
died
Brought forward 456
September  8 42
    -     9 32
    -    10 29
    -    11 23
    -    12 33
    -    13 37
    -    14 48
    -    15 56
    -    16 67
    -    17 81
    -    18 68
    -    19 61
    -    20 67
    -    21 57
    -    22 76
    -    23 68
    -    24 96
    -    25 87
    -    26 52
    -    27 60
    -    28 51
    -    29 57
    -    30 63
October  1 74  
   -    2 66
   -    3 78
   -    4 58
   -    5 71
   -    6 76
   -    7 82
   -    8 90
   -    9 102
   -   10 93
   -   11 119
   -   12 111
   -   13 104
   -   14 81
         2972 
October


130 AN ACCOUNT OF THE
died.
Brought forward 2972
October 15 80
- 16 70
- 17 80
- 18 59
- 19 65
- 20 55
- 21 59
- 22 82
- 23 54
- 24 38
- 25 35
- 26 23
- 27 13
3685
died
Brought forward 3685
October 28 24
- 29 17
- 30 21
November  1 13
- 2 21
- 3 15
- 4 15
- 5 14
- 6 11
- 7 15 
- 8 8
- 9 6
Total, 3881*
From this table it appears that the principal
mortality was in the second week of October. A
general expectation had obtained, that cold wea-
ther was as fatal to the contagion of this fever as
heavy rains. The usual time for its arrival had
come, but the weather was still not only moderate,
but warm. In this awful situation, the stoutest
hearts began to fail. Hope sickened, and despair
succeeded distress in almost every countenance.
On the fifteenth of October it pleased God to
* In the above accounts there is a deficiency of returns
from several grave-yards of 163. It is supposed in addition
to the number of persons who died in the city that 500 per-
sons who had caught the fever in the city, perished by it, in
different parts of the country.
alter                                            

131 BILIOUS YELLOW FEVER.
alter the state of the air. The clouds at last drop-
ped health in showers of rain, which continued
during the whole day, and which were succeeded
for several nights afterwards by cold and frost.
The effects of this change in the weather, appear-
ed first in the sudden diminution of the sick, for
the deaths continued for a week afterwards to be
numerous, but they were of persons who had been
confined before, or on the day in which the
change had taken place in the weather.
The appearance of this rain was like a dove with
an olive branch in its mouth, to the whole city.
Public notice was given of its beneficial effects in a
letter subscribed by the mayor, of Philadelphia,
who acted as president of the committee, to the
mayor of New York. I shall insert the whole of
this letter. In contains, besides the above informa-
tion, a record of the liberality of that city, to the
distressed inhabitants of Philadelphia.
"Sir,
"I AM favoured with your letter of the
12th instant, which I have communicated to the
Committee for the relief of the poor and afflicted of
this city.
K2 "It 

132 AN ACCOUNT OF THE
"It is with peculiar satisfaction that I execute
their request, by making in their name, on behalf
of our suffering fellow citizens, the most grateful
acknowledgements, for the seasonable benevolence
of the Common-Council of the city of New-York.
Their sympathy is balm to our wounds.
"We acknowledge the divine interposition,
whereby the hearts of so many around us have
been touched with our distress, and have united in
our relief. 
"May the almighty disposer of all events be
graciously pleased to protect your citizens from the
dreadful calamity with which we are now visited;
whilst we humbly kiss the rod, and improve by the
dispensation.
"The part, sir, which you personally take in
our afflictions, and which you have so pathetically
expressed in your letter, excites in the breasts of the
Committee the warmest sensations of fraternal af-
fection.
"The refreshing rain which fell the day before
yesterday, though light, and the cool weather
which hath succeeded, appear to have given a
check to the prevalence of the disorder; of this we
have                                         

133 BILIOUS YELLOW FEVER.
have satisfactory proofs; as well in the decrease of
the funerals, as in the applications for removal to
the hospital.
"I have at your request, this day drawn upon
you, at sight, in favour of the President and Direc-
tors of the Bank of North America, for the sum of
five thousand dollars, the benevolent donations of
the Common-Council of the city of New-York.
"With sentiments of the greatest esteem and
regard,
I am, Sir,
Philadelphia, Your most obedient humble servant,
Oct. 17, 1793. 
MATTH. CLARKSON."
Richard Varick, Mayor of
the city of New-York. 
It is no new thing for the bilious fevers of every
description, to be checked, or subdued by wet and
cold weather.
The yellow fever which raged in Philadelphia
in 1699, and which is taken notice of by Thomas
Story in his Journal, ceased about the latter end
K3 of                   

134 AN ACCOUNT OF THE
of October, or the beginning of November. Of
this there are satisfactory proofs in the register of
the interments in the Friends' burying ground,
and in a letter dated November 9th, Old Style,
1699, from Isaac Norris to one of his correspon-
dents, which his grand-son Mr. Joseph P. Norris,
politely put into my hands, with several others,
which mention the disease, and all written in that
memorable year in Philadelphia. The letter says,
"It has pleased God to put a stop to our sore vi-
sitation, and town and country are now generally
healthy." The same disease was checked by wet
and cold weather in the year 1741. Of this there
is a proof in a letter from Dr. Franklin to one of
his brothers, who stopped at Burlington, on his
way from Boston to Philadelphia on account of
the fever, until he was assured by the Doctor, that
a thunder gust which had cooled the air, had ren-
dered it safe for him to come into the city*. Mr.
* From a short note in the register of the interments in
the Friends' burying-ground, it appears, that the fever this
year made its first appearance in the month of June. The
following is a copy of that note. "12th of the 6th month
(O. S.) 1741, a malignant yellow fever now spreads
much."  Besides that note, there is the following; "25th
of the 7th month (O. S.) 1742, many who died of the
above distemper, were persons lively, and strong, and in
the prime of their time."
Lynford 

135 BILIOUS YELLOW FEVER. 
Lynford Lardner in a letter to one of his English
friends, dated September 24th, 1747, Old style,
after mentioning the prevalence of the fever in
the city, says, "the weather is now much cooler,
and those under the disorder revive. The symp-
toms are less violent, and the fever gradually
abates."
I have in vain attempted to procure an account
of the time of the commencement of cold weather,
in the autumn of 1762. In the short history of
the fever of that year, which I have inserted from
my note book, I have said that it continued to
prevail in the months of November and December.
The register of the interments in the Friends'
burying-ground in those months, confirms that
account. They were nearly as numerous in
November and December, as in September and
October. Viz. in September 22, in October 27,
in November 19, and in December 26.
The bilious remitting fever of 1780, yielded to
cool weather, accompanied by rain and an easterly
wind*.
Medical Inquiries and Observations, London Edition,
p. 106.
K4 Sir

136 AN ACCOUNT OF THE
Sir John Pringle will furnish ample satisfaction,
to such of my readers as wish for more proofs of
the efficacy of heavy rains, and cold weather, in
checking the progress and violence of autumnal
remitting fevers*.
From the 15th of October, the disease not only
declined, but assumed more obvious inflammatory
symptoms. It was, as in the beginning, more
necessarily fatal where left to itself, but it yielded
more certainly to  art, than it did a few weeks be-
fore. The duration of it was now more tedious,
than in the warmer weather.
There were a few cases of yellow fever in No-
vember and December, after the citizens who
had retired to the country, returned to the city.
I heard of only three persons who returned to
the city being infected with the disorder; so com-
pletely was the contagion destroyed in the course
of a few weeks.
In consequence of a proclamation by the Go-
vernor, and a recommendation by the Clergy of
Philadelphia, the 12th of December was observed
* P. 5, 56, 180, and 323.
as 

137 BILIOUS YELLOW FEVER.
as a day of thanksgiving throughout the state for
the extinction of the disorder in the city.
It was easy to distinguish in walking the streets,
the persons who had returned from the  country
to the city, from those who had remained in it
during the prevalence of the fever. The former
appeared ruddy, and healthy, while the latter ap-
peared of a pale or fallow colour.
It afforded a subject of equal surprise and joy to
behold the suddenness with which the city reco-
vered its former habits of business. In the course
of six weeks after the disease had ceased, nothing
but fresh graves, and the black dresses of many
of the citizens, afforded a public trace of the dis-
tress which had so lately prevailed in the city.
The month of November, and all the winter
months which followed the autumnal epidemic,
were in general healthy. A catarrh affected a
number of people in November. I suspected it to
be the influenza which had revived from a dor-
mant state; and which had not spent itself when it
yielded to the predominance of the yellow fever.
This opinion derives some support from a curious
fact related by the late Mr. Hunter of the revival
of the small-pox  in a patient, in whom it had been
suspended                                     
   

138 AN ACCOUNT OF THE
suspended for some time by the measles*. The
few fevers which prevailed in the winter were
highly inflammatory. The small-pox in the na-
tural way was in several instances confluent; and
in one or two fatal. I was prepared to expect
this inflammatory diathesis in the fevers of the
winter; for I had been taught by Dr. Sydenham,
that the diseases which follow a great and mortal
epidemic, partake more or less of its general
character. But the diseases of the winter had a
peculiarity still more extraordinary; and that was,
many of them had several of the symptoms of
the yellow fever, particularly a puking of bile,
dark-coloured stools, and a yellow eye. Mr.
Samuel D. Alexander, a student of medicine from
South Carolina, who was seized with a pneumony
about Christmas, had with a yellow eye, a dilated
pupil, and a hard pulse which beat only 50 strokes
in a minute. His blood was such as I had fre-
quently observed in the yellow fever. Dr. Grif-
fitts informed me, that he attended a patient on
the 9th of January in a pneumony, who had an
universal yellowness on his skin. I met with a
case of pneumony on the 20th of the same month,
in which I observed the same degrees of redness
* Introduction to a Treatise on the Venereal Disease,
p. 3. of the American Edition.
in                                             

139 BILIOUS YELLOW FEVER.  
in the eyes that were common in the yellow fever.
My pupil Mr. Coxe, lost blood in an inflammatory
fever, on the 18th of February, which was dis-
solved. Mr. William Innis, the brewer, had a
deep yellow colour in his eyes, on the fourth day
of a pneumony, on the 27th of the same month;
and Mr. Magnus Miller had the same symptom of
a similar disorder, on the 16th of March. None
of these bilious and anomalous symptoms of the
inflammatory fevers of the winter and spring sur-
prised me. I had been early taught by Dr. Sy-
denham, that the epidemics of autumn often insi-
nuate some of their symptoms into the winter dis-
eases which follow them. Dr. Cleghorn informs
us, that "the pleurisies which succeeded the
autumnal tertians in Minorca, were accompanied
by a vomiting and purging of green or yellow
bilious matters*.
It belongs to powerful epidemics to be followed
by some diseases after they disappear, as well as to
run into others at their first appearance. In the
former case it is occasioned by a peculiar state of
the body, created by the epidemic constitution of
the air, not having been changed by the weather
which succeeded it. The diseases which partake of
* Page 273.
the 

140 AN ACCOUNT OF THE.
the departed epidemic, resemble the drops which
follow a heavy shower of rain, or the waves which
succeed a violent gale of wind on the ocean.
The weather in March resembled that of May;
while the weather in April resembled that of
March in common years. A rash prevailed in
many families in April, accompanied in a few
cases by a sore throat. It was attended with an
itching, a redness of the eyes, and a slight fever
in a few instances. The small-pox by inoculation
in this month was more mortal than in former
years. However unimportant these facts may
appear at this time, future observations may per-
haps connect them with a similar constitution of
the air which produced our late autumnal epi-
demic.
The appearance of bilious symptoms in the dis-
eases of the winter, excited apprehensions in seve-
ral instances of the revival of the yellow fever.
The alarms though false, served to produce vigi-
lance and industry in the corporation, in airing
and purifying such houses and articles of furniture
as belonged to the poor; and which had been
neglected in the autumn, after the ceasing of the
disease.
The 

141 BILIOUS YELLOW FEVER.
The modes of purifying houses, beds, and
clothes were various. Fumigations of nitre and
aromatic substances were used by some people.
Burying infected articles of furniture under
ground, and baking them in ovens, were used by
others. Some destroyed all their beds and cloth-
ing that had been infected, or threw them into
the Delaware. Many white-washed their walls,
and painted the wood-work of their house. I
did not conceive the contagion required all, or
any of those means to destroy it. I believed cold
and water to be sufficient for that purpose. I
therefore advised the keeping the windows of in-
fected rooms open night and day, for a few days;
to have the floors and walls of houses well washed;
and to expose beds and such articles of household
furniture as might be injured by walking, upon
the bare earth for a week or two, taking cart to
turn them every day. I used no other method;
of destroying the accumulated contagion in my
house and furniture, and experience showed that
they were sufficient. Those branches of my family
who had been absent during the prevalence of the
fever (amounting to eleven in number) returned
to the city on the 22d of November, and occupied
the house and beds which had been highly in-
fected, without suffering a moment's indisposition
from it. The weather of the winter favoured 
the


142 AN ACCOUNT OF THE
the complete destruction of the contagion. It was
alternately moderate and cold; by which means
the contagion, if accidentally revived by the for-
mer, was more  effectually destroyed by the latter
state of the air.
It is possible a portion of the contagion may
exist in clothes or bedding, under such circum-
stances of warmth, as to be excited into action in
the course of the approaching summer and au-
tumn; but it cannot spread without a correspond-
ing constitution of the atmosphere. A trunk full
of infected clothes, the property of Mr. James
Bingham, who died of the yellow fever in one of
the West India islands about 40 years ago, was
opened some months after they were received by
his friends, by a young man who lived in his bro-
ther's family. This young man took the disease,
and died; but without infecting any of the family;
nor did the disease spread afterwards in the city.
The father of Mr. Joseph Paschall was infected
with the yellow fever of 1741, by the smell of a
bed in passing through Norris's Alley, in the lat-
ter end of December, after the disease had left the
city. He died on the 25th of the month, but
without reviving the fever in the city, or even in-
fecting his family.
In     

143 BILIOUS YELLOW FEVER.
In a letter from Dr. Senter of Newport, dated
January 7th, 1794, I find the following fact, which
I shall communicate in his own words. It is in-
troduced to support the principle, that the yellow
fever cannot spread in any country without the
concurrence of a predisposing constitution of air.
"This place (says the Doctor) has traded for-
merly very much to  the West India islands, and
more or less of our people have died there every
season, when the disease prevails in those parts.
Clothes of these unfortunate people have been
repeatedly brought home to their friends, without
any accident happening to them."
It is not peculiar to the contagion of the yellow
fever to require the concurrence of a morbid con-
stitution of the air to excite it into action. The
contagion of the plague perished twice in the city
of Larnaca, without spreading, from the absence
of that necessary state of the air, in the year
1759*. It is remarkable, that a morbid constitu-
tion of the air sometimes exists under very dif-
ferent, and frequently opposite circumstances of
its sensible qualities, and that the same constitution
of the air is often protracted for two, three, four,
and even six years.
* P. Russel, p. 4,
Several 

144 AN ACCOUNT OF THE
Several persons it is said died of the yellow
fever in the summer and autumn of 1763, the
year after it had been epidemic in our city. I
witnessed the symptoms which immediately pre-
ceded the death of one of them. Whether the
disease in this sporadic case was produced by a
revival of the contagion, or by miasmata gene-
rated in the city, I am unable to determine.
Dr. Mitchell informs us, that the disease ap-
peared in Virginia in the spring of 1742, after the 
autumn of 1741. In this case the contagion was
probably kept alive during the winter by the want
of cleanliness in the negro-quarters; and perhaps
by moderate weather.
This is the only fact which supports the fears
of the return of the disease to our city, in the
course of the present year. To aid our hopes,
that this will not be the case, I have great plea-
sure in adding, that it has never prevailed in suc-
cessive years either in this city or in Charleston;
in one of which there are records of its having
been five, and in the other four times epidemic.
I feel with my reader the fatigue of this long
detail of facts, and equal impatience with him, to
proceed to the  history of the treatment of the fe-
2 ver;        

145 BILIOUS YELLOW FEVER.
ver; but I must beg leave to detain him a little
longer from that part of the work, while I resume
the subject of the origin of the fever. It is an in-
teresting question, as it involves in it the means of
preventing a return of the disorder.
Soon after the fever left the city, the governor
of the state addressed a letter to the College of
Physicians, requesting to know their opinion of its
origin; if imported; from what place; at what
time; and in what matter. The design of this
inquiry was to procure such information as was
proper to lay before the legislature, in order to
improve the laws for preventing the importation
or generation of infectious diseases, or to enact
new ones, if necessary for that purpose. To the
governor's letter, the College of Physicians sent
the following answer:
"Sir,
"IT has not been from a want of respect
to yourself, nor from inattention to the subject,
that your letter of the 30th ult. was not sooner
answered; but the importance of the questions
proposed, has made it necessary for us to devote a
considerable portion of time and diligence to this
business, in order to arrive at a safe and just con-
clusion.
L "No

146 AN ACCOUNT OF THE
"No instance has ever occurred of the disease
called the yellow fever, having been generated in
this city, or in any other part of this state, as far
as we know; but there have been frequent in-
stances of its having been imported, not only into
this, but into other parts of North America, and
prevailing there a certain period of time; and
from the rise, progress, and nature of the malig-
nant fever, which began to prevail here about the
beginning of last August, and extended itself gra-
dually over a great part of the city, we are of opi-
nion that this disease was imported into Philadel-
phia, by some of the vessels which arrived in the
port after the middle of July. This opinion we
are further confirmed in by various accounts we
have received from the best authorities we could
procure upon the subject.
Signed by order of the College of Physicians,
November 26th, JOHN REDMAN, PRESIDENT.
1793.
To the Governor of Pennsylvania.
Three members of the College dissented from
the report contained in this letter. They were
Dr. Redman the President of the College, Dr.
Foulke, and Dr. Leib.
I am 

147 BILIOUS YELLOW FEVER.
I am sorry to meet my brethren upon every
question of our late epidemic in a field of contro-
versy. In the present they will have a great ad-
vantage over me, for the prejudices of the citizens
of Philadelphia are in their favour. Loathsome
and dangerous diseases have been considered by
all nations as of foreign extraction. The venereal
disease and the leprosy have no native country, if
we believe all the authors who have written upon
their origin. Prosper Alpinus, derives the almost
yearly plagues of Cairo from Syria, and Dr. War-
ren flattered the people of Barbados, by an at-
tempt to persuade them that the yellow fever of
the West Indies, was originally imported from
Siam. This principle of referring the origin of the
evils of life, from ourselves to others, is universal.
It discovered itself in Paradise, and it is every
where, an essential feature in the character of man.
I have asserted in the introduction to the history
of this fever, that I believed it to have been gene-
rated in our city; I shall now deliver my reasons
for that belief.
1. The yellow fever in the West Indies and in
all other countries where it is endemic, is the off-
spring of vegetable putrefaction. Heat, exercise,
and intemperance in drinking, (says Dr. Lind) dis-
L2 pose 


148 AN ACCOUNT OF THE
pose to this fever in hot climates, but they do not
produce it, without the concurrence of a remote
cause. This remote cause exists at all times, in
some spots of the Islands, but in other parts of even
the same islands, where there are no marsh exha-
lations, the disease is unknown. I shall not waste
a moment in enquiring into the truth of Dr. War-
ren's account of the origin of this fever. It is fully
refuted by Dr. Hillary, and it is treated as chime-
rical by Dr. Lind. They have very limited ideas
of the history of this fever who  suppose it to be
peculiar to the East or West Indies. It was gene-
rated in Cadiz after a hot and dry summer in 1764,
and in Pensacola in 1765*. The tertian fever of
Minorca, when it attacked Englishmen put on the
usual symptoms of the yellow fever†. In short,
this disease, appears according to Dr. Lind, in all
the southern parts of Europe, after hot, and dry
weather‡.
2. The same causes (under like circumstances)
must always produce the same effects. There is
nothing in the air of the West Indies above other
hot countries, which disposes it to produce a yel-
* Lind on the Diseases of Hot Climates, p. 36 and 124.
† Cleghorn, page 176.
‡ Diseases of Hot Climates, page 123.
low                                           

149 BILIOUS YELLOW FEVER.
low fever. Similar degrees of heat, acting upon
dead and moist vegetable matters, are capable of
producing it, together with all its various modifi-
cations, in every part of the world. In support of
this opinion, I shall transcribe part of a letter from
Dr. Miller, of the Delaware state.
"Dover, Nov. 5, 1793.
DEAR SIR,
SINCE the middle of last July, we
have had a Bilious Cholic epidemic in this neigh-
bourhood which exhibits phenomena very singu-
lar in this climate; and so far as I am informed,
unprecedented in the medical records, or popular
traditions of this country. To avoid unnecessary
details, it will suffice at present to observe, that the
disease on this occasion has assumed not only all
the essential characters, but likewise all the vio-
lence, obstinacy, and malignity described by the
East and West India practitioners. If any differ-
ence can be observed, it seems here to manifest
higher degrees of stubbornness and malignity, than
we usually meet in the histories of tropical writers.
In the course of the disease, not only extreme con-
stipation, frequent vomiting, and the most excru-
ciating pains of the bowels and limbs, harass the
unhappy patient; but to these succeed paralysis,
convulsions, &c. and almost always uncommon
L3 muscular                   


150 AN ACCOUNT OF THE
muscular debility,--oppression of the præcordia,
&c. are the consequence of a severe attack. Bile
discharged in enormous quantities, constantly as-
sumes the most corrupted and acrimonious appear-
ances, commonly æruginous in a very high degree,
and sometimes quite atrabilious.
"The inference I mean to draw from the phæ-
nomena of this disease, as it appears in this neigh-
bourhood, and which I presume will also apply to
your epidemic, is THIS, that from the uncommon
protraction and intenseness of our summer and
autumnal heats, but principally from the unusual
drought; we have had since the middle of July,
a near approach to a TROPICAL season, and that
of consequence we ought not to be surprized if
tropical diseases, even of the most malignant na-
ture, are ENGENDERED amongst us."
To the above information it may be added, that
the dysentery which prevailed during the late au-
tumn in several of the villages of Pennsylvania,
was attended with a malignity and mortality, un-
known before in any part of the state. I need not
pause to remark that this dysentery arose from pu-
trid exhalation, and that it is like the bilious colic,
only a modification of one original genus of bilious
fever.
But   

151 BILIOUS YELLOW FEVER.
But further, a malignant fever resembling that
which was epidemic in our city, prevailed during
the autumn in many parts of the United States,
viz. at Lynn in Massachusetts, at Weatherfield and
Coventry in Connecticut, at New Galloway in the
state of New York, on Wallkill and on Pensocken
creeks in New Jersey, at Harrisburg, and Hum-
melstown in Pennsylvania, in Caroline county in
Maryland, on the South branch of the Potomac
in Hardie county, also in Lynchburg and in Alex-
andria in Virginia, and in several counties in North
Carolina. In none of these places was there a sus-
picion of the disease being imported from abroad,
or conveyed by an intercourse with the city of
Philadelphia.
It is no objection to the inference which follows
from these facts, that the common remitting fever
was not known during the above period in the
neighbourhood of the city, and in many other
parts of the state, where it had usually appeared in
the autumnal months. There is a certain combi-
nation of moisture with heat, which is essential to
the production of the remote cause of a bilious fe-
ver. Where the heat is so intense, or of such long
duration as wholly to dissipate moisture, or when
the rains are so great as totally to overflow the
L4 marshy 


152 AN ACCOUNT OF THE
marshy ground, or to wash away putrid masses of
matter, no fever can be produced.
Dr. Dazilles, in his treatise upon the diseases of
the Negroes in the West Indies, informs us, that
the RAINY season is the most healthy at Cayenne,
owing to the neighbouring morasses being DEEPLY
overflowed-whereas at St. Domingo, a DRY sea-
son is most productive of diseases; owing to its
favouring those degrees of moisture which pro-
duce morbid exhalations. These facts will explain
the reason why, in certain seasons, places which
are naturally healthy in our country, become sick-
ly, while those places which are naturally sickly,
escape the prevailing epidemic. Previously to the
dissipation of the moisture from the putrid masses
of vegetable matters in our streets, and in the
neighbourhood of the city, there were (as several
practitioners can testify) many cases of mild remit-
tents, but they all disappeared about the first week
in September.
It is worthy of notice, that the yellow fever pre-
vailed in Virginia, in the year 1741, and in
Charleston in South Carolina in the year 1699, in
both which years, it prevailed in Philadelphia. Its
prevalence in Charleston is taken notice of in a
letter         

153 BILIOUS YELLOW FEVER. 
letter dated November 18th, O. S. 1699, from
Isaac Norris to one of his correspondents. The
letter says, that "150 persons had died in Charles-
ton in a few days," that "the survivors fled into
the country," and that "the town was thinned to
a very few people." Is it not probable, from the
prevalence of this fever twice in two places in the
same years, that it was produced (as last year) by
a general constitution of air, co-operating with
miasmata, which favoured its generation in differ-
ent parts of the continent? But again, such was
the state of the air in the summer of 1793, that it
predisposed other animals to diseases, besides the
human species. In some parts of New Jersey, a
disorder prevailed with great mortality among the
horses, and in Virginia among the cows, during
the last autumn. The urine in both was yellow.--
Large abscesses appeared in different parts of the
body in the latter animals, which when opened,
discharged a yellow serous fluid. From the colour
of these discharges, and of the urine, the disease
got the name of the yellow water.
3. I have before remarked that a quantity
of damaged coffee, was exposed at a time (July
the 24th) and in a situation (on a wharf, and in
a dock) which favoured its putrefaction, and ex-
halation. Its smell was highly putrid and offen-
sive,                                         

154 AN ACCOUNT OF THE
sive, insomuch that the inhabitants of the houses
in Water and Front streets, who were near it,
were obliged in the hottest weather to exclude it,
by shutting their doors and windows. Even per-
sons, who only walked along those streets, com-
plained of an intolerable fœtor, which upon en-
quiring, was constantly traced to the putrid cof-
fee. It should not surprise us, that this seed, so
inoffensive in its natural state, should produce,
after its putrefaction a violent fever. The records
of medicine furnish instances of similar fevers be-
ing produced, by the putrefaction of many other
vegetable substances. Fourteen men out of six-
teen, perished by a malignant fever, a few years
ago, at the island of Tortola, from the effluvia
generated by some putrefied potatoes, which were
taken out of the hold of a Liverpool vessel.
"The effluvia (says Dr. Zimmerman from a little
heap of flax, has been known to occasion a malig-
nant fever, which proved fatal to the family, in
which it first began, and afterwards spread its con-
tagion through a whole country." Dr. Rodgers
in his treatise upon the diseases of Cork, mentions
a malignant fever which swept away a great num-
ber of the students of Wadham College in Ox-
ford, "The singularity of the case (adds the Doc-
tor) engaged all the gentlemen of the faculty, in
a serious inquiry into the causes of so remarkable
an                                           

155 BILIOUS YELLOW FEVER. 
an effect, and all agreed that the contagious infec-
tion arose from the putrefaction of a vast quantity
of cabbages thrown into a heap out of the several
gardens near the College."  Lancissi relates, that
one end of the city of Rome was nearly desolated
by the effluvia of some rotted hemp, which lay in
the neighbourhood of the city. The same author
remarks, that "fevers often prevail at constanti-
nople, which owe their origin to the hemp which is
brought from Cairo, and which is put wet into the
public granaries, and suffered to ferment during the
summer. It is afterwards sold, and the seeds of
those diseases are afterwards spread among the peo-
ple." Many other facts, might be adduced of ra-
dishes, turnips, garlic, and sundry other vegetables,
generating by putrefaction, fevers, similar to those
which have been mentioned.
4. The rapid progress of the fever from Water-
street, and the courses through which it travelled
into other parts of the city, afford a strong evi-
dence that it was at first propagated chiefly by ex-
halation from the putrid coffe. It is remarkable
that it passed first through those alleys, and streets
which were in the course of the winds that blew
across the dock and wharf where the coffee lay,
and that persons were affected at a much greater
distance from Water-street by that means, than
was                                          
  

156 AN ACCOUNT OF THE
was afterwards known by means of the contagion
which was generated by infected persons.
5. Many persons who had worked, or even vi-
sited in the neighbourhood of the exhalation from
the coffee, early in the month of August, were
indisposed afterwards with sickness, puking, and
yellow sweats, long before the air of Water-street
was so much impregnated with the contagion, as
to produce such effects; and several patients whom
I attended in the yellow fever declared to me, or
to their friends, that their indispositions began
exactly at the time they inhaled the offensive ef-
fluvia of the coffee.
6. The first cases of the yellow fever have been
clearly traced to the sailors of the vessel who were
first exposed to the effluvia of the coffee. Their
sickness commenced with the day on which the
coffee began to emit its putrid smell. The disease
spread with the increase of the poisonous exhala-
tion. A journeyman of Mr. Peter Brown's, who
worked near the corner of Race and Water-streets,
caught the disease on the 27th of July. Elizabeth
Hill, the wife of a fisherman was infected by only
sailing near the pestilential wharf, about the first
of August, and died at Kensington on the 14th
of the same month. Many other names might be
mentioned                                   

157 BILIOUS YELLOW FEVER.  
mentioned of persons who sickened during the last
week in July or the first week in August, who
ascribed their illnesses to the smell of the coffee.
From three of those persons who came under my
notice, the disease was evidently propagated by
contagion: from one of them, to nearly a whole
family, and from another, to a girl of eight years
old, who was led by curiosity to examine the yel-
low colour which it was said had appeared in the
face of the infected person, after death.
7. It has been remarked that this fever did not
spread in the country, when carried there by per-
sons who were infected, and who afterwards died
with it. This I conceive was occasioned, in part
by the contagion being deprived of the aid of mi-
asmata from the putrid matter which first produced
it in our city, and in part, by its being diluted,
and thereby weakened by the pure air of the coun-
try. During four times in which it prevailed in
Charleston, in no one instance, according to Dr.
Lining, was it propagated in any other part of the
state.
8. It is very remarkable that in the histories of
the disorder which have been preserved in this
country, it has six times appeared about the first
or                                             


158 AN ACCOUNT OF THE
or middle of August, and declined, or ceased about
the middle of October-viz. in 1732, 1739, 1745,
and 1748 in Charleston; in 1791 in New-York,
and in 1793 in Philadelphia. This frequent oc-
currence of the yellow fever at the usual period
of our common bilious remittents, cannot be ascri-
bed to accidental coincidence, but must be resolved
in most cases into the combination of more active
miasmata with the predisposition of a tropical sea-
son. In speaking of a tropical season, I include
that kind of weather in which rains and heats are
alternated with each other, as well as that, which
is uniformly warm.
9. Several circumstances attended the late epi-
demic, which do not occur in the West-India yel-
low fever. It affected children as well as adults in
common with our annual bilious fevers. In the
West Indies Dr. Hume tells us it never attacked
any person under puberty. It had, moreover, many
peculiar symptoms (as I have already shewn) which
are not to be met with in any of the histories of
the West-India yellow fever.
10. Why should it surprise us to see a yellow
fever generated amongst us? It is only a higher
grade of a fever which prevails every year in
our                                          

159 BILIOUS YELLOW FEVER.
our city from vegetable putrefaction. It con-
forms in the difference of its degrees of violence,
and danger to season, as well as climate, and in
this respect it is upon a footing with the small-pox,
the measles, the sore-throat, and several other dis-
eases. There are few years pass, in which a ple-
thoric habit, and more active but limited mias-
mata, do not produce Sporadic Cases of true yel-
low fever in Philadelphia. It is very common in
South and North Carolina and in Virginia, and
there are facts which prove, that not only strangers,
but native individuals, and in one instance, a whole
family have been carried off by it in the state of
Maryland. It proved fatal to one hundred per-
sons in the city of New-York in the year 1791,
where it was evidently generated by putrid exha-
lation. The yellow colour of the skin, has unfor-
tunately too often been considered as the charac-
teristic mark of this fever, otherwise many other
instances of its prevalence might be discovered, I
have no doubt, in every part of the United States.
I wish with Dr. Mosely, the term yellow, could be
abolished from the titles of this fever, for this co-
lour is not only frequently absent, but sometimes
occurs in the mildest bilious remittents. Dr Hal-
ler in his pathology, describes an epidemic of this
kind in Switzerland, in which this colour generally
attended, and I have once seen it almost universal
in                                             

160 AN ACCOUNT OF THE
in a common bilious fever which prevailed in the
American army in the year 1776.
If any thing could surprise me after reading the
report of the College of Physicians that our late
fever was imported, in spite of every possible evi-
dence to the contrary, it would be the opinion
which was delivered publicly by some leading
members of the College, that no fever produced
by vegetable putrefaction and exhalation, had ever
been contagious. It is scarcely possible to open a
practical book upon medicine, without meeting
with facts which establish a contrary opinion.
The fevers generated by putrid cabbage, men-
tioned by Dr. Rodgers, and by putrid flax men-
tioned by Dr. Zimmerman, were both contagious.
Dr. Lind ascribes the yellow fever every where to
marsh or putrid vegetable exhalations; and this
fever, we know, spreads by contagion. Dr. Lind,
Jun. establishes the contagious nature of the marsh
fever which prevailed in Bengal in the year 1762.
I shall transcribe his words upon this subject.
"Although marsh miasmata (says he) first bring
on the disease, yet contagion presently spreads it,
and renders it more epidemic. Thus the Drake
Indiaman continued free from the disorder for
two weeks together, when she had no commu-
nication with other ships; whereas as soon as the
4 disorder

161 BILIOUS YELLOW FEVER.
disorder was brought on board, many were seized
with it within a few days in such a manner as to
leave no room to entertain the least doubt con-
cerning its pestilential nature*."
Dr. Clark mentions a contagious malignant
fever from marsh miasmata, which prevailed at
Prince's Island in the year 1771, and which after-
wards infected the crew of the Grenville India-
man†. The contagious pestilential fever in France,
so accurately described by Riverius, was pro-
duced by an exhalation from putrid vegetables,
particularly hemp and flax‡. Even intermit tents,  
the most frequent and the most numerous off- 
spring of marsh exhalation, are contagious. Of
this there are many proofs in practical authors. Bi-  
anchi describes an intermit tent which was highly 
contagious at  Wolfenbuttle in the year 1666§.  
Dr. Clark mentions a number of cases in which  
this mild species of fever was propagated by con-   
tagion. Dr. Cleghorn has established the con- 
tagious nature of intermittents by many facts.      
After mentioning numerous instances of their
* Page 35, 36.
† Observations on the Diseases of Long Voyages to Hot
Countries, vol. i. p. 123, 124.
‡ De Febre Pestilenti, vol. ii. p. 97.
§ Histor. Hepat. p. 745.
M having                      

162 AN ACCOUNT OF THE
having spread in this way, he says, "These ter-
tians have as good a right to be called contagious
as the measles, small pox, or any other disease*."
The United States, in common with other coun-
tries, have in many places exhibited proofs of the
contagious nature of fevers, produced by putrid
vegetable exhalations. The yellow fever which
the citizens of New-York wisely admit to have
been generated in their city from vegetable putre-
faction in the year 1791, spread by contagion†.
The bilious fever which prevailed in Philadelphia
in the year 1778, was evidently contagious; so
were the bilious fevers which prevailed during the
last autumn in Weathersfield, Harrisburgh, and
on the south branch of the Potomac. I hope
I shall be excused by the physicians of other states
(if this publication should fall into their hands)
for having employed a single page in combating
an error which is so obvious to common observa-
tion. My only design in exposing it, is to prevent
a repetition of its fatal influence in the only city
in the world in which  it has ever been believed or
propagated.
* Page 132.
† Addoms's Inaugural Dissertation on the Malignant
fever which prevailed in New-York, during the months of
August, September, and October, in 1791, p. 7.
I am 

163 BILIOUS YELLOW FEVER.
I am far, however, from denying that this dis-
ease has not sometimes been imported into our
country. From the authority of Dr. Lind, it ap-
pears that this has once been the case in Philadel-
phia. In this respect it is upon a footing with the
plague, which is both an imported and a generat-
ed disease, in the cities of the East. I am disposed
however to believe that the instances of the yellow
fever being imported are very few, compared with
those of its being generated in our country. What
makes this opinion probable is, that neither Great
Britain nor Ireland have ever, to my knowledge,
been infected by this fever, notwithstanding their
long and frequent commercial intercourse with the
West India islands. The summers in each of those
countries, though seldom hot enough to generate
a contagious yellow or bilious fever, are notwith-
standing warm enough to favour the propagation
of an imported contagion of that disorder. The
jail fever which has more than once been introdu-
ced into our city in crowded ships from Holland,
I suspect has been sometimes mistaken for the yel-
low fever of the West Indies. But I have an-
other reason for discrediting some of the accounts
of the importation of this fever, which have been
handed down to us by former generations, and
that is, the manner in  which the College of Phy-
sicians decided upon the question of the origin of
M2 the

164 AN ACCOUNT OF THE
the disease now under consideration. The go-
vernor of the state requested in his letter to them,
to know whether it was imported; if it were
from what place, at what time, and in what man-
ner. The report of the College of Physicians
takes no notice of either of those questions. In
vain did Dr. Foulke call upon the College to be
more definite in their answer to the governor's
letter. They had faithfully sought for the infor-
mation required, but to no purpose. The cha-
racter of their departed brother Dr. Hutchinson,
for capacity and vigilance in his office, as inspec-
tor of sickly vessels, was urged without effect as
an argument against the probability of the disease
being imported. Public report had derived it
from several different islands; had chased it from
ship to ship, and from shore to shore; and finally
conveyed it at different times into the city, al-
ternately by dead and living bodies; and from
these tales, all of which when investigated, were
proved to be without foundation, the College
of Physicians composed their letter. It would
seem from this conduct of the College as if medical
superstition had changed its names, and that in ac-
counting for the origin of pestilential fevers, ce-
lestial, planetary, and demoniacal influence, had
only yielded to the term-importation.
Let 

165 BILIOUS YELLOW FEVER. 
Let not the reader reject the opinion I have de-
livered, because it is opposed by so great a majo-
rity of the Physicians of Philadelphia. A single
physician supported an opinion of the existence of
the plague at Messina in the year 1743, in oppo-
sition to all the physicians (33 in number) of that
city. They denied the disease in question to exist,
because it was not accompanied by glandular swel-
lings. Time shewed that they were all mistaken,
and the plague, which might probably have been
checked at its first appearance by their united ef-
forts, was by means of their ignorance, introduced
with great mortality into every part of the city.
This disposition of physicians to limit the symp-
toms of several other diseases, cannot be sufficiently
lamented. The frequent absence of a yellow
colour in our late epidemic, led to mistakes which
cost the city of Philadelphia several hundred
lives.
The report of the College of Physicians has
served to confirm me in an opinion, that the
plagues which occasionally desolated most of the
countries in Europe in former centuries, and
which were always said to be of foreign extraction,
were in most instances of domestic origin. Be-
tween the years 1006 and 1680, the plague was
epidemic 52 times all over Europe. It prevailed
M3 14 times                   

166 AN ACCOUNT OF THE
14 times in the 14th century. The state of Europe
in this long period is well known. Idleness, a de-
ficiency of vegetable aliment, a camp life from the
frequency of wars, famine, an uncultivated and
marshy soil, small cabins, and the want of cleanli-
ness in dress, diet, and furniture, all concurred to
generate pestilential diseases. The plague which
prevailed in London every year from 1593 to
1611, and from 1636 to 1649, I suspect were ge-
nerated in that city. The diminution of plagues in
Europe, more especially in London, appears to have
been produced by the great change in the diet and
manners of the people; also by the more commo-
dious and airy forms of the houses of the poor,
among whom the plague always makes its first ap-
pearance. It is true, these plagues were said by
authors to have been imported either directly or
indirectly from the Levant; but the proofs of such
importation were in most cases as vague and defi-
cient, as they were of the West India origin of
our late epidemic. The pestilential fevers which
have been mentioned have been described by au-
thors, by the generic name of the plague; but
some of them appear to have originated from pu-
trid vegetable exhalations, and to have resembled
in most of their symptoms, the West India and
American yellow fever.
I am 

167 BILIOUS YELLOW FEVER.
I am aware that the opinion and facts which I
have stated upon the origin of the late epidemic,
are not popular with our citizens, but I did not
dare to conceal them; for I am persuaded a know-
ledge and belief of them, involve in their conse-
quences, the lives of millions that are yet unborn.
Commerce can be no more endangered than
Religion, by the publication of philosophical truth.
On the contrary it must suffer most by the adop-
tion of the traditional error which I have endea-
voured to refute, for while the cause of a malig-
nant fever is obvious to the senses, it will be easy
to guard against it; but while it is believed that
the disease may be imported, and no body know
from what place, at what time, and in what man-
ner, we shall not only be careless in the midst of
filth and danger, but our city will always hold its
character for health by a timid and precarious te-
nure. I am the more disposed to expect forgive-
ness from my fellow citizens for this attempt to
serve them, by the recollection of the sudden
change in the health of our city which followed
the arching the offensive dock between Front and
Third streets in the year 1782. By advising that
measure (in which I stood nearly alone) I incurred
the censure of several valuable citizens. The bills
of mortality however soon shewed that the mea-
M4 sure


168 AN ACCOUNT OF THE
sure was right, and I have since seen with great
pleasure the extraordinary healthiness of our city,
ascribed by indifferent people, to that, among other
causes.
The climate of our country can no more suffer
than the commerce of our city, by this investiga-
tion; for it fixes the late fever, and all the other
malignant fevers of the United States, upon putrid
vegetable exhalation. Without the matrix of
putrid vegetable matters, there can no more be a
bilious or yellow fever generated amongst us, than
there can be vegetation without earth-water or
air. To ascribe our late disease therefore to the
exclusive influence of the atmosphere, is a reflec-
tion upon our climate which is equally unphiloso-
phical and unjust.
Let it only be clearly proved and boldly assert-
ed, that a bilious yellow fever has been, and  may
be generated in our country, under the circum-
stances before mentioned, and the return of it, as
also of common bilious and intermitting fevers may
every where be prevented by a due attention to
the cleanliness of the wharfs and suburbs, as
well as the streets of our cities, and towns; by
draining and cultivating marshy grounds in their
neighbourhood, and in the neighbourhood of
farm                                         

169 BILIOUS YELLOW FEVER.
farm houses,--and where the last cannot be done,
by sheltering them from the current of vegetable
exhalations, by means of a body of trees that are
of speedy growth. In this manner, malignant and
deadly fevers have been banished from most of the
cities in Europe.
I have hinted in the course of this history, at
the resemblance which the yellow fever bears to
the plague. Before I dismiss this part of my sub-
ject, I shall briefly enumerate the circumstances,
and symptoms, which belong to them in common;
and afterwards mention those which are peculiar
to each of them. The utility of this digression
will, I hope appear hereafter, when I come to deli-
ver the history of the cure of the yellow fever.--
The principles which suggested and directed it,
will apply alike to both diseases.
The circumstances and symptoms in which the
plague and the yellow fever (as it lately appeared
in our city) resemble each other, are as follow:
In being accompanied and encreased by warm
weather.
In affecting those people most generally who fol-
low occupations which expose them to be much
heated.                                        

170 AN ACCOUNT OF THE
heated. The bakers were great sufferers by the
plagues at Aleppo, described by Dr. P. Russel.
In affecting persons who are suddenly debili-
tated by fear or grief.
In affecting all ages; also the poor more than
the rich; men more than women; and persons of
robust, more than those of weakly habits.
In attacking with, and without premonitory
symptoms.
In being excited by intemperance, and labour.
In being accompanied by a full, tense, depressed,
regular, or an intermitting pulse.
In being accompanied by hemorrhages. These
are less frequent in the plague than in the yellow
fever.--Abortions are alike common in both
diseases.
The following symptoms of our late yellow
fever occur likewise in the plague.
Inflammation of the brain.
Inflam- 

171 BILIOUS YELLOW FEVER.
Inflammation, mortifications, and carbuncles in
the alimentary canal and stomach.
Costiveness or diarrhœa. Copious sweats in
the beginning of the disease which afford relief.--
A discharge of a blackish liquor from the stomach
by vomiting, in the close of the disease.
A moist white tongue, in its beginning, and a
dry black tongue in its last stage.
Absence of heat and thirst in some cases.
Convulsions, syncope, great depression of spirits,
exquisite pain, so as to excite screamings in the
sick. Delirium and a temporary loss of memory
after recovery.
A red or a brilliant eye, and a great venereal ex-
citability in the convalescent state of the disease.
Buboes, and an exclusive affection of the lym-
phatic glands.
Maculæ, or red spots resembling flea bites, wa-
tery vesicles, or blisters which end in mortifica-
tions, petechiæ, anthrax, and carbuncles.
Sizy,

172 AN ACCOUNT OF THE
Sizy, dense, or dissolved blood.
The plague appears in the forms of quotidian,
tertian, and quartan fevers. It has different
grades, also different durations, from one day to
two, three and four weeks. It is most fatal at its
first appearance. Convulsive twitchings of the
tendons are less common in the plague, than in
the nervous fever. It chases away, or unites with
all other febrile diseases.
I have before remarked, that during the pre-
valence of the plague, some foreigners escape the
contagion.
The contagion of the plague infects the atmos-
phere of a whole city, and is propagated without
contact with the sick. Many people discover
marks of the presence of this contagion in their
bodies who are in apparent good health; a dis-
position to sweat is very common in such persons.
The disease is sometimes propagated by contact
by means of this sweat, when it affects the hands.
Persons infected with the contagion of the
plague, communicate it before they are sensible
of their being affected by it. The contagion is
excited at different times, from the moment it is
received                                              

173 BILIOUS YELLOW FEVER.
received into the body, until the 16th day after-
wards.
Persons who have had the plague, are capable
of re-infection.
Brutes, as cats and dogs are affected in some
instances, with symptoms of the plague, particu-
larly buboes.
Persons confined in Seraglios in Eastern coun-
tries, and in Monasteries in Catholic countries,
also grave-diggers, very often escape the plague.
The bodies of persons who die of the plague
become stiff in some instances immediately after
death. Tears likewise often appear upon their
cheeks.                                       
Cold weather checks the plague, but not so 
uniformly as it does the yellow fever.      
The diseases which succeed the plague, appear
with more or less of its symptoms.
It will appear hereafter that the cure of the
yellow fever, accorded in several particulars, with
that of the plague.
The                                    

174 AN ACCOUNT OF THE
The circumstances and symptoms in which the
plague differs from the yellow fever are as follow:
A vomiting is less common in the plague, than
in the yellow fever. Bile is less frequently dis-
charged, and the stools are less fœtid, and offensive.
There are small horny swellings upon the breast
and limbs in the plague which did not occur in
the yellow fever. They are called tokens.
The contagion of the plague does not infect
at so great a distance, as the contagion of the yel-
low fever.
It affects more universally, than the yellow fever,
and (with a few exceptions) it is more mortal when
left to itself.
It sometimes prevails in cold weather. It pre-
vails likewise in a greater variety of states of the
atmosphere.
The body is of its usual, or of a greenish colour
after death.
The plague is of animal origin. It is derived
in some instances from dead animal matters. The
plagues             

175 BILIOUS YELLOW FEVER.
plagues which laid waste the Roman Empire in
the reign of Justinian, are ascribed by Mr. Gib-
bon, to swarms of putrefying locusts. But the
most frequent source of the plague is from human
miasmata, rendered pestilential, by famine, grief,
the want of cleanliness, and by a number of per-
sons crowded together in small rooms, or houses.
The yellow fever has been confounded with the
jail or hospital fever. I shall briefly enumerate the
circumstances and symptoms in which they agree
and disagree.
The first are as follow :
The jail-fever affects persons who are debilitated
by grief, fear, or intemperance.
The pulse is sometimes intermitting in this fever.
This is taken notice of by Dr. Ferriar.
There are marks of congestion in the brain,
without any signs of inflammation in it after death.
There are likewise in this fever great depression
of spirits, sighing, delirium, palsy, and a debilitated
state of the memory after recovery. This occurs
more frequently, and in a greater degree after
the jail, than after the yellow fever.
The                                          

176 AN ACCOUNT OF THE
The eye is sometimes red, and sometimes dull
in this fever. There is frequently an absence of
thirst.
There is in the jail-fever in its worst state, a
suppression or great heat in the urine.
Buboes, petechiæ, pain along the spermatic
cord, a swelling of one testicle, ulcers in the
throat, and abscesses in different parts of the body,
have all occurred occasionally in this fever.
The circumstances and symptoms in which the
jail fever differs from the yellow fever, are as fol-
low:
It affects persons who have been previously
weakened by other diseases, or who are of weakly
habits.
The pulse is seldom full or tense, but generally
weak and quick.
The tongue soon loses its whiteness and mois-
ture, and assumes when dry, a dark colour.
The stomach is seldom disordered. The bowels
are either in their natural state, or a diarrhœa at-
4 tends.          

177 BILIOUS YELLOW FEVER.
tends. The stools are seldom bilious, or preter-
naturally fœtid.
There are great twitchings in the tendons, and 
tremors in the tongue, and limbs.
Intermissions and remissions of the fever are
seldom, or scarcely perceptible.
It prevails alike in the winter, spring, and
autumn. It is moderated, or checked by warm
weather, provided patients are placed in situations
in which they can breathe a sufficient quantity of
fresh air.
It is less contagious and mortal than the yellow
fever.
It is derived from human miasmata produced
under inferior degrees of all those circumstances,
which favour the generation of the plague. It is,
to the plague in its degree, what the common
bilious, is, to the yellow fever.
There is a camp fever described by some au-
thors, which is derived from a mixture of marsh
and human miasmata. Its symptoms are com-
N pounded                     

178 AN ACCOUNT OF THE
pounded of those which belong to the bilious, and
jail fevers.
I shall not attempt to distinguish the yellow,
from the common bilious fever. They are only
different grades of the same disease. The follow-
ing, appears to be the natural order of a scale of
such fevers as are derived from marsh miasmata.
1. The yellow fever.
2. The common bilious remitting fever.
3. The common mild intermitting fever.
4. The febricula of authors, or what are called
"inward fevers" in the southern states. Dif-
ferent degrees of force in the remote cause, in con-
junction with a difference in the qualities of the
atmosphere, frequently produce all those grades of
bilious or marsh fever in different seasons, and
sometimes, in the same season. The encrease, or
abstraction of accidental stimuli, likewise often
change these different states of bilious fever into
each other. Thus, what are called inward fevers
have often been excited by means of a ride, or a
long walk, into an intermittent; an intermittent
has                                           

179 BILIOUS YELLOW FEVER.
has been changed by the premature use of the
bark into a remitting fever, and a common remit-
tent, has, by improper regimen or violent exercise,
been excited into a yellow fever. The danger in
each case, is determined by the force of the mias-
mata, and the state of the air.
In contemplating the immense proportion of
human misery, which is produced by pestilential
diseases, we are naturally led to inquire, whether
their approaches are not indicated by some unusual 
signs in the operations of nature. What is called
instinct in many animals, has repeatedly taught
them to foresee, and to avoid many natural evils;
and if reason has not taught man to do the same,
it is probably because its exercises have not been
directed to those subjects.
I have endeavoured to discover whether any
thing uncommon occurred in the operations of
nature in the atmosphere, or in the animal and
vegetable kingdoms in the course of the winter
and summer, which preceded our late epidemic.
The result of my inquiries is as follows.
The winter of 1793 was unusually moderate.
It was supposed this had an influence upon the
weather which favoured the generation and pro-
N2 pagation


180 AN ACCOUNT OF THE
pagation of the disease. I should have been dis-
posed to admit this opinion, had moderate winters
in Pennsylvania been uniformly succeeded by
sickly autumns. Livy records that a pestilential
fever in Rome was preceded by an unusually cold
winter*.
The wild pigeons were common during the
winter of 1793 in many parts of Pennsylvania.
But they have occasionally appeared in great
flocks in our state in former winters, without
having been the harbingers of a sickly autumn.
Dr. P. Russel says, that uncommon and violent
diseases generally preceded the plague at Aleppo.
Dr. Sydenham informs us, that acute inflammatory
fevers were the forerunners of the plague in Lon-
don in 1665. I suspect that uncommon circum-
stances attending certain diseases, either as to their
violence or time of appearance, will be found to
suggest a prelude to a sickly autumn in all coun-
tries. The scarlatina anginosa I have remarked
was attended with an uncommon degree of inflam-
matory diathesis, in the month of July.  Dr. Por-
ter informed me that he had been called to several
cases of dysentery, attended with symptoms of
* Riverius, vol. ii. p. 98.
great                                           


181 BILIOUS YELLOW FEVER.
great malignity, in the neighbourhood of Frank-
fort, in the months of July and August. Dr.
Senter informed me in a letter dated the 26th of
November, 1793, that "during the last two sum-
mer months, fevers and fluxes were more obstinate
than he had ever known them, at Newport in
Rhode Island." My pupil Mr. Nathaniel Potter,
in a letter from Caroline county, in Maryland,
dated November 1st, 1793, gave me the follow-
ing information. "On my arrival at this place,
on the first of August, I was informed by gentle-
men of the faculty, that the dysentery had pre-
vailed from the first of June to the fifteenth of
July, with considerable mortality. From obser-
vations and communications from different people
in this county, I did not hesitate to predict a sickly
autumn; for it is an invariable maxim here, both
among physicians and farmers, that if the wheat
be damaged by rust or blast, a contagious dysen-
tery is soon to follow; and the sooner in the sum-
mer the dysentery appears, the more violent and
mortal will be the diseases of the autumn."
These communications, though short and few,
will be useful, if they serve to lead physicians to
observe, and record hereafter the diseases which
precede universal and mortal epidemics.
N3 There

182 AN ACCOUNT OF THE
There can be no doubt of a warm summer,
whether it be wet or dry, having often preceded
malignant autumnal fevers, Mr. Norris in a let-
ter to one of his friends, dated the 24th of Au-
gust, O. S. says that "the summer of 1699 was
the hottest he had ever felt, and that several had
died in the harvest fields with the violence of the
heat." It appears from another of Mr. Norris's
letters, dated the 12th of August, O. S. that the
yellow fever made its first appearance in that
month. The yellow fevers of 1762 and 1793,
were both preceded by warm summers.
I have one remark more to mention upon this
subject, which was communicated to me by a gen-
tleman who had resided occasionally in southern
and tropical countries. He informed me, that he
had observed in the month of July, several weeks
before the yellow fever became general, a pecu-
liar and universal sallowness of complexion in the
faces of the citizens of Philadelphia, such as he
had observed to precede the prevalence of malig-
nant bilious fevers in hot climates. Dr. Dick in-
formed me that he had observed the same appear-
ance in the faces of people in Alexandria, accom-
panied in some cases by a yellowness in the eyes,
during the last summer, and some time before vio-
lent                                          

183 BILIOUS YELLOW FEVER. 
lent bilious severs became epidemic upon the
banks of the Potomac.
With these observations I take leave of the
history of our late epidemic fever. A few of its
symptoms which have been omitted in the history,
will be included in the method of cure; for they
were discovered or produced by the remedies
which were used for that purpose.
N4 The


The following Page begins an account of the
states of the thermometer and weather from
the first of January to the first of August, and
of the states of the barometer, thermometer,
winds, and weather, from the first of August to
the ninth of November, 1793. The times of
observation for the first three months are at 7
in the morning, and 2 in the afternoon; for the
next five months they are at 6 in the morning,
and 3 in the afternoon. From the first of Octo-
ber to the ninth of November, they are as in the
first three months. 

185 AN ACCOUNT. &c.         
January, 1793.             
Therm.                     
D. 7h 2h Weather.	         			
1  27 30 Cloudy.	      
2  30 41 Fair, cloudy.       
3  30 33 Cloudy, rain.       
4  38 41 Rain, cloudy.       
5  35 42 Fair, cloudy.       
6  33 47 Cloudy, fair.       
7  33 51 Fair, fair.         
8  32 49 Fair, ditto.        		
9  33 48 Hazey, fair.        
10 38 51 Fair, ditto.        
11 35 48 Fair, clouds.       
12 31 42 Fair, ditto.        
l3 28 42 Fair, do.           
14 25 27 Hail, snow, sleet.  
15 32 37 Clouds, mists.	     
16 37 39 Rain, ditto.	     
17 37 45 Rain, snow, fair.   		
18 32 52 Fair, ditto.        		
l9 37 48 Fair, do.           		
20 33 47 Hazey, cloudy.	     		
21 36 47 Cloudy, fair.	     		
22 27 32 Fair, ditto.	     		
23 22 37 Fair, do.	     
24 30 39 Cloudy, do.	     
25 30 41 Fair, hazey.	     
26 31 - Fair.	             
27 23 38 Fair, cloudy, snow. 
28 35 45 Cloudy, fair.	     
29 29 37 Fair, ditto.			
30 22 23 Snow, hail.			
31 25 32 Cloudy, fair.			
February, 1793. 
Therm.
D. 7h 2h Weather.
 1 9 26 Fair, hazey.
 2 25 34 Rain, ditto.
 3 33 37 Cloudy, fair.
 4 25 46 Cloudy, fair.
 5 36 44 Cloudy, ditto.
 6 35 46 Cloudy, rain.
 7 36 40 Cloudy, fair.
 8 28 44 Cloudy, ditto.
 9 42 50 Rain, fair. 
10 38 40 Cloudy, fair.
11 19 27 Fair, cloudy.
12 20 28 Snow, cloudy.
13 22 31 Cloudy, snow.
14 27 39 Cloudy, fair.
15 18 40 Fair, ditto.
16 29 42 Cloudy, ditto.
17 44 48 Rain, ditto.
18 39 49 CIoudy; fair.
19 31 41 Cloudy, rain.
20 52 53 Rain, fair
21 37 49 Fair, ditto.
22 29 34 Fair, do.
23 22 34 Snow, cloudy.
24 54 59 Rain, cloudy.
25 34 35 Cloudy, ditto.
26 35 43 Rain, mist.
27 43 43 Rain, cloudy.
28 14 26 Fair, ditto.











186 AN ACCOUNT OF THE
March, 1793  
  Therm. Weather.         
D: 7h 2h	   	    	
 1 20 38 Fair, ditio.	     
 2 3l 51 Hazey, cloudy.	     
 3 48 63 Rain, fair.	     
 4 43 61 Hazey., ditto.	     
 5 51 52 Rain, fair.	     
 6 32 50 Fair, ditto.	     
 7 36 62 Fair, do. clouds.  
 8 54 60 Cloudy, rain. 	     
 9 26 41 Fair, ditto.	     
10 29 51 Fair, do.	     
11 43 55 Rain, do.	     
12 40 43 Cloudy, do.	     
13 38 39 Cloudy, fair.	     
14 26 44 Fair, do.	     
15 32 59 Fair, do.	     
16 52 62 Cloudy, fair.	     
l7 51 72 Cloudy, fair.	     
18 58 69 Hazey, cloudy.	     
19 53 59 Fair, do.	     
20 42 61 Fair, do.	     
21 41 43 Rain, cloudy.	     
22 31 47 Fair, do.	     
23 35 57 Fair, do.	     
24 37 50 Fair, do.	     
25 35 59 Fair, do.	     
26 47 54 Cloudy, rain.	     
27 43 51 Fair, cloudy.	     
28 33 45 Fair, clouds, fair. 
29 34 57 Fair, do.	     
30|41 58 Cloudy, fair.	     
31 42 61 Cloudy, fair.			
April, 1793. 
  Therm. Weather.
D. 7h 2h
 1 45 70 Cloudy, fair.
 2 47 71 Fair, ditto.
 3 56 80 Fair, do.
 4 5l 72 Cloudy, fair.
 5 53 61 Cloudy, rain.
 6 60 76 Misty, fair. 
 7 51 65 Fair, do.
 8 46 74 Fair, do.
 9 55 71 Fair, cloudy.
10 50 56 Fair, do.
11 37 63 Fair, do.
12 54 62 Cloudy, rain, fair.
13 49 62 Fair, do.
14 50 70 Fair, do.
15 45 55 Rain, cloudy.
16 46 62 Cloudy, fair.
17 48 67 Fair, clouds, fair.
18 52 66 Cloudy, fair.
19 52 75 Fair, do.
20 52 49 Rain, cloudy.
21 44 47 Cloudy, ditto.
22 43 46 Rain, cloudy.
23 42 63 Fair, do.
24 44 68 Fair, do.
25 45 65 Cloudy, cloudy.
26 53 57 Cloudy, rain.
27 47 46 Rain, do.
28 44 54 Rain, cloudy.
29 40 59 Fair, do.
30 40 65 Fair, do.




187 BILIOUS YELLOW FEVER.
May, 1793.  
  Therm.                      
D. 7h 2h Weather.            
 1 45 69 Foggy, cloudy.          
 2 52 73 Fog, clouds, fair.    
 3 60 63 Rain, do.             
 4 60 80 Fair, do.             
 5 55 56 Cloudy, do.           
 6 47 58 Cloudy, fair.          
 7 50 68 Cloudy, fair.         
 8 59 78 Cloudy, fair.         
 9 61 79 Foggy, fair.          
10 65 71 Rain, hazey.          
11 55 75 Cloudy, fair.         
12 61 76 Cloudy, rain.         
13 57 78 Fair, do.             
14 59 83 Fair, cloudy.         
15 60 71 Fair, do.             
16 50 69 Fair, do.             
17 48 74 Fair, do.             
18 61 81 Cloudy, fair.         
l9 65 85 Fair, rain            
20 65 87 Fair, do.             
21 68 86 Fair, do, clouds.     
22 72 80 Clouds, gusts.         
23 94 79 Cloudy, fair.         
24 58 75 Fair, do.             
25 52 70 Fair, cloudy.         
26 61 66 Rain, do.              
27 68 84 Cloudy, fair.         
28 70 68 Fair, clouds, rain.   
29 57 62 Cloudy, rain, clouds. 
30 54 57 Cloudy, rain.        
31 54 60 Cloudy, do.
June, 1793
 Therm.
D. 7h 2h Weather. 
 1 53 61 Rain, showery,
 2 54 64 Clouds, showers.
 3 55 62 Cloudy, rain, fair.
 4 54 60 Rain, do. cloudy. 
 5 58 72 Cloudy, fair, rain.
 6 - 71 Cloudy, rain.
 7 68 78 Fair, do.
 8 65 - Fair, do.
 9 70 88 Fog, fair.
10 74 90 Fair, do.
11 76 90 Fair, do.
12 75 88 Fair, showers.
13 74 81 Cloudy, rain.
14 63 77 Fair, do.
15 63 82 Fair, hazey.
16 67 85 Fair, do.
17 74 89 Fair, showers.
18 73 88 Fair, do.
19 77 91 Fair, do.
20 79 88 Fair, rain, fair.
21 75 85 Cloudy, rain.
22 58 78 Cloudy, fair.
23 58 78 Fair, do.
24 60 79 Fair, do.
25 67 74 Cloudy, rain. 
26 66 69 Cloudy, rain.
27 68 80 Cloudy, fair.
28 71 85 Cloudy, fair.
29 77 88 Cloudy, do.  
30 74 90 Fair, do.


188 AN ACCOUNT OF THE
JULY, 1793.
DAYS Barometer. Therm. Winds Weather.
6 AM 3 PM 6 AM 3 PM 6 AM 3 PM  
1 30 0 29 9 77 88 W W fair,
2 29 8 29 7 77 81 W	fair, showers,
3 29 9 30 0 74 80 E E cloudy,
4 30 1 30 0 70 83 E SW cloudy, fair, rain,
5 30 0 29 9 76 90 NW SW	fair, do.
6 29 9 29 9 78 91 SW SW	cloudy, thunder,
7 29 9 30 0 73 88 NE NW	fair, clouds,
8 30 1 30 1 72 85 E E cloudy, fair,
9 30 0 29 8 73 81 S SW cloudy, do.
10 30 0 30 0 70	84 W NW	fair, do.
11 30 0 30 0 74	88 NW NW fair, clouds,
12 30 1 30 2 70	84 N N fair, do.
13 30 1 30 0 68	83 NW NW fair, do.
14 30 0 30 0 65 80 N Calm fair, hazy,
15 30 0 29 9 66	75 SW SW cloudy, do.
16 29 8 29 7 70	83 W W rain, fair,
17 29 8 29 9 68	81 NW NW fair, do.
18 30 0 30 0 66	86 W SW fair, do.
19 29 9 29 9 75	85 SW W fair, cloudy, rain,
20 30 0 30 0 72	87 W NW fair, do. fhower,
21 30 1 30 1 70	86 NW NW fair, do.
22 30 0 30 0 72	87 SW SW fair, do.
23 30 0 30 0 73	91 SW SW fair, cloudy,
24 29 9 29 9 75	89 Calm W cloudy, fair,
25 30 1 30 1 71	83 NW NNW fair, do.
26 30 2 30 2 63	82 N NE fair, do.
27 30 2 30 1 64	81 S calm S	fair, cloudy,
28 30 1 30 0 72	85 Calm NNE cloudy, fair,
29 30 1 30 1 74	85 SSE NE cloudy, do. rain,
30 30 1 30 0 73	86 S SW cloudy, fair,
31 29 9 29 8 76	80 SSW SW cloudy, rain, fair.
AUGUST, 

189 BILIOUS YELLOW FEVER.   
AUGUST, 1793.
D. Barometer. Therm. Wind. Weather.
6 AM 3 PM 6 AM 3 PM 6 AM 3 PM 6 AM 3 PM
1 29 95 30 0 65 77 WNW NW cloudy, fair,
2 30 1 30 1 63 81 NW SW fair, fair
3 30 6 29 95 62 82 N NNE fair, fair,
4 29 97 30 0 65 87 S SW fair, fair,
5 30 5 30 1 73 90 SSW SW fair, fair,
6 30 2 30 0 77 87 SW W cloudy, fair,
7 30 12 30 1 68 83 NW W fair, fair,
8 30 1 29 95 69 86 SSE SSE fair, rain,
9 29 8 29 75 75 85 SSW SW cloudy, fair,
10 29 9 29 9 67 82 W SW fair, fair, 
11 30 0 30 0 70 84 SW WSW cloudy, cloudy,
12 30 0 30 0 70 87 W W fair, fair,
13 30 5 30 0 71 89 SW W fair, fair,
14 30 0 30 95 75 82 SW SW fair, rain,
15 30 0 29 1 72 75 NNE NE fair, cloudy,
16 30 1 30 1 70 83 NNE NE fair, fair,
17 30 1 30 0 71 86 SW SW fair, fair,
18 30 l 30 1 73 89 Calm SW fair, fair,
l9 30 1 30 0 72 82 N N fair, cloudy,
20 30 1 30 12 69 82 NNE NNE fair, fair,
21 30 15 30 25 62 83 N NNE fair, fair,
22 30 3 30 35 63 86 NE SE fair, fair,
23 30 25 30 l5 63 85 Calm S fair, fair,
24 30 1 30 1 73 81 Calm Calm cloudy, rain,
25 30 1 30 1 71 66 NE NE rain, gr. rain
26 30 15 30 2 59 69 NE NE cloudy, cloudy,
27 30 2 30 2 65 73 NE NE cloudy, cloudy,
28 30 2 30 15 67 80 S Calm cloudy, clearin.
29 30 16 30 15 62 86 Calm SW cloudy, fair,
30 30 1 30 1 74 87 Calm SW fair, fair,
31 30 0 30 0 74 84 SW NW rain, fair.
SEPTEMBER, 


1901 AN ACCOUNT OF THE
SEPTEMBER, 1793.
D. Barometer. Therm. Wind. Weather.
6 AM 3 PM 6 AM 3 PM 6 AM 3 PM 6 AM 3 PM
1 30 0 29 30 71 86 Calm SW fog, fair,
2 29 75 29 8 73 86 SW SW fair, fair,
3 80 0 60 NW N fair, fair,
4 30 15 30 l5 55 75 W W fair, fair,
5 30 15 30 1 62 80 SE S fair, cloudy,
6 29 97 29 95 70 89 WSW W fair, cloudy,
7 30 0 30 0 65 77 WNW NW fair, fair,
8 30 1 30 l 64 70 Calm Calm cloudy, cloudy,
9 30 0 30 0 66 80 SE NW rain, fair,
10 30 0 30 0 64 72 N NNE fair, cloudy,
11 30 1 30 0 62 72 NNE N cloudy, fair,
l2 29 96 29 9 58 76 NW NNW fair, fair,
13 29 95 30 0 57 72 NW N fair, fair,
14 30 0 30 5 58 79 NW NW fair, fair,
l5 30 0 29 97 65 80 N S fair, fair,
16 29 9 29 70 84 S SW cloudy, fair,
17 29 8 29 85 66 67 N N cloudy, cloudy,
18 30 3	44 N fair,
l9 30 4 30 35 45 70 Calm SW fair, fair,
20 30 3 30 l5 54 69 Calm SE hazy, hazy,
21 30 0 29 0 59 78 Calm cloudy, fair,
22 30 0 30 0 63 83 Calm cloudy, fair,
23 30 1 30 1 62 81 Calm SE cloudy, cloudy,
24 30 2 30 2 65 70 NE ENE cloudy, fair,
25 30 15 30 0 6l 68 NE NE cloudy, cloudy,
26 29 8 29 7 58 79 N N cloudy, fair,
27 29 7 64 NW NW cloudy, fair,
28 30 5 30 15 54 73 NW NW fair, fair,
29 30 3 30 3 56 74 NE ENE cloudy, fair,
30 30 35 30 3 57 75 Calm SW foggy, fair.
OCTOBER, 

191 BILIOUS YELLOW FEVER.
OCTOBER, 1793.
D. Barometer. Therm. Winds. Weather. 
7 AM 2 PM 7AM 2PM 7AM 2PM 7 AM 2 PM 
1 30 15 30 5 64 89 SW SW cloudy, fair,
2 29 9 30 5 70 72 W NNW cloudy, fair,
3 30 2 30 15 50	72 W SW fair, fair,
4 29 75 29 7 59	72 SW W  cloudy, cloudy,
5 30 0 30 1 58 66 N	 N fair, fair,
6 30 3 30 3 43 66 NE W fair, fair,
7 30 45 46 calm fair,	
8 30 6 30 6 53 68 N N fair, fair,
9 30 5 30 4 53 70 NW NW fair, fair,
10 30 2 30 2 49	74 E NW fair, fair,
11 30 0 29 85 51 74 W W fair, fair,
12 29 6 29 55 58 64 SW NW rain, rain,
13 29 85 29	9 49 69 NW NW fair, fair,
14 30 5 30 0 52	76 SW SW calm, fair,
l5 29 75 29	8 56 54 SW N fair, rain,
16 30 0 30 0 37	53 NNW N fair, fair,
17 30 1 30 1 37	60 NE NE fair, fair,
18 30 1 30 1 41	62 NW NW fair, fair,
19 30 0 29 9 51	66 N N cloudy, fair,
20 30 0 30 0 44	54 NW N fair, fair,
21 30 0 30 2 49	59 N NW fair, fair,
22 29 6 29 5 51	65 NW NW fair, fair,
23 29 8 29 8 47	60 W W fair, fair,
24 30 3 30 4 36	59 W NW fair, fair,
25 30 4 30 3 46	71 S S cloudy, do.h.w.
26 30 2 30 2 60	72 calm SW cloudy, cloudy,
27 30 3 30 3 44	44 NNE NNE cloudy, cloudy,
28 30 2 30 1 34	37 N N cloudy, cloudy,
29 29 85 29 85 28 44 NNW NW fair, fair,
30 30 1 30 1 28	49 calm SW hazy, hazy,
31 30 15 30	2 42 45 calm NNE cloudy, rain.
NOVEMBER, 

192 AN ACCOUNT OF THE
NOVEMBER, 1793.
D. Barometer. Therm. Wind. Weather.	
7 AM 2 PM 7AM 2PM 7AM 2PM 7 AM 2 PM
1 30 1 30 1 40 41 NNE NE rain, cloudy,
2 30 3 30 25 32 49 NNE NE fair, fair,
3 30 1 30 0 43 56 Calm SW cloudy, cloudy,
4 29 8 29 9 55 67 SW SW cloudy, fair,
5 30 15 30 1 50 64 NE NE rain, rain,
6 29 8 29 65 63 67 S S cloudy, cloudy,
7 29 8 29 8 44 64 Calm SW fair, fair,
8 29 8 29 85 43 56 SSW SW fair, fair,
9 29 9 29 95 42 64 SW SW fair, fair.
Of 

193 BILIOUS YELLOW FEVER.
Of the Method of Cure.
IN the introduction to the history of
the fever, I mentioned the remedies which I used
with success, in several cases which occurred in
the beginning of August. I had seen, and re-
corded in my note book, the efficacy of gentle
purges in the yellow fever of 1762; but finding
them unsuccessful after the 20th of August, and
observing the disease to assume uncommon symp-
toms of great indirect debility, I laid them aside,
and had recourse to a gentle vomit of ipecacuanha
on the first day of the fever, and to the usual re-
medies for exciting the action of the sanguiferous
system. I gave bark in all its usual forms of in-
fusion, powder, and tincture. I joined wine,
brandy and aromatics with it. I applyed blisters
to the limbs, neck and head. Finding them all
ineffectual, I attempted to rouse the system by
wrapping the whole body, agreeably to  Dr.
O Hume's

194 AN ACCOUNT OF THE
Hume's practice, in blankets dipped in warm vi-
negar. To these remedies I added one more;
I rubbed the right side with mercurial ointment,
with a view of exciting the action of the vessels in
the whole system, through the medium of the li-
ver, which I then supposed to be principally, tho'
symptomatically, affected by the disease. None of
these remedies appeared to be of any service; for
although three out of thirteen recovered of those
to whom they were applied, yet I have reason to
believe that they would have recovered much
sooner had the cure been trusted to nature. Per-
plexed and distressed by my want of success in
the treatment of this fever, I waited upon Dr.
Stevens, an eminent and respectable physician
from St Croix, who happened then to be in our
city, and asked for such advice and information
upon the subject of the disease, as his extensive
practice in the  West Indies would naturally sug-
gest. He politely informed me that he had long
ago laid aside evacuations of all kinds in the yel-
low fever; that they had been found to be hurt-
ful, and that the disease yielded more readily to
bark, wine, and above all, to the use of the cold
bath. He advised the bark to be given in large
quantities by way of glyster, as well as in the
usual way; and he informed me of the manner in
which the cold bath should be used, so as to de-
rive                                         

195 BILIOUS YELLOW FEVER.
rive the greatest benefit from  it. This mode of
treating the yellow fever appeared to be reason-
able. I had used bark in the manner he recom-
mended it in several cases of the sporadic yellow
fever with success in former years. I had moreover
the authority of several other physicians of repu-
tation in its favour. Dr. Cleghorn tells us, that
"he sometimes gave the bark when the bowels
were full of vicious humours. These humours
(he says) are produced by the fault of the circu-
lation. The bark by bracing the solids, enables
them to throw off the excrementitious fluids, by the
proper emunctories*."
I began the use of each of Dr. Stevens's reme-
dies the next day after my interview with him,
with great confidence of their success. I prescri-
bed bark in large quantities; in one case I ordered
it to be injected into the bowels every four
hours. I directed buckets full of cold water to
be thrown frequently upon my patients. The
bark was offensive to the stomach, or rejected
by it in every case in which I prescribed it.
The cold bath was grateful, and produced relief
in several cases by inducing a moisture on the
skin. For a while I had hopes of benefit to my
* Page 223.
O2 patients 

196 AN ACCOUNT OF THE
patients from the use of these remedies, but in
a few days, I was distressed to find they were not
more effectual than those I had previously used.
Three out of four of my patients died to whom
the cold bath was administered in addition to the
tonic remedies before mentioned.
Baffled in every attempt to stop the ravages of
this fever, I anticipated all the numerous and
complicated distresses in our city, which pestilential
diseases have so often produced in other coun-
tries. The fever had a malignity, and an obstinacy
which I had never before observed in any disease,
and it spread with a rapidity and mortality, far
beyond what it did in the year 1762. Heaven
alone bore witness to the anguish of my soul in
this awful situation. But I did not abandon a
hope that the disease might yet be cured. I had
long believed, that good was commensurate with
evil, and that there does not exist a disease for
which the goodness of Providence has not provi-
ded a remedy. Under the impression of this be-
lief, I applied myself with fresh ardour to the in-
vestigation of the disease before me. I ransacked
my library, and pored over every book that
treated of the yellow fever. The result of my
researches for a while was fruitless. The accounts
of the symptoms and cure of the disease by the
authors          

197 BILIOUS YELLOW FEVER. 
authors I consulted, were contradictory, and none
of them appeared altogether applicable to the pre-
vailing epidemic. Before I desisted from the in-
quiry to which I had devoted myself, I recollected
that I had among some old papers, a manuscript
account of the yellow fever as it prevailed in Vir-
ginia in the years 1741, which had been put into
my hands by Dr. Franklin, a short time before his
death. I had read it formerly, and made extracts
from it into my lectures upon that disorder. I
now read it a second time. I paused upon every
sentence; even word in some places arrested and
fixed my attention. In reading the history of the
method of cure, I was much struck with the fol-
lowing passages.
"It must be remarked, that this evacuation
(meaning by purges) is more necessary in this,
than in most other fevers. The abdominal viscera
are the parts principally affected in this disease,
but by this timely evacuation, their feculent cor-
ruptible contents are discharged, before they cor-
rupt and produce any ill effects, and their various
emunctories, and secerning vessels are set open,
so as to allow a free discharge of their contents,
and consequently a security to the parts them-
selves, during the course of the disease. By this
evacuation the very minera of the disease, pro-
O3 ceeding                

198 AN ACCOUNT OF THE
ceeding from the putrid miasma fermenting with
the salivary, bilious, and other inquiline humours
of the body, is sometimes eradicated by timely
emptying the abdominal viscera on which it first
fixes, after which a gentle sweat does as it were
nip it in its bud. Where the primæ viæ, but
especially the stomach, is loaded with an offensive
matter, or contracted, and convulsed with the ir-
ritation of its stimulus, there is no procuring a
laudable sweat, till that is removed; after which
a necessary quantity of sweat breaks out of its own
accord, these parts promoting it when by an ab-
sterging medicine, they are eased of the burden or
stimulus which oppresses them."
"All these acute putrid fevers, ever require
some evacuation to bring them to a perfect crisis,
and solution, and that even by stools, which must
be promoted by art, where nature does not do
the business herself. On this account an ill-timed
scrupulousness about the weakness of the body, is
of bad consequence in these urging circumstances;
for it is that which seems chiefly to make evacua-
tions necessary, which nature ever attempts, after
the humours are fit to be expelled, but is not able
to accomplish for the most part in this disease; and
I can affirm, that I have given a purge in this case,
when the pulse has been so low, that it could hardly
be                                            

199 BILIOUS YELLOW FEVER.
be felt, and the debility extreme, yet both one, and
the other have been restored by it."
"This evacuation, must be procured by lenitive
cholagogue purges."
Here I paused. A new train of ideas suddenly
broke in upon my mind. I believed the weak and
low pulse which I had observed in this fever, to
be the effect of debility of the indirect kind, but
the unsuccessful issue of purging, and even of a
spontaneous diarrhœa, in a patient of Dr. Hutchin-
son's had led me not only to doubt of, but to
dread its effects. My fears from this evacuation
were confirmed, by the communications I had re-
ceived from Dr. Stevens. I had been accustomed
to raising a weak and low pulse in pneumony and
apoplexy, by means of blood-letting, but I had
attended less to the effects of purging in produ-
cing this change in the pulse. Dr. Mitchell in
a moment dissipated my ignorance and fears up-
on this subject. I adopted his theory, and prac-
tice, and resolved to follow them. It remained
now only to fix upon a suitable purge to answer
the purpose of discharging the contents of the
bowels. I have before described the state of the
bile in the gall-bladder, and duodenum in an ex-
tract from the history of a dissection made by Dr.
O4 Mitchell.

200 AN ACCOUNT OF THE
Mitchell. I suspected that my want of success in
discharging this bile, in several of the cases in
which I attempted the cure by purging, was
owing to the feebleness of my purges. I had been
in the habit of occasionally purging with calomel
in bilious and inflammatory fevers, and had re-
commended the practice the year before in my
lectures, not only from my own experience, but
upon the authority of Dr. Clarke. I had more-
over, other precedents, for its use in the practice of
Sir John Pringle, Dr. Cleghorn, and Dr. Balfour,
in diseases of the same class with the yellow fever.
But these were not all my vouchers for the safety,
and efficacy of calomel. In my attendance upon
the military hospitals during the late war, I had
seen it  given combined with jalap in the bilious
fever, by Dr. Thomas Young, a senior surgeon in
the hospitals. His usual dose, was ten grains of
each of them. This was given once or twice a
day, until it procured large evacuations from the
bowels. For a while I remonstrated with the
Doctor against this purge, as being dispropor-
tioned to the violence and danger of the fever;
but I was soon satisfied that it was as safe as
cremor tartar, or glauber's salts. It was adopted by
several of the surgeons of the hospital, and was
universally known, and sometimes prescribed, by
the simple name of ten and ten. This mode of
giving                                          

201 BILIOUS YELLOW FEVER. 
giving calomel occurred to me in preference to
any other. The jalap appeared to be a necessary
addition to it, in order to quicken its passage
through the bowels; for calomel is slow in its
operation, more especially when it is given in large
doses. I resolved after mature deliberation, to
prescribe this purge. Finding ten grains of jalap
insufficient to carry the calomel through the bow-
els, in the rapid manner I wished, I added fifteen
grains of the former, to ten of the latter; but
even this dose was flow, and uncertain in its ope-
ration. I then issued three doses, each consisting
of fifteen grains of jalap, and ten of calomel; one
to be given every six hours until they procured
four or five large evacuations. The effects of
this powder, not only answered, but far exceeded
my expectations. It perfectly cured four out of
the first five patients to whom I gave it, notwith-
standing some of them were advanced several days
in the disorder. Mr. Richard Spain, a block-ma-
ker, in Third-street, took eighty grains of calomel,
and rather more of rhubarb and jalap mixed with
it, on the two last days of August, and on the first
day of September. He had passed twelve hours,
before I began to give him this medicine, without
a pulse, and with a cold sweat on all his limbs.
His relations had given him over, and one of his
neighbour complained to me, of my neglecting
to                                            

202 AN ACCOUNT OF THE
to advise them to make immediate preparations
for his interment. But in this situation, I did not
despair of his recovery. Dr. Mitchell's account
of the effects of purging in raising the pulse, ex-
citing a hope that he might be saved provided his
bowels could be opened. I now committed the
exhibition of the purging medicine to Mr. Stall,
one of my pupils, who mixed it, and gave it with
his own hand three or four times a day. At length,
it operated and produced two copious, fœtid
stools. His pulse rose immediately afterwards, and
a universal moisture on his skin, succeeded the cold
sweat on his limbs. In a few days he was out of
danger, and he now lives in good health as the first
fruits of the efficacy of mercurial purges in the yel-
low fever.
After such a pledge of the safety and success of
my new medicine, I gave it afterwards with con-
fidence. I communicated the prescription to such
of the practitioners as I met in the streets. Some
of them I found had been in the use of calomel
for several days, but as they had given it in small
and single doses only, and had followed it by large
doses of bark, wine, and laudanum, they had
done little or no good with it. I imparted the
prescription to the College of Physicians, on the
third of September, and endeavoured to remove
the                                          

203 BILIOUS YELLOW FEVER.
the fears of my fellow citizens, by assuring them
that the disease was no longer incurable. Mr.
Lewis, the lawyer, Dr. M'Ilvaine, Mrs. Bethel,
her two sons, and a servant maid, and Mr. Peter
Baynton's whole family, (nine in number) were
some of the first trophies of this new remedy.
The credit it acquired, brought me an immense
accession of business. It still continued to be al-
most uniformly effectual in all those which I was
able to attend, either in person, or by my pupils.
Dr. Griffiths, Dr. Say, Dr. Pennington, and my
former pupils who had settled in the city, viz.
Dr. Lieb, Dr. Porter, Dr. Annan, Dr. Wood-
house, and Dr. Mease, were among the first phy-
sicians who adopted it. I can never forget the
transport with which Dr. Pennington ran across the
street, to inform me, a few days after he began to
give strong purges, that the disease, yielded to
them in every case. But I did not rely upon purg-
ing alone, to cure the disease. The theory of its
proximate cause, which I had adopted, led me to
use other remedies, to abstract excess of stimulus
from the system. These were blood-letting cool
air, cold drinks, low diet, and applications of cold
water to the body. I had bled Mrs. Bradford,
Mrs. Leaming, and one of Mrs. Palmer's sons with
success, early in the month of August. But I had
witnessed the bad effects of bleeding in the first
week                                         


204 AN ACCOUNT OF THE
week in September, in two of my patients who
had been bled without my knowledge, and who
appeared to have died in consequence of it. I
had moreover, heard of a man who had been bled
on the first day of the disorder, who died in twelve
hours afterward. The cases produced caution,
but they did not deter me from bleeding as soon
as I found the disease to change its type, and in-
stead of tending to a crisis on the third, to protract
itself to a later day. I began by drawing a small
quantity at a time. The appearance of the blood,
and its effects upon the system, satisfied me of its
safety and efficacy. Never before did I experi-
ence such sublime joy as I now felt in contemplat-
ing the success of my remedies. It repaid me
for all the toils and studies of my life. The con-
quest of this formidable disease, was not the effect
of accident, nor of the application of a single re-
medy; but, it was the triumph of a principle in me-
dicine. The reader will not wonder at this joyful
state of my mind, when I add a short extract from
my note book, dated the 10th of September.
"Thank God! Out of one hundred patients,
whom I have visited, or prescribed for, this day,
I have lost none."
Being unable to comply with the numerous
demands which were made upon me for the purg-
ing                                           

205 BILIOUS YELLOW FEVER.       
ing powders, notwithstanding I had requested my
sister, and two other persons to assist my pupils in
putting them up; and finding myself unable to
attend all the persons who sent for me, I furnished
the apothecaries with the recipe for the mercurial
purges, together with a copy of the following
directions, for giving them, and for the treatment
of the disorder.
"As soon as you are affected (whether by
night or day) with a pain in the head or back, sick-
ness at stomach, chills or fever; more especially,
if those symptoms be accompanied by a redness or
faint yellowness in the eyes, take one of the pow-
ders in a little sugar and water, every six hours,
until they produce four or five large evacuations
from the bowels-drink plentifully of water gruel,
or barley water, or chicken water, or any other
mild drink that is agreeable, to assist the opera-
tion of the physic. It will be proper to lie in bed
while the medicine is operating; by which means
a plentiful sweat will be more easily brought on.
After the bowels are thoroughly cleansed, if the
pulse be full or tense, eight or ten ounces of blood
should be taken from the arm, and more, if the
tension or fullness of the pulse should continue.
Balm tea, toast and water, lemonade, tamarind
water, weak, chamomile tea, or barley water should
be                                            


206 AN ACCOUNT OF THE
be drank during this state of the disorder-and
the bowels should be kept constantly open, either
by another powder, or by small doses of tremor
tartar, or cooling salts, or by common opening
glysters; but if the pulse should become weak
and low after the bowels are cleansed, infusions
of chamomile and snake-root in water, elixir of
vitriol, and laudanum; also wine and water, or
wine, punch, and porter should be given, and the
bark either in infusion in water, or in substance,
may be administered in the intermission of the
fever. Blisters may likewise be applied to the sides,
neck, or head, in this state of the disorder, and
the lower limbs may be wrapped up in flannels
wetted in hot vinegar or water. The food should
consist of gruel, sago, panada, tapioca, tea, coffee,
weak chocolate, wine whey, chicken broth, and
the white meats, according to the weak or active
state of the system. The fruits of the season may
be eaten with advantage at all times. Fresh air
should be admitted into the room in all cases, and
cool air when the pulse is full and tense. The
floor should be sprinkled now and then with vine-
gar, and the discharges from  the body be removed
as speedily as possible."
"The best preventives of the disorder, are a
temperate diet, consisting chiefly of vegetables,
great                                          

207 BILIOUS YELLOW FEVER.  
great moderation in the exercises of body and mind,
warm cloathing, cleanliness, and a gently open state
of the bowels."
Hitherto there had been great harmony among
the physicians of the city, although there was a
a diversity of sentiment as to the nature and cure
of the prevailing fever. But this diversity of sen-
timent and practice, was daily lessening, and would
probably have ceased altogether in a few days,
had not the following publication subscribed A. K.
and said to be written by Dr. Adam Khun, made
its appearance on the 11th of September, in the
General Advertiser, from which it was copied into
all the papers of the city.
"SIR,
Philadelphia, Sept. 7th, 1793.
"I RECEIVED your letter today, and
shall with pleasure give you every information in
my power respecting the malignant fever, which
proves so fatal among us. As I consider debility
and putrefaction the alarming circumstances to be
attended to, and to be obviated from the earliest
commencement of the disease, my method of treat-
ment is instituted accordingly, and has been gene-
rally successful. I do not administer any emetic,
neither                                         

208 AN ACCOUNT OF THE
neither do I give a laxative, unless indicated by cos-
tiveness, when I recommend cream of tartar or castor
oil, but prefer a clyster to either. In case of nausea
I order a few bowls of chamomile tea to be taken;
if the nausea continues, it is to be relieved with the
saline draught in a state of effervescence, elixir of
vitriol, and if necessary, laudanum. The sickness
of the stomach may also be alleviated by applying
mint, cloves, or any other spice with wine or spirits
to the pit of the stomach. The stomach being
composed, 20 drops of elixir of vitriol are to be
taken every two hours in a tea cup full of strong
cold chamomile tea, and if bark can be retained,
two drachms of the  best pale bark in substance are
to be given every two hours, alternately with the
elixir of vitriol. When an ounce of bark has been
administered in this manner, the dose is to be di-
minished to one drachm every two hours, as the
continuance of the large doses might disorder the
stomach or bowels. Should the bark prove pur-
gative it will be necessary to give 10 or 15 drops of
laudanum after every stool. But if the bark can-
not be retained on the stomach, 20 drops of elixir
of vitriol are to be taken every hour, and recourse
must be had to bark clysters.
"Two ounces of bark are to be put into three
half pints of boiling  water, and boiled down to a
2 pint; 

209 BILIOUS YELLOW FEVER.
pint; the decoction to be strained, and to 4 ounces
of the decoction we add from two to four drachms
of finely powdered bark and fifty drops of lauda-
num. This mixture is to be injected every four
hours or oftener if the symptoms are violent. One
or two glasses of Madeira wine may be added to
each injection where the debility is great. Wine is
to be given from the beginning; at first the weaker
wines such as claret and rhenish; if these cannot
be had, Lisbon or Madeira diluted with rich le-
monade. The quantity is to be determined by the
effects it produces and by the state of debility which
prevails, guarding against its occasioning or en-
creasing the heat, restlessness and delirium. I pre-
fer pale bark from a conviction that most of the
red bark offered for sale, is adulterated. But I
place the greatest dependence for the cure of the
disease, on throwing cool water twice a day over
the naked body. The patient is to be placed in a
large empty tub, and two buckets full of water, of
the temperature of about 75 or 80 degrees of
Fahrenheit's thermometer, according to the state of
the atmosphere, are to be thrown over him.                                          
"He is then to be wiped dry and put to bed;
it is commonly followed by an easy perspiration and
is always attended with great refreshment to the
P patient. 

210 AN ACCOUNT OF THE
patient. This remedy however must be applied
from the earliest attack of the disease and continued
regularly through the whole course of it. Of re-
gimen it is needless to say much to you: ripe fruits,
sago with wine, and rich wine-whey are the most
proper. A spacious chamber with a free circula-
tion of air, and repeatedly changing of bed and
body linen are highly necessary. If the bark clysters
should bring on costiveness the laudanum may oc-
casionally be omitted; if this is not attended with
the desired consequences, we have recourse to a
common injection. Sprinkling the chamber with
vinegar, washing the face, neck, hands and feet with
it, and then wiping them dry, will have their use.
The fumes of vinegar and of nitre will contribute
much to sweeten the air in the chamber.
I am, &c.
A. K.
"N. B. The practice of applying the cold bath
in fevers is not new. In a malignant fever which
prevailed at Breslau in Silesia and proved extremely
fatal, yielded to none of the usual remedies, Dr.
De Haehn a physician of the place had recourse to
this remedy and found it effectual. It has also been
used with advantage in England in putrid fevers.
In                                           

211 BILIOUS YELLOW FEVER.
In many of the West India Islands it is generally
employed in their malignant fevers. Dr. Stevens,
a gentleman of high character in his profession,
who is now in this city, assures me that in the island
of St Croix where he practised medicine many
years, it has been found more effectual than any
method heretofore practised.
"I am moreover indebted to Dr. Stevens for the
following observations: that laxatives are never
employed but when clysters are not attended with
the desired effect of moving the bowels; that in
violent attacks of the disease the bark clysters are
repeated every two hours, and the water is applied
to the body every 6 or 8 hours and even more fre-
quently; that when there is a disposition to diar-
rhoea, the elixir of vitriol has a tendency to en-
crease it, and is therefore laid aside, and that the dis-
ease which he has seen in this country is of the same
nature with the malignant fever of the West
Indies."
To obviate the effects of this letter upon the
minds of the citizens, I published the next day an
account of the ill success which had attended the
use of the remedies recommended by Dr. Kuhn, in
my practice, and of the happy effects of mercurial
purges and bleeding. This publication was con-
cluded  with the following remarks:
P2 "The 

212 AN ACCOUNT OF THE
"The yellow fever now prevailing in our city,
differs very materially from that which prevails in
the West Indies, and in several particulars from
that of the year 1762. This will easily be be-
lieved, by all those who attend to the influence of
climate and seasons, upon diseases. Prescribing
for the name of a disease, without a due regard to
the above circumstances, has slain more than the
sword.
"My only design in withdrawing myself for a
moment from the solemn duties to my fellow citi-
zens, in which I am now engaged, is to bear a
testimony against a method of treating the present
disorder, which if persisted in, would probably
have aided it in desolating three fourths of our
city.
"I have had so many unequivocal proofs of
the success of the short and simple mode which I
have adopted, of treating this disorder, that I am
now satisfied, that under more favourable circum-
stances of attendance upon the sick, the disease
would yield to the power of medicine with as much
certainty as a common intermitting fever.
Septembers, 11 BENJ. RUSH."
1793. 
The 

213 BILIOUS YELLOW FEVER.
The above address to the citizens, produced the
following letter from Dr. Kuhn to the Mayor of
the city.
"SIR,
"IF you are of opinion that the enclosed
statement can have the least tendency to abate
the apprehensions of the citizens, I beg of you to
make any use of it you may think proper.
I am, with respect,
Your most humble servant,
September 13,
1793. A. KUHN.
Matthew Clarkson, Esq. Mayor 
of the city of Philadelphia. 
"FROM the 23d of August, the day on
which I saw the first patient in the yellow-fever,
to the third of September, when I was myself
confined with a remittent fever, I visited sixty per-
sons ill of various complaints. The greater part
were indisposed with remittent and intermittent
fevers; which always prevail among us at this sea-
son of the year, which all yielded readily to our
mode of treating those diseases, except in one
gentleman, who had been many years an invalid.
Seven only of this number had the yellow fever;
P3 three 


214 AN ACCOUNT OF THE
of them were parents of other gentlemen of the
Faculty. Of these seven, I was called to four, in
the early stage of the disease. Three of them are
now well; the other was in the fourth day of the
disease, when I became unwell myself. He had
then no unfavourable symptoms; but died on the
eighth day from the time he was seized."
A day or two afterwards, the following letter
appeared in all the newspapers from Mr. Hamil-
ton, the Secretary of the Treasury of the United
States, to the College of Physicians.
"GENTLEMEN,
"MOTIVES of humanity and
friendship to the citizens of Philadelphia, induce
me to address to you this letter, in the hope that
it may be in some degree instrumental in diminish-
ing the present prevailing calamity. It is natural
to be afflicted not only at the mortality which is
said to obtain, but at the consequences of that
undue panic which is fast depopulating the city,
and suspending business both public and private.
I have myself been attacked with the reigning
putrid fever, and with violence-but I trust that
I am now completely out of danger. 

215 BILIOUS YELLOW FEVER
am to attribute, under God, to the skill and care
of my friend Doctor Stevens, a gentleman lately
from the island of St. Croix, one to whose talents
I can attest, from an intimate acquaintance begun
in early youth, whose medical opportunities have
been of the best, and who has had the advantage
of much experience both in Europe (having been
in Edinburgh some years since, when the same
fever raged there) and in the West Indies, where
it is frequent. His mode of treating the disorder
varies essentially from that which has been gene-
rally practised-And I am persuaded, where pur-
sued, reduces it to one of little more than ordinary
hazard.
I know him so well, that I entertain no doubt,
that he will freely impart his ideas to you, collec-
tively or individually, and being in my own person
a witness to the efficacy of his plan, I venture to
believe, that if adopted, and if the courage of the
citizens can be roused, many lives will be saved,
and much ill prevented. I may add, that as far
as can be yet pronounced, its efficacy has been
alike proved on Mrs. Hamilton, who is now in the
disorder, contracted from me, with every favour-
able appearance.
P4 In

216 AN ACCOUNT OF THE
In giving you this information, Gentlemen, I
have done what I thought discharging a duty. I
only add, that if any conference with Dr. Stevens
is desired, that he is going tomorrow to New-
York, from which journey he has been detained
several days on my account.
I am, Gentlemen, with respect,
your obedient servant,
September 11.
A. HAMILTON.
"He lodges at Mrs. Williams's, corner of
Spruce and Third streets.
"College of Physicians."
This letter was followed by a letter from Dr.
Stevens to Dr. Redman, the president of the
College of Physicians, which was published in the
Federal Gazette of the 16th of September.
"SIR,
"IN compliance with the request of
the learned body over whom you preside, I now
cheerfully transmit them a few brief and detached
observations on the nature and treatment of the
present                                       

217 BILIOUS YELLOW FEVER.
present malignant and fatal disorder which prevails
in this city. Their humane anxiety to ascertain the
real character of the complaint, and to establish
some fixed and steady mode of cure for it, are fresh
proofs of their benevolence, and clearly evinces
that disinterested liberality for which they are so
eminently distinguished. I only regret that their
application to me has approached so near the
moment of my departure, that I have not sufficient
leisure to elucidate the subject so amply and so satis-
factorily as the importance of it deserves. Imper-
fect, however, as the enclosed sketch may be, I can
with truth assure them, that it is the result of ex-
tensive experience and accurate observation; and
that it is dictated solely by a philanthropic desire of
checking the ravages of disease, and of restoring
tranquility to the dejected minds of the public.
"This disorder arises from contagion. Its ap-
proaches are slow and insidious at the commence-
ment. It is ushered in with a slight degree of lan-
guor and lassitude, loss of appetite, restlessness and
disturbed dreams, depression of spirits, and a want
of inclination to perform the ordinary occupations
of life. The patient does not consider himself suf-
ficiently sick to complain or call in the assistance of
a physician. His feelings are rather unpleasant than
alarming.                                        


218 AN ACCOUNT OF THE
alarming. This train of symptoms continue for two
or three days, and if not removed by timely aid, is
succeeded by a sharp pain in the head, anxiety, and
suppression about the præcordia, a feeble pulse,
great prostration of strength, and a variety of other
morbid phenomena, which are too well known to
the faculty to need description. In the first stage of
the disorder, a little attention, and the well directed
effort of a skillful practitioner, may generally prove
successful in mitigating the violence of future symp-
toms, and preventing either much danger or long
confinement.
"At the first appearance of languor, lassitude,
&c. especially if the patient has been near the source
of contagion, he should carefully avoid all fatigue
of body and application of mind. Every thing that
can tend to debilitate should be carefully guarded
against. He should remain at perfect rest. His diet
should be fuller and more cordial than usual, and
a few extraordinary glasses of old Madeira may be
allowed. He should take the cold bath every morn-
ing; and if his sleep is disturbed, a gentle opiate
combined with a few grains of the volatile salts and
some grateful aromatic maybe administered at night.
A few doses of good genuine bark may be taken in
powder during the day; and if the stomach should
be                                          

219 BILIOUS YELLOW FEVER.
be affected with nausea, a strong decoction of the
same may be substituted. Great care should be
taken to keep the mind of the patient calm and
serene,--neither to terrify it with needless appre-
hension, nor alarm it by the melancholy relation of
the spreading mortality which surrounds him. It is
at this stage of the complaint, that the physician
may lay the foundation of hire success. But unfor-
tunately, it is also the period of the disease which
is commonly too much neglected by the patient.
Gentlemen of the faculty are rarely called in until
the symptoms are more alarming and dangerous.
But it is a matter of material consequence to the
patient to know that by a little attention at the com-
mencement, and by carefully watching the ap-
proaches of the disease even though it should be
contracted, it may be rendered mild, and may termi-
nate favourably. It is also of equal consequence for
practitioners to attend to these particulars in laying
down the prophylaxis to their patients.
"When the disorder has gained ground and be-
come violent and when the danger is imminent, the
most unremitted exertions should be made by the
physician to mitigate the symptoms. The nausea
and vomiting may be relieved by an infusion of cha-
momile flowers, given frequently until the stomach
is                                              

220 AN ACCOUNT OF THE
is sufficiently emptied of all crude matter. Small
doses of a cordial mixture composed of the oil of
peppermint and compound spirits of lavender, may
then be taken until the fever abates. If, notwith-
standing, the irritability of the stomach should still
continue, recourse must be instantly had to the cold
bath, which must be used every two hours or
oftener if the urgency of the symptoms should re-
quire it. After each immersion a glass of old Ma-
deira, or a little brandy burnt with cinnamon, may
be administered. Flannel clothes wrung out of
spirits of wine, impregnated with spices, may be ap-
plied to the pit of the stomach, and changed fre-
quently.
"An injection containing an ounce of powdered
bark, mixed with thin salap or sago, to which a tea-
spoonful of laudanum has been added, should be
administered. These injections may be continued
every two or three hours, omitting the laudanum
after the first. As soon as the stomach can bear
the medicines and nourishment, the bark may be
administered in small doses; as much Madeira wine
may be given as the patient can bear without af-
fecting his head, or heating him too much. All
emetics and violent cathartics should be avoided. If
the bowels should not be sufficiently open, a laxa-
tive                   

221 BILIOUS YELLOW FEVER.
tive clyster may be  necessary, or a few grains of
powdered rhubarb added to each dose of bark until
the desired effect is produced. If diarrhœa should
prevail, it must be checked by starch injections
blended with laudanum by the tinctura E. kino
japonica, or a decoction of cascarilla. All drastic
cathartics do injury when the disease is in its ad-
vanced stage. If stupor, coma, or delirium should
come on, a large blister should be applied between
the shoulders, and small ones to the thighs; stimu-
lant cataplasms should also be applied to the soles of
the feet: when hemorrhages appear, the elixir of
vitriol may be administered in conjunction with the
bark, but great care should be taken to prevent it
from affecting the bowels.
"If the pulse should be much sunk, the pro-
stration of strength great, and subsultus tendinum
take place, small doses of the liquor mineralis Hoff-
manni, or even vitriolic æther diluted with water
may be given. Musk and camphor in this stage
of the disease have likewise proved effectual. Upon
the whole, sir, I may sum up this hasty outline,
by inculcating the use of the tonic plan in its fullest
extent, and by warning against the ill consequences
of debilitating applications, or profuse evacuations
in every period of the disease: the cold bath,
bark and wine, a spacious well ventilated room,
frequent                                         

222 AN ACCOUNT OF THE
frequent change of bed and body linen, and at-
tention to rest and quiet, if properly persevered in,
will in most cases prove successful, and strip this
formidable disease of its malignity, its terror, and
its danger.
"The description I have given of this disorder,
and the utility of the plan of cure I have laid
down, are confirmed by experience and coincides
with our reason and the soundest theory; the
cause producing the effect is a strong debilitating
power; the symptoms occasioned by its applica-
tion, indicate extreme debility in the animal func-
tions, and great derangement of the nervous sys-
tem; ought not therefore the remedies adapted
to this complaint to be cordial, stimulating, and
tonic? Should not violent evacuations, which evi-
dently weaken and relax, be avoided? These are
hints which it would be presumptuous and assum-
ing in me to extend or dwell upon: to gentle-
men of such eminence as your colleagues, it is suf-
ficient to point out what reason and experience
conjointly suggest to me. Their superior judg-
ment will, I am convinced, supply every deficien-
cy, and enable them to pursue that plan which is
best adapted to public utility, and the effectual re-
moval of the present dreadful malady. If the few
observations I have suggested be serviceable to
the                                           

223 BILIOUS YELLOW FEVER. 
the inhabitants of this city, my intentions will be
fully answered, and my feelings completely grati-
fied.
I have the honour to be, Sir,
Sept. 16th, Your most obedient servant,
1793.
EDWARD STEVENS.
John Redman, M. D. president 
of the College of Physicians.
An essay upon the theory of this disease at this
juncture, would have been as ill-timed as a dis-
course upon tactics would be to an army in the
height of a battle; but Dr. Stevens's publication
made it necessary for me to appeal to the reason of
my brethren upon the theory of the disease. I
did it in a few words in the following address to the
College of Physicians.
"GENTLEMEN,
"It is with extreme regret that
I have read Dr. Steven's letter to the president
of our College in one of the news-papers. It will,
I fear,                                         

224 AN ACCOUNT OF THE
I fear, co-operate with Dr. Kuhn's plan of treat-
ing the disorder, and Mr. Hamilton's well-meant
letter, in adding to the mortality of the disorder.
If I should survive my present labours, I hope to
prove that Dr. Stevens's theory of the disease in
the West Indies, is as erroneous, as the practice
he has recommended has been fatal, in Philadel-
phia. It is a most inflammatory disorder in its
first stage. The contagion, it is true, in its first
action upon the system, frequently produces debi-
lity; but the debility here is of the indirect kind,
and arises wholly from an excess of the stimulus of
contagion upon the system. This indirect debility,
as in many other diseases, yields only to the ab-
straction of other stimuli, and to none so speedily
as to large evacuations from the bowels and the
blood-vessels.
"I have so high an opinion of Dr. Stevens's
candour and liberality as a gentleman and a physi-
cian, that I shall make no apology for thus publicly
dislenting from his opinions and practice.
"Could patients be visited by physicians as of-
ten, and attended by nurses as carefully, as in
other acute diseases, I am satisfied that the mode
of treating it which I have adopted and recom-
2 mended,

225 BILIOUS YELLOW FEVER.
mended, would soon reduce it in point of danger
and mortality, to a level with a common cold.
From, Gentlemen,
Sept. 17th. Your sincere friend and brother,
1723, 
B. RUSH."
During this controversy with the opinions and
practice of Dr. Kuhn and Dr. Stevens, I published
in the Federal Gazette, the following letter to the
College of Physicians; also some additions to the
directions I had published with the mercurial
purges.
"GENTLEMEN,
"As the weekly meetings of
our College have become no longer practicable, I
have taken the liberty of communicating to you,
the result of further observations upon the pre-
vailing epidemic.
"I have found bleeding to be useful, not only
in cases where the pulse was full and quick, but
where it was slow and tense. I have bled in one
case, where the  pulse beat only 48 strokes in a
minute, and recovered my patient by it. The
pulse became more full and more frequent after
Q it. 

226 AN ACCOUNT OF THE
it. This state of the pulse seems to arise from an
inflamed state of the brain, which shows itself in a
preternatural dilatation of the pupils of the eyes.
It is always unsafe to trust to the most perfect re-
missions of fever and pain in this state of the pulse.
It indicates the necessity of more bleeding and purg-
ing. I have found it to occur most frequently in
children.
"I have bled twice in many, and in one acute
case, four times, with the happiest effects. I con-
sider intrepidity in the use of the lancet at present
to be as necessary, as it is in the use of mercury
and jalap, in this insidious and ferocious disease.
"I lament the contrariety of opinion among the
members of our College, upon the remedies pro-
per in this disease. This contrariety seems to arise
from the yellow fever being confounded with the jail
or hospital fever. The fevers of Breslau, Vienna,
and Edinburgh, mentioned in some late publica-
tions, in which the cold bath was used with so much
success were of the latter kind. The two diseases
are totally different from each other in their cause,
seasons of prevailing, symptoms, danger, and
method of cure.
From, Gentlemen,
Sept. 12th. Your friend and brother,
1793.
BENJ. RUSH." 

227 BILIOUS YELLOW FEVER. 
FEDERAL GAZETTE.
"Dr. Rush regrets, that he is unable to comply
with all the calls of his fellow citizens, who are in-
disposed with the prevailing fever. He begs leave
to recommend to such of them as cannot have the
benefit of medical aid, to take the mercurial purges,
which may now be had with suitable directions at
most of the apothecaries, and to lose ten or twelve
ounces of blood as soon as is convenient after
taking the purges, if the head-ach and fever con-
tinue. Where the purges cannot be obtained, or
do not operate speedily, bleeding may now be used
before they are taken. The almost universal suc-
cess with which it hath pleased God to bless the re-
medies of strong mercurial purges and bleeding in
this disorder, enables Dr. Rush to assure his fellow
citizens, that there is no more danger to be appre-
hended from it, when those remedies are used in
its early stage, than there is from the measles or
influenza.
"Dr. Rush assures his fellow citizens further,
that the risk from visiting and attending the sick,
in common cases, at present, is not greater than
from walking the streets. He hopes this informa-
tion will be attended to, as many of the sick suffer
greatly from the want of the assistance of bleeders,
and of the attendance of nurses and friends.
Q2 "While 


228 AN ACCOUNT OF THE
"While the disease was so generally mortal, or
the successful mode of treating it only partially
adopted, Dr. Rush advised his friends to leave
the city: at present he conceives this advice to
be unnecessary; not only because the disease is
now under the power of medicine, but because
the citizens who now wish to fly into the country,
cannot avoid carrying the infection with them.
They had better remain near to medical aid, and
avoid exciting the infection into action, which is
now in their bodies, by a strict attention to former
directions.
"Dr. R. does not believe it will be prudent for
those persons who are in the country to return to
town, until after frost or heavy rains have taken
place; both of which alike weaken or destroy the
contagion of the yellow fever.
"September 12th, 1793.
Having mentioned the conditional use of bark,
wine, and laudanum, in my first publication, and
finding them not only useless, but hurtful, I pub-
lished the following address to the citizens of Phi-
ladelphia, on the 16th of September. In this
address I repeated my advice to live upon a milk
and vegetable diet.
"Dr. 

BILIOUS YELLOW FEVER. 229 
"Dr. Rush recommends to all such of his fel-
low citizens as are exposed to the contagion of
the prevailing fever, to live upon a milk and ve-
getable diet, and take cooling purges once or
twice a week. The effects of this regimen in ren-
dering the disease mild (where it is taken) are
nearly the same as in preparing the body for the
small-pox.
"Dr. R. advises those persons who cannot ob-
tain the attendance of a physician, by no means
to take vomits, bark, wine, or laudanum, during
the first three or four days of the disorder. As
the disease is highly inflammatory at present in
its first stages, the only proper remedies for it are,
strong purges, copious bleeding, if the pulse be
full or tense, or if it be slower than natural, and
at the same time subject to pauses in its pulsa-
tion.
"During this inflammatory state of the disease,
the drinks should be simple and cold. No animal
food should be tasted; cool air should be admit-
ted into the room, and napkins dipped in pump
water, should be applied frequently to the fore-
head.
Q3 "Dr. 

230 AN ACCOUNT OF THE
"Dr. R. recommends further, that the beds
and clothes of persons who have had the disease,
should upon no account, be exposed to the heat of
the sun, but be washed in warm, or soaked in cold
water.
"It would be an act of great humanity to the
city, to provide all the physicians and bleeders,
with horses and chairs, as it will be impossible for
them long to escape the disease, while they are so
much pre-disposed to it by constant fatigue."
September 16th, 1793.
I shall mention hereafter the substitutes I used
for the tonic remedies with I had thus publicly
decried.
On the 20th of September the following pub-
lication appeared in the Federal Gazette, subscribed
by Dr. Currie.
"Mr. BROWN,
"IT affords me particular satisfac-
tion, that I now have it in my power to inform
my fellow citizens, that the progress of the infec-
tious fever, has greatly abated, and that with a
little                                          

BILIOUS YELLOW FEVER. 231 
little longer perseverance in avoiding intercourse
with the infected, as far as humanity will permit,
paying at the same time proper attention to fu-
migating and ventilating the houses, clothing, and
utensils from whence the sick have been removed,
or where they have been confined, the infection
which has proved so mortal, will most certainly,
be entirely eradicated in a few days. The best
method for affecting this, is contained in a late
publication by the learned Dr Russel.
"I have made the strictest enquiry respecting
the number at present confined by the genuine
yellow fever, and am convinced that it does not
exceed 40 or 50 in the whole city.
"There is, however, another formidable dis-
ease prevalent, by which, I have reason to believe,
there are above a thousand ill at this time.
"The disease I mean, is the common remittent
or fall fever. This fever, however, is not infec-
tious.
"When the remitting fever attacks persons not
fully recovered from the effects of the influenza,
(which is also still prevalent here) it occasions a
violent determination of the blood to the head,
Q4 accompanied 

232 AN ACCOUNT OF THE
accompanied with acute pain, a redness of the
eyes, with a faint tinge of yellow--the pulse is
quick and the skin hot. This is the disease which
is so much under the power of blood-letting and
purging; and is as different from  the infectious,
or genuine yellow fever, as the sun is from the
moon, or light from darkness.
"In the fall fever, which succeeds the influenza,
the eye is sprightly, though red, the face turgid
and flushed :--Whereas, in the genuine yellow
fever, the eye is dull and inanimate, and suffused
with a dusky brown, the face pale, shrunk, and
cadaverous, almost from the first attack. It is in
the remitting fever, with the violent affection of
the head, that the mode of treatment advised by
Dr Rush, can only be proper; and not in the in-
fectious or yellow fever. On the contrary, in
the yellow fever it cannot fail of being certain
death. In the yellow fever, the means recom-
mended by Dr. Kuhn and Dr. Stevens, are the
most effectual, and the only ones that can be relied
on, with such a variation as circumstances, and
the period of the disease may indicate.
"It is in the fall fever, circumstanced as already
described, that there is safety in visiting and at-
tending the sick, because this fever is not conta-
gious.

BILIOUS YELLOW FEVER. 233 
gious. Can there be the same safety in visiting
patients confined with the genuine yellow fever,
which made its appearance in Water-street, the
third of August last? Let those judge who have
had opportunities of seeing its ravages! Is that
fever, in which the bond of union is immediately
dissolved between the solids and fluids, and where
the purple current issues from every pore, the
same as that, for which Dr. Rush directs bleeding
and purging? and can there be safety in visiting
persons so affected? Have we all got the conta-
gion of the yellow fever in our bodies, only wait-
ing for some exciting cause to put it into action?
By no means. The disease which Dr Rush calls
the yellow fever, and of which Dr. P. says he has
cured such numbers by the new method, is only
the fall fever, operating on persons who have been
previously affected by the influenza.
"It is time the veil should be withdrawn from
your eyes, my fellow citizens!
WM. CURRIE."
Sapt. 17th, 1793.
To this I published the following answer the
next day.
"Dr.

234 AN ACCOUNT OF THE
"Dr. Rush is extremely sorry to differ from
his friend Dr. Currie, in his opinion respecting the
prevailing epidemic, published in the Federal Ga-
zette of last evening. Dr. R. asserts from the au-
thority of Dr. Sydenham, as well as from the
observations of three and thirty years upon epide-
mic diseases, that no two epidemics of unequal
force can exist long together in the same place;
and he is sure, from what he has seen of the pre-
sent disease, that all the fevers now in the city,
are from one cause, and that they all require dif-
ferent portions of the same remedies. Dr. R. has
no other motives for wishing to be believed by
his fellow citizens in these assertions, than to beget
a confidence in them, in remedies, which he con-
ceives to be as rational, as he knows them to be
successful in the prevailing disorder. If Dr. Cur-
rie will consult Blane, Hume, Lining, and Hillary,
upon the subject of the yellow fever, he will find
that they all describe it as making its first attack
with the symptoms of a bilious remittent. Dr.
R. perfectly recollects its appearing not only in
this form, but in that of an intermittent, in the
year 1762.
"Among many arguments which might be ad-
duced to prove that all our present fevers arise
from one source, and require the same treatment,
(varied 

BILIOUS YELLOW FEVER. 235 
(varied according to their degrees of violence)
Dr. R. will mention only one, and that is, he has
cured many persons by plentiful purging and
bleeding, of the present epidemic, who have lived
in families, in which persons had died with a black
vomiting, and a yellow skin.
"No one can suppose that Dr. R's. late indis-
position (after having been constantly exposed for
three weeks, to the contagion of the yellow fever
in all its degrees of malignity) was not occasioned
by an attack of that disorder, and yet he owes
his perfect recovery through divine goodness, sim-
ply to two copious bleedings, and two doses of
the mercurial medicine, and that too, in the short
term of only two days.
September 18th, 1793.
Besides the publications I have mentioned, Dr.
Wistar addressed a history of an attack he had
of the fever, to the physicians of Philadelphia,
in the General Advertiser of the 26th of Septem-
ber. He began it by observing, that "he be-
lieved many persons had been supposed to have
been cured of the disease, who had never had
it," and he concluded without deciding upon any
of the remedies which were the subjects of con-
troversy. He added a strong testimony from his
own

236 AN ACCOUNT OF THE
own experience of the efficacy of cool air in
abating the excessive action of the arterial system.
I pass over many anonymous essays upon the
fever, which appeared in the newspapers; also
several from medical gentlemen, who beheld the
disease at a distance. They all tended more or
less to distract the public mind, and to lessen the
confidence of the citizens in the simple and pow-
erful remedies which I had recommended.
In support of the efficacy of these remedies, Dr.
Porter, Dr. Annan, and Dr. Mease, gave very de-
cided testimonies in the public papers. I shall
insert, as an epitome of them all, the following let-
ter from Dr. Porter.
"DEAR SIR,
"AS I know it will afford you
much pleasure, I send you the following statement
of cases. Within three days past I have been
called to thirty-seven persons labouring under the
prevailing epidemic. I have treated them all in the
new method, with the greatest success; nearly
half of them are so far recovered as to require no
farther assistance from me. I cannot avoid men-
tioning one case of a man in whom the advantages
of 

BILIOUS YELLOW FEVER. 237 
of bleeding were remarkable.--The pain in his
head was so violent as to lead me to order bleed-
ing previous to purging--from some inaccuracy in
the operation, he lost a greater quantity than I
directed, his attendants suppose sixteen ounces;
the consequence however was, that at my next
visit I found that my patient had walked out per-
fectly recovered. This case was clearly marked
with all the symptoms attendant on the disease in
its first stages, particularly pain in the head and
redness in the eyes.
With great regard,
I am your
Obedient servant,
September 17th.
JOHN PORTER."
"Dr. Rush."
The safety of the new remedies (as they were
sometimes called) was finally admitted by their
greatest enemies, but their efficacy was supposed to
be confined only to common remittents, to the
influenza, or to pleurisies, and other inflammatory
fevers; for those diseases were believed to be con-
stantly present in the city; and the certificates
which were published of large families having
been cured of the yellow fever by the new reme-
dies, 

238 AN ACCOUNT OF THE
dies, were discredited, or treated with contempt,
because the patients had recovered without a yel-
low colour in their faces.
To refute this error, as well as to show that
I was not singular in my opinions respecting blood-
letting, purges, and opium, I published the fol-
lowing extracts from Dr. Moseley, in the Federal
Gazette  of the 11th of October.
"MR. BROWN,
"A NUMBER of the physicians
of this city, who suppose that we have two fevers
now prevailing among us, have asserted that a
yellow colour is essential to what is called the yel-
low fever. The following extract from Dr. Mosely
will show how much they have been mistaken.
This judicious physician practised physic many
years in Jamaica, and saw the fever which he de-
scribes, in all its different forms.
"I have used (says the Doctor) the word yel-
low in compliance with custom; but I even distrust
that name, as the inexperienced may be looking
out for that appearance, and not find, until it is
too late, the disease he has to contend with. And
indeed, the yellowness of the skin, like the black
vomiting,

BILIOUS YELLOW FEVER. 239 
vomiting, is not an invariable symptom of this
fever. Those who are fortunate enough to re-
cover, seldom have it; and many die without its
appearance. Besides, the yellowness alone, leads
to nothing certain; it may arise from an inoffen-
sive suffusion of bile." P. 411â--second edition.
"The present epidemic has likewise been called
a putrid fever, and the remedies for the cure of
that species of fever have been very generally pre-
scribed. The following extract from the same
author will show the error and mischief of that
opinion and practice:"
"This disease is in the highest degree possi-
ble, an inflammatory one, accompanied with such
symptoms, in a greater extent as attend all inflam-
matory fevers, and most strikingly the reverse of
any disease that is putrid, or of one continued ex-
acerbation. It attacks all such people and under
such circumstances as are seldom the objects of
putrid diseases." P. 412.
"In another place he says, "Bleeding must
be performed, and repeated every six or eight
hours, or whenever the  exacerbations come on,
while the heat, fullness of pulse, and pains con-
tinue: 

240 AN ACCOUNT OF THE
tinue; and if these symptoms be violent and ob-
stinate, and do not abate during the first 36 or 48
hours of the fever, bleeding should be executed
even to fainting. Taking away only six or eight
ounces of blood because the patient may be faint,
which is a symptom of the disease, is doing no-
thing towards the cure. Where bleeding is im-
proper, no blood should be taken away; where
it is proper, that quantity will not relieve, and it
is losing that time which can never be regained.'
P. 427--428.
"On purges, the Doctor makes the following
remarks.
"When a sufficient quantity of blood has been
taken away, (which is never done) let the patient's
habit be what it may, while the heat, reiterated
exacerbations, flushings in the face, thirst, pains
in the head, and burning in the eyes remain, the
next step is to evacuate the contents of the bow-
els, and turn the humours downwards." P. 435.
"Speaking of opium, the Doctor says, "In a
fever so highly inflammatory, where the contents
of the whole alimentary canal are so hot and acrid,
opium must be a fatal medicine."  P. 459.
I "To 

BILIOUS YELLOW FEVER. 241 
"To these quotations I shall only add, that the
disease, from the influence of the cool weather is
probably more universally, and more highly in-
flammatory, in our city, and requires more copious
evacuations than in the island of Jamaica. It
certainly requires more speedy and more plentiful
bleeding than a common pleurisy, inasmuch as the
blood-vessels, rendered weak by the previous hot
summer, are in more danger of being ruptured
both externally and internally, from the violent
stimulus of the contagion, than in an inflamma-
tory fever, which succeeds cold weather.
BENJ. RUSH."
October 9th, 1793.
In justice to Dr Currie, I take great pleasure in
inserting the following short address to the citi-
zens, in which he retracts the opinion he had
given to the public in the Federal Gazette of the
20th of September.
"October 2d, 1793.
"ALL the physicians engaged in practice at
present in the city, agree with Dr. Rush that
blood-letting and copious purging are requisite
in the cure of the prevailing epidemic, in every
case where inflammatory symptoms are evident,
R and

242 AN ACCOUNT OF THE
and that the dispute hitherto has been about the
name of the disease, rather than the proper mode
of treatment.
W. CURRIE.
The conclusion of the above address was unfor-
tunately erroneous. The dispute between the
physicians turned upon more interesting points
than the name of the disease, as must be very ob-
vious from the perusal of the preceding pages.
I cannot dismiss the publications which held up
the existence of other febrile diseases, besides the
yellow fever, in our city, without remarking that
it requires an uncommon portion of charity to
ascribe them to just or benevolent motives. Had
the contrary opinion been erroneous, it would
have been kind not to have opposed it. The
mistake would have been innocent; but the re-
verse of this opinion was the melancholy cause, as
will appear hereafter, of the principal part of the
mortality of the disorder.
I have suppressed a letter to Dr John Rodgers
of New York, dated the third of October, con-
taining a short history of the treatment of the dis-
ease, only because it will be detailed more fully in
this

BILIOUS YELLOW FEVER. 243 
this work. That publication was intended as an
answer to many letters which I received from
practitioners in the country, requesting an account
of my mode of treating the disorder. I have like-
wise suppressed a second letter to Dr. Rodgers,
containing some extracts from Dr. Sydenham,
which were intended to establish the exclusive in-
fluence of powerful epidemics over inferior febrile
diseases. This subject has been discussed in a more
ample manner in the history or the fever.
From the different publications which I have
inserted, it appears that there were two modes of
practice pursued; the one dictated by an opinion
that the disease was highly putrid, and the other,
that it was of a highly inflammatory nature. But
besides these there were two other modes of treat-
ing the disease, the one by moderate purging with
calomel only, and moderate bleeding, on the first
or second day of the fever, and afterwards by the
copious use of bark, wine, laudanum, and aromatic
tonics. This practice was supported by an opinion,
that the fever was inflammatory in its first, and
putrid in its second stage; the other mode referred
to, was peculiar to the French physicians, several
of whom had arrived in the city from the West
Indies just before the disorder made its appearance.
Their remedies were various. Some of them pre-
scribed nitre, cremor tartar, camphor, centaury tea,
R2 the

244 AN ACCOUNT OF THE
the warm bath, glysters, and moderate bleeding,
while a few, used lenient purges, and large quan-
tities of tamarind water, and other diluting drinks.
The dissentions of the American physicians threw
a great number of patients into the hands of these
French physicians. They were moreover supposed
to be better acquainted with the disease than the
physicians of the city, most of whom it was well
known had never seen it before.
I shall hereafter inquire into the relative success
of each of the four modes of practice which have
been mentioned.
Having delivered a general account of the reme-
dies which I used in this disorder, I shall now pro-
ceed to make a few remarks upon each of them.
I shall afterwards mention the effects of the reme-
dies used by other physicians.
OF PURGING.
I HAVE already mentioned my rea-
sons for promoting this evacuation, and the medi-
cine I preferred for that  purpose. It had many
advantages over any other purge. It was de-
tergent to the bile and mucus which lined the
bowels.

BILIOUS YELLOW FEVER. 245 
bowels. It probably acted in a peculiar manner
upon the biliary ducts, and it was rapid in its opera-
tion. One dose was sometimes sufficient to open
the bowels; but from two to six doses were of-
ten necessary for that purpose; more especially
as part of them was frequently rejected by the
stomach. I did not observe any inconvenience
from the vomiting which was excited by the jalap.
It was always without, the straining which is pro-
duced by emetics; and it served to discharge bile
when it was lodged in the stomach. I did not
rest the discharge of the contents of the bowels on
the issue of one cleansing on the first day. There
is in all bilious fevers, a reproduction of morbid  
bile as fast as it is discharged. I therefore gave a
purge every day while the fever continued. I
used castor oil, salts, cremor tartar, and rhubarb
(after the mercurial purges had performed their
office) according to the inclinations of my pati-
ents, in all those cases where the bowels were ea-
sily moved; but where this was not the case, I
gave a single dose of calomel and jalap every day.
Strong as this purge may be supposed to be, it
was often ineffectual; more especially after the
20th of September, when the bowels became
more obstinately constipated. To supply the place
of the jalap, I now added gamboge to the calomel.
Two grains and an half of each made into a pill,
were given to an adult every six hours until they
R3 procured

246 AN ACCOUNT OF THE
procured four or five stools. I had other designs
in giving a purge every day besides discharging the
re-accumulated bile. I had observed the fever to
fall with its principal force upon such parts of the
body as had been previously weakened by any
former disease. By creating an artificial weak part
in the bowels, I diverted the force of the fever to
them, and thereby saved the liver and brain from
fatal or dangerous congestions. The practice was
further justified by the beneficial effects of a plentiful
spontaneous diarrhœa in the beginning of the dis-
order*; by hemorrhagies from the bowels, when
they occurred from no other parts of the body,
and by the difficulty or impracticability of reducing
the system by means of plentiful sweats. The pur-
ges seldom answered the intentions for which they
were given, unless they produced four or five stools
a day. As the fever shewed no regard to day or
night in the hours of its exacerbations, it became
necessary to observe the same disregard to time in
* In some short manuscript notes on Dr. Mitchell's
account of the yellow fever in Virginia, in the year 1741,
made by the late Dr. Kearsly, Sen. of this city, he remarks,
that in the yellow fever which prevailed in the same year in
Philadelphia "some recovered by an early discharge of black
matter by stool." This gentleman, Dr. Redman informed
me, introduced purging with Glauber salts in the yellow
fever in our city. He was preceptor to Dr. Redman in
medicine.
every 

BILIOUS YELLOW FEVER. 247 
the exhibition of purges; I therefore prescribed
them in the evening at all times when the patient
had passed a day without two or three plentiful
stools. When purges were rejected, or slow in
their operation, I always directed opening glysters
to be given every two hours. The effects of
purging were as follow:
1. It raised the pulse when low, and reduced it
when it was preternaturally tense or full.
2. It revived and strengthened the patient.
This was evident in many cases, in the facility with
which patients who had staggered to a close-stool,
walked back again to their beds, after a copious
evacuation. Dr. Sydenham takes notice of a similar
encrease of strength after a plentiful sweat in the
plague. They both acted by abstracting excess of
stimulus, and thereby removing indirect debility.
3. It abated the paroxism of the fever. Hence
arose the advantage of giving a purge in some cases
in the evening, when an attack of the fever was ex-
pected in the course of the night.
4. It frequently produced copious and universal
sweats when given on the first or second day of the
R4 fever,

248 AN ACCOUNT OF THE
fever, after the most powerful sudorifics had been
taken to no purpose.
5. It sometimes checked that vomiting which
occurs in the beginning of the disorder; and it al-
ways assisted in preventing the more alarming oc-
currence of that symptom, about the 4th or 5th day.
6. It removed obstructions in the lymphatic sys-
tem. I ascribe it wholly to the action of mercury,
that in no instance did any of the glandular swel-
lings, which I formerly mentioned, terminate in a
suppuration.
7. By discharging the bile through the bowels
as soon and as fast as it was secreted, it prevented
in most cases a yellowness of the skin.
However salutary the mercurial purge was, ob-
jections were made to it by many of our physicians;
and prejudices, equally weak and ill-founded, were
excited against it. I shall enumerate and answer
those objections.
1. It was said to be of too drastic a nature. It
was compared to arsenic; and it was called a dose
for a horse. This objection was without founda-
tion.

BILIOUS YELLOW FEVER. 249 
tion. Hundreds who took it declared they had
never taken so mild a purge. I met with but one
case in which it produced bloody stools; but I
saw the same effect from a dose of salts. It some-
times, it is true, operated from twenty to thirty
times in the course of twenty-four hours; but I
heard of an equal number of stools in two cases
from salts and cremor tartar. It is not an easy
thing to affect life, or even subsequent health, by
copious or frequent purging. Dr. Kirkland men-
tions a remarkable case of a gentleman who was
cured of a rheumatism by a purge, which gave
him between 40 and 50 stools. This patient had
been previously affected by his disorder 16 or 18
weeks*. Dr Mosely not only proves the safety,
but establishes the efficacy of numerous and co-
pious stools in the yellow fever. Dr. Say pro-
bably owes his life to three and twenty stools pro-
cured by a dose of calomel and gamboge, taken
by my advice. Dr Redman was purged until he
fainted, by a dose of the same medicine. This
venerable gentleman, in whom 71 years had not
abated the ardour of humanity, nor produced
obstinacy of opinion, came forward from his retire-
ment, and boldly adopted the remedies of purg-
ing and bleeding, with success, in several families,
before he was attacked by the  disease. His reco-
* Treatise on the Inflammatory Rheumatism, vol. i.
p.407.
very 

250 AN ACCOUNT OF THE
very was as rapid, as the medicine he had used was
active in its operation. Besides taking the above
purge, he lost twenty ounces of blood by two
bleedings in two days*.
But who can suppose that a dozen or twenty
stools in a day could endanger life, that has seen
a diarrhœa continue for several months, attended
with fifteen or twenty stools every day, without
making even a material breach in the constitution?
Hence Dr. Hillary has justly remarked, that "it
* Dr. Redman was not the only instance furnished by the
disorder, in which reason got the better of the habits of old
age, and of the formalities of medicine. About the time
the fever declined, I received a letter from Dr. Shippen,
Sen. (then above 82 years of age) dated Oxford Furnace,
New Jersey, October 13th, 1793, in which, after approving
in polite terms of my mode of practice, he adds "Desperate
diseases require desperate remedies. I would only propose
some small addition to your present method. Suppose you
should substitute, in the room of the jalap, six grains of
gamboge, to be mixed with 10 or 15 grains of calomel;
and after a dose or two as occasion may require, you should
bleed your patients almost to death, at least to fainting; and
then direct a plentiful supply of mallows tea, with fresh le-
mon juice, and sugar and barley water, together with the
most simple, mild, and nutritious food." The Doctor con-
cludes his letter by recommending to my perusal Dr. Dover's
account of nearly a whole ship's crew having been cured of
a yellow fever, on the coast of South America, by being bled
until they fainted.
rarely 

BILIOUS YELLOW FEVER. 251 
rarely or never happens that the purging in this
disease, though violent, takes the patient off, but
the fever and inflammation of the bowels*. Dr.
Clark in like manner remarks, that evacuations
do not destroy life in the dysentery, but the fever
with the emaciation or mortification which attend
and follow the disease†.
2. A second objection to this mercurial purge
was, that it excited a salivation, and sometimes
loosened the teeth. I met with but two cases in
which there was a loss of teeth from the use of
this medicine, and in both, the teeth were previ-
ously loose or decayed. The salivation was a tri-
fling evil, compared with the benefit which was
derived from it. I lost only one patient in whom
it occurred. I was taught by this accidental ef-
fect of mercury, to administer it with other views,
than merely to cleanse the bowels, and with a
success which added much to my confidence in
the power of medicine over this disease. I shall
mention those views under another head.
3. It was said that the mercurial purge exco-
riated the rectum, and produced the symptoms of
pain and inflammation in that part, which were
formerly mentioned.
* Diseases of Barbadoes, p. 212.
† Diseases in Voyages to Hot Climates, vol. ii. p. 322.
To 

252 AN ACCOUNT OF THE
To refute this charge, it will be sufficient to
remark, that the bile produces the same excori-
ation and pain in the rectum in the bilious and
yellow fever, where no mercury has been given to
discharge it. In the bilious remitting fever which
prevailed in Philadelphia in 1780, we find the bile
which was discharged by "gentle doses of salts,
and cream of tartar, or the butter nut pill, was so
acrid as to excoriate the rectum, and so offensive
as to occasion in some cases sickness and faintness,
both in the patients, and in their attendants*."
Dr Hume says further upon this subject, that
the rectum was so much excoriated by the natural
discharge of bile in the yellow fever, as to render it
impossible to introduce a glyster pipe into it.
4. It was objected to this purge, that it in-
flamed and lacerated the stomach and bowels. In
support of this calumny, the inflamed and morti-
fied appearances which those viscera exhibited
upon dissection in a patient who died at the hos-
pital at Bush-hill, were spoken of with horror in
some parts of the city. To refute this objection,
it will only be necessary to review the account
formerly given of the state of the stomach and
bowels after death from the yellow fever, in
* Medical Inquiries and Observations, London Edition,
vol. i. p. 112.
cases 

BILIOUS YELLOW FEVER. 253 
cases in which no mercury had been given. I
have before taken notice that Sir John Pringle,
and Dr Cleghorn, had prescribed mercurial purges
with success in the dysentery, a disease in which
the bowels are affected with more irritation and
inflammation than in the yellow fever. Dr. Clark
informs us that he had adopted this practice. I
shall insert the eulogium of this excellent physi-
cian, upon the use of mercury in the dysentery in
his own words. "For several years past, when
the dysentery has resisted the common mode of
practice, I have administered mercury with the
greatest success; and am thoroughly persuaded
that it is possessed of powers to remove inflamma-
tion, and ulceration of the intestines, which are
the chief causes of death in this distemper*."
5. It was urged against this powerful and effi-
cacious medicine, that it was prescribed indiscri-
minately in all cases; and that it did harm in all
weak habits. To this I answer, that there was
no person so weak by constitution, or a previous
disease, as to be injured by a single dose of this
medicine. Mrs. Meredith the wife of the Trea-
surer of the United States, a lady of uncommon
delicacy of constitution, took two doses of the
powder in the course of twelve hours, not only
without any inconvenience, but with an evident
* Vol. ii. p. 342.
increase 

254 AN ACCOUNT OF THE
increase of strength soon afterwards. Many simi-
lar cases might be mentioned. Even children
took two or three doses of it with perfect safety.
This will not surprise those physicians who have
been in the practice of giving from ten to twenty
grains of mercury, with an equal quantity of jalap,
as a worm purge, and from fifty to an hundred
grains of calomel in the course of four or five days,
in the internal dropsy of the brain. But I am
happy in being able to add further, that many
women took it in every stage of pregnancy without
suffering the least inconvenience from it. Out of
a great number of pregnant women whom I at-
tended in this fever, I did not lose one to whom I
gave this medicine, nor did any of them suffer an
abortion. One of them had twice miscarried in
the course of the two or three last years of her
life. She bore a healthy child three months after
her recovery from the yellow fever.
No one has ever objected to the indiscriminate
mode of preparing the body for the small-pox by
purging medicines. The uniform inflammatory
diathesis of that disease, justifies the practice in
a certain degree in all habits. The yellow fever
admits of a sameness of cure much more than the
small-pox, for it is more uniformly and more highly
inflammatory. An observation of Dr. Sydenham,
upon epidemics applies in its utmost extent to our
late 

BILIOUS YELLOW FEVER. 255 
late fever. "Now it must be observed (says this
most acute Physician) that some epidemic diseases,
in some years are uniformly and constantly the
same*." However diversified our fever was in
some of its symptoms, it was in all cases accompa-
nied by more or less inflammatory diathesis, and
by a morbid state of the alimentary canal.
Much has been said of the bad effects of this
purge from its having been put up carelessly by
the apothecaries, or from its having been taken
contrary to the printed directions, by many peo-
ple. If it did harm in any one case (which I do
not believe) from the former of the above causes,
the fault is not mine. Twenty men employed
constantly in putting up this medicine, would not
have been sufficient to have complied with all the
demands which were made on me for it. Hun-
dreds who were in health, called or sent for it as
well as the sick, in order to have it in readiness in
case they should be surprised by the disorder in
the night, or at a distance from a physician.
In all the cases, in which this purge was sup-
posed to have been hurtful, when given on the
first or second day of the disorder, I believe it was
because it was not followed by repeated doses of
the same, or of some other purge; or because it
* Vol. i. p. 9.
was 

256 AN ACCOUNT OF THE
was not aided by blood-letting. I am led to make
this assertion, not only from the authority of Dr.
Sydenham, who often mentions the good effects
of bleeding in moderating or checking a diarrhœa,
but by having heard no complaints of patients
being purged to death by this medicine, after
blood-letting was universally adopted by all the
physicians in the city.
It was remarkable that the demand for this
purging powder continued to encrease under all
opposition, and that the sale of it by the apothe-
caries was greatest towards the close of the disease.
I shall hereafter say, that this was not the case
with the West India remedies.
It is possible that this purge sometimes proved
hurtful when it was given after the 5th day of the
disorder, but it was seldom given for the first
time after the third day, and when it was, the pa-
tient was generally in such a situation that nothing
did him either good or harm.
I derived great pleasure from hearing after the
fever had left the city, that calomel had been
given with success as a purge in bilious fevers in
other parts of the Union besides Philadelphia. Dr.
Lawrence informed me that he had cured many
patients by it, of the yellow fever which prevailed
4 in

BILIOUS YELLOW FEVER. 257 
in New York in the year 1791, and the New
York papers have told us that several practitioners
had been in the habit of giving it in the autumnal
fevers, with great success in the Western parts of
that state. They had probably learned the use
of it from Dr. Young, who formerly practised in
that part of the United States, and who lost no
opportunity of making its praises public, wherever
he went.
My pupil Mr. Potter gave calomel and jalap in
large doses, with great success in the bilious fever
of Caroline county in Maryland, before he knew
that I had adopted that purge in the cure of our
epidemic. He had heard the history of its origin
and use from me, some months before, in a con-
versation upon bilious fevers in my shop.
I have only to add to my account of that purg-
ing medicine, that under an expectation, that the
yellow fever would mingle some of its bilious
symptoms, with the common inflammatory fevers
of the winter, and first spring months, I gave that
purge in the form of pills in every case of inflam-
matory fever to which I was called. The fatal
issue of several fevers in the city, during the win-
ter, in which this precaution had been neglected,
satisfied me that my practice was proper and
useful.
S It

258 AN ACCOUNT OF THE
It is to be lamented that all new remedies are
forced to pass through a fiery ordeal. Opium and
bark were long the objects of terror and invective
in the schools of medicine. They were adminis-
tered only by physicians for many years, and that
too with all the solemnity of a religious ceremony.
This superstition with respect to those medicines,
has at last passed away. It will I hope soon be
succeeded by a time, when the prejudices against
ten and ten, or ten and fifteen, will sleep with the
vulgar fears which were formerly entertained of
the bark producing diseases and death, years after
it had been taken, by "lying in the bones."
OF BLOOD-LETTING.
THE theory of this fever which led
me to administer purges, determined me to use
blood-letting, as soon as it should be indicated.
I am disposed to believe, that I was tardy in the
use of this remedy, and I shall long regret the loss
of three patients, who might probably have been
saved by it. I cannot blame myself for not having
used it earlier, for the immense number of patients
which poured in upon me, in the first week of
September, prevented my attending so much to
each 

BILIOUS YELLOW FEVER. 159 
each of them, as was necessary to determine upon
the propriety of this evacuation. I was in the
situation of a surgeon in a battle, who runs to
every call, and only stays long enough with each
soldier, to stop the bleeding of his wound, while
the encrease of the wounded, and the unexpected
length of the battle, leave his original patients to
suffer from the want of more suitable dressings.
The reasons which determined me to bleed were,
1. The state of the pulse, which became more
tense, in proportion as the weather became cool.
2. The appearance of a moist, and white tongue
on the first day of the disorder; a certain sign of
an inflammatory fever!                   
3. The frequency of hemorrhagies from every
part of the body, and the perfect relief given in
some cases, by them.
4. The symptoms of congestion in the brain
resembling those which occur in the first stage of
hydrocephalus internus, a disease in which I had
lately used bleeding with success.
5. The character of the diseases which had pre-
ceded the yellow fever. They were all more or
less inflammatory. Even the scarlatina anginosa
S2 had

260 AN ACCOUNT OF THE
had partaken so much of that diathesis, as to re-
quire one bleeding to subdue it.
6. The warm and dry weather which had like-
wise preceded the fever.  Dr. Sydenham attributes
a highly inflammatory state of the small-pox, to a
previously hot and dry summer; and I have since
observed that Dr. Hillary, takes notice of inflam-
matory fevers having frequently succeeded hot and
dry weather in Barbadoes*. He informs us fur-
ther, that the yellow fever is always most acute
and inflammatory, after a very hot season†.
7. The authority of Dr. Mosely had great
weight with me in advising the loss of blood, more
especially as his ideas of the highly inflammatory
nature of the fever, accorded so perfectly with my
own.                      
8. I was induced to prescribe blood-letting by
recollecting its good effects in Mrs. Palmer's son,
whom I bled on the 20th of August; and who ap-
peared to have been recovered by it.
Having begun to bleed, I was encouraged to
continue it by the appearance of the blood, and by
* Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122.
† p. 147.
the

BILIOUS YELLOW FEVER. 261  
the obvious and very great relief my patients de-
rived from it.
The following is a short account of the appear-
ances of the blood drawn from a vein in this dis-
order.
1. It was in the greatest number of cases, dense,
and of a scarlet colour, without any separation into
crassamentum and serum.
2. There was in many cases a separation of the
blood into crassamentum and yellow serum.
3. There were a few cases in which this separa-
tion took place, and the serum was of a natural
colour.
4. There were many cases in which the blood
was as sizy as in pneumony and rheumatism.
5. The blood was in some instances covered
above with a blue pellicle of sizy lymph, while
the part which lay in the bottom of the bowl was
dissolved. The lymph was in two cases, mixed with
green streaks.
6. It was in a few instances of a dark colour,
and as fluid as molasses. I saw this kind of blood
in a man who walked about his house during the
S3 whole

262 AN ACCOUNT OF THE
whole of his sickness, and who finally recovered.
Both this, and the 5th kind of blood which has
been mentioned, occurred chiefly where bleeding
had been omitted altogether, or used too sparingly
in the beginning of the disorder.
7. The crassamentum was partly dissolved in some
cases in the serum, so as to resemble bloody water.
This kind of blood has been compared by authors
to the lotura cranium, or washings of flesh.
8. In some patients, the blood, in the course of
the disease, exhibited nearly all the appearances
which have been mentioned. They were varied
by the time in which the blood was drawn, and by
the nature and force of the remedies which had
been used in the disorder.
The effects of blood-letting upon the system
were as follow:
1. It raised the pulse when depressed, and quick-
ened it, when  it was preternaturally slow, or sub-
ject to intermissions.
2. It reduced its force and frequency.
3. It checked in many cases, the vomiting which
occurred in the beginning of the disorder, and
thereby enabled the stomach to retain the purging
medicine.

BILIOUS YELLOW FEVER. 263 
medicine. It likewise assisted the purge in pre-
venting the dangerous or fatal vomiting which
came on about the 5th. day.
4. It lessened the difficulty of opening the bowels.
Upon this account, in my publication of the 12th
of September, I advised bleeding to be used before,
as well as after taking the mercurial purge. Dr.
Woodhouse informed me that he had several times
heard patients call for the close stool while the
blood was flowing from the vein.
5. It removed delirium, coma, and obstinate
wakefulness. It also prevented or checked he-
morrhagies; hence perhaps another reason why
not a single instance of abortion occurred in such
of my female patients as were pregnant.
6. It disposed in some cases to a gentle perspi-
ration.
7. It imparted strength to the system; hence pa-
tients frequently rose from their beds, and walked
across their rooms in a few hours after the opera-
tion had been performed.
8. The redness of the eyes frequently disap-
peared in a few hours after bleeding. Mr. Coxe
S4 observed

264 AN ACCOUNT OF THE
observed a dilated pupil to contract to its natural
size, within a few minutes after he had bound up
the arm of his patient. I remarked in the former
part of this work, that blindness in many instances
attended or followed this fever. Only two such
cases occurred among my patients. In one of
them it was of short continuance, and in the other
it was probably occasioned by the want of suffi-
cient bleeding. In every case of blindness that
came to my knowledge, bleeding had been omit-
ted, or used only in a very moderate degree.
9. It eased pain. Thousands can testify this
effect of blood-letting. Many of my patients
whom I bled with my own hand, acknowledged
to me while the blood was flowing, that they were
better; and some of them declared, that all their
pains had left them, before I had completely
bound up their arms.
10. But blood-letting had in many cases an
effect, the opposite of easing pain. It frequently
encreased it in every part of the body, more espe-
cially in the head. It appeared to be the effect of
the system rising suddenly from a state of indirect
debility, and of an encreased action of the blood-
vessels which took place in consequence of it. I
have frequently seen complaints of the breast, and
of

BILIOUS YELLOW FEVER.  
of the head, made worse by a single bleeding,
and from the same cause. It was in some cases an
unfortunate event in the yellow fever, for it pre-
vented the blood-letting being repeated, by ex-
citing, or strengthening the prejudices of patients
and physicians against it. In some instances, the
patients grew worse after a second, and in one,
after a third bleeding. This was the case in Miss.
Redman. Her pains encreased after three bleed-
ings, but yielded to the fourth. Her father Dr.
Redman concurred in this seemingly absurd prac-
tice. It was at this time, my old master reminded
me of Dr. Sydenham's remark, that moderate
bleeding did harm in the plague, where copious
bleeding was indicated, and that in the cure of
that disorder, we should leave nature wholly to
herself, or take the cure altogether out of her
hands. The truth of this observation was very
obvious. By taking away as much blood as re-
stored the blood-vessels to a morbid degree of
action, without reducing this action afterwards,
pain, congestion, and inflammation, were fre-
quently encreased, all of which were prevented,
or occurred in a less degree, when the system rose
gradually from the state of depression which had
been induced by indirect debility. Under the in-
fluence of the facts and reasonings which have
been mentioned, I bore the same testimony in
acute 

266 AN ACCOUNT OF THE
acute cases, against what was called moderate bleed-
ing, that I did against bark, wine, and laudanum
in this fever.
11. Blood-letting when used early on the first
day, frequently strangled the disease in its birth,
and generally rendered it more light, and the con-
valescence more speedy and perfect. I am not sure
that it ever shortened the duration of the fever
where it was not used within a few hours of the
time of its attack. Under every mode of treatment,
it seemed disposed after it was completely formed
to run its course. I was so satisfied of this peculi-
arity in the fever, that I ventured in some cases to
predict the day on which it would terminate, not-
withstanding I took the cure entirely out of the
hands of nature. I did not lose a patient on the
third, whom I bled on the first, or second day of
the disorder.
12. In those cases which ended fatally, blood-
letting restored, or preserved the use of reason,
rendered death easy, and retarded the putrefac-
faction of the body after death.
I shall now mention some of the circumstances
which directed and regulated the use of this
remedy.
1. Where

BILIOUS YELLOW FEVER. 267 
1. Where bleeding had been omitted, for three
days, in acute cases it was seldom useful. Where
purging had been used, it was sometimes successful.
I recovered two patients who had taken the mer-
curial purges, whom I bled for the first time on the
7th day. One of them was the daughter of Mr.
James Cresson; the other was a journeyman ship-
carpenter at Kensington. In those cases where
bleeding had been used on the first day, it was both
safe and useful to repeat it every day afterwards,
during the continuance of the fever.
2. I preferred bleeding in the exacerbation of
the fever. The remedy here was applied when the
disease was in its greatest force. A single paroxism,
was like a sudden sqall of the system, and unless
abated by bleeding, or purging, produced universal
disorganization. I preferred the former, to the lat-
ter remedy, in cases of great danger, because it was
more speedy, and more certain in its operation.
3. I bled in several instances in the remission of
the fever,  where the pulse was tense or chorded,
more especially if the patient were unable to
sit up without fainting. The bleeding in these
cases lessened the violenceof the succeeding pa-
roxism.
4. I 

268 AN ACCOUNT OF THE
4. I bled in all those cases in which the pulse was
preternaturally slow, provided it was tense. Mr.
Benj. W. Morris, Mr. Thomas Wharton Jun.
and Mr. Wm. Sansom, all owe their lives probably
to their having been bled in the above state of the
pulse. I was led to use bleeding in this state of
the pulse, not only by the theory of the disease
which I had adopted, but by the success which had
often attended this remedy, in a slow and depressed
state of the pulse in apoplexy and pneumony. I
had, moreover, the authority of Dr. Mosely in its
favour, in the yellow fever, and of Dr. Sydenham,
in his account of a new fever, which appeared in
the year 1685. The words of the latter physician
are so opposite to the cases which have been men-
tioned, that I hope I shall be excused for insert-
ing them in this place. "All the symptoms of
weakness (says our author) proceed from nature's
being in a manner oppressed, and overcome by the
first attack of the disease, so as not to be able to
raise regular symptoms adequate to the violence of
the fever. I remember to have met with a remark-
able instance of this several years ago, in a young
man I then attended; for though he seemed in a
manner expiring, yet the outward parts felt so cool,
that I could not persuade the attendants he had a
fever, which could not disengage, and shew itself
clearly, because the vessels were so full as to ob-
struct

BILIOUS YELLOW FEVER. 269 
struct the motion of the blood. However, I said,
that they would soon find the fever rise high
enough upon bleeding him. Accordingly after
taking away a large quantity of blood, as vio-
lent a fever appeared as ever I met with, and did
not go off till bleeding had been used three or four
times*."
5. I bled in those cases in which the fever ap-
peared in a tertian form, provided the pulse was
full and tense. I well recollect the surprise with
which Mr. Van Berkel heard this prescription from
me, at a time when he was able to walk and ride
out on the intermediate days of a tertian fever.
The event which followed this prescription, shew-
ed that it was not disproportioned to the violence
of his disease, for it soon put on such acute and
inflammatory symptoms as to require six subsequent
bleeding to subdue it.
6. I bled in those cases where patients were able
to walk about, provided the pulse was the same as
has been mentioned under the 4th head. I was
determined as to the propriety of bleeding in these
two supposed mild forms of the fever, by having
observed each of them when left to themselves
frequently to terminate in death.
* Vol. ii. p. 351.
7. I

270 AN ACCOUNT OF THE
7. I paid no regard to the dissolved state of the
blood, when it appeared on the first or second day
of the disorder, but repeated the bleedings after-
wards in every case, where the pulse continued to
indicate it. It was common to see sizy blood suc-
ceed that which was dissolved. This occurred in
Mr. Josiah Coates, and Mr. Samuel Powel. Had
I believed that this dissolved state of the blood arose
from its putrefaction, I should have laid aside my
lancet as soon as I saw it; but I had long ago part-
ed with all ideas of putrefaction in bilious fevers.
The refutation of this doctrine, was the object of
one of my papers in the Medical Society of Edin-
burgh, in the year 1767. The dissolved appear-
ance of the blood, I suppose to be the effect of a
certain action of the blood-vessels upon it. It oc-
curs in fevers in which no putrid, or foreign mat-
ter has been introduced into the system. The ty-
phoid pneumony described by Dr. Huxham in his
epidemics, and well known in the southern states
of America, in the spring of the year, has never,
been ascribed to any other remote cause, than the
sensible qualities of the air, and yet the blood is
generally dissolved in this disorder.
8. The presence of petechiæ did not deter me
from repeating blood-letting, where the pulse re-
tained its fullness or tension. I prescribed it with
success in the cases of Dr. Mease, and of Mrs.
Gibler,

BILIOUS YELLOW FEVER. 271  
Gibler, in Dock-street, in each of whom petechiæ
had appeared. Bleeding was equally effectual in
the case of the Rev. Mr. Keating at a time, when
his arms were spotted with that species of erup-
tions which I have compared to Mosquito bites.
I had precedents in Dr. De Haen*, and Dr. Sy-
denham†, in favour of this practice. So far from
viewing these eruptions as signs of putrefaction, I
considered them as marks of the highest possible
inflammatory diathesis. They disappeared in each
of the above cases after bleeding.
9. In determining the quantity of blood to be
drawn, I was governed by the state of the pulse,
and by the temperature of the weather. In the
beginning of September I found one or two mo-
derate bleedings sufficient to subdue the fever;
but in proportion as the system arose by the dimi-
nuition of the stimulus of heat, and the fever put
on more visible signs of inflammatory diathesis,
more frequent bleedings became necessary. I
bled many patients twice, and a few three times
a day. I preferred frequent and small, to large
bleedings in the beginning of September; but
towards the height and close of the epidemic, I
* Ratio medendi, vol. ii. p. 162. vol. iv. p. 172.
† Vol. i. p. 210, and 2644.
I saw

272 AN ACCOUNT OF THE
saw no inconvenience from the loss of a pint, and
even twenty ounces of blood at a time. I drew
from many persons seventy and eighty ounces in
five days; and from a few, a much larger quanti-
ty. Mr. Gribble, cedar-cooper, in Front-street,
lost by ten bleedings an hundred ounces of blood;
Mr. George, a carter in Ninth-street, lost about the
same quantity by five bleedings; and Mr. Peter
Mierken, one hundred and fourteen ounces in five
days. In the last of the above persons the quan-
tity taken, was determined by weight. Mr. Toy,
blacksmith near Dock-street, was eight times bled
in the course of seven days. The quantity taken
from him was about an hundred ounces. The
blood in all these cases was dense, and in the last
very sizy. They were all attended in the month
of October, and chiefly by my pupil Mr. Fisher;
and they are all this day living and healthy in-
stances of the efficacy of copious blood-letting,
and of the intrepidity and judgement of their young
physician. Children and even old people, bore
the loss of much more blood in this fever, than in
common inflammatory fevers. I took above thirty
ounces, in five bleedings from a daughter of Mr.
Robert Bridges, who was then in the 9th year of
her age. Even great debility, whether natural or
brought on by previous diseases, did not in those
few cases in which it yielded to the fever, deprive
4 it

BILIOUS YELLOW FEVER. 273 
it of the uniformity of its inflammatory character.
The following letter from my friend Dr Griffitts,
written soon after his recovery from a third attack
of the fever, and just before, he went into the
country for the re-establishment of his health, will
furnish a striking illustration of the truth of the
above observation.
"I cannot leave town without a parting adieu
to my kind friend, and sincere prayers for his
preservation.
I am sorry to find that the use of the lancet
is still so much dreaded by too many of our phy-
sicians; and while lamenting the death of a valu-
able friend this morning, I was told that he was
bled but once during the disorder. Now, if my
poor frame, reduced by previous sickness, great
anxiety, and fatigue, and a very low diet, could
bear seven bleedings in five days, besides purging,
and no diet, but toast and water, what shall we
say of physicians who bleed but once?"
October 19, 1793.
I have compared a paroxysm of this fever to a
sudden squall; but the disease in its whole course
was like a tedious equinoctial gale, acting upon a
ship at sea; its destructive force was only to be
T opposed

274 AN ACCOUNT OF THE
opposed by handing every sail, and leaving the
system to float, as it were, under bare poles. Such
was the fragility (if I may be allowed the expres-
sion) of the blood vessels, that it was necessary to
unload them of their contents, in order to prevent
the system sinking, from hemorrhagies, or from
effusions in the viscera, particularly the brain.
9. Such was the indomitable nature of the pulse
in some patients, that it did not lose its force after
numerous and copious bleedings. In all such
cases, I considered the diminution of its frequency,
and the absence of vomiting, as signals to lay aside
the lancet. The continuance of this preterna-
tural force in the pulse, appeared to be owing to
the contagion which was universally diffused in
the air, acting upon the arterial system in the same
manner that it did in persons who were in apparent
good health.
Thus have I mentioned the principal circum-
stances which were connected with blood-letting,
in the cure of the yellow fever. I shall now con-
sider the objections that were made to it at the
time, and since the prevalence of the fever.
It was said that the bleeding was unnecessarily
copious; and that many had been destroyed by it.
To

BILIOUS YELLOW FEVER. 275 
To this I answer, that I did not lose a single pa-
tient whom I bled seven times, or oftener, in this
fever. As a further proof that I did not draw an
ounce of blood too much, it will only be necessary
to add, that hemorrhagies frequently occurred af-
ter a third, a fourth, and in one instance (in the
only son of Mr. William Hall) after a sixth bleed-
ing had been used; and further, that not a single
death occurred from natural hemorrhagies in the
first stage of the disorder. A woman who had
been bled by my advice, awoke the night follow-
ing in a bath of her blood, which had flowed
from the orifice in her arm. The next day she
was free from pain and fever. There were many
recoveries in the city from similar accidents. There
were likewise some recoveries from copious na-
tural hemorrhagies in the more advanced stages of
the disorder, particularly when they occurred from
the stomach and bowels. I left a servant maid of
Mrs. Morris's in Walnut-street, who had dis-
charged at least four pounds of blood from her
stomach, without a pulse, and with scarcely a
symptom that encouraged a hope of her life; but
the next day I had the pleasure of finding her out
of danger.
It is remarkable that fainting was much less
common after bleeding in this fever, than in com-
T2 mon

276 AN ACCOUNT OF THE
mon inflammatory fevers. This circumstance was
observed by Dr. Griffitts, as well as myself. It
has since been confirmed to me by three of the
principal bleeders in the city, who performed the
operation upwards of four thousand times. It oc-
curred chiefly in those cases where it was used for
the first time on the third or fourth day of the dis-
ease. A swelling of the legs, moreover, so com-
mon after plentiful bleeding in pneumony and
rheumatism, rarely succeeded the use of this reme-
dy in the yellow fever.
2. Many of the indispositions, and much of the
accidental weakness of persons who had been
cured by copious blood-letting, have been ascribed
to it. This is so far from being true, that the re-
verse of it has occurred in many cases. Mr. Mier-
ken worked in his sugar-house in good health,
nine days after his last bleeding; and Mr. Gribble,
and Mr. George seem by their appearance to have
derived fresh vigour from their evacuations. I
could mention the names of many people who
think their constitutions have been improved by
the use of those remedies; and I know several per-
sons in whom they have carried off habitual com-
plaints. Mr. Richard Wells attributes his relief
from a chronic rheumatism to the copious bleed-
ing and purging which were used to cure him of
the

BILIOUS YELLOW FEVER. 277 
the yellow fever; and Mr. William Young, the
bookseller, was relieved of a chronic pain in his
side, by means of the same remedies.
3. It was said, that blood-letting was prescribed
indiscriminately in all cases, without any regard
to age, constitution, or the force of the disease.
This is not true as far as it relates to my practice.
In my prescriptions for patients whom I was un-
able to visit, I advised them, when they were inca-
pable of judging of the state of the pulse, to be
guided in the use of bleeding, by the degrees of
pain they felt, particularly in the head; and I sel-
dom advised it for the first time, after the second,
or third day of the disorder.
In pneumonies which affect whole neighbour-
hoods in the spring of the year, bleeding is the
universal remedy. Why should it not be equally
so, in a fever which is of a more uniform inflam-
matory nature, and which tends more rapidly to
effusions, in parts of the body, much more vital
than the lungs?
I have before remarked, that the debility which
occurs in the yellow fever, is of the indirect kind.
The debility in the plague is of the same nature.
It has long been known that direct debility is to
T3 be

278 AN ACCOUNT OF THE
be removed by the gradual application of stimuli,
but it has been less observed, that the excess of
stimulus in the system is best removed in a gradual
manner, and that too, in proportion to the de-
grees of indirect debility, which exist in the sys-
tem.
This principle in the animal economy has been
acknowledged by the practice of occasionally stop-
ping the discharge of water from a canula in tap-
ping, and of blood from a vein, in order to pre-
vent fainting.
Child-birth, induces fainting, and sometimes
death, only by the sudden abstraction of the sti-
mulus of distention and pain.
In all those cases where purging or bleeding
have produced death in the yellow fever or plague,
when they have been used on the first or second
day of those disorders, I suspect that it was oc-
casioned by the quantity of the stimulus abstracted
being disproportioned to the degrees of indirect
debility. The following facts will I hope throw
light upon this subject.
1. Dr. Hodges informs us, that "although
blood could not be drawn in the plague, even in 
the

BILIOUS YELLOW FEVER. 279
the smallest quantity without danger, yet an hun-
dred times the quantity of fluids, was discharged
in pus from buboes without inconvenience*."
2. Pareus, after condemning bleeding in the
plague, immediately adds an account of a patient,
who was saved by an hemorrhage from the nose
which continued two days†.
3. I have before remarked that bleeding proved
fatal in three cases in the yellow fever in the
months of August; but at that time, I saw one, and
heard of another case, in which death seemed to
have been prevented by a bleeding at the nose.
Perhaps the uniform good effects which were ob-
served to follow a spontaneous hemorrhage from
an orifice in the arm, arose wholly from the gra-
dual manner in which the stimulus of the blood
was in this way abstracted from the body. Dr.
Williams relates a case of the recovery of a gen-
tleman from the yellow fever by means of small
hemorrhages which continued three days from
wounds in his shoulders made by being cupped.
He likewise mentions several other recoveries by
hemorrhages from the nose, after "a vomit-
* Page 114.
† Shenkius, Lib. vi. p. 881.
T4 ing 

280 AN ACCOUNT OF THE
ing  of black humours, and a hiccup had taken
place*."
4. There is a disease in North Carolina known
among the common people by the name of the
"pleurisy in the head." It occurs in the winter
after a sickly autumn, and seems to be an evane-
scent symptom of a bilious remitting fever. The
cure of it has been attempted by bleeding, in the
common way, but generally without success. It
has, however, yielded to this remedy in another
form, that is, to the discharge of a few ounces of
blood obtained by thrusting a piece of quill up the
nose.
5. Riverius describes a pestilential fever which
prevailed at Montpelier in the year 1623, which
carried off one half of all who were affected by
it†. After many unsuccessful attempts to cure it,
this judicious physician prescribed the loss of two
or three ounces of blood. The pulse rose with
this small evacuation. Three or four hours after-
wards, he drew six ounces of blood from his pa-
tients, and with the same good effect. The next
* Essay on the Bilious or Yellow Fever of Jamaica, p.
40.
† De Febre Pestilenti, vol. ii. p. 145, 146, and 147.
day,                                          

BILIOUS YELLOW FEVER. 281
day, he gave a purge, which he says rescued his
patients from the grave. All whom he treated
in this manner recovered. The whole history of
this epidemic is highly interesting, from its agree-
ing with our late epidemic in so many of its symp-
toms, more especially as they appeared in the dif-
ferent states of the pulse.
An old and intelligent citizen of Philadelphia,
who remembers the yellow fever of 1741, says
that when it first made its appearance, bleeding
was attended with fatal consequences. It was laid
aside afterwards, and the disease prevailed with
great mortality until it was checked by the cold
weather. Had blood been drawn in the manner
mentioned by Riverius, or had it been drawn in
the usual way, after the abstraction of the stimulus
of heat by the cool weather, the disease might
probably have been subdued, and the remedy of
blood-letting, thereby have recovered its cha-
racter.
Dr Hodges has another remark in his account
of the plague in London in the year 1665, which
is still more to our purpose than the one which I
have quoted from it upon this subject. He says
that "bleeding as a preventive of the plague was
only safe and useful, when the blood was drawn
by                                          

282 AN ACCOUNT OF THE
by a small orifice, and a small quantity taken at
different times*."
I have remarked in the history of the yellow
fever of last autumn, that it was often cured on
the first or second day by a copious sweat. The
Rev. Mr. Ustick was one among many whom I
could mention, who were saved from a violent at-
tack of the fever, by this evacuation. It would
be absurd to suppose that the contagion which
produced the disease was discharged in this man-
ner from the body. The sweat seemed to cure the
fever, only by lessening the quantity of the fluids,
and thus gradually removing the indirect debility
of the system. The profuse sweats which some-
times cure the plague, as well as the disease which
is brought on by the bite of poisonous snakes, seem
to act in the same way.
The system under the impression of the conta-
gion of a malignant fever, resembles a man strug-
gling beneath a load of two hundred weight, who
is able to lift only one hundred and seventy-five.
In order to assist him, it will be to no purpose to
attempt to infuse additional vigour into his mus-
cles by the use of a whip or of strong drink.
* Page 209.
Every 

BILIOUS YELLOW FEVER. 283
Every exertion will serve only to waste his
strength. In this situation (supposing it impossible
to divide the weight which confines him to the
ground) let the pockets of this man be emptied of
their contents, and let him be stripped of so much
of his cloathing, as to reduce his weight five and
twenty or thirty pounds. In this situation he will
rise from the ground; but if the weights be ab-
stracted suddenly, while he is in an act of exertion,
he will rise with a spring that will endanger a se-
cond fall, and probably produce a temporary con-
vulsion in his system. By abstracting the weights
from his body more gradually, he will rise by de-
grees from the ground, and the system will accom-
modate itself in such a manner to the diminution
of its pressure, as to resume its erect form, without
the least deviation from the natural order of its
appearance and motions.
It has been said that the stimulating remedies of
bark, wine, and the cold bath, were proper in our
late epidemic in August, and in the beginning of
September, but that they were improper after-
wards. If my theory be just, they were more
improper in August, and the beginning of Septem-
ber, than they were after the  disease put on the
outward and common signs of inflammatory dia-
thesis. The reason why a few strong purges cured
the                                          

284 AN ACCOUNT OF THE
the disease at its first appearance was, because
they abstracted in a gradual manner some of the
immense portion of stimulus under which the ar-
terial system laboured, and thus gradually relieved
it from its low degrees of indirect debility. Bleed-
ing was fatal in these cases, only because it re-
moved this indirect debility in too sudden a man-
ner.
The principle of the gradual abstraction, as well
as of the gradual application of stimuli to the bo-
dy, in all the diseases of indirect debility on the
one hand, and of direct, on the other, opens a wide
field for the improvement of medicine. Perhaps
all the discoveries of future ages will consist more
in a new application of established principles, and
in new modes of exhibiting old medicines, than in
the discovery of new theories, or of new articles
of the Materia Medica.
The reasons which induced me to prescribe
purging and bleeding, in so liberal a manner, na-
turally led me to recommend cool and fresh air
to my patients. The good effects of it were ob-
vious in almost every case in which it was applied.
It was equally proper whether the arterial system
was depressed, or whether it discovered in the
pulse, a high degree of morbid excitement. Dr 
Griffitts

BILIOUS YELLOW FEVER. 285  
Griffitts furnished a remarkable instance of the
influence of cool air upon the fever. Upon my
visiting him on the morning of the eighth of Oc-
tober, I found his pulse so full and tense, as to in-
dicate bleeding, but after sitting a few minutes by
his bed-side, I perceived that the windows of his
room had been shut in the night by his nurse, on
account of the coldness of the night air. I desired
that they might be opened. In ten minutes af-
terwards, the Doctor's pulse became so much
flower and weaker, that I advised the postpone-
ment of the bleeding, and recommended a purge
instead of it. The bleeding notwithstanding be-
came necessary, and was used with great advantage
in the afternoon of the same day.
The cool air was improper only in those cases
where a chilliness attended the disease.
For the same reason that I advised cool air, I
directed my patients to use cold DRINKS. They
consisted of lemonade, tamarind, jelly, and raw
apple water, toast and water, and of weak balm,
and chamomile tea. The subacid drinks were pre-
ferred in most cases, as being not only most agree-
able to the taste, but because they tended to cor-
rect by mixture, the acrid quality of the bile. All
these drinks were taken in the early stage of the
disorder.                                       

286 AN ACCOUNT OF THE
disorder. Towards the close of it, I permitted
the use of porter and water, weak punch, and
when the stomach would bear it, weak wine
whey.
I forbad all cordial and stimulating food in the
active state of the arterial system. The less my
patients ate, of even the mildest vegetable food,
the sooner they recovered. Weak coffee, which
(as I have formerly remarked) was almost univer-
sally agreeable, and weak tea were always inoffen-
sive. As the action of the pulse diminished, I in-
dulged my patients with weak chocolate; also
with milk, to which roasted apples, or minced
peaches, and (where they were not to be had)
bread, or Indian mush were added.
Towards the crisis, I advised the drinking of
weak chicken, veal, or mutton broth, and after
the crisis had taken place, I permitted mild animal
food to be eaten in a small quantity, and to be
increased according to the waste of the excitabi-
lity of the system. This strict abstinence which I
imposed upon my patients did not escape obloquy,
but the benefits they derived from it, and the ill
effects which arose in many cases from a contrary
regimen, satisfied me that it was proper in every
case in which it was prescribed.
COLD                                     

BILIOUS YELLOW FEVER. 287
COLD WATER was a most agreeable and power-
ful remedy in this disorder. I directed it to be
applied by means of napkins to the head, and to
be injected into the bowels by way of glyster. It
gave the same ease to both, when in pain, which
opium gives to pain from other causes. I like-
wise advised the washing of the face and hands,
and sometimes the feet with cold water, and always
with advantage. It was by suffering the body to
lie for some time in a bed of cold water, that the
inhabitants of the island of Massuah cured the most
violent bilious fevers*. When applied in this
way, it gradually abstracts the heat from the body,
and thereby lessens the action of the system. It
differs as much in its effects upon the body from
the cold bath, as rest in a cold room, differs from
exercise in the cold and open air.
I was first led to the practice of the partial ap-
plication of cold water to the body, in fevers of
too much force in the arterial system, by observ-
ing its good effects in active hemorrhages, and by
recollecting the effects of a partial application of
warm water to the feet, in fevers of an opposite
character. Cold water when applied to the feet
as certainly reduces the pulse in force and fre-
* Bruce's Travels.
quency, 

288 AN ACCOUNT OF THE
quency as warm water applied in the same way,
produces contrary effects upon it. In an experi-
ment which was made at my request by one of my
pupils, by placing his feet in cold pump water for
a few minutes, the pulse was reduced 24 strokes
in a minute, and became so weak as hardly to be
perceptible.
In the use of the remedies which were necessary
to overcome the inflammatory action of the sys-
tem, I was obliged to reduce it below its natural
point of excitement. In the present imperfect
state of our knowledge in medicine, perhaps no
disease of too much action, can be cured without
it.
I have said in another place, that I was early
obliged to desist from the use of wine, bark, and
laudanum in the first stage of this disorder. I found
them as offensive to the stomach, and nearly as
hurtful in its second stage, as I had found them in
its first. In this situation new resources in the ma-
teria medica were opened to me. I had observed
a favourable issue of the fever in every case, in
which a spontaneous discharge took place from
the salivary glands. I had observed further, that
all such of my patients (one excepted) as were sa-
livated by the mercurial purges recovered in a few
2 days.          

BILIOUS YELLOW FEVER. 289
days. This early suggested an idea to me that
the calomel might be applied to other purposes,
than the discharging of bile from the bowels. I
ascribed its salutary effects when it salivated in the
first stage of the disorder, to the excitement of
inflammation and effusion in the throat, diverting
them from more vital parts of the body. In
the second stage of the disorder, I was led to
prescribe it as a stimulant, and with a view of
obtaining this operation from it, I aimed in all
cases to obtain a salivation as speedily as possible.
Two precedents encouraged me to make trial of
this remedy.
In the month of October 1789, I attended a
gentleman in a bilious fever, which ended in many
of the symptoms of a typhus mitior. In the lowest
state of his fever, he complained of a pain in his
right side, for which I ordered half an ounce of
mercurial ointment to be rubbed on the part af-
fected. The next day, he complained of a sore
mouth, and in the course of four and twenty hours,
he was in a moderate salivation. From this time
his pulse became full and slow, and his skin moist.
His sleep and appetite suddenly returned, and in a
day or two he was out of danger. The second
precedent for a salivation in a fever, which occur-
red to me was in Dr. Haller's short account of the
U works                                      

290 AN ACCOUNT OF THE
works of Dr. Cramer*, and which I had a year
before copied into my note book. The practice
was moreover, justified in point of safety as well
as the probability of success, by the accounts
which Dr. Clark has lately given of the effects of
a salivation in the dysentery†. I began by pre-
scribing the calomel in small doses, at short inter-
vals, and afterwards I directed large quantities of
the ointment to be rubbed upon the limbs. The
effects of it in every case in which it affected the
mouth, were salutary. Dr. Woodhouse improved
upon my method of exciting the salivation, by
rubbing the gums with calomel, in the manner
directed by Mr. Clare. It was more speedy in its
operation in this way than in any other, and equal-
ly effectual. Several persons appeared to be bene-
fitted by the mercury introduced into the system in
the form of an ointment, where it did not produce
a salivation. Among these, were the Rev. Dr.
Blackwell, and Mr. John Davis.
Since the above account was written of the good
effects of a mercurial salivation in this fever, I have
had great satisfaction in discovering that it was pre-
scribed with equal, and even greater success, by
Dr. Wade in Bengal, in the year 1791, and by Mr.
* Bibliotheca Medicinæ Practicæ, vol. iii. p. 491.
† Diseases of long voyages to Hot Climates, vol. ii. p. 334.
Chisholm                                      

BILIOUS YELLOW FEVER. 291 
Chisholm in the island of Grenada, in the cure of
bilious yellow fevers *.  Dr. Wade did not lose one,
and Mr. Chisholm loft only one, out of forty-eight
patients  in whom the mercury affected the salivary
glands.  The latter gave 150 grains of calomel,
and applied the strongest mercurial ointment below
the groin of each side, in some cases.  He adds
further,  that not a single instance of a relapse oc-
curred, where the disease was cured by salivation.
After the reduction of the system, blisters were
applied with great advantage to every part of the
body. They did most service when they were
applied to the crown of the head. I did not see a
single case,  in which a mortification followed the
sore, which was created by a blister.
Brandy and water, or porter and water, when
acceptable to the stomach, with now and then a cup
of chicken broth, were the drinks I prescribed to
assist in restoring the tone of the system.
In some cases I directed the limbs to be wrapped
in flannels dipped in warm spirits, and cataplasms
of bruised garlic to be applied to the feet. But
my principal dependence, next to the use of mer-
curial medicines, for exciting a healthy action in
the arterial system, was upon mild and gently sti-
* Medical Commentaries, vol. xviii. p. 209. 288.
U2 mulating                     


292 AN ACCOUNT OF THE
mulating food. This consisted of rice broths, the
flesh of poultry, oysters, thick gruel, mush and
milk, and chocolate. I directed my patients to
eat or drink a portion of some of the above arti-
cles of diet every hour or two during the day,
and in cases of great debility, I advised their being
waked for the same purpose two or three times in
the night. The appetite frequently craved more
favoury articles of food, such as beef-stakes, and
sausages; but they were permitted with great cau-
tion, and never till the system had been prepared
for them by a less stimulating diet.
There were several symptoms which were very
distressing in this disorder, and which required a
specific treatment.
For the vomiting, with a burning sensation in
the stomach, which came on about the 5th day,
I found no remedy equal to a table spoonful of
sweet milk taken every hour, or to small draughts
of milk and water. I was led to prescribe this
simple medicine, from having heard from a West
India practitioner, and afterwards read in Dr.
Hume's account of the yellow fever, encomiums
upon the milk of the cocoa-nut for this trouble-
some symptom. Where sweet milk failed of giving
relief, I prescribed small doses of sweet oil, and in
some cases a mixture of equal parts of milk, sweet
oil             

BILIOUS YELLOW FEVER. 293
oil and molasses. They were all intended to di-
lute, or blunt the acrimony of the humors which
were either effused, or generated in the stomach.
Where they all failed of checking the vomiting,
I prescribed weak chamomile tea, or porter, or cy-
der and water, with advantage. In some of my
patients, the stomach rejected all the mixtures, and
liquors which have been mentioned. In such cases,
I directed the stomach to be left to itself for a few
hours, after which it sometimes received and re-
tained the drinks that it had before rejected, pro-
vided they were administered in a small quantity
at a time.
The vomiting was sometimes stopped by a blister
applied to the external region of the stomach.
A mixture of liquid laudanum and sweet oil,
applied to the same place, gave relief where the
stomach was affected by pain only, without a
vomiting.
I have formerly mentioned that a distressing
pain often seized the lower part of the bowels.
I was early taught that laudanum was not a proper
remedy for it. It yielded in almost every case,
to two or three emollient glysters, or to the loss
of a few ounces of blood.
U3 The                     


294 AN ACCOUNT OF THE
The convalescence from this fever was in gene-
ral rapid, but in some cases it was very slow. I
was more than usually struck by the great resem-
blance which the system in the convalescence from
this fever, bore to the state of the body and mind
in old age. It appeared, 1. in the great weak-
ness of the body, more especially of the limbs.
2. In uncommon depression of the mind, and in a
great aptitude to shed tears. 3. In the absence
or short continuance of sleep. 4. In the frequent
occurrence of appetite, and in some cases in its
inordinate degrees. And 5. In the loss of the
hair of the head, or its being suddenly changed in
some cases to a grey colour.
Pure air, gentle exercise, and agreeable society,
removed the debility both of body and mind of
this premature, and temporary old age. I met
with a few cases, in which the yellow colour conti-
nued for several weeks after the patient's recovery
from all the other symptoms of the fever. It was
removed most speedily and effectually by two or
three moderate doses of calomel and rhubarb.
A feeble and irregular intermittent, was very
troublesome in some people, after an acute attack
of the fever. It yielded gradually to chamomile or
snake-root tea, and country air.
In                             

BILIOUS YELLOW FEVER. 295 
In a publication dated the 16th of September,
I recommended a diet of milk and vegetables, and
cooling purges to be taken once or twice a week,
to the citizens of Philadelphia. This advice was
the result of the theory of the disease I had adopt-
ed, and of the successful practice which had arisen
from it. In my intercourse with my fellow citi-
zens, I advised this regimen to be regulated by
the degrees of fatigue and contagion to which
they were exposed. I likewise advised moderate
blood-letting to all such persons as were of a ple-
thoric habit. To men whose minds were influ-
enced by the publications in favour of bark and
wine, and who were unable at that time to grasp
the extent and force of the contagion of this ter-
rible fever, the idea of dieting, purging, or bleed-
ing the inhabitants of a whole village or city, ap-
peared to be extravagant and absurd: But I had
many precedents, besides the authority of reason,
in favour of the advice. Dr Mitchell recommend-
ed moderate bleeding with success, as a preventive
of the yellow fever in Virginia, in the year 1741.
A military surgeon belonging to the French
troops at Hispaniola, assured Dr. Foulke that he
had for many years bled the recruits from France,
as soon as they arrived, and thereby secured them
from a seasoning by the yellow fever. The less
mortality of this disorder in the French and Spa-
U4 nish,

296 AN ACCOUNT OF THE
nish, than in the English Islands, has been justly
attributed to the natives of France and Spain car-
rying with them to the West Indies more tempe-
rate habits, in the use of wine and animal food,
than the natives Great Britain. I had more-
over, the analogy of the regimen made use of to
prepare the body for the small pox and plague,
in favour of this advice. Dr. Haller has given
extracts from the histories of two plagues, in
which the action of the contagion was prevented
or mitigated, by bleeding*. Dr. Hodges con-
firms the utility of the same practice. The bene-
fits of low diet, as a preventive of the plague,
were established by many authors, long before
they received the testimony of the benevolent Mr.
Howard in their favour. Socrates in Athens,
and Justinian in Constantinople, were preserved by
means of their abstemious modes of living, from
the plagues which occasionally ravaged those ci-
ties. By means of the low diet, gentle physic, and
occasional bleedings, which I thus publicly recom-
mended, the disease was prevented in many in-
stances, or rendered mild where it was taken.
But my efforts to prevent the disease in my fel-
low citizens, did not end here. I advised them,
not only in the public papers, but in my inter-
* Bibliotheca Medicinæ Practicæ, vol. ii. p. 93, and 387.
course                                        

BILIOUS YELLOW FEVER. 297
course with them, to avoid heat, cold, labour,
and every thing else that could excite the conta-
gion (which I knew to be present in all their bo-
dies) into action. I forgot upon this occasion the
usual laws which regulate the intercourse of man
with man in the streets; and upon the public
roads, in my excursions into the neighbourhood
of the city, I cautioned many persons whom I
saw walking or riding in an unsafe manner of the
danger to which they exposed themselves; and
thereby, I  hope, prevented an attack  of the dis-
order in many people. If in a single instance I un-
happily excited an emotion of terror in a fellow
citizen, by this conduct, I thus humbly ask his
pardon. There should be no ceremony in cal-
ling to a man to avoid a precipice, or in pulling
him out of a fire.
It was from a conviction of the utility of low
diet, gentle evacuations, and of carefully shunning
all the exciting causes which I have mentioned,
that I concealed in no instance from my patients,
the name of their disorder. This plainness, which
was blamed by weak people, produced strict obe-
dience to my directions, and thereby limited the
propagation of the fever in many families, or
rendered it when taken, as mild as inoculation
does the small-pox. The opposite conduct of se-
veral                                           


298 AN ACCOUNT OF THE
veral physicians, by preventing the above precau-
tions, encreased the mortality of the disease; and
in some instances contributed to the extinction of
whole families. Such have been, and ever will
be, the effects of ignorance and fraud in the pro-
fession of medicine.
I proceed now to make a few remarks upon the
remedies recommended by Doctors Kuhn and
Stevens, and by the French physicians.
Had the whole materia medica been ransacked,
there could not been found any three medicines
more opposite to the disorder than bark, wine, and
laudanum. In every case in which I prescribed
bark, it was offensive to the stomach. In several
mild tertians which attended the convalescence
from a common attack of the fever, I found it al-
ways unsuccessful, and once hurtful. Mr. Wil-
ling took it for several weeks without effect.
About half a pint of a weak decoction of the
bark produced in Mr. Samuel Meredith, a parox-
ism of the fever, so violent as to require the loss
of ten ounces of blood to moderate it. Dr. An-
nan informed me that he was forced to bleed one
of his patients twice, after having given him a
small quantity of bark, to hasten his convalescence.
If in any case it was inoffensive, or did service, I
suspect                                       

BILIOUS YELLOW FEVER. 299 
suspect it must have acted upon the bowels as a
purge. Dr Sydenham says the bark cured inter-
mittents by this evacuation*; and Mr. Bruce says
it operated in the same way, when it cured the bi-
lious fevers at Massuah.
Wine was nearly as disagreeable as the bark to
the stomach, and equally hurtful. I tried it in
every form, and of every quality, but without suc-
cess. It was either rejected by the stomach, or
produced in it a burning sensation. I should sus-
pect that I had been mistaken in my complaints
against wine, had I not since met with an account
in Skenkius of its having destroyed all who took
it in the famous Hungarian fever, which prevailed
with great mortality over nearly every country in
Europe, about the middle of the 16th century†.
Dr. Wade declares wine to be "ill adapted to the
fevers of Bengal, where the treatment has been
proper in other respects."
Laudanum has been called by Dr. Mosely "a
"fatal medicine" in the yellow fever. In one of
* Vol. i. p. 440.
† Omnes qui vini potione non abstinuerunt, interiere,
adeo ut summa spes salvationis in vini abstinentia collocata
videreter. Lib. vi. p. 847.
my                                          


300 AN ACCOUNT OF THE
my patients who took only fifteen drops of it,
without my advice, to ease a pain in his bowels,
it produced a delirium, and death in a few hours.
I was much gratified in discovering that my prac-
tice, with respect to the use of opium in this fe-
ver, accorded with Dr. Wade's in the fever of
Bengal. He tells us that "it was mischievous in
almost every instance, even in combination with
antimonials."
The spices were hurtful in the first stage of the
fever, and when sufficient evacuations had been
used, they were seldom necessary in its second.
The elixir of vitriol was in general offensive to
the stomach.
The cold bath was useful in those cases where
its sedative prevailed over its stimulating effects.
But this could not often happen, from the sud-
denness and force with which the water was
thrown upon the body. In two cases in which I
prescribed it, it produced a gentle sweat, but it
did not save life. In a third it removed a deliri-
um, and reduced the pulse for a few minutes, in
frequency and force, but this patient died. The
recommendation of it indiscriminately in all cases,
was extremely improper. In that chilliness and
tendency          

BILIOUS YELLOW FEVER. 301 
tendency to fainting upon the least motion, which
attended the disorder in some patients, it was an
unsafe remedy. I heard of a woman who was
seized with delirium immediately after using it,
from which she never recovered; and of a man
who died a few minutes after he came out of a
bathing tub. Had this remedy been the exclu-
sive antidote to the yellow fever, the mortality of
the disease would have been but little checked by
it. Thousands must have perished from the want
of the means to procure tubs, and of a suitable
number of attendants to apply the water, and to
lift the patient in and out of bed. The reason of
our citizens ran before the learning of the friends
of this remedy, and long before it was abandoned
by the physicians; it was rejected as useless, or
not attempted, because impracticable, by the good
sense of the city. It is to be lamented that the
remedy of cold water has suffered in its character
by the manner in which it was advised. In fevers
of too  much action, it reduces the morbid excite-
ment of the blood-vessels, provided it be applied
without force, and for a considerable time to the
body. It is in the jail-fever, and in the second
stage of the yellow fever only, in which its stimu-
lancy, and tonic powers are proper. Dr Jackson
establishes this mode of using it, by informing us,
that                                           

302 AN ACCOUNT OF THE
that when it did service, it "gave vigour and
tone" to the system *.
The third mode of practice which I mentioned
in this fever consisted of an union of the evacu-
ating, and tonic remedies. The physicians who
adopted this mode, gave calomel by itself in small
doses on the first, or second day of the fever, bled
once or twice in a sparing manner, and gave the
bark, wine, and laudanum in large quantities upon
the first appearance of a remission. After they be-
gan the use of these remedies, purging was omit-
ted, or if the bowels were moved, it was only by
means of gentle glysters. This practice I shall
say hereafter was not much more successful than
that which was recommended by Dr Kuhn and
Dr Stevens. It resembled throwing water and
oil at the same time upon a fire, in order to ex-
tinguish it.
The French remedies were nitre, and cremor
tartar in small doses, centaury tea, camphor, and
several other warm medicines; subacid drinks
taken in large quantities, the warm bath, and mo-
derate bleeding.
* Fevers of Jamaica.
After 

BILIOUS YELLOW FEVER. 303 
After what has been said, it must be obvious to
the reader, that the nitre and cremor tartar in
small doses, could do no good, and that camphor
and all cordial medicines must have done harm.
The diluting subacid drinks which the French
physicians gave in large quantities were useful in
diluting and blunting the acrimony of the bile, and
to this remedy assisted by occasional bleeding, I
ascribe most of the cures which were performed by
those physicians.
Those few persons in whom the warm bath pro-
duced copious and universal sweats recovered, but
in nearly all the cases which came under my no-
tice, it did harm.
I come now to inquire into the comparative
success of the four different modes of practice
which have been mentioned.
I have already said that ten out of thirteen
whom I treated with bark, wine, and laudanum,
and that three out of four, in whom I added the
cold bath to these remedies, died. Dr. Penning-
ton informed me, that he had lost all the patients,
(six in number) to whom he had given the above
medicines. Dr. Johnson assured me with great
concern, about two weeks before he died, that
he                                          
 

304 AN ACCOUNT OF THE
he had not recovered a single patient by them.
Whole families were swept off, where these me-
dicines were used. But further, most of those
persons who caught the fever in the city, and sick-
ened in the country, or in the neighbouring towns,
and who were treated with tonic remedies, died.
There was not a single cure performed by them
in New York, where they were used with every
possible advantage. But why do I multiply proofs
of their deadly effects? The clamours of hundreds
whose relations had perished by them, and the
fears of others, compelled those physicians who
had been most attached to them, to lay them aside,
or to prepare the way for them (as it was called)
by purging and bleeding. The bathing tub soon
shared a worse fate than bark, wine, and lauda-
num, and long before the disease disappeared, it
was discarded by all the physicians in the city.
In answer to these facts, we have been told that 
Mr. Hamilton, and his family recovered by the use
of Dr. Stevens's remedies. I shall not say of these
cures, what some gentlemen of the faculty who
had seen but little of the disease, and who had for-
gotten that a powerful epidemic banishes, or unites
with all other diseases, have said of my cures, viz.
that they were not of the yellow fever. It was
impossible for Mr. Hamilton to have had a fever
4 at

BILIOUS YELLOW FEVER. 305
at that time of any other kind. The neighbour-
hood in which he lived in the country, was healthy,
and he had been daily exposed at his office in Ches-
nut-street, to the contagion of the prevailing epide-
mic. The disease in this case was either very light,
or Mr. Hamilton owes more to the strength of his
constitution, and the goodness of Heaven, than
most of the people who recovered from the disor-
der. That it was light in all the branches of Mr.
Hamilton's family who were infected by him, I in-
fer from this being the case in every similar in- 
stance in which the disease spread in the country.
"Success (says Dr. Sydenham) is not a sufficient
proof of the excellency of a method of cure in
acute diseases, since some are recovered by the im-
prudent procedure of old women; but it is fur-
ther required, that the distemper should be easily
cured, and yield conformably to its own nature*,"
and again speaking of the cure of the new fever
of 1685, this incomparable physician observes,
"If it be objected, that this fever frequently yields
to a quite contrary method to that which I have
laid down, I answer, that the cure of a disease by
a method which is attended with success only now
and then in a few instances, differs extremely from
* Vol. ii. p. 254.
X that 

306 AN ACCOUNT OF THE
that practical method, the efficacy whereof appears
both from its recovering greater numbers, and all
the practical phenomena happening in the cure*."
After what has been said of Mr. Hamilton's
cure, it will not be expected that I should say any
thing of the three patients mentioned in Dr. Kuhn's
letter to the mayor who recovered under the use
of Dr. Stevens's remedies. The fourth patient
mentioned by Dr. Kuhn, whom he left on the 4th
day of the disease with "no unfavourable symp-
toms" was Dr. Hutchinson. I visited him the day
after Dr. Kuhn left him, and found him sitting in
a chair near the head of his bed, with all his
clothes on, as if he had been in his usual, health.
A short examination of his case, satisfied me that
he was in extreme danger. His face was suffused
with blood. He had a full pulse, and a hemor-
rhage from his gums, which last symptom I was
told came on the day before. I pressed him to
take a strong mercurial purge, but he refused it.
From that moment I despaired of his recovery.
He died three days afterwards.
The reader will naturally pause after reviewing
these remarks upon the above cures, and ask,
* Vol. ii. p. 354.
whether                                     

BILIOUS YELLOW FEVER. 307
whether it was consistent with the rules of just and
safe reasoning in medicine, to deduce a general
and uniform method of treating this disorder, from
the favourable issue of only four or five cases, and
whether it was candid, to condemn in the most un-
qualified manner, a contrary mode of practice,
after repeated public, and private declarations,
that it had at that time, cured several hundred
people.
Far be it from me to deny that indirect debility
may not be overcome by such stimuli as are more
powerful than those which occasion it. This has
sometimes been demonstrated by the efficacy of
bark, wine, and laudanum, in the confluent and
petechial small-pox; but even this state of that dis-
order, yields more easily to blood-letting, or to
plentiful evacuations from the stomach and bowels
on the first or second day of the eruptive fever.
This I have often proved, by giving a large dose
of tartar emetic, and calomel, as soon as I was sa-
tisfied from circumstances, that my patient was in-
fected with the small-pox. But the indirect debi-
lity of the yellow fever appears to be much great-
er, than that which occurs in the small-pox, and
hence it more uniformly resisted the most power-
ful tonic remedies.
X2 I have


308 AN ACCOUNT OF THE
I have publicly asserted, that the remedies which
I adopted, and of which I have given a history,
cured a greater proportion than ninety-nine out
of an hundred of all who applied to me on the
first day of the disorder before the 15th day of
September. I regret that it is not in my power
to furnish a list of them, for a majority of them
were poor people, whose names are still unknown
to me. I was not singular in this successful prac-
tice in the first appearance of the disorder. Dr.
Pennington assured me on his death bed, that he
had not lost one, out of forty-eight patients whom
he had treated agreeably to the principles and
practice I had recommended. Dr. Griffitts tri-
umphed over the disease in every part of the city,
by the use of what were called the new remedies.
My former pupils spread by their success, the re-
putation of purging, and bleeding, wherever they
were called. Unhappily the pleasure we derived
from this success in the treatment of the disorder,
was of short duration. Many circumstances con-
tributed to lessen it, and to revive the mortality
of the fever. I shall briefly enumerate them.
1. The distraction produced in the public mind,
by the recommendation of remedies, the opposites
in every respect of purging and bleeding.
2. The

BILIOUS YELLOW FEVER. 309 
2. The opinion which had been published by
several physicians, and inculcated by others, that
we had other fevers in the city besides the yellow
fever. This produced a delay in many people in
sending for a physician, or in taking medicines for
two or three days, from a belief that they had
nothing but a cold, or a common fever. Some
people were so much deceived by this opinion,
that they refused to send for physicians left they
should be infected by them, with the yellow fever.
In most of the cases in which these delays took
place, the disease proved mortal.
To obviate a suspicion, that I have laid more
stress upon the fatal influence of this error than
is just, I hall here insert an extract of a letter I
have lately been favoured with from Mr. John
Connelly one of the city committee, who fre-
quently left his brethren in the City Hall, and spent
many hours in visiting and prescribing for the sick.
"The publications (says he) of some physicians
that there were but few persons infected with the
yellow fever, and that many were ill with colds
and common remitting and fall fevers, proved fa-
tal to almost every family which was credulous
enough to believe them. That opinion slew in
hundreds, if not its thousands, many of whom did
nor send for a physician until they were in the last
X stage                     

310 AN ACCOUNT OF THE
stage of the disorder, and beyond the power of
medicine."
3. The interference of the friends of the stimu-
lating system, in dissuading patients from submit-
ing to sufficient evacuations.
4. The deceptions which were practised by
some patients upon their physicians in their re-
ports of the quantity of blood they had lost, or
of the quality, and number of their evacuations
by stool.
5. The impracticability of procuring bleeders
as soon as bleeding was prescribed. Life in this
disease, as in the apoplexy, frequently turned upon
that operation being performed within an hour.
It was often delayed from the want of a bleeder,
one or two days.
6. The inability of physicians, from the num-
ber of their patients, and from frequent indisposi-
tion, to visit the sick, at such times, as was neces-
sary to watch the changes in their disorder.
7. The great accumulation, and concentration
of the contagion in sick rooms from the continu-
ance of the disease in the city, whereby the system
was             

BILIOUS YELLOW FEVER. 311
was exposed to a constant stimulus, and the effect
of evacuations was thus defeated.
8. The want of skill or fidelity in nurses to ad-
minister the medicines properly, to persuade pa-
tients to drink frequently; also to supply them
with food or cordial drinks when required in the
night.
9. The great degrees of indirect debility in-
duced in the systems of many of the people who
were affected by the disorder, from fatigue in at-
tending their relations or friends.
10. The universal depression of mind, amounting
in some instances to despair, which affected many
people. What medicine could act upon a patient
who awoke in the night, and saw through the
broken and faint light of a candle, no human
creature, but a black nurse, perhaps asleep in a
distant corner of the room, and who heard no
noise, but that of a hearse conveying, perhaps, a
neighbour or friend, to the grave? The state of
mind under which many were affected by the dis-
ease, is so well described by the Rev. Dr. Smith
in the case of his wife, in a letter I received from
him in my sick room, two days after her death,
that I hope I shall be excused for inserting an
X4 extract                                    
 

312 AN ACCOUNT OF THE
extract from it. It forms a part of the history of
the disease. The letter was written in answer to
a short note of condolence which I sent to the
Doctor immediately after hearing of Mrs. Smith's
death. After some pathetic expressions of grief,
he adds, "The scene of her funeral, and some
preceding circumstances, can never depart from
my mind. On our return from a visit to our
daughter, whom we had been striving to console
on the death of Mrs. Keppele, who was long fa-
miliar, and dear to both, my dear wife passing the
burying ground gate, led me into the ground, view-
ed the graves of her two children, called the old
grave digger, marked a spot for herself as close
as possible to them and the grave of Dr. Phineas
Bond, whose memory she adored. Then by the
side of the spot she had chosen, we found room
and chose mine, pledging ourselves to each other,
and directing the grave-digger that this should be
the order of our interment. We returned to our
house. Night approached. I hoped my dear
wife had gone to rest, as she had chosen since her
return from nursing her daughter, to sleep in a
chamber by herself, through fear of infecting her
grand child and me. But it seems she closed not
her eyes; sitting with them fixed through her
chamber window on Mrs. Keppele's house, until
about midnight she saw her herse and followed it 
with           

BILIOUS YELLOW FEVER. 313
with her eyes as far as it could be seen. Two
days afterwards Mrs. Rodgers, her next only sur-
viving intimate friend, was carried past her win-
dow, and by no persuasion could I draw her from
thence, nor stop her sympathetic foreboding tears,
so long as her eyes could follow the funeral, which
was through two squares, from Fourth to Second
street, where the herse disappeared." The Doc-
tor proceeds in describing the distress of his wife.
But pointed as his expressions are, they do not
convey the gloomy state of her mind with so much
force as she has done it herself in two letters to
her niece Mrs. Cadwallader, who was then in the
country. The one was dated the 9th, the other
the 11th of October. I shall insert a few extracts
from each of them. "October 9th; It is not
possible for me to pass the streets without walking
in a line with the dead. Passing infected houses,
and looking into open graves. This has been the
case for many weeks. I don't know what to write,
my head is gone, and my heart is torn to pieces."
"I intreat you to have no fears on my account. I
am in the hand of a just and merciful God, and his
will be done."
October 11th: "Don't wonder that I am so
low to day. My heart is sunk down within me."
The                                         

314 AN ACCOUNT OF THE
The next day this excellent woman sickened, and
died on the 19th of the same month.
If in a person possessed naturally of uncommon
equanimity, and fortitude, the distresses of our
city, produced such dejection of spirits, what must
have been their effect upon hundreds, who were not
endowed with those rare and extraordinary quali-
ties of mind? Death in this, as well as in many
other cases in which medicine had done its du-
ty, appeared to be the inevitable consequence of
the total abstraction of the energy of the mind in
restoring the natural motions of life.
Under all the circumstances which have been
mentioned, which opposed the system of depletion
in the cure of this fever, it was still far more suc-
cessful than any other mode of cure that had
been pursued before in the United States or in
the West Indies.
Three out of four died of the disorder in Ja-
maica, under the care of Dr. Hume.
Dr. Blane considers it as one of the "most
mortal" of diseases, and Dr. Jackson places a
more successful mode of treating it, among the
subjects                                        

BILIOUS YELLOW FEVER. 315 
subjects which will admit of "innovation" in
medicine.
After the 15th of September my success was
much limited, compared with what it had been
before that time. But at no period of the disease
did I lose more than one in twenty of those whom
I saw on the first day, and attended regularly
through every stage of the fever; provided they
had not been previously worn down by attending
the sick.
The following statement which will admit of
being corrected, if it be inaccurate, will I hope,
establish the truth of the above assertions.
About one half of the families whom I have at-
tended for many years, left the city. Of those
who remained, many were affected by the disor-
der. Out of the whole of them, after I had
adopted my second mode of practice, I lost only
five heads of families, and about a dozen servants
and children. In no instance did I lose the master
and mistress of the same family. My success in these
cases was owing to two causes; 1st, To the credit my
former patients gave to my public declaration, that
we had only one fever in the city; hence they ap-
plied                                        


316 AN ACCOUNT OF THE
plied on the first day, and sometimes on the first
hour of their indisposition; and 2dly, To the nu-
merous pledges many of them had seen of the
safety and efficacy of copious blood-letting by my
advice, in other diseases: hence my prescription
of that necessary remedy, was always obeyed in
its utmost extent. Of the few adults whom I lost,
among my former patients, two of them were old
people; two took laudanum without my know-
ledge; and one refused to take medicine of any
kind; all the rest had been worn down by previ-
ous fatigue.
I have before said that a great number of the
blacks were my patients. Of these not one died
under my care. This uniform success among
those people, was not owing altogether to the
mildness of the disease, for I shall say presently,
that a great proportion of a given number died un-
der other modes of practice.
In speaking of the comparative effects of purg-
ing and bleeding, it may not be amiss to repeat,
that not one pregnant woman to whom I pre-
scribed them died, or suffered abortion. Where
the tonic remedies were used, abortion or death,
and in many instances both, were nearly universal.
Many          

BILIOUS YELLOW FEVER. 317 
Many whole families, consisting of five, six, and
in three instances, of nine members,  were reco-
vered by plentiful purging and bleeding. I could
swell this work by publishing a list of those fami-
lies; but I take more pleasure in adding, that I
was not singular in my success in the use of the
above remedies. They were prescribed with
great advantage by many of the physicians of the
city, who had for a while given tonic medicines
without effect. I shall not mention the names of
any of the physicians who totally renounced those
medicines, left I should give offence by not men-
tioning them all. Many large families were cured
by some of them, after they adopted and pre-
scribed copious purging and blood-letting. One
of them cured ten in the family of Mr. Robert
Haydock, by means of those remedies. In one of
that family, the disease came on with a vomiting
of black bile.
But the use of the new remedies was not di-
rected finally by the physicians alone. The cler-
gy, the apothecaries, many private citizens, seve-
ral intelligent women, and two black men, prescri-
bed them with great success. Any more, many
persons prescribed them to themselves; and as I
shall say hereafter, with a success that was une-
qualled by any of the regular or irregular practi-
tioners in the city. 
It

318 AN ACCOUNT OF THE
It was owing to the almost universal use of 
purging and bleeding, that the mortality of the
disease diminished in proportion as the number of
persons who were affected by it, encreased about
the middle of October. It was scarcely double of
what it was in the middle of September, and yet
six times the number of persons were probably at
that time confined by it.
The success of copious purging and bleeding
was not confined to the city of Philadelphia. Se-
veral persons who caught the disease in town, and
sickened in the country, were cured by them.
Could a comparison be made of the number of
patients who died of our late fever, after having
been plentifully bled and purged, with those who
died of the yellow fever in the years 1699, 1741,
1747, and 1762, I am persuaded that the propor-
tion would be very small in the year 1793, com-
pared with the former years*. Including all who
died under every mode of treatment, I suspect the
* It appears from one of Mr. Norris's letters, dated the
9th of November, O. S. that there died 220 persons in the
year 1699, with the yellow fever. Between 80 and 90 of
them he says belonged to the society of Friends. The city
at this time probably did not contain more than 2 or 3000
people, many of whom it is probable fled from the disorder.
mortality                                        

BILIOUS YELLOW FEVER. 319 
mortality to be less in proportion to the popula-
tion of the city, and the number of persons who
were affected, than it was in any of the other years
that have been mentioned.
Not less than 6000 of the inhabitants of Phila-
delphia probably owe their lives to purging and
bleeding, during the late autumn.
I proceed with reluctance to inquire into the
comparative success of the French practice. It
would not be difficult to decide upon it from ma-
ny facts that came under my notice in the city;
but I shall rest its merit wholly upon the returns
of the number of deaths at Bush-hill. This hospi-
tal, after the 22d of September, was put under
the care of a French physician, who was assisted
by one of the physicians of the city. The hospital
was in a pleasant and airy situation; it was provid-
ed with all the necessaries and comforts for sick
people that humanity could invent, or liberality
supply. The attendants were devoted to their
duty; and cleanliness and order pervaded every
room in the house. The reputation of this hospi-
tal and of the French physician, drew patients to
it in the early stage of the disorder. Of this I
have been assured in a letter from Dr. Annan,
who was appointed to examine and give orders of
admission                                      


320 AN ACCOUNT OF THE
admission into the hospital, to such of the poor of
the district of Southwark, as could not be taken
care of in their own houses. Mr. Olden has like-
wise informed me, that most of the patients who
who were sent to the hospital by the city commit-
tee (of which he was a member) were in the first
stage of the fever. With all these advantages,
the deaths between the 22d of September and the
6th of November, amounted to 448 out of 807
patients who were admitted into the hospital with-
in that time. Three fourths of all the blacks
(nearly 20) who were patients in this hospital
died. A list of the medicines prescribed there
may be seen in the minutes of the proceedings of
the city committee. Calomel and jalap are not
among them. Moderate bleeding and purging
with Glauber salts, I have been informed, were
used in some cases by the physicians of this hos-
pital. The proportion of deaths to the recove-
ries, as it appears in the minutes of the committee
from whence the above report is taken, is truly
melancholy! I hurry from it therefore to a part
of this work, to which I have looked with plea-
sure, ever since I sat down to compose it.
I have said that the clergy, the apothecaries,
and many other persons who were uninstructed in
the principles of medicine, prescribed purging, and
4 bleeding 

BILIOUS YELLOW FEVER. 321 
bleeding with great success in this disorder. Ne-
cessity gave rise to this undisciplined sect of practi-
tioners, for they came forward to supply the places
of the regular bred physicians who were sick or
dead. I shall mention the names of a few of those
persons who distinguished themselves as volunteers
in this new work of humanity. The late Rev.
Mr. Fleming one of the ministers of the Catholic
church, carried the purging powders in his pocket,
and gave them to his poor parishioners with great
success. He even became the advocate of the new
remedies. In a conversation I had with him on
the 22d of September, he informed me, that he
had advised four of our physicians whom he met
a day or two before, "to renounce the pride of
science, and to adopt the new mode of practice,
for that he had witnessed its good effects in many
cases." Mr. John Keihrale, a German apothecary
has assured me that out of  314 patients whom he
visited, and 187 for whom he prescribed from the
reports of  their friends, he loft only 47  (which is
nearly but one in  eleven) and that he treated them
all  agreeably to the method which I had recom-
mended. The Rev. Mr. Schmidt one of the mi-
nisters of the Lutheran church, was cured by him.
I have before mentioned an instance of the judg-
ment of Mr. Connelly, and of his zeal in visiting
and prescribing for the sick. His remedies were
Y bleeding 

322 AN ACCOUNT OF THE
bleeding and purging. He moreover, bore a con-
stant and useful testimony against bark, wine, lau-
danum, and the warm bath*. Mrs. Paxton in
Carter's alley, and Mrs. Evans the wife of Mr.
John Evans in Second-street, were indefatigable;
the one in distributing mercurial purges composed
by herself, and the other in urging the necessity
of copious bleeding and purging among her friends
and neighbours, as the only safe remedies for the
fever. These worthy women were the means of
saving many lives†. Absalom Jones, and Richard
Allen, two black men, spent all the intervals of
* In the letter before quoted, from Mr. Connelly, he
expresses his opinion of those four medicines in the follow-
ing words. "Laudanum, bark, and wine, have put a
period to the existence of some, where the fever has been
apparently broken, and the patients in a fair way of reco-
very; a single dose of laudanum has hurried them suddenly
into eternity. I have visited a few patients, where the hot
bath was used, and am convinced that it only tended to
weaken and relax the system, without producing any good
effect."
† The yellow fever prevailed at the Caraccos in South
America in October 1793, with great mortality, more espe-
cially among the Spanish troops. Nearly all died who
were attended by physicians.  Recourse was finally had to
the old women, who were successful in almost every case to
which they were called. Their remedies were a liquor called
narencado (a species of lemonade) and a tea made of a root
called                                              

BILIOUS YELLOW FEVER. 323
time, in which they were not employed in burying
the dead, in visiting the poor who were sick, and
in bleeding and purging them, agreeably to the
directions which had been printed in all the news
papers. Their success was unparalleled by what
is called regular practice. This encomium upon
the practice of the blacks, will not surprise the
reader when I add, that they had no fear of putre-
faction in the fluids, nor of the calumnies of a
body of fellow citizens in the republic of medi-
cine, to deter them from plentiful purging and
bleeding. They had besides no more patients,
than they were able to visit two or three times a
day. But great as their success was, it was ex-
ceeded by those persons who in despair of procu-
ring medical aid of any kind, purged and bled
themselves. This palm of superior success, will
not be withheld from those people, when I explain
the causes of it. It was owing to their early use
of the proper remedies, and to their being guided
in the repetition of them, by the continuance of a
tense pulse, or of pain and fever. A day, an af-
called fistula. With these drinks, they drenched their pa-
tients for the first two or three days. They induced plenti-
ful sweats, and probably, after blunting, discharged the
bile from the bowels. I received this information from an
American gentleman who had been cured by one of those
amazons in medicine, in the above way.
Y2 ternoon, 

324 AN ACCOUNT OF THE
ternoon, and even an hour, were not lost by these
people in waiting for the visit of a physician who
was often detained from them, by sickness, or by
new and unexpected engagements, by which means
the precious moment for using the remedies with
effect, passed irrevocably away. I have stated
these facts from faithful inquiries, and numerous
observations. I could mention the names, and
families of many persons who thus cured them-
selves. One person only shall be mentioned, who
has shown by her conduct what reason is capable
of doing when it is forced to act for itself. Mrs.
Long, a widow, after having been twice unsuc-
cessful in her attempts to procure a physician, un-
dertook at last to cure herself. She took several
of the mercurial purges, agreeably to the printed
directions, and had herself bled seven times in the
course of five or six days. The indication for re-
peating the bleeding, was the continuance of the
pain in her head. Her recovery was rapid, and
complete. The history of it was communicated
to me by herself, with great gratitude, in my own
house, during my second confinement with the
fever. To these accounts of persons who cured
themselves in the city, I could add many others,
of citizens who sickened in the country, and who
cured themselves by plentiful bleeding and pur-
ging, without the attendance of a physician.
From                                        

BILIOUS YELLOW FEVER. 325 
From a short review of these facts, reason, and
humanity awake from their long repose in medi-
cine, and unite in proclaiming, that it is time to
take the cure of pestilential fevers out of the hands
of physicians, and to place it in the hands of the
people. Let not the reader startle at this propo-
sition. I shall give the following reasons for it.
1. In consequence of these pestilential fevers
affecting a great number of people at one time,
it has always been, and always will be impossible
for them all to have the benefit of medical aid,
more especially as the proportion of physicians to
the number of sick, is generally diminished upon
these occasions, by desertion, sickness and death.
2. The safety of committing to the people the
cure of pestilential fevers, particularly the yellow
fever and the plague, is established by the simpli-
city and uniformity of their proximate cause, and
of their remedies. However diversified they may
be in their symptoms, the system in both diseases
is always under a state of indirect debility, and in
all cases requires the abstraction of stimulus in a
greater or less degree, or in a sudden or gradual
manner. There can never be any danger of the
people injuring themselves by mistaking any other
disease for a yellow fever, or plague, for no other
Y3 febrile

326 AN ACCOUNT OF THE
febrile disorder can prevail with them. It was
probably to prevent this mistake that the Bene-
volent Father of mankind, who has permitted no
evil to exist which does not carry its antidote along
with it, originally imposed that law upon all great
and mortal epidemics.
3. The history of the yellow fever in the West
Indies, proves the advantage of trusting patients
to their own judgment. Dr. Lind has remarked,
that a greater proportion of sailors who had no
physicians, recovered from that fever, than of
those who had the best medical assistance. The
fresh air of the deck of a ship, a purge of salt
water, and the free use of cold water, probably
triumphed here over the cordial juleps of physi-
cians.
4. By committing the cure of this and other
pestilential diseases to the people, all those cir-
cumstances which prevented the universal success
of purging, and bleeding in our late epidemic,
will have no operation. The fever will be mild
in most cases, for all will prepare themselves to
receive it by a vegetable diet, and by moderate
evacuations. The remedies will be used the mo-
ment the disease is felt or even seen, and the con-
tagion generated by it, will be feeble and propa-
gated            

BILIOUS YELLOW FEVER. 327
gated only to a small distance from such patients.
There will then be no disputes among physicians
about the nature of the disease to distract the pub-
lic mind, for they will seldom be consulted in it.
None will suffer from chronic debility induced by
previous fatigue, in attending the sick, nor from
the want of nurses, for few will be so ill as to re-
quire them, and there will be no "foreboding"
fears of death or despair of recovery, to invite an
attack of the disease, or to ensure its mortality.
The small-pox was once as fatal as the yellow
fever and the plague. At present, it yields as
universally to a vegetable diet, and evacuations,
in the hands of apothecaries, the clergy, and even
of the good women, as it does in the hands of
Doctors of physic.
They have narrow conceptions, not only of the
divine goodness, but of the gradual progress of
human knowledge, who suppose that all pestilen-
tial diseases shall not, like the small-pox, sooner or
later cease to be the scourge and terror of man-
kind.
For a long while, air, water, and even the light
of the fun, were dealt out by physicians to their
patients with a sparing hand. They possessed for se-
veral centuries the same monopoly of many artificial
Y4 remedies. 


328 AN ACCOUNT OF THE
remedies. But a new order of things is rising in
medicine, as well as in government. Air, water,
and light are taken without the advice of a physi-
cian, and bark and laudanum are now prescribed
every where by nurses, and mistresses of families,
with safety and advantage. Human reason cannot
be stationary upon these subjects. The time must,
and will come, when in addition to the above re-
medies, the general use of calomel, jalap, and the
lancet, shall be considered among the most essential
articles of the knowledge, and rights of man.
It is no more necessary, that a patient should be
ignorant of the medicine he takes to be cured by
it, than that the business of government should be
conducted with secrecy, in order to ensure obedi-
ence to just laws. Much less is it necessary that
the means of life should be prescribed in a dead
language, or dictated with the solemn pomp of a
necromancer. The effects of imposture in every
thing are like the artificial health produced by the
use of ardent spirits. Its vigour is temporary, and
is always followed by misery and death.
The belief that the yellow fever and the plague
are necessarily mortal, is as much the effect of a
superstitious torpor in the understanding, as the
ancient belief, that the epilepsy was a supernatural
disease, and that it was an offence against heaven
to                                           

BILIOUS YELLOW FEVER. 329
to attempt to cure it. It is partly from the influ-
ence of this torpor in the minds of some people,
that the numerous cures of the yellow fever per-
formed by a few simple remedies, were said to be
of other diseases. It is necessary, for the conviction
of such persons, that patients should always die of
that, and other dangerous disorders, to prove that
they have been affected by them.
The repairs which our world is undergoing, as
far as they relate to the melioration of the condi-
tion of man, will be incomplete, until pestilential
fevers cease to be numbered among the widest out-
lets of human life.
There are many things which are now familiar
to women and children, which were known a cen-
tury ago, only to a few men who lived in closets,
and were distinguished by the name of philoso-
phers.
We teach an hundred things in our schools less
useful, and many things more difficult, than the
knowledge that would be necessary to cure a yel-
low fever or the plague.
In my attempts to teach the citizens of Phila-
delphia by my different publications, the method
of                                           

330 AN ACCOUNT OF THE
of curing themselves of our late fever, I observed
no difficulty in their apprehending every thing
that was addressed to them, except what related
to the different states of the pulse. All the know-
ledge that is necessary to discover when blood-
letting is proper, might be taught to a boy or girl
of twelve years old in a few hours. I taught it in
less time to several persons during the prevalence
of our late epidemic.
I would as soon believe that ratifia was intend-
ed by the Author of Nature, to be the only drink
of man, instead of water, as believe that the know-
ledge of what relates to the health and lives of a
whole city, or nation, should be confined to one,
and that a small or a privileged order of men.--
But what have physicians, what have universities,
or medical societies done after the labours, and
studies of many centuries towards lessening the
mortality of pestilential fevers? They have either
copied, or contradicted each other, in all their
publications. Plagues and malignant fevers, are
still leagued with war and famine, in their ravages
upon human life.
Botallus in France, and Dr. Sydenham in Eng-
land, it is true, long ago used the proper remedies
for those disorders with universal success; but
they                                          

BILIOUS YELLOW FEVER. 331
they were unable to introduce them into general
practice. The reason is obvious: They recom-
mended them in their writings only to physicians.
At the expense of an immense load of obloquy,
I have addressed my publications to the people.
The appeal though hazardous, in the present state
of general knowledge in medicine, has succeeded.
The citizens of Philadelphia are delivered from
their fears of copious evacuations, of cold air, and
cold water, and above all, of a sore mouth from
mercury, in the cure of the yellow fever; and the
pride and formalities of medicine, as far as they
relate to this disease, are now as completely dis-
carded in our city, as the deceptions of witchcraft
were, above a century ago.
To prevent the propagation and mortality of
this fever, it will be necessary when it makes its
appearance in a city or country, to publish an ac-
count of those symptoms which I have called the
precursors of the disease, and to exhort the peo-
ple as soon as they feel those symptoms, to have
immediate recourse to the remedies of purging or
bleeding. The danger of delay in using one, or
both those remedies, should be inculcated in the
strongest terms, for the disease, like Time, has a
lock on its forehead, but is bald behind. The
bite of a rattle-snake is seldom fatal, because the
medicines                                      

332 AN ACCOUNT OF THE
medicines which cure it, are applied, or taken, as
soon as the poison comes in contact with the blood.
There is less danger to be apprehended from the
contagion of the yellow fever in the system than
from the poison of the snake, provided the reme-
dies for it, are administered within a few hours af-
ter it is excited into action.
Let persons who are subject to chronic pains, or
diseases of any kind, be advised not to be deceived
by them. Every pain at such a time, is the be-
ginning of the disease; for the contagion I have
said, always acts first on debilitated parts of the
body. From an ignorance of the law of epidemics
many persons by delaying their applications for
help, perished with our late fever.
Let nature be trusted in no case whatever, to
cure this disease, and let no attack of it, however
light, be treated with neglect. Death as certainly
performs his work, when he steals on the system
in the form of a mild intermittent, as he does, when
he comes on with the symptoms of apoplexy, or a
black vomiting.
Cleanliness in houses and dress, cannot be too
often inculcated during the prevalence of a yellow
fever.
Lastly,                                        

BILIOUS YELLOW FEVER. 333
Lastly, Let those who are in health be directed
to prepare their bodies by means of a low diet, for
the reception of the disease in the manner that has
been formerly mentioned; let pleasure, and even
labour, where it exposes men to the heat of the
sun, or of a culinary fire, be every where suspended.
Thus, while the system is prepared to bend like
the willow, the contagion of the fever will pass over
it, without doing any harm.
Let it not be supposed, that I mean, that the
history which I have given of the method of cure
of our late epidemic, should be applied in all its
parts, to the yellow fevers which may appear
hereafter in the United States, or which exist at
all times in the West India islands. Season and
climate vary this, as well as all other diseases.
Bark and wine, so fatal in our late, may be pro-
per in a future yellow fever. But without the
fear of being refuted, I will notwithstanding assert,
that the proper remedies for this fever at all
times, and in all places in its first stage, must be
evacuations. The only inquiry, when the disease
makes its appearance, should be, from what part
of the body these evacuations should be procured;
the order which should  be pursued in obtaining
them, and the quantity of each of the matters to
be                                            

334 AN ACCOUNT OF THE
be discharged, which should be withdrawn at a
time.
Thus far did I venture from my theory of the
disease, and from the authorities of Dr. Hillary
and Dr. Mosely, to decide in favour of evacua-
tions in the yellow fever in hot climates; but Dr.
Wade, and Mr. Chisholm again support me by
their practice in the fevers of the East and  West
Indies. They both gave strong mercurial pur-
ges, and bled in some cases. Dr. Wade confirm-
ed by his practice, the advantage, of gradually
abstracting stimulus from the system. He never
drew blood even in the most inflammatory cases,
until he had first discharged the contents of the
bowels. The Doctor has further established the
efficacy of a vegetable diet, and of water as a
drink, as the best means of preventing the disor-
der in a hot climate.
The manner in which the contagion of the
plague acts upon the system, is so much like that
which has been described in the yellow fever, and
the accounts of the efficacy of low diet in pre-
paring the body for its reception, and of copious
bleeding, cold air and cold water, in curing it,
are so similar, that all the directions which relate
to                                            

BILIOUS YELLOW FEVER. 335
to preventing, mitigating, or curing the yellow
fever, may be applied to it. The fluids in the
plague shew a greater tendency to the skin, than
they do, in the yellow fever. Perhaps upon this
account, the early use of powerful sudorifics
may be more proper in the former, than in the
latter disorder. From the influence of early purg-
ing, and bleeding in promoting sweat in the yellow
fever, there can be little doubt, but the efforts of
nature to unload the system in the plague through
the channel of the pores, might be accelerated by
the early use of the same remedies. One thing with
respect to the plague is certain; that its cure de-
pends upon the abstraction of stimulus, either by
means of plentiful sweats, or of purulent matter
from external sores. Perhaps the efficacy of these
remedies depends wholly upon their diminishing
the indirect debility of the system in a gradual man-
ner. If this be the case, those natural discharges
might be easily and effectually imitated by small and
repeated bleedings.
To correspond in quantity with the discharge
from the skin, blood-letting in the plague should
be copious. A profuse sweat continued for twen-
ty four hours, cannot fail of wasting many pounds
of the fluids of the body. This was the duration
of                                             

336 AN ACCOUNT OF THE
of the critical sweats in the famous plague which
was known by the name of the English sweating
sickness, and which made its appearance in the
army of Henry VII. in Milford-Haven in Wales,
and spread from thence through every part of the
kingdom.
The principles which lead to the prevention and
cure of the yellow fever and the plague, apply
with equal force to the mitigation of the measles,
and to the prevention or mitigation of the scarlatina
anginosa, the dysentery, and the jail or hospital fe-
ver. I have remarked in a former publication*, that
a previous vegetable diet lessened the violence and
danger of the measles. Dr. Sims taught me seve-
ral years ago, to prevent or mitigate the scarlatina
anginosa, by means of gentle purges after Children
are infected by it†. Purges of salts have in many
instances preserved whole families and neighbour-
hoods from the dysentery where they have been
exposed to the contagion. During the late Ame-
rican war, an emetic seldom failed of preventing
an attack of the hospital fever, when given in its
forming state‡. I have had no experience of the
* Medical Inquiries and Observations, vol. ii. page 244.
† Medical Memoirs, vol. i.
‡ Medical Inquiries and Observations. vol. i. page 211.
4 effects             

BILIOUS YELLOW FEVER. 337
effects of previous evacuations in abating the vio-
lence, or preventing the mortality of the malig-
nant sore throat, but I can have no doubt of their
efficacy from the sameness of the state of the sys-
tem in that disorder, as in other malignant fevers.
The debility induced in it, is of the indirect kind,
and the supposed symptoms of putrefaction, are
nothing but the disguised effects of a sudden and
violent pressure of an inflammatory stimulus upon
the arterial system.
With these observations I close the history of
the rise, progress, symptoms, and treatment of the
bilious remitting yellow fever which lately ap-
peared in Philadelphia. My principal aim has
been to revive, and apply to it, the principles, and
practice of Dr. Sydenham, and however coldly
those principles, and that practice may be received
by come physicians of the present day, I am satis-
fied that experience in all ages, and in all countries,
will vouch for their truth and utility.
Z



[339]
NARRATIVES of escapes from
great dangers of shipwreck, war, captivity, and
famine, have always formed an interesting part of
the history of the body, and mind of man. But
there are deliverances from equal dangers, which
have hitherto passed unnoticed, I mean, from
pestilential fevers. I shall briefly describe the state
of my body and mind, during my intercourse with
the sick in our late epidemic. The account will
throw additional light upon the disorder, and pro-
bably illustrate some of the laws of the animal
economy. It will moreover serve to furnish a
lesson to all who may be placed in similar circum-
stances, to commit their lives without fear, to the
protection of that BEING who is able to save to
the uttermost, not only from suture but from pre-
sent evil.
Some time before the fever made its appearance,
my wife and children went into the state of New-
Jersey where they had long been in the habit of
spending the summer months. My family about
the                                          


340 AN ACCOUNT OF THE
the 25th of August, consisted of my mother, a sis-
ter who was on a visit to me, a black servant man,
and a mulatto boy. I had five pupils, viz. Warner
Washington, and Edward Fisher, of Virginia,
John Alston of South Carolina, and John Red-
man Coxe (grandson to Dr. Redman) and John
Stall both of this city. They all crowded around
me upon the sudden encrease of business, and with
one heart devoted themselves to my service, and
to the cause of humanity.
The credit which the new mode of treating the
disease acquired in all parts of the city, produced
an immense influx of patients to me from all quar-
ters. My pupils were constantly employed; at
first in putting up purging powders, but after a
while, only in bleeding and visiting the sick.
Between the eighth and the 15th of September
I visited and prescribed for between an hundred and
an hundred and twenty patients a day. Several of
my pupils visited a fourth or fifth part of that
number. For a while we refused no calls. In
the short intervals of business which I spent at my
meals, my house was filled with patients, chiefly
the poor, waiting for advice. For many weeks I
seldom ate without prescribing for numbers as I
sat at my table. To assist me at these hours, as
well                                          

BILIOUS YELLOW FEVER. 341
well as in the night, Mr. Stall, Mr. Fisher and
Mr. Coxe, accepted of rooms in my house, and
became members of my family. Their labours
now had no remission.
Immediately after I adopted the antiphlogistic
mode of treating the disorder, I altered my man-
ner of living. I left off drinking wine and malt
liquors. The good effects of the disuse of these
liquors, helped to confirm me in the theory I had
adopted of the disease. A troublesome head-ach,
which I had occasionally felt, and which excited
a constant apprehension that I was taking the fever,
now suddenly left me. I likewise at this time left
off eating solid animal food, and lived wholly, but
sparingly, upon weak broth, potatoes, raisins,,
coffee, and bread and butter.
From my great intercourse with the sick, my
body became highly impregnated with the conta-
gion. My eyes were yellow, and sometimes a
yellowness was perceptible in my face. My pulse
was preternaturally quick, and I had profuse
sweats every night. These sweats were so offen-
sive as to oblige me to draw the bed-cloths close
to my neck to defend myself from their smell.
They lost their fœtor entirely upon my leaving
Z3 off                  

342 AN ACCOUNT OF THE
off the use of broth, and living intirely upon
milk and vegetables. But my nights were ren-
dered disagreeable, not only by these sweats, but
by the want of my usual sleep, produced in part
by the frequent knocking at my door, and in part
by anxiety of mind, and the stimulus of the con-
tagion upon the system. I lay down in conformi-
ty to habit only, for my bed ceased to afford me
rest or refreshment. When it was evening, I
wished for morning; and when it was morning,
the prospect of the labours of the day, caused me
to wish for the return of evening. The degrees
of my anxiety may be easily conceived, when I
add, that I had at one time upwards of thirty
heads of families under my care: among these
were Mr. Josiah Coates, the father of eight, and
Mr. Benjamin Scull, and Mr. John Morrell, each
fathers of ten children. They were all in immi-
nent danger; but it pleased God to make me the
instrument of saving each of their lives. I rose
at 6 o'clock, and generally found a number of
persons waiting for advice in my shop or parlour.
Hitherto the success of my practice gave a tone
to my mind, which imparted preternatural vigour
to my body. It was meat and drink to me to ful-
fil the duties I owed to my fellow citizens in this
time of great and universal distress. From a hope
that                                          
 

BILIOUS YELLOW FEVER. 343
that I might escape the disease, by avoiding every
thing that could excite the contagion in my body
into action, I carefully avoided the heat of the
sun, and the coldness of the evening air. I like-
wise avoided yielding to every thing that should
raise or depress my passions. But at such a time,
the events which influence the state of the body
and mind are no more under our command, than
the winds or weather. On the evening of the
14th of September, after eight o'clock, I visited
the son of Mrs. Berriman, near the Swedes
church, who had sent for me early in the morn-
ing. I found him very ill. He had been bled in
the forenoon by my advice, but his pulse indi-
cated a second bleeding. It would have been dif-
ficult to procure a bleeder at that late hour. I
therefore bled him myself. From hanging over
his breath and blood for ten minutes, and after-
wards riding home in the night air, debilitated as
I was by the labours of the day, I found myself
much indisposed the ensuing night. I rose not-
withstanding at my usual hour. At 8 o'clock I
lost ten ounces of blood, and immediately after-
wards got into my chair, and visited between for-
ty and fifty patients before dinner. At the house
of one of them, I was forced to lie down a few
minutes. In the course of this morning's labours,
my mind was suddenly thrown off its pivots, by
Z4 the

344 AN ACCOUNT OF THE
the last look, and the pathetic cries of a friend for
help, who was dying under the care of a French
physician. I came home about two o'clock, and
was seized immediately afterwards with a chilly
fit and a high fever. I took a dose of the mercu-
rial medicine, and went to bed. In the evening
I took a second purging powder, and lost ten
ounces more of blood. The next morning I
bathed my face, hands, and feet in cold water for
some time. I drank plentifully during the day
and night, of weak hyson tea, and of water, in
which currant jelly had been dissolved. At 8
o'clock I was so well as to admit persons who came
for advice into my room, and to receive reports
from my pupils of the state of as many of my
patients as they were able to visit; for unfortu-
nately they were not able to visit them all (with
their own) in due time; by which means several
died. The next day I came down stairs, and pre-
scribed in my parlour for not less than an hundred
people. On the 19th of the same month, I resumed
my labours, but in great weakness. It was with
difficulty that I ascended a pair of stairs, by the
help of a banister. A slow fever, attended with
irregular chills, and a troublesome cough, hung
constantly upon me. The fever discovered itself
in the heat of my hands, which my patients often
told me were warmer than their own. The con-
tagion                                        

BILIOUS YELLOW FEVER. 345
tagion now began to affect me in small and infec-
ted rooms, in the most sensible manner. On the
morning of the 4th of October I suddenly sunk
down in a sick room upon a bed, with a giddiness
in my head. It continued for a few minutes, and
was succeeded by a fever which confined me to
my house the remaining part of the day.
Every moment in the intervals of my visits to
the sick, was employed in prescribing in my own
house for the poor, or in sending answers to mes-
sages from my patients; time was now too pre-
cious to be spent in counting the number of per-
sons who called upon me for advice. From cir-
cumstances, I believe it was frequently 150, and
seldom less than 50 in a day, for five or six weeks.
The evening did not bring with it the least relax-
ation from my labours. I received letters every
day from the country, and from distant parts of
the Union, containing inquiries into the mode of
treating the disorder, and after the health and
lives of persons who had remained in the city.
The business of every evening was to answer these
letters, also to write to my family. These em-
ployments by affording a fresh current to my
thoughts, kept me from dwelling on the gloomy
scenes of the day. After these duties were per-
formed, I copied into my note book all the obser-
vations                                       


346 AN ACCOUNT OF THE
vations I had collected during the day, and which
I had marked with a pencil in my pocket book in
sick rooms, or in my carriage. To these constant
labours of body and mind were added distresses,
from a variety of causes. Having found myself
unable to comply with the numerous applications
that were made to me, I was obliged to  refuse
many, every day. My sister counted forty seven
in one forenoon before 11 o'clock. Many of
them left my door with tears, but they did not
feel more distress than I did, from refusing to fol-
low them. Sympathy when it vents itself in acts
of humanity, affords pleasure, and contributes to
health, but the reflux of pity, like anger, gives
pain, and disorders the body. In riding through
the streets, I was often forced to resist the entrea-
ties of parents imploring a visit to their children,
or of children to their parents. I recollect, and
even yet, I recollect with pain, that I tore myself
at one time from five persons in Moravian-alley
who attempted to stop me; by suddenly whipping
my horse, and driving my chair as speedily as
possible beyond the reach of their cries.
The solicitude of the friends of the sick for
help, may further be conceived of, when I add,
that the most extravagant compensations were
sometimes offered for medical services, and in one
instance,                                      

BILIOUS YELLOW FEVER. 347
instance, for only a single visit. I had no merit in
refusing these offers, and I have introduced an ac-
count of them only to inform such physicians as
may hereafter be thrown into a similar situation,
that I was favoured with an exemption from the
fear of death, in proportion as I subdued every
selfish feeling, and laboured exclusively for the be-
nefit of others. In every instance in which I was
forced to refuse  these pathetic and earnest  appli-
cations, my distress  was heightened by the fear,
that the persons whom I was unable to visit, would
fall into improper hands, and perish by the use of
bark, wine, and  laudanum.
But I had other afflictions besides the distress
which arose from the abortive sympathy which I
have described. On the 11th of September, my
ingenious pupil Mr. Washington, fell a victim to his
humanity. He had taken lodgings in the country,
where he sickened with the disorder. Having
been almost uniformly successful in curing others,
he made light of his fever, and concealed the
knowledge of his danger from me, until the day
before he died. On the 18th of September Mr.
Stall sickened in my house. A delirium attended
his fever from the first hour it affected him. He
refused, and even resisted force when used to com-
pel him to take  medicine. He died on the 23d
of                                           

348 AN ACCOUNT OF THE
of September *. Scarcely had I recovered from the
shock of the death of this amiable youth, when I
was called to weep for a third pupil, Mr. Alston,
who died in my neighbourhood, the next day. He
had worn himself down before his sickness, by un-
common exertions in visiting, bleeding, and even
sitting up with sick people. At this time Mr. Fisher
was ill in my house. On the 26th of the month
at 12 o'clock, Mr. Coxe my only assistant was seized
with the fever, and went to his grand father's.
*This accomplished youth had made great attainments
in his profession. He possessed with an uncommon genius
for science, talents for music, painting and poetry. The
following copy of an unfinished letter to his father (who
had left the city) was found among his papers, after his
death. It shews that the qualities of his heart were equal
to those of his head.
Philadelphia, September 15, 1793.
"My DEAR FATHER,
"I TAKE every moment I have to spare
to write to you, which is not many, but you must excuse
me as I am doing good to my fellow creatures. At this
time every moment I spend in idleness, might probably cost
a life. The sickness encreases every day, but most of those
who die, die for want of good attendance. We cure all
we are called to on the first day, who are well attended, but
so many Doctors are sick, the poor creatures are glad to
get a Doctor's servant."
I fol-            

BILIOUS YELLOW FEVER. 349
I followed him with a look which I feared would
be the last, in my house. At two o'clock my sister
who had complained for several days, yielded to
the disorder, and retired to her bed. My mother
followed her, much indisposed, early in the eve-
ning. My black servant man had been confined
with the fever for several days, and had on that
day for the first time quitted his bed. My little
mulatto boy of eleven years old, was the only per-
son in my family who was able to afford me the
least assistance. At 3 o'clock in the evening, I
finished the business of the day. A solemn stillness
at that time pervaded the streets. In vain did I
strive to forget my melancholy situation by answer-
ing letters, and by putting up medicines to be dis-
tributed next day among my patients. My faith-
ful black man crept to my door, and at my request
sat down by the fire, but he added by his silence
and dullness, to the gloom which suddenly over-
powered every faculty of my mind.
On the first day of October at 2 o'clock in the
afternoon, my sister died. I got into my carriage
within an hour after she expired, and spent the
afternoon in visiting my patients. According as
a sense of duty, or as grief has predominated in
my mind, I have approved and disapproved of this
act, ever since. She had borne a share in my la-
bours.                                       
 

350 AN ACCOUNT OF THE
bours. She had been my nurse in sickness, and my
casuist in my choice of duties. My whole heart
reposed itself in her friendship. Upon being in-
vited to a friend's house in the country, when the
disease made its appearance in the city, she de-
clined accepting the invitation, and gave as a rea-
son for so doing, that I might probably require her
services in case of my taking the disorder, and that
if she were sure of dying, she would remain with
me, provided that by her death she could save
my life. From this time I declined in health and
strength. All motion became painful to me. My
appetite began to fail. My night sweats conti-
nued. My short and imperfect sleep was disturbed
by distressing, or frightful dreams. The scenes
of them were derived altogether from sick rooms,
and grave yards. I concealed my sorrows as much
as possible from my patients, but when alone,
the retrospect of what was past, and the pro-
spect of what was before me, the termination of
which was invisible, often filled my soul with the
most poignant anguish. I wept frequently when
retired from the public eye, but I did not weep
over the lost members of my family alone. I be-
held or heard every day of the deaths of citizens
useful in public, or amiable in private life. It was
my misfortune to lose as patients, the Rev. Mr.
Fleming and Mr. Graesel, both exhausted by their
labours                                        

BILIOUS YELLOW FEVER. 351
labours of piety and love among the poor, before
they sickened with the disorder. I saw the last
struggles of departing life in Mr. Powel, and de-
plored in his death, an upright and faithful servant
of the public as well as a sincere and affectionate
friend. Often did I mourn over persons who had
by the most unparalleled exertions, saved their
friends and families from the grave, at the expense
of their own lives. Many of these martyrs to hu-
manity, were in humble stations. Among the mem-
bers of my profession with whom I had been most
intimately connected, I had daily cause of grief
and distress. I saw the great and expanded mind
of Dr. Pennington, shattered by delirium just
before he died. He was to me dear and beloved,
like a younger brother. He was moreover a
Joab in the contest with the disease. Philadelphia
must long deplore the premature death of this ex-
cellent physician. Had he lived a few years longer,
he would have filled an immense space in the re-
public of medicine *. It was my affliction to see
my friend Dr. John Morris breathe his last, and
* Before he finished his studies in medicine, he published
a volume of ingenious and patriotic "Chemical and Œco-
nomical Essays, designed to illustrate the connection between
the theory and practice of chemistry, and the application
of that science to some of the arts and manufactures of
the United States of America."
2 to

352 AN ACCOUNT OF THE
to hear the first effusions of the most pathetic grief
from his mother, as she bursted from the room in
which he died. But I had distress from the sick-
ness, as well as the deaths of my brethren in phy-
sic. My worthy friends, Dr. Griffitts, Dr. Say,
and Dr. Mease, were suspended by a thread over
the grave nearly at the same time. Heaven in
mercy to me, as well as in kindness to the public,
and their friends, preserved their lives. Had they
died, the measure of my sorrows would have been
complete.
I have said before, that I early left off drinking
wine; but I used it in another way. I carried a
little wine in a vial in my pocket, and when I felt
myself faintly, after coming out of a sick room, or
after a long ride, I kept about a spoonful of it in
my mouth for half a minute, or longer, without
swallowing it. So weak and excitable was my
system, that this small quantity of wine refreshed
and invigorated me as much as half a pint would
have done at any other time. The only difference
was, that the vigour I derived from the wine in
the former, was of shorter duration than when
taken in the latter way.
For the first two weeks after I visited patients
in the yellow fever, I carried a rag wetted with
4 vinegar,

BILIOUS YELLOW FEVER. 353
vinegar, and smelled it occasionally in sick rooms:
but after I saw and felt the signs of the universal
presence of the contagion in system, I laid
aside this, and all other precautions. I rested my-
self on the bedside of my patients, and I drank
milk, or eat fruit in their sick-rooms. Besides be-
ing saturated with the contagion, I had another
security against being infected by my patients,
and that was, I went into scarcely a house which
was more infected than my own.  Most of the
people who called upon me for advice, left a por-
tion of contagion behind them. Four persons
died next door to me on the east; three a few
doors above me on the west; and five in a small
frame house on the opposite side of the street, to-
wards the south. On the north side, and about
150 feet from my house, the fever prevailed with
great malignity in the family of Mr. James Cres-
son. But this was not all. Many of the poor
people who called upon me for advice, were bled
by my pupils in my shop, and in the yard, which
was between it, and the street. From the want
of a sufficient number of bowls to receive their
blood, it was sometimes suffered to flow and pu-
trefy upon the ground. From all these sources,
streams of contagion were constantly poured into
my house, and conveyed into my body by the air,
and in my aliment. Thus charged with the fuel
Aa of 
 

354 AN ACCOUNT OF THE
of death, I was frequently disposed to say with
Job, and almost without a figure, to "corrup-
tion, thou art my father; and to the worm, thou
ary my mother and my sister."
The deaths of my pupils sister have often
been urged as objections to my mode of treating
the fever. Had the same degrees of labour and
fatigue which preceded the attack of the yellow
fever in each of them, preceded an attack of a
common pleurisy, I think it probable that some,
or perhaps all of them, would have died with it.
But when the influence of the concentrated con-
tagion which filled my house, was added to that
of constant fatigue upon their bodies, what reme-
dies could be expected to save their lives? Un-
der the above circumstances, I consider the reco-
very of the other branches of my family from the
fever (and none of them escaped it) with emo-
tions, such as I should feel, had we all been revived
from apparent death, by the exertions of a humane
society.
In getting hastily out of my carriage about the
22d of September, I wounded one of my fingers
with a small nail. As my hands were constantly
exposed to the contagion of the fever in feeling
pulses? I had this wound carefully wrapped up,
from                                         

BILIOUS YELLOW FEVER. 355
from an apprehension that the contagion when re-
ceived directly into the blood, might more cer-
tainly excite the fever, than when received in the
ordinary way. In the hurry of business, the rag
dropped off my finger without my noticing it. The
wound inflamed, but healed notwithstanding in a
few days, and I found no inconvenience from it.
The issue of this accident was highly satisfacto-
ry to me, as it established the analogy between the
small-pox and yellow fever, and confirmed me in
the propriety of preparing the body for the re-
ception of the latter, by the same regimen, as
for the former disorder.
For upwards of six weeks I did not taste ani-
mal food, nor fermented liquors of any kind.
The quantity of aliment which I took inclusive
of drinks, during this time, was frequently not
more than one or two pounds in a day. Yet
upon this diet, I possessed for a while uncommon
activity of body. This influence of abstinence
upon bodily exertion, has been happily illustrated
by Dr. Jackson in his directions for preserving
the health of soldiers in hot climates. He tells
us, that he walked an hundred miles in three days
in Jamaica, during which time he breakfasted on
tea, supped on bread and salad, and drank nothing
Aa2 but 

356 AN ACCOUNT OF THE
but lemonade or water. He adds further, that
he walked from Edinburgh to London in eleven
days and an half, and that he travelled with the
most ease when he only breakfasted and supped,
and drank nothing but water. The fatigue of
riding on horseback, is prevented or lessened by
abstinence from solid food. Even the horse suf-
fers least from a quick and long journey, when he
is fed sparingly with hay. These facts add weight
to the arguments formerly adduced, in favour of
a vegetable diet in preventing or mitigating the
action of the contagion of malignant fevers upon
the system. In both cases the abstraction of sti-
mulus, removes the body further from the reach
of indirect debility.
Food supports life as much by its stimulus, as
by affording nourishment to the body. Where
an artificial stimulus acts upon the system, the
natural stimulus of food ceases to be necessary.
Under the influence of this principle, I increased,
or diminished my food with the signs I discovered
of the increase, or diminution of the contagion
in my body. Until the 15th of September I
drank weak coffee, but after that time, I drank
nothing but milk, or milk and water in the in-
tervals of my meals. I was so satisfied of the
efficacy of this mode of living, that I believed life
might            

BILIOUS YELLOW FEVER. 357
might have been preserved, and a fever prevented,
for many days with a much greater accumulation
of the contagion in my system, by means of a
total abstinence from food. Poison is a relative
term, and an excess in quantity, or a derangement
in place, is necessary to its producing deleterious
effects. The contagion of the yellow fever pro-
duced sickness and death, only from the excess of
its quantity, or from its force being increased by
the addition of those other stimuli which I have
elsewhere called exciting causes.
In addition to low diet, as a preventive of the
disorder, I obviated costiveness by taking occa-
sionally a calomel pill, or by chewing rhubarb.
I had read, and taught in my lectures, that
fasting encreases acuteness in the sense of touch.
My low living had that effect in a certain degree
upon my fingers. I had a quickness in my per-
ception, of the state of the pulse in the yellow
fever, that I had never experienced before in any
other disorder. My abstemious diet, assisted per-
haps by the state of my feelings, had likewise an
influence upon my mind. Its operations were
performed with an ease, and a celerity, which
rendered my numerous, and complicated duties,
much less burdensome, than they would probably
Aa3 have

358 AN ACCOUNT OF THE
have been under other circumstances of diet, or a
less agitated state of my passions.
My perception of the lapse of time was new to
me. It was uncommonly slow. The ordinary
business and pursuits of men appeared to me in a
light that was equally new. The herse and the
grave mingled themselves with every view I took
of human affairs. Under these impressions I re-
collect being as much struck with observing a
number of men employed in digging the cellar of
a large house, as I should have been at any other
time, in seeing preparations for building a palace
upon a cake of ice. I recollect further, being
struck with surprise about the 1st of October, in
seeing a man busily employed in laying in wood
for the approaching winter. I should as soon
have thought of making provision for a dinner on
the first day of the year 1800.
In the account of my distresses, I have passed
over the slanders which were propagated against
me by some of my brethren. I have mentioned
them only for the sake of declaring in this public
manner, that I most heartily forgive them; and
that if I discovered at any time, an undue sense
of the unkindness and cruelty of those slanders, it
was not because I felt myself injured by them, but
because          

BILIOUS YELLOW FEVER. 359
because I was sure they would irreparably injure
my fellow citizens, by lessening their confidence
in the only remedies that I believed to be effectual
in the reigning epidemic. One thing in my con-
duct towards these gentlemen may require justifi-
cation; and that is, my refusing to consult  with
them. A Mahometan and a Jew might as well
attempt to worship the Supreme Being in the
same temple, and through the medium of the
same ceremonies, as two physicians of opposite
principles and practice, attempt to confer about
the life of the same patients. What is done in
consequence of such negotiations (for they are
not consultations) is the ineffectual result of neu-
tralised opinions; and wherever they take place,
would be considered as the effect of a criminal
compact between physicians, to assess the property
of their patients, by a shameful prostitution of the
dictates of their consciences. Besides, I early dis-
covered that it was impossible for me by any rea-
sonings, to change the practice of some of my bre-
thren. Humanity was therefore on the of
leaving them to themselves; for the extremity of
wrong in medicine, as in morals and government,
is often a less mischief, than that mixture of right
and wrong which serves by palliating, to perpetu-
ate evil.
After 

360 AN ACCOUNT OF THE
After the loss of my health, I received letters
from my friends in the country, pressing me in the
strongest terms to leave the city. Such a step had
become impracticable. My aged mother was too
infirm to be removed, and I could not leave her.
I was moreover, part of a little circle of physi-
cians, who had associated themselves in support of
the new remedies. This circle would have been
broken by my quitting the city. The weather
varied the disease, and in the weakest state of my
body, I expected to be able from the reports of
my pupils, to assist my associates in detecting its
changes, and in accommodating our remedies to
them. Under these circumstances, it pleased God
to enable me to reply to one of the letters that
urged my retreat from the city, that "I had re-
solved to stick to my principles, my practice, and
my patients, to the last extremity."
On the ninth of October, I visited a consider-
able number of patients, and as the day was warm,
I lessened the quantity of my clothing. Towards
evening I was seized with a pain in the back,
which obliged me to go to bed at eight o'clock.
About twelve I awoke with a chilly fit. A violent
fever with acute pains in different parts of my bo-
dy, followed it. At one o'clock I called for Mr.
Fisher who slept in the next room. He came in-
stantly                                        

BILIOUS YELLOW FEVER. 361
stantly, with my affectionate black man, to my
relief. I saw my danger painted in Mr. Fisher's
countenance. He bled me plentifully, and gave
me a dose of the mercurial medicine. This was
immediately rejected. He gave me a second dose,
which likewise acted as an emetic, and discharged
a large quantity of bile from my stomach. The
remaining part of the night was passed under an
apprehension that my labours were near an end.
I could hardly suspect to survive so violent an at-
tack of the fever, broken down, as I was, by
labour, sickness, and grief. My wife and seven
children, whom the great and distressing events
that were passing in our city, had jostled out of
my mind for six or seven weeks, now resumed
their former place in my affections. My wife had
stipulated in consenting to remain in the country,
to come to my assistance in case of my sickness;
but I took measures, which, without alarming her,
proved effectual in preventing it. My house was
a Lazaretto, and the probability of my death,
made her life doubly necessary to my family. In
the morning, the medicine operated kindly, and
my fever abated. In the afternoon it returned,
attended with a great inclination to sleep. Mr.
Fisher bled me again which removed the sleepiness.
The next day the fever left me, but in so weak a
state, that I awoke two successive nights with a
faintness                                       
  

362 AN ACCOUNT OF THE
faintness which threatened the extinction of my
life. It was removed each time by taking a little
aliment. My convalescence was extremely slow.
I returned in a very gradual manner to my former
habits of diet. The smell of animal food, the first
time I saw it at my table, forced me to leave the
room. During the month of November, and all the
winter months I was harassed with a cough, and
a fever somewhat of the hectic kind. The early
warmth of the spring, removed those complaints,
and I now enjoy, through divine goodness, my
usual state of health.
I should be deficient in gratitude, were I to con-
clude this narrative without acknowledging my
obligations to my surviving pupils Mr. Fisher and
Mr. Coxe, for the great support and sympathy I
derived from them in my labours and distresses.
I take great pleasure likewise in acknowledging
my obligations to my former pupil Dr. Woodhouse,
who assisted me in the care of my patients, after
I became so weak as not to be able to attend them
with the punctuality their cases required. The
disinterested exploits of these young gentlemen in
the cause of humanity, and their success in the
treatment of the disorder, have endeared their
names to hundreds, and at the same time, afforded
a pre- 

BILIOUS YELLOW FEVER. 363
a prelude of their future eminence and usefulness
in their profession.
But wherewith shall I come before the great
FATHER and REDEEMER of men, and what
shall I render unto him for the issue of my life,
from the grave?
-Here all language fails-
"Come then, expressive silence, muse his praise."
FINIS.