A
TREATISE
ON THE
NATURE,  ORIGIN and  PROGRESS
OF THE
    YELLOW   FEVER,
WITH OBSERVATIONS ON ITS TREATMENT ;
COMPRISING
    £n Account of tfje Diftafe
IN SEVERAL OF THE CAPITALS OF THE UNITED STATES ;
But more particularly as it has prevailed in

           BOSTO T$./'t*' *
by SAMUEL-BROWN,  m.'b.
•* Their flefh fliall confume away while theyftand upon their feet, and their
 eyes fhall confume away in their holes, and their tongue {ball confume
 away in their mouth."                   Zech. xiv. 12.

" His breath goeth forth, he returneth to his earth; in that very day his
 thoughts perilh."                     Psalm clxvi. 4.
          BOSTON:
PRINTED BY MANNING faf LORING.
April, 1800. 
 
At a Meeting of the TRUSTEES of the HUMANE SOCI-
                ETY,  January  6th,  1800.
       X HE Committee, appointed the 4th of November laft, to
examine the Treatifes on the fubjecl of the Yellow Fever, made
the following Report ;

   1 ft.  That the Premium,  offered by this  Society to the perfon
who mould communicate the greateft number of fa&s, relative to
the  Yellow Fever, lately prevalent  in feveral  of the  principal
cities of the United States, in their advertifement of March laft,
be,  and  is hereby adjudged  to the Author  of the paper marked
*  * * *.   And upon  opening  the  fame,  it  appeared,  that
Samuel Brown, M. B. was  the Author.

   2d. That the  Firfl  and Third Part  of the Communication
above mentioned be publifhed by this Society, under the direction
of a Committee, for that purpofe to be appointed j  which Report
was read and accepted.

   Voted,  That the Prefident, Dr. Dexter and  Dr? Spooner,
the former Committee, with the addition of the Rev. Dr. Parker,
be a Committee to publifh the Treatife, offered for a reward, up-
on fuch terms as they fhall think proper ; and that the fame Com-
mittee be, and they are  hereby authorifed to  procure a  piece of
plate, and prefent the fame to Mr. Samuel Brown, for his ac-
ceptance, with a fuitable infcription, to the value of Fifty  Dollars.

         An ExtraS from the Minutes of this Society,
                             JOHN AVERY,  Secretary.
   THE above Report of the very refpe&able Committee of
the Humane  Society confers on me a mark of honourable appro.
bation, equal  to my moft fanguine expectations,  and far beyond
the confidence of hope.  On this occafion my beft feelings are
awakened ; and it is with the livelieft gratitude I receive the Pre-
mium,  accompanying  the approbatory fanction :   I have only to
                                                      hope,
c 
(   iv    )
hope, that hereafter it will fhnd as evidence, not only of the wil-
ling ability and bounteous intentions of the  Society, but alfo of
the propriety of their decisions and juftnefs of their beftowments ;
while its quality and value mall be truly emblematic of the purity
and munificence of thofe principles, which befpeak the true Samar-
itan, and which form the bafis of the Inftitution, juftly claiming the
appropriate name of The Humane Society.
   Although there has been no lack of endeavour to render the
work as accurate, ufeful and fatisfa&ory as poffible, yet ftill it may
be found deficient in one or all  of  thefe particulars :  errors no
doubt there are, fufficiently numerous to require the exercife of
much charity,  and an  equal fhare of candour to excufe ; neither
of which, however, is folicited ;  for they are only deferable or ef-
 timable, fo far as they are the fpontaneous  effufion of generous and
 enlightened minds.
   It is Ihortly to meet  the public ,eye ;  and mould it be  pro-
ductive of utility, equal to what might be expected from the very
honourable fanchon it has received, the confummation of my hap-
pinefs will be the refult.  And even if, in principle and doctrine,
it be calculated to preferve one blank on  the frightful  catalogue
of death,  or mail refcue a fingle fellow mortal  from a premature
confignment to the  tomb, my apprehenfions of envious criticifm
 or uncandid remark  are at  an end }  they are fwallowed up in
 victory.
                  Tour obliged and humble Servant,
                                   SAMUEL BROWN.
   N. B.  The  extracts from Dr. Mitchill's private letters are
entirely without his permiffion.  I could not refrain from deriv-
ing that reputation to the work, and  inftruction  to the public,
which I  am fure they are calculated to afford.  It is hoped this
will  be  confidered  as fufficient apology for the  liberty I have
taken. 
HHUU HI J
^L reliminar
j.
HMBWBUBI
       1 HE important movements of the prefent
day will form a  moft interefting and ever memo-
rable  epocha in the hiftory of the world ; they
will be lafting in their confequen'ces, and extensively
influential upon  men and things.   Perhaps no pe-
riod was ever more  portentous, or more marked
with calamitous  events.  The indications are  nu-
merous  of  a  very fparce diffufion of intellectual
radiance, and that the moral elements are either
confounded in the obfcurity of fophiftry and er-
ror, or enveloped in  more  than Egyptian dark-
nefs.   There is fcarcely a dawn of light upon the
rational  horizon.   Europe  is become a theatre of
gladiators:  the cut and thrufi are the moft approv-
ed and  fafhionable ta&ics at the  prefent  day ;
and thus it is,  that  whole territories, inftead of
being nurferies and abodes of harmony and love,
are changed  into mere flaughter-houfes, where
hecatombs of human  victims are daily facrificed
and offered up at the fhrine of ambition and the
love of domination.  " Spoiling and violence are be-
fore me ; and there are that raife upftrife and conten-
tion."   " / have cut off the nations,  their towns are
defolate-, I made  their Jireets wajle,  that none pajeth
by ; their cities are deJlroyed,fo jhat there is no man,
that there is  none inhabitant."
                                            But 
                    C   vi   )
   But the work of "death is not always performed
 by legions and battalions;  Though the temple of
 Janus mould never be (hut, and the whole appara-
 tus of war fhould be kept in conftant employ, ftill
pcflilencc could boaft a fuperiority in the number of
 its victims.   This is a foe, againft  which neither
 ramparts  nor intrenchments afford any fecurity :
 " It wajleth at noon day ;" and every principal town,
 throughout the United States, exhibits recent and
 mournful teftimonials  of its  ravages.   We  will
 not enter upon a particular detail  of the diftrefTes,
 which Philadelphia, New York, Bofton, and other
 commercial places  h.aye experienced ;   the tale of
 wq would be  too afflictive for even  the  dulleft
 fenfibility to bear,  and the feelings of  humanity
 would be agonized to over excitement^
   To leflen the quantum of human wretchednefs j
to widen, as far as pOflible, the circle of rational
happinefs, and increafe the means of temperate en-*
joyment, will ever be among the  firft  objects and
the leading defire  of the benevolent and  philan^
thropia   To this end,  and thus  truly in accord
with the  principles and avowed  object of their
Inftitution, the Humane Society directed the fol-
lowing advertifement to. the public :—
   " AT a meeting of the Truftces  of the Humane
Society of the  Commonwealth  of Maffaqhu'fetts,
March 4th, 1799.
   ' The prcfervation of life being the great ob^
jecl of  this  Society,  the  formidable epidemic,,
which has lately made its appearance in the Unit-
ed States, and which threatens with depopulation
                                         fome 
                   (  vii   )
fome of our faireft  and moft flourifhing cities, is
juftly comprehended within the views  of the  In-
ftitution.
   " Therefore, Voted, That a piece of plate, of the
value of Fifty Dollars, be given for the communica-
tion of the great eft number of important and well
fubftantiated facts inftrumental in giving origin to
the Yellow Fever in  the United States.   Thefe may
refpect the circumftances of importation ; the fitu-
ation of places in which  it appeared ;  the waters
ufed by the inhabitants; the diet and occupations
of the perfons moft affected by the difeafe; the
ftate of the  atmofphere previous to and at the
time of its prevalence ; together with  all fuch  ac-
cidental caufes, as may have concurred in the gen-
eration of the epidemic ;—to be ftated in concife
terms, with the authorities and  publications  by
which  they are fupported.  The  communication,
for which the above Premium- is offered, to be  di-
rected  and fent to Dr. Aaron Dexter, Correfpond-
ing  Secretary of faid Society, on or  before the
firft of November next, without any name or inti-
mation to whom it belongs, but  marked in any
manner the perfon fending it fhall think fit,  ac-
companied with a paper fealed up, having on the
outfide a correfponding  mark, and on the infide
the name and addrefs of the Author.  The Truftees
pledge themfelves not to open any fealed  paper,
but that which has a mark correfponding to one
on the fuccefsful communication.
    " An Extract from the Minutes  of the Tritfiees of
        the Humane  Society of Mafachufetts.
                 "JOHN AVERY,  RccSec'y."
                                          I  am 
                   (   viii  )
   I am free to acknowledge, that the following
fheets are moftly a compilation, confuting of ex-
tracts from different medical authors ; this I men-
tion the more readily  in this place, as I confider it
the beft recommendation of the work ;  for, in my
eftimation, the work  has merit in the fame pro-
portion as there is kfs of my own and more of s'
others.  What really belongs to me  is prefented
in a ftate  of  inaccuracy and difarrangement, that
demands apology,  and which, but for the peculi-
arity of   circumftances  I  have been  in, refult-
ing  partly from the bufinefs in which I am en-
gaged, would  be  inexcufable.   The  truth is—
laft winter fome facts and obfervations, relative to
the  fever,  were haftily thrown together in  the
form of a pamphlet;  certain portions of which
were foon after publifhed in  the newfpapers, and
in the Medical Repofitory of New York.   The in-
tention of publifhing the whole work collectively
was relinquifhed.   Various avocations and duties
took up my  attention, and  fully  employed my
time.  The fubject  was without further consid-
eration, until about four weeks ago, when I was
induced to refume it:  what could from that time
be done, is done, and is now fubmitted to candid
inflection  and impartial decifion.

   Boston,  November,  1799. 
TREATISE,   &c.
    THE  deftructive fever which prevailed in Bofton
     from the latter part of July to about the middle
of October^ 1798,  was not materially'different from
that which prevailed here in the fummer and autumn
of 1796.   It varied only in the degree or violence of
the fymptoiris; the difeafe proving  fatal generally on
the fourth or fifth day after its attack j Seldom after
the feventh;
   The following  letter from Dr. Mitchill, of New-
York, September 10th, 17^8,  comprifes the  general
Forms and distinguishing features ot the difeafe, and
alfo affords valuable hints refpe&ing the proper treat-
ment 1—
   " The difeafe appears to me to manifeft itfelf under
feveral  diftinct forms, to wit: 1. Symptoms of gaf-
tritis,  anorexia* vomiting, &c. or  of  the dyfenteric
kind, with ftools of flime, blood and green gall, &c.
This form of the diftemper,  invading the alimentaTy
canal chiefly,  I have found capable of  being relieved
very happily by folutions of lime, poUafh zndfoda in wa-
ter, aided by fomething cathartic, fuch as Ol.  Ricini,
Tart. Solub, Rochelle Salt, &c. to carry off indurated
faeces.  Thefe alkaline remedies are now much in ufe
here ; I  have employed them  all fummer  in my hof-
pital practice.  Doctors Smith and Miller have  had re-
peated experience  of their good effects in the gaftr^c
 and inteftinal  forms of the difeafe ; and they allay
anorexia, naufeaand black-vomiting j I fuppofe ufeful
                B                              by 
 ,0            A   TREATISE   ON

 by neutralizing feptic acid, too  redundant to  be fat-
 urated by the bile.   Lixiv.  Tartar,  is  my  conftant
 remedy for chancres and fyphylitic  ulcers  ;  and I
 find it'a good and  fucceisful  application;  with foap-
 fuels for an injection both in men  and women.   In
 my hofpital practice,  they are my Standing  prefcrip-
 tions.  Such  is the  analogy between the poifon of
 plague and that  of fyphilis.   2.  Symptoms of high
 excitement in the heart  and fanguiferous veHels man-
 ifeft by increafed heat, red eyes, dry Skin and tongue,
 thirft, high delirium, full pulfe, &c.   This is the form
 requiring blood-letting,  and bearing the  repetition of
 the operation  to  an  extraordinary degree  in fome
 cafes.   In  fome  cafes of this  fort, letting  blood  is a
 grand remedy, and perhaps in many  instances a fine
 qua non of the cure,  3.  Symptoms of torpor, lifilefs-
 nefs,  coma, low delirium, moderate heat, little, and in
 fome  instances  no  pain, extreme mulcular  debility,
 want of irritability,  a destruction  of the vis  infita,
 dulncfs of fenfation and perception, yellownefs  of the
 eyes and fkin in moft cafes, without pain in the right
 hypochondrium, fhortnefs of  breath, with little or no
•Special  diforder either in the  blootf-veffels  or alimen-
 tary  canal.  This  train of Symptoms forms one of
 the moft infidious modes of the distemper, the patient
 declaring that little or nothing is the matter with him,
 although  verging  faft upon  diftblution.    In fuch  a
 dangerous State of the cfmi'titution, I have from much
 obfervation and much reflection, been led to believe
 that the nerves and mufcles  as well  as the blood are over-
 charged with fepton, and w«^r-charged with  oxygene;
 whence a  rationale of the torpor,  &c. can be eafily
 deduced.    The indication of cure then will be the
 fame  as in  fcurvy ;  that is, to introduce oxygene and
 fubduct fepton.   For I believe, and you will, I  think,
 find it^true, riiat the form of difeafe now under con-
 fideration might, with propriety, be denominated acute
fcur.vy in  oppofition  to the orelinary or chronic fcurvy,
 and receive a  fuitable treatment.   I have prefcribed
                                             neutral 
          THE  YELLOW  FEVER.         u

neutral mixtures, lemonade, cyder, peaches, pears and ap-
ples for feveral  patients, moftly to try  whether this
idea is founded in fact.
   " The foregoing Symptoms may be varioufly blended
together, and make a very complicated diforder, with
which the phyfician muft get along as well as he can."
   Some phyficians have aflerted,  and many people be-
lieve, that a difeafe of the like nature and form  has
never appeared or been  known till late  years.  This
however is not true ; proof in abundance may be had
from  various writers of  natural hiftory, and the  dif-
eafes of different countries and at different periods of
time.   The following from Mr. Hughes' Natural Hif-
tory of the Ifland of Barbadoes  is in  point.  It  will
be found to have very near agreement  with the difeafe
in all its forms as defcribed by Dr. Mitchill.
   " The ifland of Barbadoes is fubject to a very ma-
lignant fever (though I believe in common with oth-
er countries  between the tropics) now called the Yel-
low Fever.
   " Dr. Warren, in his ingenious Treatife upon  the
diftemper, concludes it to be a fpecies of the Plague,
and that the infection was unhappily brought to Mar-
tinico in bales of goods  from Marseilles  in the year
1721 ; though others, who have reSided  much  longer
in the ifland, are of a different opinion, efpecially  Dr.
Gamble, who remembers, that it was very fatal here
in the year 1691, and that it was then called the  new
diftemper, and afterwards Kendals' fever, the peftilen-
tial fever, and the bilious fever.
   -" The fame fymptoms did not always appear in all
patients, nor alike in every year when  it vifited us.
It is moft commonly rife and  fatal in May, June, July
and Auguft  ;  and  then moftly  among  Strangers,
though a great many of the inhabitants, in the year
1696, died of it, and a great many at different periods
fince.
  " The patient is commonly feized with afliivering fit,
as in an ague, which lafts an  hour or two, more  or
                                             lefs ; 
12     ,      A  TREATISE  ON

lefs j  and the danger is gueffed at, according to tha
feverity and continuance of the ague.
  " After the fhiyering fit, a violent fever comes on,
with exceffive pains in the head, back and limbs, lofs
of Strength and fpirits,  with great dejection of mind,
infatiable thirft and reftlefsnefs, and fometimes too
with a yomitipg attended with pains in the head, the
eyes being red,  and that rednefs in a few days turning
to yejlownefs..
  ♦6 If the patient turns yellow foon, he hath fcarce a
chance for life; and the fooner he does fo the worfe.
  6* The pain in the head is often very great, when firft
feized with the fever.
  '* After fome days are paffed, this pain abates, as well
as the fever; and the patient falls into a breathing fweat
and a temperate heat, fo that he appears to be better j
but, on a narrow view, a yellownefs appears in his eyeq
and fkin, and he is vifjbly worfe,
 " About this time he fometimes fpits blood, and that
by mouthfuls j  as this continues,  he grows cold, and
his pulfe abates, till at laft it  is quite gone ; and the
patient^ becomes almoft as cold as a Stone ;  and con-
tinues in that ftate, with a compofed, fedate mind.
  " In this condition he may perhaps live twelve hours.
without any  fenfible pulfe or heat, and then expire.
Such  were  the  fymptoms and progrefs of this fever
in the year 1715.
  " Sometimes likewife the patients  have profufe difc
charges of blood by ftool, and foon after die; and
fometimes likewife at the nofe, by which  means they
have been relieved ; but when t^e blood iffues from
thence but in few drops,  it is a bad prognoftic, and
is generally the harbinger of death.
  «In moft of thefe cafes, the patients are generally hot
arid dry; the blood taken from them very red, and
fcajcely will coagulate ;  the  grume  fwimming upon
the {urrace of the ferum in a thin  leaf, having  fcarce
any confiftence.                            °
   ' The patients have likewife often intolerable pains 
          THE  YELLOW  FEVER.         13

in and  about the ftomach :  Sometimes with thofe
pains they fhall have a Uvor, and the plain marks of
a fphacelus Shall poffefs the greateft part of the abdo-
men before they die,  particularly the region of the
ftomach and liver.
   " It often happens that the ftck perfon fhall He almoft
ftupid; and being afked how he does, fay, he is very
well;  at other times  he labours under the greatefi
 agonies and fits of groanings.
   " A loofe tooth being drawn fpom a perfon who had
 the fever very feverely, there iffued out from the hole
 a great quantity of black,  Stinking blood, which Still
 kept oozing till the third day, on which  the patient
 died in great agonies and convulfions.
   u After death, the corpfe of fuch appear livid in fome
 parts or other ; or elfe marked with peftilential fpots,
 carbuncles, or btiboes.
    " Without fpeedy help from the phyfician, the  pa-
 tient often dies in three days' time."
    If "both ofthefe writers  had been practitioners in
 this  town during th,e prevalence of  the fever, and
 mould have given a hiftory pf the difeafe, its progrefs
 and fymptoms, I cannot think they would have done it
 with more accuracy, or with clofer agreement in point
 oi fact, than in thefe extracts ; although the firft is an
 account of the fever prevalent  at New-York, in  the
 fummer of 1798 j the latter an account of the fever as
 it prevailed Jn the ifland of Barbadoes, 1715.
    The difeafe here  affumed precifely the  fame  forms
 as mentioned by Dr. Mitchill, with only the addition.
 of fome  cafes  of pholera Morbus ; thefe more fre-
 quent  during the exceflive heat in Auguft.  The dyfen-
 tery was moft prevalent with the younger claf* of in-
 habitants, down to infants.
    The fecond and third forms of the difeafe were
 principally confined to the middle aged, and to  fan-
 guineous  and  plethoric  conftitutions.   Thefe  two
 forms, if  my obfervations have been accurate, exifted
 almoft invariably  in  every individual fubject  where 
»4
A  TREATISE   ON
the termination was fatal, and after the fourth day;
the fccond form being only the commencement and
firft ftao*e of the diforder, which was fucceeded fooner
or later, according to the violence of the difeafe, by
a fccond fct of fymptoms, which make the third form
of the difeafe as mentioned by Dr. Mitchill, and which
generally were fatal. •
   The fecond  fet of fymptoms  enumerated  by Dr.
Mitchill,  were more diftinct and common during the
month of Auguft,  when  the heat, perhaps,  was
never  more   exceflive  in  this  climate  for  fuch  a
length of  time : and in  many inftances thefe fymp-
toms were fo extreme,  as to  end the life of the pa-
tient before the third fet of fymptoms had  appeared.
This fatal termination was  within forty-eight hours,
or on the third day after the  attack.
   In Some patients, the  fecond form of the difeafe
moftly prevailed, more  particularly with the  middle
aged and below ; in others, the difeafe exhibited only
the third form or fet of fymptoms;  moftly with thofe
above the middle age,  and when the weather  grew
colder.
   The ague and rigors were generally the premonitors
of the difeafe.  Exceflive heat foon came on, and>
with the moft, continued until a profufe cuticular and
inteftinal  evacuation, and alfo bleeding, gave relief;
or, till they ended in the death of the patient, with
the fymptoms of the fecond form, viz. high delirium,
fuddenly piercing pains in the head, and alfo exceflive
in the ftomach and bowels, back and loins:  Or, ter-
minating in fymptoms  of the third form, as noted by
Dr. Mitchill, and thus by Mr. Hughes—" The patient
grows cold, pulfe abates till quite gone ; he  fometimes
continues in this State 10 or 12 hours, with a compo-
fed, fedate mind ; and if he be alked how he does, an-
fwers, that he is very well, feels no pain, &c."—And
this was moft  commonly the  cafe after much bleeding
from the mouth, either  in confequence of too great
mercurial ftimulation, or  occafioned by a diffolved
State of the fluids.                                It 
          THE  YELLOW  FEVER.        i5

  It Should be here obferved, that even during the
greateft vafcular excitement and heat, cold chills would
fometimes pervade the fyftem, with the fuddennefs of
an electric aura.
  The appearance of the blood was various,  accord-
ing to the time of the diSeafe in which it was taken
from the patient.   I think more coagulable when ta-
ken early in the difeafe, than after.   There were fre-
quent instances of uncommon  reluctance in the flow
of the blood, although the pulfe felt Strong and full.
The blood was in almoft every  inftance dark, and of
the appearance of that of perfons drowned  or Stran-
gulated.   In fome inftances, it did not coagulate after
remaining in the cup twenty-four hours. •
  The ftate of the bowels at the commencement of the
difeafe, was various in different fubjects ;  generally
coitive.  The difcharges, after mercury had been free-
ly ufed, and when excited by cathartics, more efpecial-
ly after  giving  caftor   oil, were  almoft  invariably
profufe, thin, and almoft as dark as ink.
  I had myfelf an attack of the difeafe,  which lafted
four and twenty hours before a complete relief.  The
diftrefs of head was great, occafioned by violent pulfa-
tions  or bounds of the heart ; and  as often, as every
two or three minutes.  It feemed as though the heart
was under a conftant and violent  ftruggle to propel
a fluggifh column of fluid, relifting  or preSIing too
hard upon it ;  and thefe  violent leaps  of the heart,
which gave a fevere and piercing pain  in  the head,
feemed to be the efforts of a collected force  to unbur-
then itfelf.  Over my face was a fuffufion, dark, as if
of venal, rather than arterial blood ; fomewhat refem-
bling the appearance in an epileptic paroxyfm.   I felt
thofe  fudden chills of cold which I have before men-
tioned ;  alfo a general laflitude and  much reluctance
to motion;  but had not  thofe fevere  pains in the
Stomach and bowels.   I took feverally two full doles
of jalap cathartic,  with mercury ;  ufed freely, warm
diluent and  diaphoretic drinks; got into a warmed
                                             bed ; 
\G            A  TREATISE   ON

bed ;  increased the quantity of clothes, applied Sliced
onions to the  axillas, &c.   A .profufe perforation
came  on ;  the fymptoms fubfided,  and did  not
return.
  Three fubjects ddad of the1 difeafe,  were diffect'ed
by Doctors Warren and Rand,  of which  they pub-
lished ah account, Sept. 8th, and is as  follows :
  " The firft cafe was of a man,  who died  on the
Sixth day from the Seizure ; and as ho application was
made to a phyflcian, till the fifft ftage of the  difeafe
had nearly expired,  the State of the  organs may be
considered in a great meafure as the natural effect of
the difeafe, undifturbed by art.
  " In the cavity of the cheft,tne lungs were temarka-
bly affected ; they contained an uncommon quantity
of dark blood,  in their veffels,  which rendered them
apparently mote denfe than ufual j  the veficles not
being distended with air, and their fubftance confe-
quently lefs compreffible than ufual.    The posterior
part of both lobes  was extremely livid, and in the
cavities of the thorax, was contained a large  portion
of extravafated blood, firmly coagulated, to the quan-
tity  of eight  or ten  ounces, as  nearly as could be
eftiniated.
 " The pericardium contained as much a$ two or three
ounces of fluid blood.  The heart was of its ufual
fize ;  but the coronary veins were fo diftended with
blood, as to exhibit the appearance of  a moft fuccefs-
ful injection.  In the cavity of the abdomen, the part
moft  confpicuoufly  morbid was  the liver.  This or-
gan appeared to be much inflamed both on its convex
and concave furfaces  ; its fubftance was much indurat-
ed, and on cutting, refembled in colour a boiled liver.
The gall bladder was contracted to a very  fmall  fe,
and contained not  more than a quarter of  an ounce
of a thick, glutinous, and almoft infpiffated fubftance,
rcfembling pitch.  There were  no marks of any con-
siderable quantity of the bile having been lately con-
tained in the  fack,  and none of the neighbouring
                                             parts 
THE .YELLOW  FEVER.
*7
parts  had the leaft  tinge that denoted its prefence.
On cutting through the ductus communis choledocus,
no bile iifued from  the aperture ;  the hepatic  duct
had alfo evidently, for fome time, ceafed to tranfmit
its fluid from the liver.   The  ftomach exhibited  an
enormous diftenfion of its veins, efpecially round the
pylorus, and had every mark of great inflammation*
The inteftines in general  were  in the fame State with
the ftomach ; the Smaller were considerably diftended,
and  the  larger  contracted.  The fpleen was uncom-
monly turgid, but in other refpects, in a natural State.
The peritoneum on the under Side of  the diaphragm,
and the pleura on the upper, bore the  veltiges  of  in-
flammation, but no other parts of thofe membranes
appeared to have been difeafed.
  " The omentum was confiderably  thickened, and
from the turgefcence of its blood veffels, of a colour
unufually dark.  There were no appearances  in the
thorax, or abdominal vifcera, of Suppuration, nor was
any  degree of fetor  perceived to arife from them ;
nor was there the leaft mark of even incipient  putre-
faction in any part of the body.  It may  be  proper
to remark on this cafe, that in  every Stage of the dif-
eafe,  the difcharges from the bowels were of the col-
our and conliftence of water gruel, excepting a few
evacuations of a matter Similar to what is  called the
black vomit ; and that this ufually fatal fymptom had
alfo preceded the patient's death, on the fourth day of
the difeafe.
  " The fecond cafe.—The fubject of this diffection was
the body of a perfon who died on the  12th  day from
the attack, with fymptoms of  the mixed kind ; a  re-
miSlion  of the difeafe had taken place, at the period
ufually critical, upon which, on the fixth  day, a deliri-
um enfued,  and continued to the moment of fatal
termination.
  " On opening the cranium, the brain was found to
have its veffels aftonifhingly diftended  with blood,  an
ounce or two of ferum was effufed between the dura
                  C                          and 
A  TREATISE  ON
and pia mater.  Under the fagital fature, and by the
fides of the longitudinal finus, where the veins termi-
nate in that cavity, a lymphatic band,  about an inch
wide, extending nearly the whole length of the finus,
was formed by the coagulable lymph, which had been
effufed from the blood veffels, by  the violence of the
preceding inflammation, and this fubftance had ferved
as a medium of adhelion, between the  dura and pia
mater in that part.
  " The lungs adhr.red very firmly  to  the pleura on
the right Side, and appeared  posteriorly to have been
much inflamed, and in fome parts to be indurated, in
portions about the Size of a  pigeon's egg.   The left
lobe adhered fo firmly to the pleura, as not to be fep-
arated but by tearing the fubftance of the lungs,
which here appeared  extremely difeafed,  and in a
ftate of actual fuppuration throughout  its whole fub-
ftance.  The heart was in its natural ftate.  The liv-
er was much enlarged, and in a ftate that  denoted a
high degree of  inflammation ; the convex furface of
the great lobe near the gall bladder  exhibiting marks
of extravafation, as if violently contufed.   The gall
bladder was full of bile, and the ducts pervious.
  " The ftomach was  nearly in its  natural ftate, but
on the infide, the  furface of  the villous coat, was be-
fmeared with a matter which  feemed  to  be of the
fame nature with  the  black  vomit, though nothing
of this kind had been ejected  in  the  courfe of the
difeafe.
  "The duodenum was much inflamed for feveral
inches from its commencement at the  ftomach, and
the whole tract of the fmaller inteftines was in a fim-
ilar ftatc.  The urinary bladder  was  contracted  to
the flze of a pullet's egg, and its inner  coat appeared
to have been  in  a  high ftate of inflammation, the
veffels having been diftended to fuch a  degree,  as to
have fuffered a rupture, and to have effufed a quanti-
ty of blood into the cavity of this organ.   The  ftatc
of the lungs in this fubject,  was  probably the confe-
                                          quence, 
       .   THE   YELLOW   FEVER.        19

quence, chiefly, of a previous difeafe, independent of
that which proved fatal.  An affection of the lungs had
for fome  time existed, whilft the fubject was in other
refpects in tolerable health, and in the purfuit of his
bufinefs ;  fo that a pulmonary consumption  would,
in all probability, have Shortly  put  a period to his
life, had the difeafe, of which he  died, never overtak-
en him.
  " The third cafe—In  this inftance the difeafe ter-
minated fatally on the fourth day.
  " Upon opening the thorax, the  lungs  difcovered
marks  of inflammation, anteriorly, and  were ex-
tremely gorged with blood in the posterior  part of
their refpective lobes.
  " The  liver exhibited marks of inflammation, ef-
pecially on its  concave  furface and  pofterior part ;
its texture was  altered and of a  very denfe  confift-
ence.  The gall bladder was completely obliterated,
its coats having coalefced with the contiguous parts,
fo as to form with them one confufed membranous fub-
ftance.   The  ftomach was  externally, to appearance,
in a natural ftate, but its inner coat was covered with
black coloured fluid, denominated the black vomit.
   " The colon, in fome parts, had been much inflamed,
as well as part of the omentum where attached to the
inteftine.
  " It  is worthy  of remark, that in both the  cafes
where the gait bladder had been difeafed,  and ceafed
to  perform  its functions ;  or where the liver  had
been rendered  incapable of fecreting the bile, the
body became yellow  before  death ;  whereas in the
other,  where  the  bile  was found  in due quantity,
this circumftance did not occur."
  The  following defcription of fymptoms and appear-
ances mark the difeafe in its more malignant  form,
when the patient dies on the third or  fourth day ;
fometimes as  late as the feventh.
  " After the  firft  indifpofition,  which  fometimes
lafts feveral hours, the difeafe will become  more  vio-
                                             lent. 
20
A  TREATISE  ON
lent.  There will be a faintncfs, and generally a  gid-
dinefs of the head, with a  fmall degree of chillinefs
and  horror.  Then immediately will  fucceed a high
degree of fever, great heat, and Strong beating in all
the arteries  of  the  body,  particularly obfcrvable in
the carotid and temporal  arteries ;  flufhings  in the
face, gafping for cool air, white  tongue, but  tinged
with yellow after the retchings have commenced ;
exceflive thirft,  rednefs, heavinefs, and  burning in the
eyes ; heavinefs and  darting pains  in the head,  and
fmall of the back, and often down the thighs  ;  pulfe
quick, generally full and Strong ;  in  fome cafes quick,
low, and vacillating ;  fkin  hot and dry,  fometimes
with a partial and momentary moifture ;  ficknefs of
the ftomach from the  firft, which  increafes with the
difeafe ;  and immediately after any thing is taken to
quench  the  thirft, retchings fucceed, in which bilious
matter  is brought up ; anxiety with ftricture, fore-
nefs, and intenfe heat about the pryecordia ; great reft-
lefsnefs  ; heavy refpiration  ; fighing ;  urine deep coir
oured, and but little in quantity.   This  is  the firft
ftage of the fever, and many continue 24, 36, 48, or
60 hours, and this conftitutcs its inflammatory period.
  " The fecond  ftage begins with an abatement of many
of the preceding fymptoms, and the rife of others :—
fometimes with a deceiving tranquillity, but with per-
turbation, if the patient fhould fall into a fleep ; then
a yellow tinge is obferved in the eyes, neck, and breaft ;
the heat fubiides, and fometimes with chillinefs.  But
not  with that  fort of ftrong rigor, which,  when it
happens, terminates the difeafe by fweat, or by copi-
ous bilious evacuations, upwards or downwards.  The
retchings increafe and turn porraceous ;  the pulfe flags,
but is fometimes high, and fometimes  foft ;  the fkin
moift and clammy ; urine  ir. fmall quantity,  and of
a dark croceous colour ; the tongue, in fome cafes, is
harfh, dry, and  difcoloured  ; in others it is furred and
moift ;  confufion in the head, and fometimes delirium,
with eyes glaffy.  This ftage of the  difeafe fometimes
                                         continues 
          THE  YELLOW  FEVER.        21

continues only for a few hours, fometimes for 12, 24,
36, or 48 hours, but feldom longer.
  " It is in the beginning of this fecond ftage when at-
tempts have failed,or have been neglected in the inflam-
matory ftage,  that  the great Struggle is to be made
between life and death.
  " In the  third and laft ftage of  the fever, the
pulfe  finks  and  becomes unequal and intermittent,
fometimes  very quick ;  frequent vomitings,  with
gre.it  Straining  and noife  in vomiting,  and what is
brought up  now, is more in quantity, and lias the ap-
pearance of  the grounds of coffee, or  is of a flate col-
our ;  nothing can  be retained in the  ftomach ;  diffi-
cult breathing ;  tongue black ;  cold,  clammy fweats ;
eyes yellow,  and funk ; yellowncfs round the mouth
and temples, and foon after over the whole body.
  " This univerfal yellownefs growing deeper colour-
ed, accompanied by an aggravation  of  all the-other
fymptoms, is the immediate forerunner of death. Deep
refpiration ;  fubfultus tendinum ; a convulfive kind of
Sighing; black urine ; deathlike coldneft of the hands,
feet and legs ; heat Still about the pit of the Stomach ;
delirium, an4 Struggling to get up in  the bed ;  fault-
ering fpeech,  trembling,  blood oozing  from  the
mouth and  noftrils ; fometimes from the corners of
the eyes  and from the ears ;  vomiting black, bloody
cruor ; Stools the fame ; livid fpots about the  body,
particularly  the  praecordia; hiccup ;  muttering ; cq*
ma;—death."*
fiifiory of the Difeafe as it prevailed in Boflon in the
            fummer and autumn  of 1798.
  The firft appearance o,f the difeafe was in the family
of Mr. Stoddard, in Fore-ftreet, near the market-place,
June 21 ft.  Mrs. Stoddard died on the, third day after
the  attack.  Her daughter was  next  fick of the dif-
                                             eafe,
        • Mofrley. 
22
A  TREATISE  ON
eafe,  and died within a Short time ;  on the  fccond
or third day.  Another young woman,  and a fon,
were, with much difficulty, recovered of the difeafe.
  The market-place is a low, funken part of the town.
It is, from fituation, the refervoir of every putrid mat-
ter, flowing in from more elevated parts of the town,
and accumulated by every rain.  It is furrounded with
docks of ftagnant waters, filled with offal and all man-
ner of  noxious matters, which,  becoming  putrid,
throw up, at  every ebb of tide, a Stench very difagree-
able to the adjacent inhabitants.  Befides, the market-
houfe and Stalls are always fupplied in abundance, with
meats of various kinds, more or lefs of which will al-
ways, in the  hotter feafon of the year, be in a ftate of
incipient putrefaction ; and fometimes far advanced.
This afliSts to deftroy the falubrity of the furrounding
atmofphere,  by loading it with animal effluvia,  per-
ceivable by the fmell, many times, at the diftance of
an hundred yards or more.
  July 21 ft.   Again the difeafe appeared,  on Cod-
man's wharf, an appendage of the market-place,  and
near Stoddard's wharf, where it firft appeared.  Sev-
en adults fucceffively, but in a Short time of each oth-
er, took the difeale—all  died.   For two or three
weeks, all the cafes of the fever were of perfons either
ftationed in  or near the market, or  who often fre-
quented this place ; and I am informed, that not one
of tweijjy, or upwards, who firft took the  difeafe,
was recovered.
  Fort-hill was the other part of the town, where the
difeafe was moft  prevalent—on the front and fouth-
eafterly part of it, extending along to Liberty-fquare,
and on through Kilby-ftreet to State-ftreet.   In thefe
two parts of the town, the matter of the difeafe feem-
ed to be concentrated, and thence was taken and dif-
perfed through the town, particularly through Fore-
ftreet and State-ftreet.
  Fort-hill is very much expofed to reflected heat.
The  weftern  breezes are almoft entirely  excluded
                                            from 
THE  YELLOW  FEVER.
from the fouth-eafterly fides of the hill;  while thefe
are fo inclined as to meet the fun's rays in perpendic-
ular direction.
  This hill, from its fummit to its bafe, is underlaid
with one entire ftratum of clay ; and the foil is thin,
which, therefore, being foon Surcharged with putrid
refidua, and thefe refidua, prevented penetrating be-
low the mould, were  thrown out in  unufual quan-
tities,  during the  exceffive heat pi  July  and Au-
guft ; which fo contaminated the furrounding atmof-
phere, as to occafion a  mortality greater here, than in
any other part of the town.  Scarce a family efcaped.
One family loft five perfons out of fix.   And proba-
bly the mortality would have been as  great in other
families, had they not  made a timely removal.
   In Front-Street, which extends from Market-Square,
fronting the harbour E. and S. E. quite to the north-
ern extremity of the town, the fever raged through
the latter part of Auguft, all September, and a part of
October.   Some perfons were Seized of the dileafe in
Crofs-ftreet, (an appendage of Front-Street) probably
from the exhalations  of putrid collections in a cellar
in  this ftreet, which  had  been gathering  for three
years, without removal.  They were fo offenfive, that
it was neceffary to beftrew  the  cellar with feveral
hogfheads  of lime, before  any perfon could be hired
to clean it.  The  filth was firft removed into the
ftreet, where it lay more than a week; during which
 time,  the  perfon  who occupied the houfe took the
fever; but, being removed, recovered.  Four perfons
of one family, whofe  circumftances did not admit of
 their  removal, became fubjects of the difeafe, and all
died : likewife, and near thefe, two females of anoth-
er family died of the fame difeafe.
   All along the fouth-eaft  fide of Front-ftreet,  there
 are wharves of various length,  from the Town Dock
to Hancock's Wharf,  between which are extremely
 offenfive docks.
                                                In 
24            A  TREATISE   ON
   In a wefterly direction  from Front-ftreet, and on
 the north-wefterly part of the town, is the Mill-pond,
 which is margined  by almoft the wiiole  extent of
 Back-Street.  This pond is the common receptacle of
 a great number of dead dogs, cats, and Smaller ani-
 mals, befides  large quantities of  putrid meat, iifh,
 and other  vegetables.  There alfo empty the Sewers
 and drains from vaults and cellars of the  buildings
 furrounding  this place.  This pond was frequently,
 during  the fummer, deprived of its waters,  and its
 naked furface  expofed to  the exceflive  heat of the
 fun.  The confequcnce was, the Same malignancy of
 difeafe among  many families adjacent the pond, and
 along Back-Street,  as in other parts of the town.
   It Should here  be  obferved, that, in feveral of the
 buildings near the market, (I think on Codman's
 wharf, and other adjacent wharves) were Stored green
 hides, and fome in a high  State  of putrefaction ; 16
 much fo, that it was with much difficulty any perfon
 could be procured  to tranfport them.  They, finally,
 were offered for  almoft nothing, to any  one who
 Should undertake their removal.   A perfon  appeared,
 took and depofited  them  in  a  cellar on Wheeler's
 Point, where they were foon difcovered  by their in-
 tolerable fmell, and ordered to be removed.   Accord-
 ingly, they were next  carried to  an  oppofite Shore,
 and fpread upon a  point of land to dry.  The perfon
 thus employed immediately fickened, and died on the
 third day.
   On Fort-hill, likewife, hides to the amount of fev-
 eral  thoufand were  depofited ;  and, when  difcov-
 ered, were in a  flmilar ftate as the above.   Alfo, large
 quantities of fpoiled and putrid beef and  fifh  were
 found in ftores and cellars, in and near thefe places.
 It will be remembered, that all intercourfe and com-
 merce with the French Weft-Indies  were  exprefsly
forbidden, by a law of the general government enact-
ed for this purpofe  : and this might be one caufe why
fuch quantities were fuffered to Spoil and waftc.
                                            Some 
           THE  YELLOW  FEVER.        25

   Some frefli fifh, in one of the Stalls in Kilby-ftreet,
leading from State-ftreet to Fort-hiU,  were thrown
into a  barrel or hogfhead-tub, to  be prepared for
pickling.   In this ftate they were neglected for feveral
days, the  owner being  away fifhing.  They became
very putrid, and, when  the owner returned,  were
thrown into the dock :   immediately fuch an intoler-
able effluvium arofe, as to drive the people in the neigh-
bourhood from  their houfes and  their work.  The
neighbourhood  foon  became very fickly,  and many
died.  Several of the families  I attended  with Dr.
Jeffries.
   It may be well further to obferve, of thofe parts of
the town where the difeafe  feemed to originate, that
they are, in fituation,  low,  confined, crowded with
buildings,  and full of  inhabitants ;  fhut out from
northern and weftern breezes, open  to the fouth and
eaft ; expofed to the fun's heat, and this greatly in-
creafed by  reflection and refraction from pavements,
buildings, &c.;  and on Fort-hill many  of the build-
ings are white, which makes the reflection Still greater.
The Streets are narrow,  for  the  moft part dirty, and
not  unfrequently filthy.
   " Multitudes and multitudes of lives are annually
facrificed,  in  all cities,  to the avarice of the original
proprietors of lots.  The little narrow, dirty houfes,
kitchens and yards, furrounded with  high  fences,
excluding air and vegetation ; all that can diflipate or
abforb the  noxious exhalations ;  all that  can  purify
the atmofphere,  and refreSh the exhausted frame of a
human being, panting beneath  a  fultry fun—every
thing in our cities is contrived to  wajle the powers of
life, andfhorten its duration."*
  The number dead of  the difeafe has been Stated at
two hundred and fifty :   I believe that three hundred
is not above the real amount.  Perhaps one out of
three died:  but the mortality  varied  according to
circumftances.  (See obituary lift.)
                   D                          The
* WeMtcr's Trsatife. 
26
A   TREATISE  ON
   The fever prevailed with much malignity till about
 the middle of October, when it was completely check-
 ed by an inundating Storm from the north-eaft,  of
 three days continuance.   The atmofpherc was  much
 agitated by a ftrong  wind, and fo perfectly changed
 and falubriated, that, after this, the type of the difeafe
 was wholly changed.  The common bilious autumnal
 fever fucceeded, and was confidcrably mortal.  The laft
 weeks in November, and through the month of De-
 cember, glandular tumefactions and inflammations,
 fore throat, and peripneumonic affections, were pretty
 numerous, and the moft frequent complaints : alfo, in
 December, there was a confiderable number of cafes of
 flow, putrid or typhus fever.
   In obftetric cafes, during the fever,  there feemed
 to be an unufual tendency to haemorrhage, or flood-
 ing, proving fatal to  a confiderable number.
   With regard to the general ftate of the atmofphere,
 I fhall only obferve, that,  during  the latter  part  of
 July,  the whole of Augult, and a part of September,
 the weather, perhaps, was never known fo uniform-
 ly and excefiively hot and debilitating ;  the winds
 generally from the fouth,  and  furcharged with heat,
 and often with a clammy moifture.  The effect upon
 the conftitution was not unlike what is told of the
 Siroc wind of Sicily. " During the continuance  of
 this wind, all nature appears to languifh ; vegetation
 withers, the beafts of the field droop, the animal fpir-
 its  feem to be too  much  exhaufted to admit of the
 leaft bodily exertion, and  the fpring and elafticity of
 the air appear to be loft ;  the pores of the body feem
 at once opened, and all the fibres relaxed ;  the appe-
 tite deftroyed, and digeftion flow, difficult, and much
 impaired."
  The common atmofphere, for the moft part, was
 opaque and fmoky, as if the earth's furface were un-
 dergoing a flow combuftion.   It feemed a heteroge-
 neous mixture of particles, in a  State of oppofition and
propulfion :  refpiration  frequent  and unrefrefhin^.
                                             The 
r
THE  YELLOW  FEVER.
27
The fun, in mid-day height,  appeared as a volume of
blood, dark and angry.  As it declined to the weft-
ern horizon, its diameter widened greatly ;  and, at
an hour's height, or  more,  was almoft invisible, or
fhrouded as with fackcloth.   Thefe appearances, how-
ever,  were not conftant.
  It  is found, by experiment with  the  eudiometer,
that the upper region of the  atmofphere actually con-
tains  a  greater proportion of  oxygene, and  lefs of
azote, or fepton, than nearer the furface ;  and, for
this reafon ; oxygene has a Stronger affinity for caloric,
concentered in the fun as its fountain ; and becaufe
refpiration, combuftion,  putrefaction, and  all thofe
proceffes and mutations of fubftances, which occafion
the confumption of oxygene and Superabundance of
fepton, are always on or near the earth's furface.
  In hot feafons and climates, putrid difeafes are com-
mon, becaufe oxygene, which is the primary recipient   f
of heat, (caloricj or caloric  in  its firft combined or
embodied State,  is calorified and drawn up into the
higher regions of the atmofphere, by which the  ani-
mal fyftem is deprived of the portion requifite  for the
proceffes of animalization. By reafon of this deficien-
cy, the carbone, hydrogene, &c. are not duly elimi-
nated and thrown off; the azote is not duly combin-
ed, affimilated, and wrought  into animal fibre   Thus
the materials compofing  the mafs of fluids become
more  and more heterogeneous, unrefined, and  un-
ncutralized ;  and thus the  conftitutkm affumes the
tendency or predifpofition to putrefaction ; this is al-
fo afliitcd by heat or caloric  acting upon and pervad-
ing the  fyftem from  without, which,  by its great
Stimulation,  deranges  the organic motions, making
the animal fecretions too rapid  and abundant, and of-
ten fuperfeding them by chemical combinations and
proceffes.  Hence the propriety, in  order to prevent
putrefaction, of ufing, for food and drinks, fuch as
are in a neutral and unforced ftate,  and which  Ion"-
refift putrefaction in themfelves, that the animal pow^
                                              ers 
zS            A  TREATISE   ON

ers may not be too much exerted or impeded, hav-
ing already buffered from the exceflive ftimulation of
external heat.  That  food  is undoubtedly the belt,
which raifes the leaft internal heat and  commotion.
It may alfo be proper to take, as  preventatives, fuch
medicines as  will invigorate  and confolidate the an-
imal  fibre, and,  at the fame time,  oxygenate the
fyftem.
   Active inflammations are  complaints which are
found to prevail in the colder feafons, and for reafons
the reverfe of thofe  abovementioned ;  viz. becaufe
oxygene abounds  in the atmofphere,  by which it is
homogenized, condenfed, clarified, and rendered more
elaftic ;  and  this, becaufe it  is  not acted upon,  and
drawn into the fuperior regions, by the fun's perpen-
dicular rays.   Oxygene being thus concentrated, and
brought nearer the  furface of the earth, is abforbed
by refpiration, &c. in too great abundance ; its agen-
cy becomes exceflive ;  too much  is embodied  in the
animal fibre ;  the veffels and organs are rendered tur-
gid, and inflammation is the confequence.  Hence the
reafon animal food is more coveted in  winter than
in fummer.
  It will be found, I believe, on Strict  obfervation,
that  every epidemic,  or wide  fpread difeafe, is al-
ways  preceded by or attended with fome  peculiar ftate
or temperature of atmofphere ; and thefe phenomena
it is  of importance to obferve and  note,  when en*
deavouring to inveftigate the origin and  nature of
difeafe.   Thus all the remarkable winds of the tropi-
cal regions have their different  characters, and  alfo
their  diftinct  and peculiar effects upon the human
conftitution,  and upon the animal and vegetable king-
doms ; viz. the Monfoons, the Siroc, the Harmattan,
the Samiel, &c.  They all  have  precurfory tokens,
which announce their approach,  and by which their
effects may be guarded againft and avoided : fo with
Strict  attention and inveftigation, the kind and fevcrity
of an epidemic might not only be known, but with
                                         certainty 
THE  YELLOW  FEVER.
29
certainty  predicted, by  afcertaining  the kind atid
quakities of the gafeous acid particles which abound
in the different Seafons, and which occaiion the varia-
tion of temperature.
  " An epidemic difeafe may be diftinguifhed from
a difeafe proceeding from infection or  Specific conta-
gion, by the following circumstances :
  " 1 ft.   An epidemic peftilence is preceded by in-
fluenza, affections of the throat,  or  acute  and ma-
lignant fevers.
  " 2d.  An epidemic predominates  over Other dif-
eafes ;  totally abforbing  them, or compelling them
to  affume its characteristic fymptoms." *  A further
confideration  of this branch  of the  fubject  will  be
found under the general propofition,  That the difeafe
is neither fpecifically contagious, nor of foreign origin.

  Now, what is the probable caufe of this difeafe, or
what fhall we denominate the poifonous matter,  fo
calamitous in  its  effects on  the human constitution,
and which has fpread defolation and death through
many of the moft flourifhing and populous cities and
towns in  the Union ?
  The  account of the difeafe,  as it appeared in this
town, which we have given above, plainly Shows that
it was of  local and domeftic origin ;  that it  took rife
from an  atmofphere vitiated by putrid exhalations,
aided by other caufes of debility,  exceflive heat, &c.
                 CAUSES.

  FROM marfli exhalations  and human effluvia, has
it been believed from the earlieft ages of phyfic to the
prefent  time,  that  malignant and peftilential difeafes
derived their  origin.   Marfh miafmita are always
more or lefs furcharged or commixed with animal
efiluvia, from the putrefaction of various animals and
                                            inlects
            * Wcbfter's Treadle. 
5°
A  TREATISE  ON
infects that  have periShed in Stagnant places ; fo that
it  will be difficult  to  draw the line of demarcation
between the precife nature of the one and the other.
Befides, animal life fubfifts from vegetable  life, and
therefore animal fubftances can only differ from  vege-
table fubftances, in that they have fuftained the opera-
tion of a higher degree of life   The materials in  vege-
table fubftances mutt be the fame as in animal fubftan-
ces, only differently apportioned and combined  ; the
product then by decompofition or  putrefaction  can-
not be effentially different, but only in the  propor-
tions  of the ingredients.  The jail fever, I believe,
has invariably been  afcribed  to human perfpiration
rendered putrid from heat and confined atmofphere,
together with other caufes of uncleannefs.  It would
be exceedingly difficult to fhow the difference between
the effluvia  of animal fubftances in the ftate of putre-
faction, and human  perfpiration rendered putrid,  as
juft ftated.   Now daily experience ftill confirms, that
it is in the neighbourhood of marfhes, and all  fuch
places where vegetable and animal putrefaction  takes
place  to any extent, that  peftilential and other difeafes
of various grades and  violence prevail.  Epidemics,
attended with carbuncles and buboes, which are de-
nominated,'^ conjunction with ordinary fymptoms of
what is called jail and hofpital fever, the characteristics
of the plague, down to the mildeft intermittents, have
appeared, and raged with extraordinary violence, oc-
cafioned by the exhalations from  putrefying animal
and vegetable fubftances.
   The numerous testimonies of the  moft judicious
writers, Shew,  that there are few climates where in-
stances have not occurred of malignant epidemic and
endemic difeafes from thefe fources.   Bengal, on both
fides  of the Ganges, and Egypt, annually overflowed
by the Nile, experience an unhealthy and  peftilential
atmofphere, immediately after the exhalations  from
the putrefying collections  of vegetable and animal
matter begin to arife,  which  dirtufing thcmfelves  in
                                               the 
           THE  YELLOW  FEVER.        3i

 the air, bring on difeafes of various grades of malig-
 inncy, according to the greater or lefs contaminated
 ftate of the atmofphere, and  other concomitant cir-
 cumftances.  Of Grand Cairo, Dr. Mead obferves—
 " It is  Situated in  a fandy plain, at the  foot  of  a
 mountain, which,  by keeping  off the  winds  that
 would refrefh  the  air, makes the heat very ftifling.
 Through  the midft of it paffes a canal, which is filled
 with water during the overflowing of the  Nile, and
 after the river is decreafed, it gradually dries up.   In-
 to this canal  the people throw all kinds  of  filth, car-
 rion, &c.  fo that the ftench arifing from  it, and the
 mud together, is infufferable.   In this  fituation of
 things,  the plague  every year constantly preys upon
 the inhabitants, and is only flopped when the Nile,
 by overflowing, wafhes away the load of filth."   Of
 Bengal thus—" During the rain,  this rich and fertile
 country  is covered  by the Ganges, and converted as
 it were into a large pool of water.  In the month of
 October,  when the ftagnated  water begins to be ex-
 haled by the  heat of the fun,  the  air is  then greatly
 polluted by the vapours from the flime and mud left
 by the Ganges,  and by  the corruption  pf dead fifh
 and other animals.  Difeafes then rage—fevers of the
 remitting  and  intermitting  kind.  If  the  feafon
 be very fickly, fome are feized with a malignant fever,
 of which  they foon* die.  The body is covered with
 blotches of  a livid colour, and the corpSe, in a few hours,
 turns quite livid and corrupted.   At this time fluxes
 prevail."   He  further  obferves, that the  ifland of
 Bombay has been rendered much more healthy than
 it formerly was, by a wall, built to prevent the en-
 croachments of the fea, where it formed a fait marfh;
 and  by an order, that  none  of  the natives fhould
 manure their cocoa-trees with putrid fifh.  He alfo ob-
ferves of Bencoolen, in the ifland of Sumatra, that
it is the moft unhealthy of all the Eaft India fettle -
ments;  but that by building their fort on a dry, el-
evated place, about three miles from the town, it be-
                                            came 
3*
A  TREATISE  ON
came fufficiently healthy.   Batavia, the capital of the
Dutch Eaft India  dominions, (Dr. Lynd) is annually
fubject to a fatal and  confuming ficknefs :  " It has
been remarked, that the ficknefs rages with the great-
eft violence when  the rains have abated, and the fun
has evaporated the water in the ditches, fo that  the
mud begins to appear.  The ftench from the mud is
intolerable."  Mr. lyes, in his journal  of  a  journey
from India to  Europe  by land, obferves, that Gam-
broon, in Perfia, is very unhcalthful, and that various
authors, as well as the  prefent Englifh factory, " im-
pute its unhealthinefs, during the Summer  months,
to the noxious eilluvia  with which the air is  contam-
inated from the great quantities of blubber-Jifh left by
the fea upon the Shore, and which very foon become
highly offensive."  The Same writer obferves of Baf-
forah, that fifteen years before his vifit to this place,
the banks of the river Euphrates having been demol-
ifhed by the Arabs, to  revenge an injury done them
by the Turks, its environs were inundated.  " The
ftagnating water in the adjacent country, and the great
quantity of dead and corrupted fifh at that time lying
upon the fhore, polluted the whole atmofphere, and
produced a putrid and moft mortal  fever, of which
between twelve and fourteen  thoufand of the inhab-
itants perifhed ; and at the fame time, not above two
or three of the Europeans who were fettled there ef-
caped."   It is further obferved of this place, (Tytler's
Treatife)  by a gentleman refiding  there in  1780,
" that the canal that runs through a great part of the
city being filled with the  bodies of animals, and  all
kinds of putrid matters ;  and, at low tides,  all thefe
fubftances expofed to the  fun, made  the  air in the
town  fcarce Supportable ;  and, being totally deftitute
of police, the ftreets were in many places covered with
human ordure, the bodies of  dead dogs and cats, fyc.
which emitted a ftench more  difagreeable and putrid
than any thing he ever experienced."   " In all fpots,
(Dr. Lynd) in the Eaft  Indies, fituated  near large
                                          fwamps, 
THE  YELLOW  FEVER.
33
fwamps, or the muddy banks of rivers, or the foul
Shores of the feas, the vapours exhaling from putrid
Stagnated water, produces mortal difeafes."  He more
particularly mentions,  that the yellow fever often rag-
ed at Greenwich Hofpital, in Jamaica, which, he ob-
ferves, v.ks built near a marfh, and could not proceed
from any Source of infection in the hofpital.  He ev-
ery where attributes the  yelluW fever to the vapours
arifng  from putrefying  vegetable arid animal  fub-
ftances.  Dr. Clark, in his  " Obfervations on the dif-
eafes  of long voyages  to hot countries," mentions a
contagious malignant fever, which prevailed  at Prince
Ifland,  in  1771, produced  from the exhalations of
putrefying vegetable fubftances.
  The plague, which caufed fo great terror* and mor-
tality in London,  1625 and 1636, according  to the
account given of it  by Mr. Woodal, furgeon  to St.
Bartholomew's Hofpital,  and furveyar-geHeral to the
Eaft India Company, who  Was preSenbtlje two years
it prevailed there,  was  evidently generated  in  that
city, from caufes limilar to  thofe already related.  He
fays—" The tcrreftrial caufes (after mentioning  it as
a punishment inflicted on mankind for their fins) are,
by common  confent of moft writers, as followeth ;
venomous,  Stinking vapours, arifing from Standing
ponds or pools, ditches, lakes, dunghills, finks, chan-
nels,  vaults, or the like ; as alfo,  unclean ilaughter-
houfes of beafts, dead carcaffcs of men,  as in  time of
war, and of Stinking fifh,  fowl, or any thing that hath
contained life,  and  is putrid ;  as alfo, more particu-
larly in great cities,  as London, the unclean keeping
of houfes, lanes, alleys, and ftreets : from thofe recit-
ed, and the like infectious venomous  vapours, by
warmth of the fun exhaled, are apt and able to infect
the living bodies of men, and thereby to produce the
plague, as experience too much fheweth."
  According to Dr. St. John, the seriform fluid, which
is exhaled from  animal bodies in a ftate of putrefac-
tion,  acts at certain times more powerfully  than at
                    E                     others, 
34
A  TREATISE  ON
others, and is indeed in one ftage of the procefs infi-
nitely more  noxious than any other elaftic fluid yet
difcovered.  Dr. St. John informs, that he knew a gen-
tleman, who, by flightly touching  the inteftines of a
human body, beginning to  liberate this corrofive gas,
Was affected with a violent  inflammation, which in a
very Short time extended up almoft the entire length
of his arms, producing an extenfive ulcer of the moft
foul  and frightful appearance, which continued for
feveral months, and reduced him to a miferable ftate
of emaciation.  He mentions, alfo, a celebrated pro-
feffor, who was attacked with a violent inflammation
of the nofe and fauces, from which he with difficulty
recovered, by ftooping  for an inftant  over  a body,
which  was beginning  to give forth this deleterious
fluid.  Hence he infers, that  the fame gas, modified,
or mixe\d, or united with others, may be  the occafion of
the plague, which has fo often threatened to annihilate
the human fpecies.
   In the war of 1775, in Germany, a destructive fever
prevailed, attributed then  to an infection of the air
by the putrid effluvia from the vaft numbers killed in
battle, and  alfo to a.calm in the  atmofphere for a
long time.
   Pringle, Jackfon, Hume, Mofely, M'Lane, and a
number of other medical writers,  ancient and mod-
ern, might be cited, in proof that  effluvia, from animal
and vegetable putrefaction,  may  give rife to, and are
the common caufes of, malignant and peftilential dif-
eafes.  But there is no occafion for confulting books,
knowing the opinion of any, or going abroad for con-
firmation of what has been advanced reflecting the
origin of malignant difeafes.  Our  own obfervation's,
and the evidence of our fenfes, are quite fufficient to
convince, I  muft  not  fay all,  that they do not arife
from any other caufe,  fo far as any material agent  is
concerned.  Dr. Reynolds, (Webster's Collection,  p.
197) States a cafe of fever in a young woman, evident-
ly excited by the effluvia of a putrid carcafs, lying on
                                              the 
THE  YELLOW  FEVER.        35
the borders of a marShy piece of  ground,  where She
was obliged frequently to  pafs and repafs.  She was
at firft affected with violent pains in the  head, and
ficknefs at her ftomach.   On the fecond day She was
bled ; but her fever increafed, and She became deliri-
ous :  a number of blifters, furrounded by inflamma-
tion, appeared  upon her feet and hands, fingers and
toes ; She died on the fourth  day.   Dr. Bayley, in his
Treatife on the epidemic of New-York,  in  1795,
ftates a cafe of fever produced from the exhalations of
vegetables in  a ftate of putrefadion.   The caufe was
detected from an unufual  and offenfive fmell, which
proceeded from the cellar.  Two perfons went down
to examine,  and found,  in  one  corner of  a fmall
tight room, a quantity of June cabbages, on which
the fun had Shone about three hours in a  day ; they
were rotten, and  had fallen down in ajump of pu-
trefaction.   On being Stirred, there immediately iffued
forth fuch an intolerable ftench, as obliged thofe in the
cellar to quit it inftantly.   Vomiting came on,  which
lafted nearly an hour.  Three perfons in the family
were taken with  all the leading  fymptoms of  the
yellow fever.
    The malignant  epidemic, or yellow  fever,  which
prevailed  in the  fummer  of 1797, in  Providence,
 Rhode-Ifland ;  in 1795, m Norfolk, Virginia ; in New
 York the fame year, and in every year it has prevailed
 there fince ; in Philadelphia,* in  1793, and the fubfe-
 quent years ; in Newbury-Port, in  1796—if  we may
 give any credit to the accounts of the difeafe in thofe
 places, from men of the firft refpectability, and  dif-
 tinguifhed for literary and profeflional eminence,  ev-
 idently took their origin from  gaffes exhaled from
 vegetable and animal fubftances collected together,
                                                 and
   * In the opinion of Dr. Rufh, the difeafe is invariably the offspring of putrid,
 exhalations from vegetable and animal fubftances; but is epidemic only in hot
 climates, or in the hot feafons of colder climates.  Thefe noxious exhalations.
 are thrown out, and the difeafe produced, I. .From the docks. 2. From fhips
 at the wharves.  3. From the common fewers. 4. From the gutters. 5. From
 dirty cellars and yards. 6.  Privies.  7. From putrefying maffes  of matter
 lying in the neighbouring part of the city. 8. Fiom impure pump-water. 
36            A  TREATISE   ON

and rendered putrid on cxpofure to a moift and heat-
ed  atmofphere.  The difeafe in this town,  both in
1796 and 1798, was clearly from this caufe, and could
not, with any propriety or reafon, be afcribed to any
other fource,  as will appear  from the hiftory already
given  of its origin  and  progreSs.   It  is  ufelefs and
unneceffary to  add to the  number of facts already
ftated, though  this could very eafily be done, for they
are to be met with in all directions, and to be found
in  almoft every treatife  on this fubject.  Thofe al-
ready related  fufficiently confirm,  that  the  greateft
degree of vitiation  which the  atmofphere manifests,
by  its operation upon the conftitution, proceeds from
the effluvia emitted  from certain  animal and vegeta-
ble fubftances during putrefaction.  And as far as the
innumerable facts on this fubject  have been collected
and examined, there exifts the moft cogent evidence,
that the products juft named are the real matter  and
caufe of all malignant or peftilential difeafes, in com-
bination with  other circumftances, inclining or  pre-
difpofing the  conftitution to difeafe.  What was the
precife nature of thefe exhalations, and which the  par-
ticular noxious gas,  had only been gueffed at  and  con-
jectured,  perhaps not  even this, until Dr. Mitchill,
profeffor  of chemiftry,  natural hiftory and  agricul-
ture, in Columbia College,  engaged in an inveftiga-
tion of its properties.  He difcovered it to be a  por-
tion of fepton* (azote) the offspring of putrefaction,
united chemically with more or lefs of oxygene,  (the
acidifying principle) in the form  of  feptic (nitric)
acid.   On the formation arid prefence of  this com-
pound, it is prefumed peftilential and malignant dif-
eafes depend :  And  in proportion as a greater or lefs
quantity of the above compound is formed; in  pro-
                                            portion
          * Dr. Mitxhill's Nomenclature.
  Scpton, for azote or nitrogene.
  Septous ga?, for azotic gas, or atmofpheric mephitis.
  Gafeous oxyd of feptcn, for diphlogifticatcd nitrous air.
  Septic gas, for nj trous gas.
  Septous acid, for nitrous acid.
  Septic acid, for nitric acid.
  ^Septate, feptite, for nitrate, nitrite, &c. 
THE  YELLOW
FEVER.
37
portion to its fparce or concentrated ftate ;  in propor-
tion to the length of time, the fufceptibility of the
conftitution to be operated upon, and the circum-
stances under which it is applied,  will the difeafe, de-
pending upon this caufe, be more or lefs violent, and
attended with various peftilential fymptoms.
 Hifiory of the Production, Nature, Properties, and Effects
                 of the Septic Acid^

   According to Dr. Mitchill, and the feveral medical
 gentlemen,  who profeffedly advocate and fupport his
 theory, fepton, the bafe of  the acid of putrefaction,
 or feptic acid, is one of the moft abundant elements in
 nature, and  is the peculiar product of vegetable and
 animal  putrefactions:  this is proved by experiment.
 It is  produced in much greater abundance from ani-
 mal fubftances.  Fourcroy afferts, that " animal fub-
 ftances differ from vegetable fubftances, in putrefying
 more eafily and more fpeedily, yielding  much  more
 azotic (feptic) gas."   Septic gas is a combination of
 fepton with  caloric, (the matter of heat;) this  gas
 makes up nearly three-fourths of  the  atmofphere.
 It is  incapable of fupporting animal refpiration,  or
 combuftion,  while  it makes a part of  the nutriment
 or food of plants, which  have the power of decom-
 pofing and retaining it; and thus it becomes a con-
 stituent part of their  fubftance.   Dr. Mitchill  fup-
 pofes, and the  opinion feems to be confirmed by the
 experiments  of Eagleton  Smith, that fepton enters
 into  the  compofition of all poifpns  or contagions.
 ft From chemical combinations  of thefe (fepton  and
 oxygene)  acting upon different parts of the body,
 feem to fpring the common fymptoms of fevers, dyf-
 enteries and  plagues.  And thus a clear idea can be
 entertained of the nature and compofition of common
infeclion.   But, as there are fome diftempers of a na-
                                             ture 
38            A   TREATISE  ON
  ture that have been called fpecifically contagious, their
  conftitution may be conceived, by luppofing the mat-
  ter of fmall-pox, for inftance, to derive  its peculiar
  quality from a commixture of carbone with the mat-
  ter of ordinary contagion ; that of  fyphilis  to arife
  from phofphorus, blended with  the  fepton and oxy-
  gene ;  that of mealies, from a  combination of  ful-
  phur;  that of pcrtuflis, or croup, from the addition
  of the unknown radical of the muriatic acid, forming
  a nitro-muriatic oxyd  or acid vapour, &c.; and, in
  like  manner,  may  conjectures be found about  the
  poifonous matter of rabid and other  animals."
    Septon, in combination with oxygene,  the princi-
  ple of  acidity,  forms  the gafeous oxyd  of fepton ;
  (dephlogifticated nitrous air ;) 2- feptic (nitric) gas;
  3. and 4. feptous and feptic (nitrous and nitric) acids ;
  and 5. feptic  acid gas.  In the firft  of thefe forms,
  that  of the  gafeous oxyd, in which  the  acidifying
  principle is fo  fmall,  as not to manifest the fmalleft
  degree of acidity ;   it is capable  of fupporting com-
  buftion, but is highly deleterious to the lives of ani-
  mals, which it deitroys the moment they are furround-
  cd by an atmofphere of this.kind.  (2. and 3.) The
  next degrees of combination of oxygene with fepton,
  are  feptic gas, and feptic acid gas,  wrhich are never
  found to exift in the atmofphere for any confiderable
  length of time, being artificially produced.  (4. and 5.)
  The higheft degree  of combination and concentration
  of fepton and oxygene, form  the feptic acid and the
  feptic acid gas, which is their moft common form of
  combination.
    Septon and oxygene are the principal ingredients
  of the  common atmofphere,  when  in  a  ftate moft
  conducive to the prefervation and  vigour  of both
  \regetable and animal life ; but in the constitution of
  the atmofphere, and in the formation  of  the feptic
  ncid, the relative  quantities  of each ingredient  are
  very different :  four parts of oxygene, and one of
*  fenton, chemically combined, form feptic acid ; while
                                       twenty-feven 
THE  YELLOW  FEVER.        39
twenty-feven of the latter,  and feventy-three of the
former, constitute atmofpheric air.  In the formation
of atmofpheric air, befides, fepton and oxygene are
not chemically combined ;  they are diffufed through
and  mixed with each other,  like clay and wa-
ter.   Their chemical union is prevented, by  their
greater attraction, feparately, for caloric than for each
other.   Were  not this  the cafe, and if " ihefe two*
fubftances (fays Dr. Bedoes) were  not,  by fome cir-
cumstances, prevented from clofely  uniting,  all the
oxygene, with a part of the azote,  (fepton) would
be changed into a highly concentrated acid, and the
water of our globe would be concentrated into aqua-
fortis," (feptous acid.)
   The feptic  acid and feptous gaffes, thus formed,
have a moft powerful operation upon a great variety
of fubftances, of both the mineral and vegetable king-
doms, as alfo upon animal  nature.   Iron,  in particu-
lar,  is corroded and confumed"by it ; to this, when
much  diffufed in the atmofphere,  are  many of the
maladies of plants afcribable.  Such was the condition
of the atmofphere, during the ficknefs at New-York,
 1798 ; fo much  was it furcharged with noxious acid
gaffes and vapours, that the iron railing, in the front
of houfes, was covered with a thick and unufual coat
of ruft ;  and the fmooth and bright parts of the pump-
 handles in the ftreets were, during a  few hours of reft
 in  the night,  exceedingly  corroded by every drop of
 moifture which fell upon them.   The leaves of trees,
 on  which this corroding moifture had  fettled, often
 became fpotted ; and thefe fpots, before any froft had
 appeared, turned to mortification.   At this  time,
 white cotton  garments, fpread  to  dry after wafhing,
 acquired fuch ftains and  fpots by  being buffered to
 hang out during the nights, when this milt prevailed,
 as  to  be indelible afterwards, by twice boiling in al-
 kaline lie.  Thefe effects of poifonous atmofphere were
 difcovered to take place even in the moft elevated and
 healthful parts  of  the city.  A Taline efflorefcence,
                                          fuppofed 
40            A   TREATISE  ON

fuppofed to be nitrous, was obferved on the pavements
of many places, particularly Front, Water and Pearl
ftreets.  (Med.  Rep.  vol. II. p. 214.)  What  is  here
ftated of New-York, was true of this town,  Bofton.
The iron railing, in  front of the crefcent row of the
tontine  buildings, was  rufted in a Similar manner ;
and the faline efilorefcence, mentioned to have  been
feen  on the ftreets in New-York, almoft covered the
walls of thefe brick  buildings, the height  of feveral
feet from the ground, and in fpots over all  the Shaded
fides of thofe buildings.
  The feptic acid, generated by putrefaction, is always
on the earth's furface, and  its vapours never rife to
a great height above  it.   From thefe exhalations, the
water of dews, mifts and fogs, precipitated when the
atmofphere  is cooled, particularly during the night,
receives a portion of  the fame acid, which, thus unit*
ed, attach themfelves to animal and vegetable bodies,
and in this manner  produce the effects we have juft
ftated.  This alfo accounts for the deleterious effects
of fogs and night airs,  in warmer latitudes,  fo often
noticed by different  medical writers,  and  which are
faid fometimes inftantly to deftroy human  life.   One
night's expofure is often fatal.
  The timber and metals of Ships, ufed in the tranf-
portation of grain, particularly wheat, are found to
be peculiarly fubject to decay ; and becaufe the grains
of wheat, getting below the flooring, putrefy ;  thus
fepton is furniShed,  which, in union with oxygene
from the air or water of the veffel,  forms the feptic
acid ;  immediately  the work of destruction com-
mences upon the timbers, bars and fpikes of  the vef-
fel, till nothing but rot and ruft remains.   By the pu-
trefaction of this  fubftance,  or  Such as contain the
feptic bafe,  it is fuppofed,  and very probably, many
of the difeafes of feamen are originated.
  Metals ruft, and wood decays, much fooner on and
above the furface of the earth, than below it; be-
caufe feptic  acids are only formed where atmofpheric
air and heat can have accefs.
                                             From 
THE  YELLOW  FEVER.       41
  From, the  fofter and more perifhable parts of an-
imal bodies, an acid liquor is formed, which is capa-
ble of breaking down, or eating away, the texture of
the moft compaft and durable.   Thus,  both in the
grave and the dunghill, by the operation  of the acid
of putrefaction, the firmnefs of  bones  and teeth is
diffolved, as it  expels the acid of phofphorous, and
affociates itfelf with their calcareous bafis,  in the form
of calcareous nitre, (nitrate of lime.) Thus the tough-
er compages of horn is,  by flower degrees,  made to
yield to the fame powerful menftruum :  in like man-
ner, the fkinny parts of animals, whether crude or
tanned, lofe  their cohefion by the destroying  effect:
of this offspring of corruption ;  the accelerated cor-
ruption of Shavings, Straw,  and rags of linen, cotton
and  wool, added to animal manure, leaves little or no
doubt, that their more rapid diforganization, in fuch
cafes,  proceeds from  the  nitric  (feptic)  acid,  by
which they are penetrated.   Such feems to be the Op-
eration of  feptic acid, concurring with other caufes,
in breaking  down the   nicely  wrought and  firmly
fabricated  works  of animated  machinery.  And ev-
ery other thing would be obliged to yield to  its  ra-
pacity and violence, had.it  not been fo provided, that
this arch deftroyer Should become glutted with con-
queft, and thus unable to purfue the work of deftruc^-
tion any longer.
   The fubftances capable of coercing and restraining
thefe active  and volatile materials, and  preventing
their ravages upon animal nature, as alfo upon things
of  the vegetable and mineral kingdoms,  are, all  the
various fpecies of alkalies,  and calcareous earths, or
lime ; likewife, all the variety of neutral falts, formed
of  a weaker acid than the  feptic acid.   Accordingly,
we find the plaiftered walls  of houfes, jails, hofpitals,
and other buildings, often furcharged with this acid,
by  which it has been abforbed and  neutralized.
From thefe  materials, nitre or falt-petre (feptite  of
                   F                      pot-aSh) 
42
A  TREATISE  ON
pot-aSh)  may be obtained in great abundance ;  in-
fomuch  that  a body  corporate, in Paris,  obtained
licenfe to take away as much of the  old mortar of the
walls of  houfes, torn down, as they pleafed, for the
exprefs purpofe of making nitre.   The walls of the
prifon at Olmutz, where La Fayette was confined,
were covered with falt-petre, or fuper-faturated with
the  feptic acid, which moft probably occafioned the
fevere ficknefs he endured,  and that of his wife and
two  daughters, while in this place of  confinement.
A difcovery, which Dr. Mitchill made himfelf, in the
jdty of New-York, comes in very well here, and proves
very fully the ftrong attractions which the alkalies
have for the feptio acid.   On the outfide of the wall
of a kitchen was an afh-houfe, and in the fide a clofet;
nothing  feparated the afhes from the clofet,  but this
wall, which was thin, and of brick; they were  fo
porous,  that, in the courfe of time, a faline effloref-
cence was obferved on the  bricks  within the clofet
near the floor.  On examination, the pot-afh, which
had apparently penetrated through the wall, in a ftate
of folution, was found  to be changed to nitre,, by
combination with feptic  acid, which it had doubtlels
attracted from  the-air of the  room.  And in this
way, he  obferves, is a confiderable portion  of the mif-
chief prevented, which would be caufed  by fuch nox-
ious Steams, if left to float about at large.  (Page 348.
vol. II. Med. Rep.)
   Grounds frequently trodden by cattle, and impreg-
nated with  their excrements ; the walls of flaughter-
houfes, and the like,  where exhalations from putrid
animal and vegetable fubftances abound ; as well as the
formation of  nitrous earths at the bottom of graves,
and where  animal bodies have decayed, Show that
earths and foils have art attraction for, and unite with
this  acid, and its vapours.  Now,  if it be true, that
feptic vapours have the power of producing the dif-
eafes that  have been  afcribed to them, then thofe
countries and places, where  the foil  is compofed of
                                            thofe 
THE
YELLOW  FEVER.
43
thofe fubftances and materials, which have an affinity
with thefe gaffes, and which, attracting and neutraliz-
ing them, deftroy their virulence, will be found the
moft healthy.   On the Ohio, and moft of the Weft-
ern Territory,  many parts of England,  France, &c.
and fome of the Weft India iflands, whofe foil is un-
derlaid  with calcareous  Strata, or lime-ftone, are in-
stances in proof; thefe places are healthy,  and free
from epidemics.
   Dr. Cafta,  an intelligent Portuguefe  phyfician, and
lately or now in this country, as an official character,
defcribes the city  of Liibon as more accommodate to
the generation of filth, and the accumulation of nox-
ious animal and vegetable materials, than to the con-
venience or comfort  of the inhabitants ;  its ftreets
narrow,  not well arranged, and the buildings high ;
but being built principally of calcareous ftone, which
attract the feptic  acids,  it is very much exempt from
epidemic difeafes, except thofe parts of the city, where
the buildings are  of different materials, (other local
circumftances being lefs  favourable to  health)  there
malignant  difeafes frequently  appear.   (Med. Rep.
vol. III. No. i.  p.  i.)
   Clay has but  a feeble attraction for the feptic acid.
Soils, underlaid with ftrata of clay, are very fubject
to intermittent fevers, as almoft every one muft rec-
ollect ; and if the feafon  is uncommonly hot, and the
atmofphere inflammatory, thefe difeafes affume a very
high degree of malignancy.  It has been often remark-
ed, and there is much truth in it, that  fertility of foil
and difeafes  are frequently concomitants ; the reafon
is obvious, from  what has  been  ftated.   In general,
then, it is afferted, and both experience and obferva-
tion verify the fact, that where the atmofphere pof-
feffes  vital air enough to fupport the life of animals,
and is not infected with fuch a quantity of feptic and
peftilential vapours, as to induce ficknefs, fuch a ftate
of atmofphere feems beft adapted both to the conve-
nience and health of plants and animals.  But in Situ-
                                            ations 
44
A  TREATISE   ON
ations where the foil, over rich with moift and putrid
materials, exhales its feptic and unwholefome Steams,
thence agues,  fevers, and plagues are  excited, and
there it is that vegetation goes on vigorously ; while,
on fandy, mountainous and rocky places, where only
fmall quantities of putrid fubftances can collect, where
the atmofphere is not at all  poifoned with their  ex-
halations, but the refpirable portion of it is unufually
large—in fuch circumstances plants thrive but poorly,
and difeafes are rare.
  " The feptic poifon, (venim feptique) fays Arthaud,
(Defcription de 1* Hofpital General du  Cam. p. 12.)
which rifes after the fall of the autumnal rains, in  the
ifland of St. Domingo, fometimes almoft fuddenly de-
stroying the Vital principle ;  at others, forming foul
and gangrenous ulcers, and by its unconquerable ma-
lignity, caufing wounds to refift all manner of reme-
dies  ; and then again difcolouring the Skin ;  or,  ob-
ftructing the mefenteric glands, keeping up a Slow fe-
ver,  inducing emaciation, and finally exhaufting the
ftrength, by  a ferous  flux s   this  aeriform venom
brings on their plagues  or malignant fevers, which,
though of local origin, are generally faid to have been
imported in Ships from  the coafts of Africa."  But
now, more particularly, reflecting its


Aclion and Effecls on Animal Life, particularly upon the
                Human  Conflitution.

   Peftilential vapours, generated as they undoubtedly
are,  in great  profufion,  in  cities, fleets and armies,
(places favouring putrefaction,  and the accumulation
of filth of every kind) having  either overcome thofe
restraints in nature, wifely provided to counterbalance
their power, and affuage their ravages ;  or, not meet-
ing with thefe, rife from their putrid maffes and filthy
matrices, and are diffufed  in all  their  abundance
through the atmofphere of thofe places ;  and thus,
                                       Surrounding 
           THE   YELLOW   FEVER.         45

furrounding the bodies of men, and filling their hab-
itations, foon commence their  destructive influences.
They may be either taken in by refpiration,  mixed
with the faliva,  and conveyed into the ftomach, and
applied to the internal organs ;  or, they may be gen-
erated  in  the alimentary canal, by the putrfeaction
of  animal and  vegetable fubftances  taken  as food.
The food  is prevented  from too fudden putrefaction,
by  the faliva, gaftric liquor, pancreatic juice, and bile,
which, mixing with it, diffolve and prepare it  for the
various purpofes  it is  intended to ferve.  As long,
then, as the ftomach fecretes its liquors in healthy and
due quantities, will its contents be kept in utter impossi-
bility of forming the feptic poifon.   But when  thefe
preventatives  are entirely fufpended, or weakened,
from debilitating caufes, fuch as the too liberal ufe of
fpirituous liquors, exceflive heat, fatigue, or from any
other procefs, by which its healthy functions are de-
stroyed or impaired, then it is evident that the food
will  be liable to  corrupt,  and  the products formed
from thefe materials, within the ftomach and intef-
tines, Similar to thofe which obtain without  the body.
A fource of  poifonous  effluvia  feems thus to exift in
our bodies ; and, from its Stimulant qualities, the oc-
currence of naufea, burning pain, and exceflive vom-
iting, together with other Symptoms  of gaftritis, will
not  be difficult  of  explanation.*    To  this caufe,
whether generated in the prima via, or taken in from
a vitiated atmofphere,  when applied to the inteftinal
canal, are diarrhseas, dyfenteries, and cholera morbus,
                                               difeafes
  * " Mr. Prior, the infpe&or-general of beef and pork, in this Commonwealth,
(New-York) during the fummer and autumn of 1799, examined feveral thou-
fand barrels of provisions, in various ilates of decay, partly from the bad quality,
and partly from the fcanty quantity of the Muriate of Soda, (fea-falt) with
which they were pickled, he and his aflift ants amounted, in the whole,  to forty
ferfont; they all obferved, when beef began to putrefy, it always turntd four.
This acidity could be both fmellei and tafled.  When it infinuated itfelf into cuts
and fcratches on their hands, it caufed them to inflame,  and be difficult to heal.
And out oiftrty, fo expofed to the acid fumes of corrupting beef, tbirty-eigbt were
affected with dyfcntery, attended with more or lefs of fever, naufea, and ca-
tarrh."
                               ' (MS. Lttter f,on TV, Mitchill.) 
4<S            A   TREATISE   ON
difeafes of the fame genus, only differently modified,
referable.  The inflamed ftate of the ftomach, duo-
denum, and  lower parts of the inteftinal  canal, and
the black, gangrenous and mortified fpots, are all ow-
ing to the operation of this acid, which, in fome.cafes,
may acquire a higher degree of malignancy than com-
mon, by uniting  with a larger portion  of oxygene.
The coffee-coloured matter, commonly called  black
vomit, ejected in what are called bilious remitting fevers,
feems to owe its colour to a mixture of  this acid, as
appears from its ftimulant nature,  noticed by diffec-
tors, with a quantity of bile and blood, which is pour-
ed out of fuch veffels as have their coats  deftroyed by
this poifon.
  On the  application of thefe peftilential  fluids, which
have been considered the caufe of  the difeafes  men-
tioned, to the  bodies of men, which  it  may  com-
pletely furround in fome cafes, is it  prefumed, are the
various eruptions and petechia, fo  common in fevers
of the worft type, to be explained ;  and not often to
be  referred to critical depofitions of humours  from
'.he blood.  Thefe affections will put on different ap-
pearances  and malignancy, in  proportion to the con-
centrated  ftate  of the poifon, the constitution, and
parts to which It  is applied.   From the difpofition of
this acid to  adhere to bed-clothes  and  bedding, of
which there are innumerable inftances, it will readily
appear how thefe  peftilential eruptions are produced,
especially on thofe parts that are kept conftantly cov-
ered, as the back, loins, &c. which are thus continual-
ly furrounded by an  atmofphere of contagious va-
pours,  The  Skin, thus befet by this fluid, whofe par-
ticles feem to inhere  in its pores, becomes inflamed,
and puts  on this morbid appearance,  The yellow
colour of the Skin, in fome cafes of highly contagious
difeafes, feems to depend  upon the fame caufe, and
is not an abforption of the bile, as  has been fuppofed
by writers on bilious remitting fevers. If thefe changes
of colour  in the Skin were really' owing to abforbed
                                               or 
THE  YELLOW  FEVER.
or to regurgitated bile, the colour of the urine in thefe
cafes ought to be deeply tinged with this fluid,  and
the feces to put  on an afiVcoloured appearance, as in
jaundice ; but none of thefe appearances are obferved
to take place in, the fevers,  where this pretended ab-
forption is alleged.  Befides, it is well known,  that
fuch parts of the Skin, to which this pqifon is artificial-
ly applied, will put on a yellow appearance, refembhng
that which is obferved to take place in what is called
yellow fever.
   This acid, in a vaporific form,  does, no doubt,
fometimes enter the trachea, with the air in  refpira-
tion, where it may inflame and deftroy the parts with
which  it comes in contact; and, in its paflage to the
lungs,  if in a concentrated form, may occafion hidden
death.   In this manner may the fudden extinction of
life, in perfons expofed to the contagion of the plague,
as obferved by  Ruffel,  be  accounted for.   If  this
gafeous fluid be  inipired in fuch a diluted ftate, as not
to occafion immediate death,  it may caufe catarrhal
affections, anxiety, coma, fuffocation, &c. depending
on the fparfe or concentrated form, and circumftances
under  which  it is applied.   When mixed with at-
mofpheric air, and taken into the lungs, it will not
ferve the purpofes of  refpiration, as but  a fmall  por-
tion of vital air  will be decompounded, owing to the
large quantity of non-refpirable air which is taken in.
The heat of the body mult thereby be leffened,  and
the contractions  of the heart and arteries become more
Slow and feeble.  In  this way may the  purple  and
blackifh fpots, of perfons dead of fever, occafioned by
this acid and  its oxyd, and the livid and dark colour
of the  Skin,  attended with coldnefs during  life, be
accounted for  ;  the lungs not being able to reftore to
the fyftem its ufual and  neceffary Supply of oxygene.
Hemorrhages,  debility,  and proftration of Strength,
together with  want of cohefion  in the folids, might
all be explained upon  the fame principle,  the  mufcles
being deprived of their  ufual quantity of  oxygene,
and overcharged with fepton. 
48            A   TREATISE  ON
  If this acid be formed in the ftomach and inteftines,
or taken in by the Saliva, and applied to the mouth,
fauces,  cuticular  and pulmonic furface, it will moft
probably be taken up by the abforbent veffels of  the
Skin and pulmonic organs, or abforbed by the lacteals
of the inteftines ; and in this way the blood is con-
taminated.
  The acid fweats,  thrown  out  from  the  poifoned
mafs of blood, by means of the fmall exhalent arteries,
in malignant and peftilential difeafes, forming the mat-
ter of infection,  and adhering to the bed-clothes and
linen, which, by its corrofive qualities, it deftroys and
rots; and, if excreted in any confiderable quantity,
fo commonly relieves the patient, (inafmuch as  the
volume of poifon, contained in the arterial fyftem,
is thereby leflened) Shews that the blood, in  certain
difeafes, -contains fomething  of a  noxious nature.
The appearances alfo, which blood, drawn in peftilen-
tial fevers, puts on, correfpond with that in which
feptic gas  had been artificially injected.   Blood, thus
infected with this poifon, taken up by the abforbent
veffels, will be  carried the round of circulation, and
will continue to Stimulate  the heart and  arteries,
wearing out their  excitability,  and, confequently,
bring on death, if the conftitution be incapable of be-
coming habitutated to its Stimulus, or a part, or whole,
of the Stimulus be not fubducted.  If it be prefent in
any great quantity, it may caufe a fudden extinction of
the vital principle, as is obferved fometimes to happen
in highly peftilential difeafes.
   The abovementioned  compounds, when  abforbed
by the lymphatics, may inflame them, and  caufe ob-
structions, indurations, and even fuppuration, of thofe
glands through which they pafs, as is commonly ob-
ferved to take place in the inguinal and axillary glands,
in the plague,  and other difeafes produced  by a  pef-
tilential ftate of the atmofphere, where it is abforbed
in a highly concentrated form.   Inftances have occur-
red, where  the lymphatics  of the hand, on this ex-
                                           tremity 
THE  YELLOW  FEVER.
tremity being wounded, in diffectingbodies, in which
the feptic acid appears  already  to  be  formed, were
highly inflamed, and could be readily traced from the
part where this fluid had been applied, in their courfe
to the glands in the axilla,  in  which fubfequent in-
flammation  took place.
             ANTIDOTES.

   THE firft  which I Shall  mention, are the natural
ones—the  gaftric liquOr and the gall.   Many pathol-
ogists have fuppofed, that  the gall, or the bitter of
foda, (for foda is an ingredient of  the bile) promotes
putrefaction  in the inteftinal canal, and thereby was
the caufe of much febrile mifchief; but experiments,
by Dr. Saunders and others, prove  the contrary; and
that it is really a grand preventative of the very evils
it has been accufed of producing.   Its  alkaline qual-
ities Show,  that it is well calculated to check putrefac-
tion, and quell a redundant acid in  the firft paffages.
The yellownefs of the Skin, in certain peftilential dif-
eafes, can be better accounted for  from the influence
of feptic acid, Striking out a colour as it  acts upon the
lkin, or the depofition of putrid blood, than from the
prefence of the bile ; and the confiderable quantity of
it fecreted  in fome of the cafes of  poifoning,  called
fever, Shows, not that it is the caufe of the difeafe,
but that a  copious flow of it has prevented, in the in-
teftines,  the  fatal confequences of  much feptic venom,
produced there.  The greennefs of  the bile, in fuch
cafes, is proof of  its mixture with an acid ;  and, if
further evidence is wanted, of its falutary and preferr-
ing power, examine the diffections of bodies dead of
the yellow fever, &c. and it will appear, that,  as far
above and  below the orifice of the ductus communis
choledochus,  as the biliary fluid extends,  fo far the
duodenum  and continuous parts of the inteftines are
                   G                         free 
   5*            A  TREATISE   ON

   free from inflammation and its confequences.  Now,
   if by any means the digeftive  powers are deranged,-
   and the gaftric liquor is not duly fupplied, and if the
   liver ceafes to perform its office, and the bile is not
   thrown into the mteftines, in  quantity fufficient to
   retard putrefaction  of the alimentary fubftances, and
   to prevent the  formation of  feptic acid, the aid of
   medicine, and artificial preparations, mult be reforted
   to.   For this purpofe,  and with this  intention, the
   moft of the neutral falts have been prefcribed, as the
   proper remedies, and found falutary and  uleful ;. to-
   gether with many bitter vegetable preparations, oils,
   &c.   The falts, eonfidered as the moft effectual cleanf-
   ers of the alimentary canal, of any feptic and feculent
   matters, are  the carbonate of pot-afh, (fait of worm-
   wood) aeetite of pot-afh, (regenerated tartar)' fulphite
   of pot-afh, (vitriolated tartar)' tartrite of pot-afh, (fol-
   uble tartar) tartrite of foda, (Rochelle fait) fulphate of
   foda, (Glauber's fait.)   Thefe falts are decompofed by
   the feptic acid, which  coming in contact  with them,
   the alkaline bafes will part with the acids,  with which
   they are combined, and unite with the feptic, accord-
   ing to the laws of attraction, and form with them fep-
   tites.  By this means, the caufe of the difeafe will be
   removed, arid the patient, if not too much worn
   down by difeafe,  recovers,   The muriate  of  foda
   (common fea-falt)  is highly recommended in dyfen-
   teric complaints.  Wright Obferves, that marine  fait,
   diffolved in any of the  vegetable acids, operated as a
   charm in  the dyfenteries, in  the ifland of Jamaica,
   when all the other remedies,  which  have been cele-
   brated in curing this difeafe, had failed.  Oils have an
   attraction for, and readily combine with  the feptic
   acid.  Caftor  oil was ufed here (Bolton) as a cathar-
   tic,  in the laft  epidemic, with evident good effect.
   The difcharges it occafioned were very copious, liquid,
\   green, and, in fome cafes, almoft as dark as ink.
     "The neutral falts, with  the bafis of foda, (obferves
   Dr. Mitchill) are among the moft mild, and agreeably
                                            efficacious 
           THE  YELLOW  F£VER.         5*

 efficacious articles of the Shops.  The tartrite of foda,
 (Rochelle fait) is an elegant remedy, and one of which
 I have employed, with much fatisfaction, to keep the
 inteftines free  from noxious  materials, in our pefti-
 lential and other fevers.  The phafphate of foda, (foda
 phofphorata) is, perhaps, a yet more elegant medicine,
 readily foluble in water, eafy to take, and not difficult
 to  be decompounded  in the bowels.  The carbonate
 of foda, diffolved in  water, and  taken into the ftom-
 ach,  at the rate of from four  to eight grains in two
 or three hours, is a moft gentle and  efficacious reme-
 dy in dyfenteries, and  in cholera infantum.  If tenef-
 mufi is violent, clyfters of foda often afford  almoft in-
 stant relief.   Laudanum, if neceffary, may be joined
 in both cafes.   Indeed, in the three enumerated forms,
 foda is capable of attracting the feptic acid, which, no
 doubt, is a frequent  exciting caufe of dyfentery."
  Dr. Barker^,  of Portland, is a very refpectable tefti-
 mony, in favour of the ufe of lime, magnefia, and al-
 kaline falts,  in dyfenteries  and putrid fevers.  Thefe
 difeafes were prevalent there in  the fummer and au-
 tumn of 1798.  He fays—'"The mode of treatment,
 which i  purfued, was to eleanfe the ftomach with
 ipecac, and the inteftines with rhei and fal. abfynth. or fal.
 cathart. with fal. abfynth. Lubricous oils and  mucilages
 were occasionally employed, as alfo enemas.   But the
 remedies which I depended upon, to counteract the
 noxious  caufe,  were alkaline  falts and earths.  My
 common prefcription was, aq.cal. Ifoj  ; fal. abfynth. 3ij.
 the dofe from  one to two  ounces every hour ;  and,
 in fome cafes, every half hour, or oftener,  in an in-
 fufion of camomile flowers.    Befides  this, I  ufed
tefia. magnes.  or creta,  frequently from  one to  two
ounces in twenty-four hours."

  Thus are exhibited the moft prominent features, and
the leading  pofitions of the Mitchillian doctrine  of
epidemic difeafes, and " theory of peftilential fluids ;"
taken principally from  his own writings, and from a
                                           treatife 
52           A  TREATISE   ON
treatife by Dr. Lent.  For further  confirmation  and
proofs, in detail, together with an abundance of nov-
el and important facts, well adapted argument, inge-
n:-us reaibning and juft  conclusion,  I mull refer to
the   ritings  themfelves.  They will  be  found  well
defe. >. upi rhe attention of every inquirer ; of the agri-
cult or,  the chemical elaboratift,  the  natural philofo-
pher, the pathologist,  and the medical practitioner.
  THE laws and operations of animal life, are many
and various; fome of its  more  interior effects and
movements are totally removed beyond the reach of
human inveftigation ; fo far, at leaft, as this inveftiga-
tion  is made  to reft upon the knowledge  gained
through the external and bodily fenfes,  If there is
not only a difficulty, but an impoffibility,  in  investi-
gating and  explaining, to human  apprehenfion, the
operations of the animate machinery in an unimpair-
ed ftate, we are not to wonder, or feel difappointment,
if many of the phenomena of difeafe Should not admit
of clear elucidation.   That pathology, or theory of
difeafe, which will explain the moji of its fymptoms,
Should be confidered as the beft ; and that the trueft
phyfiology, which accounts for the moft of the opera-
tions and functions  of organic life.  It is perfectly
erroneous to fay, that vitality is derived from any of
the elements of nature,  taken in  or  applied  to the
fyltem.  This is fo far from true,  that, inSlead of their
imparting any real vitality, fomething is always fuper-
added to the materials,  taken into the fyftem, wheth-
er in a gafeous elementary form, or otherwife, before
they can become a part of it, or  are affimilated ; and
any  thing or  fubftance, that will not  yield to the di-
geftive powers of the fyftem, or, that cannot be chang-
ed by them, from the nature, form and qualities it
pofleued before it  entered the fyftem, is deleterious
and destructive of its life, in that it does not yield to
                                               its 
          •fHE  YELLOW  FEVER.        53

its operations ;  which is the cafe with every thing
that nas not parted with the living principle ;  becaufe
life cannot operate upon life without mutual injury.
This Shows,  that there  is fomething in animate na-
ture, fuperior to any thing in external or material
nature.   It is true, that animal  life is fupported by
the things taken in or applied to  the body ; but  this,
in no way, proves that it is derived from, and is pro-
duced by  them : on the contrary, were not animal
life fourced in a higher principle than any of the ma-
terial elements,  there could be no fuch thing as nat-
ural death ; becaufe, constantly furrounding the body,
they are  always ready to cheriSh and fupport the life
they have imparted;  and this life the body muft al-
ways continue to receive, if originally received in con-
fequence of their operation upon it.   When  materia}
fubftances are applied to the living or fenfitive prin-
ciple, fuch as are congenial to it, and are capable of co-
operation with  it, are felected, become adherent to,
and recipient of, animal and fpiritual life and form ;
and thus  are poffeffed of a nature fuperior to that in
their elementary ftate ;  thus fublimate and fpiritual-
ized, they are fitted to receive, embody, and organize
our very thoughts, perceptions  and affections ;  and
thus they are made the fubftrata  and externals of the
fpiritual body, for future and eternal existence.  What
is not capable of becoming thus fubftantiate and Spir-
itualized, or of receiving, retaining,  and perpetuating;
the life or fpiritual nature, is ejected and thrown off
This procefs is continued until the foul is completely
embodied an^  enveloped in  fuch of the natural ele-
ments as are, from the  fpiritual nature, rendered im-
perishable ; then it is that the natural body begins to
decay ; that is, as foon  as the fpiritual form is com-
plete and the ftature full ; old age comes on, and, at
length the body dies ; becaufe ot no further ufe, and
is only  a cumbrous inveftiture, and  real impedi-
ment.—The natural powers are the ftrongeft, moft
operative, and the irritability more diffufed,  in infan-
                                                cy* 
54            A   TREATISE  ON
 cy,  childhood, and up to manhood; then gradually
 leflening, in proportion to the increasing exertion and
 Strength of intellectual agency.   It is not pretended,
 that what is here afferted is from any real or pofitivc
 knowledge of the fact;  it never can be known from
 any natural experience, or developement from natural
 proof, however elevated the point of intellection and
 intuition may be.  But effecls from an application and
 operation of the natural elements upon animated bod-
 ies, may and can  be known ;  and thefe are the proper
 fubjects for inveftigation.   They will  always be found
 fufficiently numerous to employ the moft  induftrious,
 perfevering, active and penetrating minds.
   The criterion of juft estimation, hinted at in the
 above remarks, viz.  that that is  the beft pathology
 which explains the moft of the phenomena of difeafes
 and their caufes, does not make again ft the Mitchillian
 doctrine; but, on the contrary, inclines us to efpoufe
 it as the moft rational and juft:  yet it is  not without
 its difficulties.
   Some phyficians are in the opinion, that merely a
 defect or abftraction of oxygene will give rife to putrid
 difeafes.; and  the opinion is not deftitute of plaufir
 biljty, nor feemingly, unsupported by fact.
   The Same concurrence of circumftances neceffary to
 the production of the feptic acid,  will  occafion a-di-
 minution  of oxygene; fo  far then  the  reafoning is
 equally applicable in both cafes.   The phenomena of
 difeafe, aiui the effects in  either cafe upon the human
 conftitution,  ought to determine which  hypothefis
 has moft of probability, and which is in clofeft agree?
 ment with real fact.
   The healthy temperature of  the body, the prefer-
 vation of animal heat, all the various fecretions and
 excretions ;  in Short,  the whole procefs of animaliza-
tion depends upon the action and functions of the
 whole Series of veffels  and organs ; and their action
certainly depends upon a regular fupply of vital air or
oxygene.  This is afferted upon the authority of legitr
                                            imate 
THE  YELLOW  FEVER.        5$
imate experiment  and well attefled fact.   Ihe im-
portant ufe of this ingredient in the admininration of
the animal economy has caufed it  to be considered as
the pabulum vitas of all animal nature.  The extreme
veffels, in  the nourishment and prefervation  of the
fyftem, are continually employed  in  forming animal
oxyds of different  kinds, as  the fat and jellies of the
membranous and white parts ; in  the various  depofi-
fitions  of mufcle,  bone, tendon,   &c. for  thefe are
all  continually  abforbed, thrown  off in the  various
excretions, and inceffantly renewed.   They are con-
tinually employed in filling up all  the cavities  and in-
terftices, &c.  But  when the body is attacked by a
malignant diforder, appearances are then much chang-
ed, and all thefe various operations either immediate-
ly ceafe, or ate totally reverfed*  Inftead of the forma-
tion of animal oxyds, folids, &c. there is a very mani-
fest decompofitwn and diffolution of them ; witnefs the
great emaciation of the body, the great fecretion and
flow of bile  in many instances, the aftonifhing accu-
mulation of fcecal and putrid matters in  the alimenta-
ry canal ;  infomuch that almoft  a conftant cathartic
evacuation is neceffary, during the progrefs of the dif-
eafe, and even in a ftate of convalescence.   In fact, fi-
bre and fluid, animal fat and gall,  fceces and urine, all
the fecretions and excretions are blended in one com-
mon and heterogeneous mafs ; poured into and lodg-
ed  in  the alimentary  canal.   Now if this condition
of  the body is a proof of the prefence of feptic acid,
it as ftrongly marks a defect of oxygene.
   But now examine the blood.  The  direct and man-
 ifeft effects of vital air upon the blood,  as  proved by
manifold  and well attelted  experiments,  are,  1. Its
oxygenation, by which it  is  globulated, and thefe
globules rendered firm, compact,  folid,  and diitinct ;
and the whole  mafs coagulable.    2. It  reddens  the
blood, or  gives to it a bright vermillion tinge,  and
when it is in this ftate, then it is, that that principle
is fupplied to the fyftem, which fupports  the life and
                                           motion 
56           A  TREATISE   ON
motion of its whole machinery.   Now thefe are not
the appearances in difeafes.  The dark and livid colour
of the blood,  when the difeafe has advanced to the
fecond or third day, and is  violent ;  its  frequent
incoagulable  ftate ;  the petechia? or purple fpots ;
the black  and  offenfive  difcharges  by  ftool  and
vomit, are proof direct,  of defect of oxygene, a con-
fequent prevalence of  fepton, and  an incipient  pro-
greffive putrefaction :  that is, if we give any credit
to pneumatic chemiftry, and the phyfiological deduct
tions from principles long Since eftabliShed.
   "At  the  clofe of the Second ftage," fays  Mofeley,
" of the difeafe, and at  the time the third ftage com-
mences, which decides the fate of the patient, he be-
comes tranquil and compofed, free from diftrefs or anx.
iety, infomuch that the difeafe feems to be at an end j
but the delufion foon vanifhes, a fatal  ftorm  foon fuc-
ceeds the calm, which overwhelms the patient, and
completes the cataftrophe ; a mortification comes on, the
fluids are diffolved) and  profufe difcharges  of   black
blood entile."
   The face  is livid in apoplexies, in Strangulations,
in fits of coughing,  &c. becaufe the procefs  of  refpi-
ration being fufpended,  the accefs of vital air is pre-
vented.  The countenance, in a fit of malignant fe-
ver, is livid, and not diflimilar in appearance to that
of an apoplexy or fit of hyfterics.
   But is not a defect, abstraction, or want of oxy-
gene  an effecl  of which the formation of the  feptic
acid, either in the fyftem or out of it, is the caufe ?
For although fepton and oxygene,in their feparate ftate,
have  a very weak, if  any attraction for each other ;
yet when brought into chemical union, then their at-
tachment becomes very  Strong, and the combination
rapid and intimate, until arrived at the point of fatur-
ation.  Admit now the fact, that feptic acid is fome-
times formed in the alimentary canal,  and that thefe
are the circumstances attending its formation, if there
Should not  be prefent at the time of the formation
                                                of 
           THE  YELLOW  FEVER.        57

of the feptic acid,  a quantity of oxygene in a gafeous
and difengaged ftate, fufficient  to carry the combina-
tion to the point of faturation, it may even be drawn
from the blood and animal  fibre,  thus occasioning
the livid appearance  of the body and blood, always
more or lefs the distinguishing marks of a putrid fe-
ver.  But if this diminution of oxygene, in and out
of the fyftem, refults from the formation of  the fep-
tic acid, it muft be Simultaneous with  this formation
of the acid, and proximate of any effect from the
acid upon the  fyftem.   This brings us to the moft in-
fuperable  difficulty to be met with in the Mitchillian
theory.  If the irritability of the fyftem is kept up,
by a regular and inceffant fupply  of oxygene, and if
this fupply is withheld or taken from the fyftem, fyn-
chronous  with the formation of the feptic acid, the
irritability muft ceafe or be fufpended as an immediate
confequence, and previous to any  other effect of the
acid upon the  fyftem :  how then can  it  produce its
effects by its Stimulating qualities ?  Befides, it is not
afcertained, whether  the withholding or abstracting
that principle or ingredient which fupports the irrita-
bility of the fyftem, will not be as fatal to it, occafion
as much  commotion  and anguiSh, and produce as
great a malignancy of difeafe,  as  an over fupply of
the fame  ingredient, or as an exceflive ftimulation,
from whatever caufe, producing indirect debility.
  Frequently it happens, that chills or rigours  precede
the firft attack of fever, and that at this time there is
a torpor  and  almoft total inaction of all the veffels
throughout  the fyftem ;  after this, and frequently
through  the progrefs  of the difeafe,  alternations of
heat and chills take place.  But if the fever were  ex-
cited and continued by  exceflive ftimulation of the
feptic acid, this ftimulation muft be  kept up and  in-
creafed uniformly, (during the prefence of the acid)
from the firft morbid impreffion, until followed by in-
direct debility.
  The blood and fibre of infants and youth are more
oxygenated than that of adults.  Infants and youth
                  H                            are 
58            A  TREATISE  ON

are peculiarly fubject to the local form of epidemic
difeafe, called dyfentery ;  with adults, the difeafe af-
fumes the more general form of fever.  The inflam-
matory ftage of fever is much  longer with the middle
aged, than with  thofe that are paft  the meridian of
life.   The  irritability  of the  fyftem  diminifhes pro-
portionably with the advancement of age;  and  the
irritability  varies  with the degree of oxygenation,
which depends upon the various proportions of vital
air, or oxygene, taken  into the fyftem.  Females and
pregnant women are lefs liable to be  affected by epi-
demic difeafes, than males of the fame age.   The fe-
male fyltcm  is conftitutionally fubject to  occafional
variations in the proportions of oxygene in the blood,
caufing the maenorrhagic difcharges ; and this may be
a realbn, that they are  not fo  liable to be difeafed by
atmofpheric viciflitude, from a want of the fame prin-
ciple or oxygene.
   We have thus ftated and difeuffed  what  appeared
to be difficulties in the Mitchillian theory : as well as
fomething favouring the idea,  that putrid difeafes are
occafioned by a want of the acidifying and confolidat-
ing principle.  Perhaps it would not  become  me to
exprefs any pofitive opinion in the  cafe ;  I therefore
fufpend my judgment.   Facts, experiments, and  the
teftiinony of medical  authors are  appealed to and
adduced, by the  advocates of thefe  two  opinions.
That  the difeafe is caufed in  one or both  of thefe
ways,  according to predifponent circumftances, there
feems every reafon to conclude.  Predifpofing caufes,
perhaps, have as much to do  in deciding  the char-
acteristics and real nature of a difeafe, as the exciting
caufes themfelves :  indeed it is difficult to determine
or Show the difference,  in  many inftances, between
them. Difeafes, therefore, may be variant proportiona-
bly with their predifpofing caufes.   Dr. MitchiU's in-
veftigations are novel and interesting  ; his arguments
copious, and his deductions, fo far as facts can be had
and will extend, are juft.   The abilities, which have
                                             done 
THE  YELLOW  FEVER.
 done fo much, can ftill do more ;  and although fome
 obfcurities and difficulties ftill remain, yet we do not
 defpair that in the end they will be obviated,  by fair
 explanation, and a progreflive developement of truth.

   We fhall here introduce a page or two from Vol.
 II. Medicina Nautica, upon which we  fhall  offer fome
 remarks, which will ciofe the difcuffion of the fubject
 of peftilential fluids.
   " It is fomewhat Angular, that among all the variety
 of articles, that has attracted the attention, and excited
 the ingenuity  of phyficians, none of  them have ever
 recommended a procefs for fupplying faclitious oxygene.
 But it is eafily to be perceived, that their wits have
 been  directed, not to the fupport of the vital flame,
 by chemical agents of health ;  but folely to the de-
 struction of the matter of contagion, by morbific va-
 pours.  (Page 53.)
   " The atmofphere of all  warm climates probably
 poffeffes a larger proportion  of oxygene, than that of
 our more northerly latitudes ; and there may be fome
 peculiarity of  conftitution, in unfeafoned Europeans,
 that difpofes their blood to receive a greater quantity
 of this ftimulus, and which may favour the difeafe in
 queftion.   The feafoned  European, the native white
 inhabitant, and all the people of colour, to the deep-
 eft  black,  who have  refided  in the (Weft  India)
 lflands, are obferved to  be  fecure againft the yellow
 fever: or, if  they become affected, it is from caufes
 which are common  to them  with the new-comers
 from the northerly regions.  The fallow looks and com-
 plexion of thefe people certainly fhow that their blood
 is not fo florid, and confequently lefs oxygenated, than
 thofe  who are fubject to  this endemic : and  this fact
 clearly points  out  and confirms what has been moft
 fuccefsful in the prevention.   This alfo Strongly eluci-
 dates  the theory of  Dr.  Mitchill, whofe prophylactic
 means entirely correfpond  with  the moft approved
experience on the fubject.   His doctrine does not fu-
                                           perfede 
6o
A  TREATISE  ON
perfede what has been thought the beft practice, and
while it rather confirms it, has added other affiftants
that were before employed with doubt and hefitation,
becaufe there was  no principle eftabliShed  to direct
their  application.
  " Particular fpots of foil, and efpecially fwampy dis-
tricts of country,  give  out thefe peftiferous exhala-
tions, which fo Angularly affect  the human  body ;
and as  we  recede  from  the places where  they are
evolved, we in proportion avoid the poifon.   In other
words, they are too much diluted  to  be hurtful ; or
they excite difeafes neither fo acute nor fatal.  (Page
 IOI.)
  " We  have been called upon to give our opinion, in
what manner contagion affects the human body : Is
it to be confidered as a Stimulant, exhaufting the fen-
forial powers, and producing indirect debility ? This
fubject  has  been haftily difpofed  of elfewhere :  we
have ftill many doubts; but our reflections  are not
fufficiently matured to decide.  The matter of conta-
gion, whatever it may be ; (it may be nitrous gas, or
any other gas) certain it is,  that it affects the  human
body by SirSt impregnating the atmofphere.   All thefe
gaffes, we readily admit, may be called Stimulants, if
taken into  the  Stomach,  or applied to an excoriated
furface ; but as diffufed in the medium which animals
breathe, they render it lefs fit for  refpiration.  The
elective  attraction of the lungs, giving out  and re-
ceiving noxious and falutary principles, by expiration
and infpiration, is deftroyed by the prefence of the
contagious miafmita; and the firft fymptoms of infec-
tion would appear  to be  the  imperfect expanfion of
the lungs, abfiraclion of heat and oxygene, with  a cor-
refponding  fenfation throughout  the whole  frame.
We fee no reafon, however, that excludes the fuppo-
fition of the hurtful quality being firfi applied to the
nerves,  fpread  on the delicate  membranes  of the
bronchia, and from them communicated to the fyftem.
Is it inconsistent with the wife defence which nature
                                               has 
THE  YELLOW  FEVER.        61
his given  to  other organs, to fay that the nerves ex-
panded on the pulmonary veficles, are endowed with
a perceptive difpofition, that enables them to distin-
guish the hurtful qualities of the air, abstracted from all
cnemical combination which refpiration may effect on
the vital fluid ?  Is it grofs to fay that they feel ? that
they poffefs an animal appetency for the exprefs pur-
pofe ?  Their fenfe we know to be moft exquifite, from
the leaft irritation, throwing the trachea and bronchia
into convulfive action.  And thefe nerves muft be admi-
rably fuited for that intention ;  as the blood, warmed
and Stimulated by every  frelh acceflion  of  oxygene,
muft be constantly bellowing  excitement.  Surely it
is reafonable to admit, from analogy,  that the  lungs,
 fo wonderfully constructed,  may diftinguiSh a  poi-
fonous quality in the air, through the  medium of
 nerves, as well as the optic nerves  Should difcern
 light.    Sulphurous and nitrous gas excite coughing:
 an excoriated  or wounded part feels an increafe of
 pain, when held in a veffel containing oxygene gas:
 with equal propriety, therefore, it may be faid, that
 the pulmonary nerves become  difeafed  by the appli-
 cation of contagious matter, and that the lungs, in
 confequence, ceafe to perform  aright their chemical
 functions.  I am led into thefe reflections,  by being
 perfuaded, that  this fubject has been considered  too
 much in a chemical view ; and the prefence of a vital
 principle operating in the fyftem, made but of fecond-
 ary confequence in this  fublime operation of nature.
 Whether this  opinion will be  admitted or not, our
 doubts are not yet removed,  that the effecl of contagion
 is the  abfiraclion offiimulus from the body, and the fucceed-
 ing typhus a difeafe of direcl debility.
    "We can hardly fuppofe that cantagious  matter
 acts as  a ftimulant  producing indirect debility, when
 we fee its action fo manifestly affifted by predifpofi-
 tion, and that depending  generally on a debilitated ftate
 of the body.  Its previous ftimulant power has never
 been  marked;  and the very  Slow progrefs of the ear- 
62
A  TREATISE  ON
 ly fymptoms fometimes is a Strong argument againft
 its exiltence.  But if it induces fever, by directly af-
 fecting the organs of refpiration, by deficient Stimulus
 t<> their nerves, or by imparting lefs,oxygene to the blood,
 the whole operation may be accounted for, without
 admitting its ftimulant power.   The  difeafed condi-
 tion of the ftomach, we think, is always a fecondary
 attendant on the febrile ftate: the contrary opinion
 arofe chiefly from the notion, that the poifon was re-
 ceived by the ftomach, afterwards taken into the cir-
 culation, and there became the caufe of the fever.
 This could never be the cafe in thofe  inftances where
 contagion in a moment, quicker than thought, induces
 wild delirium, and fometimes inftant death.   As  act-
 ing  immediately on  the  organs of refpiration,  the
 fact is explained;  and alfo leaves us ftrongly impreff-
 ed, that the nervous fyftem is primarily affected."
   If there  be much of truth and  medical  orthodoxy
 in the above paragraphs,there is at the fame time much
 contradictory affertion ; and the facts ftated,  (if they
 are facts) feem quite  in open rupture with each oth-
 er.   In one place, the production  and artificial fupply
 of oxygene is  recommended as a corrective of febrile.
 miafmita, the generation of which, it is faid, is favour-
 ed by air, which refpiration in crowded places has ren-
 dered impure.  And it is  further thought, that  con-
 tagious matter induces fever, by  imparting  lefs oxy-*
 gene to the blood, than is ufual in a ftate of health;
 thereby depriving the nerves of the natural and wont-
 ed ftimuli.  But then in another  place,  and contrary
 of this, it is ftated, that, probably, the atmofphere of
 all warm climates pofleffes a larger proportion of  ox-
 ygene, than the more northerly latitudes ; and that,
 from fome peculiarity of  conftitution, the blood of
 Europeans is more difpofed to receive  a greater quan-
 tity of this ftimulus,  than  the blood of the natives;
 and,  that this is the reafon the former are more fub-
ject to the difeafe of yellow fever; but that, if the dif-
 eafe  do  attack the latter, it is from a caufe, common
                                                to 
          THE  YELLOW  FEVER.        6j

to the former !—Now, that the blood of unfeafencd
Europeans, who have, as ftated in the extracts, been
accuftomed  to breathe in an atmofphere of an under
proportion of  oxygene, Should  neverthelefs  poffefs
more oxygene than the blood of the natives, who have
always breathed an atmofphere of an over proportion
of oxygene, is to me unaccountable.   Befides, why is
it advifed, in order to avoid peftiferous exhalationsj
which fo peculiarly affect the human conftitution, to
recede from fwampy diftricts, whence they proceed ?
Is it becaufe there is, in thefe places, lefs or more of
oxygene than in elevated Situations ?  1 will not at-
tempt to folve the difficulty, until 1 am more fully
perfuaded of the facts.   Eudiometrical experiments,
efpecially thofe made by Dr. Clark, if accurately done,
eftablifh  directly the oppofite  opinion—that there  is
lefs of oxygene in thefe climates.   Both of thefe itate-
ments, I conceive, may be thus far true ; that, in the
warmer latitudes, there is more  oxygene elaborated
and drawn from vegetable furfaces, and other ways,
during the day, than in colder latitudes ;  but that, in
the  night, it is  diminished in exact proportion to its
greater abundance in the day time.  If this be fact,
and if it be further true, as is afferted by the moft re-
fpectable phyficians in the Weft Indies, that the difeafe
almoft invariably commences in the night,  it is moft
powerful and decifive in favour of the opinion,  that
the fever is a difeafe of direct debility, and occafioned
by a deficient fupply of oxygene.
           TREATMENT.

  THE method of cure generally advifed and pur-
fued by the  phyficians here,  was concifely this :—
On  the commencement of  the  difeafe,  or in the
firft paroxyfm, when there is great heat and convulfed
motion of  the heart and veflels,  evacuate throughly
and univerfally, by mercurial cathartics,  by diapho-
                                             refis, 
64            A  TREATISE  ON
refis,  and by blood-letting ;  all thefe, with poultices,
fomentations, pediluvium, bathing, (cold and warm)
blistering enemas,  &c. in Such  extent, variety,  and
continuance of  application, as circumltances require.
After one or two effectual cathartic evacuations, give
mercurial pills of one, two or three grains, every one,
two or three hours, as Symptoms Shall indicate.  Move
the bowels with fomething cathartic every, or every
other day.   Drinks—fubacid,  diluent, emolient.
Continue thus,  till arterial commotion and heat fub-
fide ; fecretions  and excretions are in Some meafure re-
stored, and the figns  of returning health appear.
Then ufe reftoratives, viz. wine, bark, &c.  Food—
light and eafy to the ftomach, but generous and gently
Stimulating ;  in fmall quantities, and often.
  Cathartic  Evacuants—To cleanfe the firft paf-
fages  as  thoroughly and fpeedily as poflible, which
certainly is the  leading indication in the cure, calomel
is considered as the fafeft, moft certain and effectual.
For this purpofe, it is fometimes given, without mix-
ture with  any  other cathartic,  from  12, 15 to 20
grains, in powder or bolus ;  but more frequently it
is ufed with jalap ;  from 10 to 15 gr. cal.—from 20 to
25 jal.  Some phyficians give the preference to fenna,
manna, cream of Tartar, falts, oils, &c. for cleanfing
the bowels.   After adminiftering fome one or more
of thefe,  once or twice, with thorough  effect;  then
the fmall pills of calomel are given, as we have al-
ready ftated.  " I believe," fays Dr. Warren,*  (and
this was the univerfal opinion of phyficians in  Bof-
ton) " that the  moft efficacions remedy, and  the only
one to be relied on (in the cure of the fever) is mer-
cury.  It is certain,  that, as far as  my observation
has extended, under no  other method of treatment
did fo many recover."  " The calomel was often con-
tinued through the whole courfe of the fever ;  and
ptyalifm was ufually brought  on within three or four
days : though fometimes  upwards of 200 grains were
given, at the rate of a grain every hour, without any
                                           fpecific
      * Tytle^pajejoj. 
          THE   YELLOW  FEVER.         63

 fpecific effect on the falivary glands.   In proportion as
 the forenefs of the mouth advanced,  the  fymptoms
 univerfally gave way ; and in every patient, two on-
ly excepted,  this effect  of the remedy  was a  fure
 pledge of recovery."
  Bleeding—When there is a full, hard pulfe, dry
Skin, great heat, and violent pains in the  head, ftom-
ach and bowels, is certainly an excellent remedy,  if
not a fina qua non of a cure.  With the plethoric and
middle aged,  it is fometimes  neceffary  to repeat it
feveral  times.  The quantity taken muft  be in pro-
portion to the ftrength of the patient,  and the ur-
gency of fymptoms.  In this town,  1798, it was un-
ufual to bleed beyond the third time ;  oftener twice.
  After bleeding,  and the evacuation of  the  bow-
els of  their  putrid  or  putrefying contents,  and
with the intention of allaying the exceflive  vafeu-
lar diftrefs, and preventing the putrefaction, and dif-
folution  of the blood and fluids;   the more urgent
and painful fymptoms, which mark the feveral Stages
of the difeafe, claim attention and remedy.
  Blistering—The firft ftage of the difeafe was gen-
erally marked with fevere and  pungent  pains in the
head, and down the back and loins ; alfo a heat, and
burning fenfation at the prsecordia, together with nau-
fea  and vomiting, or  violent retchings to vomit.
Epifpaftics upon the back, neck, or under the oc-
ciput, and  over the  ftomach,  are  found to be fer-
viceable in  allaying thefe fymptoms ; fometimes the
relief and benefit is very evident.  Fomentations were
fometimes ufed as a fubftitute for blistering, tojrelieve
the diftreffing fymptoms of gaftritis.  Mint tea, with
a few drops of liquid laudanum, is good to allay con-
vulfions or naufea of the ftomach.   Dr. M'Lane ufed
with good effect, a folution  of white vitriol, in pep-
permint water, with the addition of a little laudanum,
or paragoric elixir.  Two fcruples of the vitriolic were
diffolved in fix ounces of water, with thirty drops of
laudanum.  He gave a table fpoonful every half hour,
                   I                           till 
66
A   TREATISE  ON
  till the fymptoms difappeared.   Blisters are applied to
  the temples, neck and back, thighs and arms, to roufe
  the fyftem from  the  torpor, low  delirium,  and ex-
  treme debility, which mark the fecond ftage of the
  difeafe.
    Pediluvium—This, with poultices, &c. is frequent-
  ly ufed to moderate the violent deterrnination of the
  blood to the head, and to affift in opening the pores
  of the Skin, and in bringing on perfpiration.  But all
  this is  perhaps better and more  expeditiously done,
  by the
    Warm Bath—Dr. M'Lane, after bleeding his pa-
  tient, and evacuating the bowels by phyfic, or an in-
  jection, ordered  him into  the  warm bath, and while
,, fitting there, half elevated out of the tub,- three  buck-
  ets of cold water were dafhed over him.  He was then
  taken out, and, after being well rubbed with a rough
  dry clofh, was put to bed, and well covered.   The
  room was chofen airy and open, and the bed placed
  in fuch a  manner, that no direct draught of air play-
  ed upon  it.   Drs. Rufli and Griffiths  advife,  if the
  difeafe  does  not  yield  to cathartic evacuation and
  bleeding,  to endeavour to bring on a profufe perfpi-
  ration,  by wrapping  up the patient in blankets, with
  five or  fix hot bricks, wet with vinegar,  applied to
  different parts of his body ; giving the patient  at the
  fame time repeated draughts of hot camomile tea, or
  fage tea;  hot lemonade, or weak punch, hot liquor,
  that is agreeable  to him to drink.
    " The  fweating remedy fhould be ufed hut four or
  five hours 2X"&.time,  and but once in the twenty-four
  hours.  If the patient  fhould  become faint, during
  the exercife of this excellent remedy, it fhould be difcon-
- tinued  for a few hours ; but renew, (under  the cir-
  cumftances formerly mentioned) if the difeafe con-
  tinue."
    Cold Bathing—-Is by many phyficians confidered
  as a fovereign remedy ;  efpecially during what is call-
  ed the inflammatory ftage of  the  difeafe, or  while
                                              there 
            THE   YELLOW   FEVER.         67

 there is great heat and arterial commotion in the fyf-
 tem.   The  manner  of application is,  generally,  to
 ftrip  the  patient naked,  removing  from under him
 fuch of the bed-clothes as would be injured  by wet-
 ting them ;  let  his  pofture be  eafy ;  then dafli the
 water upon  him, with fome force, by Standing at a
 diftance from  the patient, and from any convenient
 velfe!, till the heat  appears to be abated.   Another
 mode  of  laving  the  body is   by rubbing  it with
 fponges dipped in cold water, or vinegar and water.
 In this manner the  face,  hands and arms,  feet and
 legs, fhould be moiftened  every  hour in the day, dur-
 ing the heat  of fever.   In  this  town, during the laft
 epidemic, when the heat of the fummer was  moft ex-
 ceflive, and the  difeafe  bearing  the  inflammatory
 type, this remedy was ufed by Drs. Euftis, Hayward,
 and Whipple, with very evident good effect, produce
 sng, in feveral inftances, complete jelief and  an expe-
 ditious cure.   Dr. Currie recommends the ufe of the
 cold bath  under the following precautions,  viz.—*
 When  there is  no fienfe of chillinefs prefent;  where tfye heat
 of the furface is above what is natural; and when there
 is no general or prof ufe perfpiration.   It is alfo considered
 as an  excellent  internal remedy, in  fevers of all de-
 fcriptions; and it is recommended to be taken in fuch.
 quantities as  the patient Shall defire, but  under the
 Same restrictions as when externally applied.
   Enemas—During the  extreme  irritability of the
 ftomach, the "administration of  medicine in  this way
 fhould be entirely fufpended ; all attempts will prove
 fruitlefs,  and the  difficulty only  increafed and  aggra-
 vated by fuch attempts.*   In the  mean time, cathartic
                                                  and
                       *
  " I had a cafe of black-vomiting in my own family, on Long-Ifland, this fea-
 fon (1799.) A young girl, my niece, three days after leaving the city, in the
 month of September, was found to labour under the ufual fymptoms of the
 peftilence. Apprchenfive of the threatened irate of the ftomach, I evacuate'd
 the alimentary canal as foon as poflible, by cathartic1-, and  ordered'the bowels
to be kept open by clyilers. Toward the clofe of the fecond day of the malady,
fhe vomited up dark-coloured matter in the ufual manner, and I believed the
time of her death was very near. As I had never known any remedies, whether
acid, alkaline, or neutral, nor of any other quality, do good in that dangerous
condition of the ftomachj but had always found every thing taken in of the me-
                                                 dicinal 
68
A   TREATISE   ON
and nutritious injections muft be made with frequen-
cy, with  fuch  topical applications  as fymptoms Shall
indicate.   The injection may be veal or chicken broth,
or  water-gruel, if meant  to be wholly  nutritive  ;  if
for a cathartic effect, a table fpoonful or  two of Glau-
ber's falts may be diffolved in  the  gruel, and a little
fweet  oil and  molaffes added  ;  a  table fpoonful of
each.
   Opium—was  frequently  combined with calomel,
to prevent it from palling off by the bowels, and aflift
its diffufion in the fyftem, and  thereby  infure its ef-
fects upon the glandular  fyftem.   When   there was
no inclination to vomit,  and  to produce  a diapho-
retic effect, a  grain or two of tart. emet. was added.
Opium was alfo ufed, when fuch cafual fymptoms oc-
curred, as indicate the ufe of this medicine ; and this
was more efpecially the cafe during convalefcence.
   Drinks—To aflift and promote the different evac-
uations,  always proper to be made as the firft thing
neceffary in the cure of fever,  large quantities of di-
                                                       luent

dicinal kind  to do harm, by inareafing the irritation and difpofition to vomit, I
determined,  in this cafe, to leave the ftomach as much to itfelf as I could.  I
therefore withheld all medicines, and forbade  the adminiftration of food, until
the patient fhould afk for it, and gratified her to the full, by allowing the draughts
of cool water fhe called for.  The furface of the body was bathed frequently
with cool falt-water and foap-fuds alternately ; and an epifpaftic was applied to
the epigaftric region. The black-vomiting ctafed toward the end of the third
day ; and after an abftinence of eight days from all kind of food, fhe afked for
a roafted potatoe.  During thofe eight days, fhe drank no drink but cool water ;
and, what is very remarkable, at  the end of  that time poffeffed more ftrength
than fhe did  on the third day from the attack.  She recovered, and has been very
well ever fince.  I am quite fatisfied, from the ill-fuccefs of giving medicine to
flop black-vomiting, that the beft way is to let the ftomach remain as much at
reft as poffible, and not  be tormented and thrown into convulfions by foreign
matters taken down.  In order to make this mode of management  fuccefrful,
the alimentary canal ought to be  cleared effectually, in the early part of the dif-
eafe ; and the large inteftines fhould be plied with injections.  A phyfician,
 who flayed in New York the whole of this feafon, informed me he had, in ad-
 dition to a total ceffation of remedies by the mouth, given injections from time
 to time with large quantities  of laudanum, in fome cafes as much as half an
 ounce at a time.  While this thebaic tincture acted upon the large inteftines,
 the vomiting flopped, and the ftomach was eafy. If, when its effect was paft,
 the vomiting returned, the injection with the laudanum was repeated, and corj-
 tinued as long as the fymptoms required. The event of this mode of manage-
ment, he fays, was the recovery of a greater proportion of the fick, than by any
 other practice ;—and 1 think it very likely to be true."
                                    (MS.  Letter from Dr. Mitchill. 
           THE  YELLOW  FEVER.         69

luent andfubacid drinks are given.   Toaft and water,
tamarind water, lemonade, currant jelly diffolved in
water, apple-water, barley-water,  balm tea,  marfh-
mallows tea, &c. &c.  In the latter ftage of the dif-
order, the drinks may be porter and water, claret and
water, milk  and water,  camomile tea,   Clutton's
febrifuge fpirit, thirty drops in cold water,  given be-
tween the dofes of calomel, is recommended by Dr.
Rand, as excellent, to  cool the body and allay the
thirft :  and, befides being grateful, it compofed the
jactitation, and was often fedative at night,   A tea
fpoonful of vitriolic aether, in half a wine glafs of cold
water, is highly commended  by Dr. Chefholm, as an
excellent  febrifuge  medicine.   Given as  above, he
found it extremely grateful to the patient; and that
thirft, naufea, and oppreffion often fled before it.
   Food—None, till after the crifis.  Then begin with
the lighteft and mildeft kind, and fuch as is eafieft of
digeftion, and fuch as can be taken in a liquid form.
Weak tea and coffee, milk or water porridge, milk in
water, roafted or baked fruits, chocolate, fago, weak
chicken or veal broth ; from thefe gradually advance
in the ufe of the more fubftantial foods, until the pow-
ers of digeftion  are fully and permanently reftored.
   Apartments—For the fick Should be the higheft
 in the houfe,  without  coming immediately  under the
 roof.  The more elevated the room, the purer the air
 will be found.  In the beginning  of the fever, when
 the Skin is hot, and the pulfe tenfe, cool and pure air
 Should be freely admitted, and constantly agitated and
 circulated through the room, and  over the  bed of the
 patient.   The Sheet or blanket, which covers the pa-
 tient, Should be occafionally taken by the corners, and
 quickly raifed up and down, which will not only an-
 fwer the purpofe of fanning  and  cooling the patient,
 but alfo  fupply frefh air  to the body,  which other-
 wife  becomes mephitic and deleterious.
   The  linen of the bed, and on the body, muft be
 Shifted as  foon as any thing unclean is attached to
                                            them j 
7o
A  TREATISE  ON
them ; the  evacuations from the body muft be cau-
tioufly and  expeditiously  removed;  and all  poffible
care taken to keep the room and bed fweet and clean.
Sprinkle  frequently with vineg-ir ; waih with  foap-
fuds, or with alkaline lie.  In cafes of great weaknefs,
the patient  Should not be permitted to rife from his
bed, when under the operation of phylic, nor  upon
any other occafion.
   The utility of mercurial remedies,  in epidemic dif-
eafes  of  all defcriptions and degrees  of malignity,
Seems  now  almoft  univerfally acknowledged by the
medical  faculty j it is even  considered as a fpecific in
the  fmall-pox, mealies,  dyfentery,  fearlatina,  influ-
enza, Sec. &c.  In a medical publication, of  Septem-
ber, 1798,  and while the malignant fever was  mak-
ing its ravages among  us, I obferved refpecting the
ufe of this remedy as follows :
   In this town (Bolton) gentlemen  of the faculty
confide much in the ufe of  mercury, as a remedy in
the prevalent difeafe ;  and  Drs. RuSh and  Griffiths
of  Philadelphia  fay, if  the  mouth and gums can be
affected,  and a falivation raifed, the cure is almoft cer-
tain.  Alas, how frequently have they and their breth-
ren  failed in this attempt!   Southern  papers of late
are little elfe than mementos of difeafe and mortality,
and the city of Philadelphia, the metropolis of the
Union, one vaft tomb of  putrefaction  and death!
But I mean  not to Speak againft  the ufe of mercury,
as a remedy.  I  believe it a very good one, rightly
ufed.  I  have feen very Salutary  effects from it ; but
that it may  be Salutary in its effects, it Should not be
confined in its operations to the prima via, and internal
organs and veffels,  but it  Should have determination,
to the Skin alfo, and to the glandular  parts of the fyf-
tem ; and thus become a univerfal evacuant.  Might
it not, therefore,  be more frequently combined with
diaphoretic and anodyne medicine ?
   But how docs  mercury operate, in producing this
univerfal Stimulation and evacuation ? h it not by im-
                                           parting 
THE  YELLOW  FEVER.
7*
parting oxygene-to the fyftem ?  If fo, it is  the  very
treatment and indication of cure recommended and
pointed out  by  Dr. Mitchill, of New York; viz. to
itxhd\it\ fepton, and introduce oxygene ;  and  is confir-
mation ftrong, that feptic compounds are the caule of
the difeafe.   1 am Strengthened in this opinion,  from
obferving the countenances of thofe under  mercurial
treatment, in venereal and  gonorrheal complaints,
which are florid and  tranfparent ;  more  eipecially
when the cure is nearly completed.'  Alfo—In florid
confumptions, mercury, by all, is allowed to be preju-
dicial ;  I  believe,  becaufe the fyftem is already fupcr-
oxygenated.
   It" is a fact well known, that mercury, in its metallic
ftate, has- no effect upon the human body.  Experi-
ments alfo prove, that  the  effects of mercurial  oint-
ment are wholly owing to the fmall quantity of mer-
cury that has been oxydated in  the courfe  of a long
trituration.
   On the other hand, it is wTell known, that in  per-
fons who have rubbed themfelves with mercurial oint-
ment, or who have taken the oxyd of mercury inter-
nally,  the mercury,  after having produced its ufual
effects upon the fyftem, has paffed through  the pores
of the Skin in a metallic form, and has amalgamated it-
felf with watches, gold in the pocket, &c.
   It has been afked—" If mercury  is thus  beneficial
by imparting oxygene to the  fyftem, whether oxy-
gene without the mercury will not  effect: the cure ?"
Future trial and experience will  beft decide the quef-
tion.   It was with this intention that Dr. Mitchill,
as he has told us, prefcribed the various fruits abound-
ing with oxygene, mentioned  in  his  letter above.
But if the oxygene is meant to be applied to the
lungs in refpiration, the attempt, I think, will be un-
fuccefsful, and fail of cure ; not becaufe  of any fault
of the remedy, but becaufe this organ, being  early
affected by the difeafe, its functions are fo materially
impaired as not  to admit of  being  reftored by any
                                           efficacy 
72            A  TREATISE  ON
efficacy of the medicine.  The blood which is found
to gorge and diftend the lungs, increafes their denfity,
Shuts up the abforbent mouths of the veflels, renders
them impervious, and inacccffible to the  oxygene air
applied, So that it cannot reach and purify  the vol-
ume of bleod as it paSfes through them ;  or, if at  all,
the quantity muft be quite fmall, and inadequate to
the effect intended.  The  benefit  of the accefs of
freSh  and pure air, in  cafes of high fever, is univer-
fally admitted.  Air is more or lefs pure and exhilara-
ting,  in proportion as it is  more or lefs  oxygenated.
  But whatever may  be the  efficient ingredient in
mercurial preparations, certain it is, there is no med-
icine more fafe and infallible,  in promoting diaphore-
fis, or univerfal perfpiration :  it feems to have a direct,
if not a fpecific effect upon the  glandular  and lym-
phatic fyStems, exciting them  to motion and action,
by  which means the morbific matter is eliminated
and  difcharged from the fyftem,  either by defluxion
into the  alimentary canal, or from the cuticular and
external emunctories ;  and alfo the fecretions and ex-
cretions reftored to fome degree of healthful regular-
ity, without which life cannot long be prefcrved.
       PREVENTATIVE   MEANS.

  MANY plans have, at different times, been propof-
ed, for clarifying  and preferving the purity of city
atmofpheres ; but  moft of them  have been either too
partial and limited, or ill timed, and fo reluctantly ex-
ecuted, as that the expected good  effects have not
been  realized.  The exertions hitherto have failed,
(this town the laft fummer  is an exception) and no
barrier has  yet been oppofed, fufficient to  fupprefs
this  death-working  difeafe.   It yet  boldly  Stalks
among us.
  All large  cities have ever been, and ever will be,
afflicted with peftilential difeafes,  until privies, grave-
                                            yards, 
THE  YELLOW   FEVER.
 yards, and nuifances are removed ;  fewers construct-
 ed,  and aqueducts  completed—and until every at*
 tention and care is paid to the prefervation of clean*
 linefs, in  doors and out $  as alfo to convenience and
 good accommodation!  This  can  only be  done  by
 wife, appropriate  and Strictly executed lawsj meeting
 the willing and prompt  compliance tif the inhabitants*
   Frequently agitating the atmofphere, fprinkling and
 Watering the ftreets  and houfes,  will be  found  very
 falutary.  It will ferve to abforb and neutralize tljofe
 acid particlesj that may have Collected in the  atmos-
 phere, in confequence of great heat, and by the aid of
 putrefaction.  It will be found greatly beneficial,  to
 ftrew docks, ftagnant waters, privies, &c. frequently
 with cauftic lime.   This was tried in Boltons 1788,with
 manifest good effect. But all tnis  will be to no  purr
 pofe, without a Strict attention to diet and the habits of
 ppdy.   The  matter  of  difeafe may  be generated irt9
 gs well as out of the  body.   A light, eafy* vegetable
 .diet  is the molt proper: meat? highly injurious* be-
 caufe it  corrupts the fluids, and renders  them liable
 to putrefaction  from any Slight interruption  of the
 animal  functions.   Ardent fpirits-—pernicious at all
 times.   All exercife of body and mind Should be temr
 perate,  orderly, and methodical*   Our delights  and
 enjoyments Should be prefcribed by reafon, and regu-
 lated by prudence ;   not by the extent  of appetite*
 paflionj or defire.  They Should enliven  and invigo-
 Tate, not deprefsand exhauft.
   The  predisposing Causes—-Generally enumerat-
 ed, are, fatigue, a long .walk,  Standing in the  fun or
 in a  current of air, intemperance in eating or  drink-
 ing,  cpftivenefs, yiolent  paifionsj or fudden emotions
 of the mind, too  thin  drefs,  light bed-clothes,  and,
 above all, the night air.   Thefe, as well as the caufes
 or caufe directly exciting ]tfee difeafe, are to be  avoid-
ed or prevented.
     Now more particularly;*
   Reafons  and facts the moft obvious, lead us to af-
cribe the difeafe of the feveral capitals of the Union
                    K                   (certainly 
74           A  TREATISE   ON

(certainly of Bofton) to local circumflances, dietetic vices,
and diforderly habits.  The circumstances of Situation,
and the cafual caufes, we have already detailed.  They
are fuch as pretty clearly Shew the difeafe to be of do-
meftie  origin.   I do not deny that the difeafe may be
generated in Ships as well  as  in  houfes, brought to
our  wharves',  and (if the  feafon  and other circum-
stances be favourable) circulated through the town :
but at  prefent  there  feems to be no reafon to con-
clude,  that the  late ficknefs was thus originated.
   Regimen,  personal  management, &c—The
mode of living confidered as moft  injurious and de-
structive of health, by inducing that kind of tempera-
ment,  which predifpofes to infection and difeafe, con-
Sifts in  the exceflive .ufe of ftrong or fpirituous liquors,
and of grofs animal food : The powers of life, by this
mode of living, are Strained to the higheft pitch; and,
when expofed  to difeafe, there is  no new or unem-
ployed force to repel  the enemy.   The Strength col-
lapfes ; debility or exhauftion, with all its fad confe-
quences, enfues.  It is to this circumftance, mainly,
that we are to afcribe the unufual mortality, and the
general difficulty, almoft impoflibility, of cure in the
late fever.
  Perhaps  no people  in  the world make fo free a ufe
of fiejh food as  the Americans, efpecially in populous
towns  ; by which means the ferum  of the blood is load-
ed-with crude  and heterogeneous  matters, the  cruor
increafed to over proportion, the lymph vitiated and
changed from  its glutinous, cohefive,  plaftic nature;
and  thus the  whole  mafs becomes acrid, corrofive,
and of putrid  tendency ; and thus the fluids,  being
mixed  and confounded, are  rendered unfit for receiv-
ing the proper degrees of animation ; the procefs of
animalization is impeded, and difeafe enfues.
  Dr. M'Lean, in  a treatife on the fever of St. Do-
mingo, obferves, that if the difeafe came on after a
debauch in wine, &c.  there was always  the greateft
danger;  and he hardly ever knew one inftance of a
                     ■                  favourable 
THE  YELLOW  FEVER.         75
favourable termination, when the fever began under
thefe circumftances.  And it is  further remarked by
phyficians of New-Vork and Philadelphia, that French-
men, who had not long refided there, almoft univer*
fally efcaped the difeafe ; which I think cannot be bet.
ter accounted for, than by afcribing it to a difference
of  temperament, from their regular and abftemious
mode of living.  They are  efpecially fpare in the ufe
offlefhfood.
   While the difeafe was in its commencement in this
tpwn, I found,  on inquiry, that the attack was  in
many inftances preceded by fome fpecies of intempe^
ranee ;  moft frequently, in eating or drinking.   One
had eaten freely of pine-apples  on  going  into bed.
Another had feafted much, and copioufly partook of
wine, and at laft yielded profirate obedience to the juicy
fovereign ; but was foon roufed from this humble at-
titude, by the pangs of an  internal fire, which  it was
difficult to  extinguish but with  life.  One, after  a
hard day's labour,  ate  a  full  fupper of fried  meat,
went to bed, but awoke from fleep in torments of a
cholera morbus.  I could enlarge the enumeration, and
particularize inftances; but this  is  not  neceffary  ;
enough, however,  to evince, that our only  fafety is
within  the  precincts of temperance, moderation, and
reafon:  All beyond is ruin  and difeafe.   Death is
there, and the guefts of the deepeft mifery.
   A writer of nice Qbfervation, of acute and  exten,
five refearches, afferts, that the wonderful and  effica-
cious powers of regimen will never be attended to. until
the human  mind acquires a great capacity of thought
and reflection, which makes a man his own phyfician,
carrying a  delicate attention  to the effects of food,
clothing, air, fleep,  &c. &c.   Man will never  obtain
either moral or phyfical health, until he knows  himfelf
   Cleanliness.—- After a proper  diet, nothing more
contributes to health and its prefervation,  than'clean-
linefs of perfon and apparel.  A want of a due atten*
tion to this  particular of domeftic economy, is the oc-
                                             cafion 
76            A   TREATISE  ON

cafion of a variety of difeafes in  young and old, viz.
the itch, fcald-head, leprofy, fcurvy, rheumatifm ; and
if It does not give origin to peftilential feVers, plague,
fee. it certainly helps to extend, circulate, and contin-
ue them, when once they have appeared.
   Phyficians,  who have written on the fubject of fe-
vers and epidemical difeafes, obferye, that they, almoft
without exception, commence with the poorer  cla6
of citizens, who are too frequently as negligent of
deanrihefs and neatnefs of perfon, as they are regard-
jefs of the quantity and quality of the  food and drink
they confume.
   It was not unfVequent, on the  firft visitation of a
patient of the above defcription, to find him envelop-
ed in a rotten feather-bed,  little lefs  pleafant to the
plfaclories, than a lump of putrefaction ; or, rolled up
in blankets,  quilts and rags, which would not have
been more difagreeable, if they had been ufed in the
loweft offices of a foundling hofpital.
   Frequent bathings, in  the  warmer  feafons, when
the blood is in a  calm ftate of circulation, is Very Sal-
utary,  and greatly contributes to the continuance of
health.   When the body has been a confiderable time
in full perfpiration, the volatile particles of the perfpir-
ed matter efcape, and leave  an incrufted matter upon
the furface of the body, which often frets and corrodes
the extremities of the exhalent veffels, and thus lay
the foundation for difeafe.   This is remedied by fre-
quently laving the body in water of moderate tem-
perature*   It alfo agreeably refrefhes and invigorates'
the fyftem, and  preferves and enlivens the actions of
the lymphatic veffels, upon which  the purity of the
                                                blood,
   « Mr. Volney, in his Travel* in Egypt and Syria, Chap. xvii. informs, that
" it Cairo, it is obferved the water-carriers, continually wet with the freft wa-
fer they carry in fkins upon their backs, are never fubjeA to the plague." This
fact, feys Mr. Webfter, if accurately ftated, is worth an empire.
 '  The moft fafe, eafy, pleafant and beneficial mode of nfing water, is, to bathe
<ft waft the body in a private  apartment at home.  This may be done feveral
ways-j-ekhe* in a large  veffel, immerfing the whole body at once ; or, what
is left trouBlefome, with a fingle pail or b6wl of water, in a bed-chamber.
Tne warning may be done with the hand, or a fponge, in a few moments, as
the perfon rifes in the morning, or retires at night.  (Wtbfert Treatife.) 
THE  YELLOW  FEVER.
it
blood, and the perfect health of the body, very much
depend.  This practice Should become frequent, as it
was among the ancients, and is now with the inhab?
itants of the fouthern and middle latitudes.
  To me it feems moft probable, that the proximate
caufe of all fevers affecting the fyftem, generally, is de-
ranged motion, or a  total want of action in the lym-
phatic fyftem, confifting of  exhalents and abforbents.
When  thefe veffels are in healthy motion, all  delete-
rious matters, floating in  the  common mafs of the
circulating medium,  are  eliminated  and  perfpired.
But, let this procefs be checked, and the Skin becomes
hot and inflamed ; the whole body foon feels all the
diftrefs of a fever paroxyfm*
   By the  abforbent  velfels, the body is preferved in
that ftate of dilution and fupplenefs, fo neceffary tq
organic function and mufeular motion : perhaps the
body is more diluted by cuticular and pulmonic ab-
forption, than by the various drinks taken in by the
ftomach ;  and if a patient were indulged with all the
drinks he  might crave, in the progtefs of a violent
fever,  it might not  equal the quantity required in a
Slate of health.  The excefs of quantity, that is crav-
ed and taken in by  the Stomach,  is occafioned by a
check upon the ufual fupply by the abforbents.
   Sailors  at fea, when in  want of  freSh  water to
Quench thirft, plunge  into  the fea ;  and, remaining
a while, their thirft fubfides.  Whether this is effect*
ed by abforption of moifture, in the form of gas, and
combined after entering the fyftem ; or, whether the
particles of  water are abforbed, I pretend not to de-
cide.  It is, however, generally accredited by modern
phyfiologifts,  that the fkin  is  to the lymphatic fyftem,
What the lungs are to  the arterial; and it is  pretty
clearly  afcertained,  that there is a conftant decom-
pofition and confequent abforption of oxygene from at-
tnofpheric air, or water in  contact with the Skin, by
Which  the  irritability  is  preferved and fupported.
jfow, there is much  reafon for fuppofing, that  all pu-
                                              tricj 
 y8           A  TREATISE   ON

trid difeafes are in confequence of deficient fupply of
oxygene, or vital air ;  which, certainly, is very import.
ant in all the functions of the animal economy, if not
the prime fupporter of all mufcular irritability.  Hence
then the indication of cure in fever of much heat, to
lave the body with  water of  various temperatures,
according to circumftances,  The fuperabundant heat,
confined within  the body by the dry, denfe and
hardened furface of the Skin, enters into and is drawn
off by the water and  cold thus applied, the fkin being
rendered lax, pliant and porous ;  and thus the heat
and paroxyfm of fever immediately fubfide.
   Anointing  the body  with olive oil has lately
been much fpoken  of,  as  an almoft  certain  rem?
edy in  the cure of the plague, and alfo of the hydro-
phobia.  Oil  and animal fat  decompofe the feptic
acid.   If there has been much exercife and fatigue of
body,  and if the perfpiration  has been  profufe, after
laving  with water, it may he  very ferviceable to rub
the fkin with a fponge dipped in this oil; at any rate,
it will  ferve,to foften and  lubricate the Skin, foothe
the mouths of the exhalent veffels that have been un-
duly exercifed and fretted by the acrid and faline mat-
ter of  perfpiration.  This will be moft  conveniently
done at evening.   It will be found proper to have a
veft particularly to Sleep in after this treatment.   It is
a good practice to Shift the linen every night, and to
have a garment purpofely to Sleep in.   Never Sleep on
feathers  after the firft of May to the beginning  of
October, inclufively.   The clothing fhould always  be
varied  with the difference of feafon, conftitution and
habits, attending particularly to neatnefs, conveniency
and eafe.   Preferve, as much as poffible, an even  tem-
perature of body, and  be  guarded  againft hidden
changes of weather, more particularly the damp airs
of the  night.
   Phyficians, in  the Wefl Indies,  recommend  very
highly  wearing waiftcoats of India cotton under the
linen.  They are  confidered as much preferable  tQ
                                           flannel, 
            THE   YELLOW   FEVER.          7§

flannel, becaufe better conductors  of heat, lefs irri-
tating,  and  therefore more comforting, and equally
abforbent of perfpirationy
   A due  attention to diet and regimen will,  for the
moft part, render the ufe of medicine quite unnecef-
fary : Should there be, however, at any time a tenfion
or coltivenefs  in  the bowels,  Some cooling cathartic
may be taken to reftore them to a healthy  itate, par-
ticularly a folution of cream of Tartar,  or Glauber's
fait.   If the ftomach fhould be found loaded  with
vifcid, phlegmy,  or  bilious matters, or indigeftibh?
fordes, an emetic  will be proper.

To prevent and defiroy the Matter  of Difeafe in  Ships,
          Jails, Hofpitals, private  Dwellings, &c.
   Whether  it  be true,  that the  difeafe,  which  has
raged with fuch unconquerable violence in moft of the
cities and capital towns of the United States for eight
or nine years  paft, be  occafioned  by the generation
and diffusion of feptic acids ;   or,  whether  it arifes
from a fparfity of oxygene in  the atmofphere, and
an abstraction of  it from  the body by exceflive heat,
&c. is  not material to our  prefent  purpofe to  be de-
cided :   in  either cafe, the  remedial or  preventative
means muft be the fame.*
                                                        In
  * " Wtoen a difeafe proceeds from an elementary fource, men rtia'y juft as
well attempt to fave the cats, the wild animals, or the fifh of  the ocean from
the effects of that principle, as their own fpecies, by laws enjoining quarantine
and purification of fhips.  In nine cafes of ten, in which quarantine is enjoined,
human efforts are oppofed to the great laws of nature, and are therefore uftlefs.
In all cafes, where the air of  a country exhibits evidence of a peftilential ctyi-
ftitution, in an increafe of the number and violence of the fymptoms of com-
mon  difeafes ; in the production  of certain epidemics,  as catarrh, anginas,
meafles, petechial fevers, and the like ;  in the death of fifh, or the unufual dif-
eafes of cattle and other  animals;  in all fuch cafes, the peftilence which in-
vades man will be found to arife from the uncontrollable laws of the elements;
and quarantine will be utterly unavailing, to guard cities againft its introduction
and ravages."  (Wcbfier,p. 207. Vol. II.)
  I am as much convinced of the abfurdity of quarantine  regulations, for the
prevention of difeafes, as they have been ufually eftablilhed and executed, as
any one can be.   But this is not what I aim  at, as objectionable, in the above
quotation.  Mr. Webfter  has; run into conclufions, which it is not fafe to ad-
mit, and which  I think  are  not ftri&ly juft.  I allude to the difiinAion he
makes between elementary caufes of difeafe, and local cau .t, or infection.
                                                        The 
 8o                A   TREATISE   ON

    In fhips,  therefore, which may be fuppofed to con-
 tain noxious  efiluvia, whether  derived  from infected

 articles,  or generated from  the  collection  and  putre:
 faction of'fuch materials as contain fepton, (and thefe
 always make tip  a part of the freighting of fhips,  viz,
 provifionsj  meat,  &c.  of  various kinds 5   trunks of
                                                             clothes,

 The latter, he thinks, are within the reach of police regulations, and the con-
 trol of human exertion ; but that condition of the elements,  which  gives rift
 to all epidemic, difeafes, he afferts is not thus controllable, but  depends wholly
 upon the invariable laws and operations of nature ; and therefore, in thefe cafes.,
 he infills that quarantine, and police regulations, are altogether futile.   I cannot
 admit that the elements, in their natural  ftate, are ever hoftile to the health,
 convenience, and happinefs of man ;  that is, when his happinefs is rational, his
 convenience not lubimftcal,  his health not failitiout or  forced.   Whenever the
 condition of the elements becomes fo deranged, as to he productive of epidemic
 difeafe, it is  proof to me, that the laws of nature  have been partially interrupted
 by  a falfe economy, by the perverting faculties, and  the mifapplication of  the
 phyfieal and intellectual  powers of man.  All general caufes are made up whol-
 ly of particular or  local  caufes ; and no caufe can become general, prior to the
 cxiftence of  particular or local caufes: remove, therefore, the local and particu-
 lar caufes, and the general or elementary caufe, ceafes or never  will exift.  At-
 tention to city cleanlinefs and naval purification,  if it does not put an imme-
 diate arreft upon the difeafe, already become  epidemic, may  fhorten the  pe-
 riod of its duration, and completely prevent a return of it.  Mr. Webfter ad-
 mits, (if  not m the above quotation) that there may be cafes of fporadic difeafe
 of the fame characteriftic marks, and equally malignant as thofe of an epidem-
 ic ;  the nature of the caufe, then, muft be the fame in both cafes; a*d the dif
 fetence only in the degree of extent.   The only inquiry then, is, What is the
 nature and qualities of that clement or matter,  (fo far as any thing material \$
 concerned) which gives origin to difeafe ? This afcertained, the means of rem-
 edy will  be  the fame, only differently proportioned, according to the locality
 or univerfality of the caufe.  There may be fome peculiarity in the fituation of
 Our earth, relative to the reft of the planetary fyftem, which may caufe the fun
 to pour its rays in greater profufion, in fome years than in others, upon certain
 portions  of the earth's furface, thereby making  one year more fickly than an-
 other ; but this never will happen to fo great a degree, as to render difeafe in'
 evitable, if a due temperament of body and mind is preferyed; if the economy
 W regular, the indulgences and habits chafte and temperate.
   (Vol. II. p. aoo.)—" Remove the fick, cleanfe the houfes arid clothes, do what-
 ever human  art and labour is competent to effect, all will not avail {  cafes fpring
 up in every quarter, and  the difeafe takes its courfe."-^Thcn, die wemuft ;  fori
 contend, that, if to prevent an epidemic  difeafe is thus impoflible, there never
 could he a fingle inftance of recovery from the difeafe, during  the continuance
 of  the peftilential  ftate of the atmofphere.   All medical aid would be totally
 ufelefs, and  labour  loft; for a difeafe never can be cured, that cannot be/r«-
 vented.   I muft ftill be of opinion, that if cities could be  rendered more com-
 modious, by a different arrangement of ftreets and buildings ; if the means of
 purification  and cleanlinefs, both of  perfon and in domeftic  economy,  could
 be  particularly, generally, and univerfally embraced,  and ftrictly obferved, it
 would interpofe an effectual barrier to almoft every fpecics of difeafe.  Lon-
 gevity would be much more frequent, and man, now lite the graft  -which the
, wind pajeth  mer, and it is gone, would then fall, like a fhock of corn fully ripe,
 in all the fragrance of wifdom, and maturity of age ;  every movement  in the
 iourney of life being prompted by defire  of good, and marked with nfefuluef*,
 he  would only die to live. 
           THE  YELLOW  FEVER.        Si

elothes, fometimes rotten with dirt and perfpiration ;
bedding, often in a fimilar condition) it will be proper,
from the known affinity which fubfifts between thefe
infectious  vapours and calcareous earth (lime) to ex-
pole this fubftance  to an  atmofphere  impregnate
ed  with  thefe  vapours.   White-waShing between
decks,  and fuch other places where it is practicable ;
alfo, llrewing it in the holds of Ships, will be the moft
advantageous  methods in which it can  be applied.
Frequent repetitions  will be neceffary where the in-
fectious matter is abundant.  In inftances where thefe
effluvia have, for any length of time, been prefent in
fuch abundance as to attach to, and infmuate into the
timbers of veffels, from whence they may be forced
out by exceflive heat, and when thus liberated, in-
fect the cfews, it  will be highly proper ta walh, fre-„
quently, the timbers thus impregnated, with a folu-
tion of the vegetable alkali (pot-alli) in Water.  This
fubftance has the greateft known affinity with the  fep-
tic  acid ; it will therefore difengage it from its con-
nexion  with the  wood, neutralize, and render it
harmlefs.  A frequent ufe of alkaline liquors in apart-
ments muft tend greatly to cleanfe and carry off nox-
ious vapours ;  and will alfo, by being imbibed into
the texture of the wood, take up and convey away
fuch of the noxious matter as may ftill remain.  Ven-
tilation muft not be neglected ; the contaminated at-
mofphere will thereby have part of its volume convey-
ed off,  and a quantity of  purer air admitted.  If any
of the  articles, defigned as  provifion for the Ship's
hands,  fhould become in any degree putrid, they muft
be parted with immediately ; and every attention and
pains given to preferve perfonal cleanlinefs : lefs of ar-
dent Spirits, and more of foap and water fhould be
recommended  and enjoined for fhips*  ufe.
  The  fame means made ufe  of for preventing the
origin  and fpread of  difeafes in fhips,  are equally
proper  to  be ufed in prifons, hofpitals, and dwelling-
houfes  j  viz. frequently white-wafhing the plaftered
                    L                      walls 
82
A  TREATISE  ON
walls with lime, and wafliing the floors with ftrong
foap-fuds, or alkaline liquor ; at the Same time taking
every poflible method to ventilate the  apartments
with frelh  and pure air, and keeping its circulation
and diffufion  as equable as poffible.
  How much this  practice of white-wafhing with
lime, and other attentions to cleanlinefs in dwelling
apartments,  has to do  in the prevention of difeafe,
cannot be better illtiftrated, than from the account of
a vifit to Venice, while the plague wras defolating the
place, by that illuftrious champion of humanity, the
philanthropic Howard.  His intention, by this, was
to learn their mode  of managing hofpitals and laza-
rettos,  and to be perfonally informed of their  quar-
antine regulations.
  ----" Soon after  unloading the boat, the fub-prior
came, and  Shewed  me my lodging  in the new laza-
retto ;  a very dirty  room, full of vermin,  and with-
out table, chair, or bed.  That day,  and the next
morning, I employed a perfon to waSh my room ; but
this did not remove the offenfivenefs of it, or prevent
that conftant  head-ache, which I  had  been ufed to feel
in vifiting other lazarettos,  and fome of the hofpitals
in Turkey.   My guard fent a report of my health to
the office, and, on the representation of our conful, I
was removed to the old lazaretto.  Having brought a
letter to the prior  from the Venetian ambaffador at
Constantinople, I hoped now to have had a comfortable
lodging. But I was not fo happy.  The  apartment,
confuting of an upper and lower room, was no  lefs
difagreeable and offenfive than the former.  I prefer-
red lying in the lower room, on a brick floor, where
I was almoft  furrounded by water.  After fix days,
however, the prior  removed me to an apartment in
fome refpects better,  and confuting of four rooms.
Here I had a pieafant view ; but  the rooms were with-
out furniture, very dirty, and  no lefs offenfive than
the fick wards of the worft hofpital.   The walls of my
chamber, not having been cleaned for half a century,
                                            were 
THE  YELLOW  FEVER.        83
were faturated with  infeblion.  I got them  warned re-
peatedly with boiling water, to remove the offenfive
fmell, but without any effect.   My appetite failed, and
I concluded I was in danger of the flow hofpital fever.
   I propofed white-wafhing my room with lime, flack-
ed in boiling water, but was oppofed by ftrong preju-
dices.  I got this, however, done one morning, through
the affiftance of  the BritiSh conful, who Supplied me
with a quarter of a bulhel of frefh lime for that pur-
pofe.  The confequence was, that my room was im-
mediately rendered fo fweet and frefh, that I was able
to drink tea in it in the afternoon, and to lie in it
the following night.   On the next day, the walls were
dry, as well as fweet, and in a few days I recovered
my appetite."
   Is it wonderful that fuch places, as here defcribed,
Should be  fubject to  plague, or other malignant dif-
eafes ?  There is furely more reafon for furprife, that
places thus regulated, and under  thefe circumstances,
fhould ever be exempted from them.   But what is
moft of all aftonifhing,  is,  that the difeafe Should be
afcribed to foreign origin, and not confidered as en-
gendered,  nurtured,  and brought up among them-
felves, and within their  own walls ! Surely, fuch peo-
ple are deep in the ditch, if  any  blindnels, or blind
guide, can bring them there.
   After attention to cleanlinefs in doors,  the ftreets
and alleys next are  to be attended to :  all putrefcible
fubftances  muft be  carefully  removed, by  Shovels,
brooms and walking.  " Multitudes of lives may be
faved, and' the  lofs of bufinefs  prevented  by thefe
means; they are the guardian angels of public health."
   It will be forever idle to fweep and cleanfe the ftreets,
lanes, &c. unlefs the back yards are attended to at the
fame time.  The privy houfes are a very great  nui-
fance,: and, together with the central burial grounds,
contribute not a little to the foUrce and fpread of dif-
eafe.  The contents of thefe places, and other putrid
matter on the furface of the earth, mix with and in-
                                           sinuate 
84            A  TREATISE  ON

Sinuate into the foil around, till,  reaching and con*
taminating the waters of the wells,  render them, if
not immediately poifonous, certainly naufeous and un-
fit for family ufes.  Befides, when the fun comes to
act with  powerful influence upon the earth's furface,
a perfpiration  is excited, by which thefe noxious mat,
ters are thrown out, and  raifed into the atmofphere
in the form of mephitic gaffes  ; thus filling  it with
deadly miafma.  Certain  it- is, that caloric, or the
matter of heat, is the agent or efficient caufe  of  all
thofe mutations and evolutions of matter in animal
and vegetable  fubftances,  denominated  by fermenta-
tion and putrefaction \  and by its agency on  thofe
fubftances, infection,  or a feptous  atmofphere is pro?
duced, which  gives origin to difeafe.
   " The ftimuli of putrid fevers, or the plague, and
that of the mephitis, which is exhaled during the pu-,
trefaction of  animal  fubftances, in places where  at-
mofpheric air  cannot  enter, as in  tombs and  burial
grounds, &c. are  often very hidden and destructive
in their effects, having fuch an  aflinity with oxygene,
that as foon as they come in contact with the fibre,
they deprive  it of its oxygene, and produce death,
frequently in  an inftant.
   " The moft efficacious mode  of preventing the fatal
effects of this  gas, is, by the detonation of nitre upon
burning  charcoal.   During the decompofition of  the
nitre,  a  considerable quantity of oxygene air efeapes,
and fupplies oxygene, which combines with the me-
phitic air, rendering it harmlefs." {Moifes on the  blood.)
   Every fpot  of ground in cities, not  occupied by
fome building, Should be fet with  trees, balm of Gil-
ead if they can be procured, of abundant foliage, and
rapid and high growth j  but not fo clofe as to prevent
the circulation of air.  They will not only impoverish
the earth, -by abforbing its moifture, and with  it  the
metalic effluvia, feptous fubftances  and putrid refidua,
injurious to animal life,  the generation  of which de-
stroys the purity and healthy ftate of the atmofphere,
                                                by 
           THE  YELLOW  FEVER.        85
      ,                                        *
by depriving it of its oxygene or elaftic principle \  but
they alfo fupply, by their perfpiration, this purifying
matter, or oxygene, fo neceffary to animal existence,
combuftion,  jScc.;  and thus  it is  found, that trees,
Shrubberies, groves, S?c. generate air, produce breezes
and gaies,  which, agitating the common atmofpheric
mafs, preferve it in its healthmefs and falubrity.
   What is nutriment to vegetables is poifon  to  ani-
mals : while plants ahforb azotic gas,  or atmofpheric
mephitis, and  emit vital or oxygenous air,  man, on
the contrary, exhales a confiderable quantity of mephi-
tis, and owes the continuance of  his existence  to the
abforption of oxygene,  or vital air;  and thus, by a
kind  of reciprocity of fervices, the  two kingdoms
would feem to labour for each other.
   "The freffinefs  of  the country,  the delights of
fpring, and all that infufion of health and fpirits which
we feel in  a morning's walk, are  now  no myftery :
at that hour the plants are, by the fun and moifture,,
roufed from Slumber, their functions reftared, and  this
work of reciprocity and mutual benefit begins.  PerT
haps  there is not in all nature a more beautiful har-
mony than this, that the foul breath of animals gives
life to plants, while the air, refpired by plants, is ufeful
to animals and delightful to man."
   By the vigilant attention of  the Board of Health,
by their perfonal exertions, together with  a  feafon
for the moft part cool and moift; and, through  the
favour of Him, whom winds and feas obey, we are,  and
have been  through this  feafon, bleffed  with  health,
plenty an4 peace.

The Difeafe is not originated or propagated by any fpecific
                     Contagion-.

   * Specific  contagion is matter fecreted in the  hu-
man fyftem by organic veffels in difeafed  or morbid
                —                            action.
  * In Mr. Webfter's Treatife, p. 141, fpecific contagion is defined to be a quality
pr difeafe, which, within a fuitable diftance, communicates it from a body af-
ft'iSK'd with, it to a found body, with great certainty, and under all circum-
                                               ftances 
86            A  TREATISE   ON

action.  One  particle of this variola or fecreted mat-
ter abforbed, will as infallibly produce the difeafe, as a
much larger quantity.   The matter of fmall-pox is of
this defcription.  Difeafes from contagion prevail  in
all  feafons  and climates, when once communicated ;
but thofe who have been once the fubjects  of conta-
gion are never afterwards affected by it.
   No material of  this defcription, and thus infallible
and uniform in its  effects,  has  ever been  difcovered
in either the plague or yellow fever, if there  is  any
difference in the difeafes, except in degree of violence.
Some phyficians, however, afl'ert that the matter from
a bubo, one of the characteriftie marks of the plague,
when communicated to the fyftem  by inoculation,
will produce the difeafe, and therefore adopt the opin-
ion, that this difeafe, as well as the yellow fever, is
fpecifically contagious.   But it muft be remembered,
that all the experiments that have been instituted for
afcertaining this fact, were at the time the difeafe was
epidemic, and therefore it  cannot with any propriety
be  infifted on, that the difeafe was produced by the
inoculated matter, but by the fame caufes which pro-
duced it in  others, who were not inoculated, or in any
way expofed to perfons fick of  the difeafe.   Befides,
it  fhould alfo be confidered, that  contagious difeafes
are gradual and progreflive ; uniform  in their char-
acteriftie fymptoms and term of duration, in all cli-
mates, and  in  every fubject.  This is not  the cafe with
the fever and plague.   They are  epidemic only in
the fouthern latitudes,  and in the  warmeft feafons of
the middle  latitudes ;  at other feafons, and in different
circumftances  with  refpect to  heat,  cold,  moifture,
                                              drynefs,
fiances of feafon, weather, or fituation.   This contagion is of two kinds; firft,
that which acts by contact only, as that of the itch, leprofy, hydrophobia, and
fyphilis; ftcondly, that which produces its effects with equal certainty, by near
approach, without contact, as that of fmall-pox. and mealies. That quality of
difeafe, which may or may not excite it in a found body, within a fuitable dif-
tance, or by contact; and which depends on heat, foul air, an apt difpofition in
the receiving body, or other contingent circumftances, and which may excite
the difeafe in the fame perfon more than once, is called infefiion.  Difeafes from .
infe&ion are cither fporadic or epidemic, according to the nature and force of
concurrent and predifpofing caufes. Contagion and infc&ion have been ufed,
throughout this Treatife, in the fenfe as above defined. 
THE  YELLOW  FEVER.        87
drynefs, &c.  the difeafe  is only fporadic  and mild.
When  the difeafe is highly malignant,  it terminates
within 48 hours from its commencement;  on the
third and  fifth days,  and feldom extends beyond the
fevcnth day : but in the colder feafons, the difeafe not
only becomes partially local, but is certainly changed
in its fymptoms, form, and time of duration ;  inftead
of 7 days, it fometimes  runs on to the nth, 15th*
20th, 30th, 40th, before  a crifis.
   "Specific contagion,*"  obferves Dr. M'Lean,  (and
I Shall make free ufe  of his arguments)  " I  con-
ceive,  cannot  produce  a  difeaSe  lefs uniform in
its appearance,  than fmall-pox  and meaftes.    But
every epidemic  and peftilential difeafe^ which has
hitherto been reputed contagious, affumes fuch various
and diffimilar appearances, in different  perfons, that
they cannot be the effect of any power, equal and uni*
form in its operation.  The fymptoms are not, in any
two perfons, exactly alike.  Hence  the difference of
opinion among the phyficians of Philadelphia, during
their late  epidemic j  fome afferting, that every difeafe
had refdved itfelf into yellow fever, while others af-
firmed, that the difeafes of the city were various.
This diSlimilarity of fymptoms, which occafioned this
difference of opinion at Philadelphia, is,  to me, a con-
vincing proof,  were there no other, that the yellow-
fever of that city did not arife from any power, of
fuch uniform operation as contagious matter.  Like
wine, opium, or mercury, fpecific contagion muft pro-
duce fimilar effects  upon all men,  who are fimilarly
fituated.  It muft act alike in Egypt and in America,
in London and in Constantinople.   But according to
all accounts, the fymptoms  of  epidemic difeafes, in
different.  parts  of the world,  are   very  diffimilar ;
while thofe of difeafes, that are undoubtedly contagi-
ous, fuch as fmall-pox, meaSles,  lues venerea, &c. are
the fame in all.   Wine will intoxicate,  cathartics will
purge, mercury will falivate in all  countries.   They
will produce thefe effects  upon almoft all men ;  cer-
                                            tainly 
 88            a   treatise  on

 tainly upon all men in health.   Thofe  only, who
 are in a ftate of difeafe, higher in degree than thofe
 powers  can  producej  will  refift  their  operation.
 But this proportion cannot be  one in  a thoufand,
 perhaps  not one in ten  thoufand.   Such alio may be
 the proportion that would efcape  from  the effects
 of a  fpecific  contagion  applied to  them*   It in
 common, however, for  men in health to  be expofed
 to contact with the fick, and to efcape.  In that cafe>
 contagion, if the  difeafe had  been contagious, muft
 inevitably have been applied $ and without producing
 its imputed effects."
   It is a fact, attefted by many medical Writers, that
 perfons are liable to  be attacked,  both by  the  plague
 and yellow fever, an indefinite number of times; but
this is not characteristic of Such  difeafes as are allowed
 to be contagious.
   Another fact, and the fame is noticed by the  writer
juft quoted, women, children, and the aged, are pecu-
liarly exempt from the difeafe ;  this certainly  has
 been the cafe, while the difeafe prevailed here in 1796,
 and  the  laft year,  1798.  But  if contagion  was  the
fource of thefe epidemic difeafes, the cafe would be
exactly reverfed:  old people,  women and children,
being more frequently in the way of contagion,  be-
caufe more conlined, would be more frequently and
more feverely attacked.
   We  repeat  then—the fever or plague is not conta-
gious,  or propagated  by  any fpecific matter ;  we
make the affertion the more  confidently, not only
as it refults  from  our  own  obfervation and con-
viction,  but  alfo becaufe it  is the concurrent opinion
of a majority of phyficians,  in all countries, and thefe
not the leaft refpectable.  We begin firft at home.
   Dr. Warren fays of the  laft  epidemic,  1798, Bof-
ton—" That the fever was in a degree contagious, 1
cannot entertain a  doubt; but that it was not fo in a
very high degree,  1 am as fully perfu^ded from the
number of cales in which there was reafon to believe it
                                             could 
            THE   YELLOW   FEVER.        89

 could not have been taken in that way.  In moft inftances j
 where contagion  might have been fufpecled, the fub-
 jects were fo fituated, that they might have received
 it from the fame fource as thofe  with whom they had
 communicated.   I cannot learn  that any evidence has
 been furnilhed of infection from the Sick, who  had
 been removed into the  country, though  there  were
 inftances  of fuch  removals, under the moji malignant
forms  which it  affumed."—I  venture to  affert, that
 not a phyfician in town, young or old, will go further
 in  advocating the contagious nature of the difeafe,
 than Dr.  Warren has here  done.  He  admits  that it
 was " in a degree contagious ;"  but I prefume only in
 the manner that Dr. Rulh  holds it to be contagious ;
 not from  any fpecific matter, fecreted or produced in
 the fyftem by the operation of the difeafe,  but only
   " If the breath, perfpiration, and other excretions of
 a perfon, in a yellow fever,  be confined in a fmall
 clofe room, they may produce a fimilar difeafe, efpec-
 ially when they act upon a body previously debilitat-
 ed  by grief or fatigue.  But they are generally inof-
 fenfive, where the fick are accommodated in open,
 well  ventilated Situations.   Out of upwards of one
 thoufand  perfons, who have carried this difeafe into
 the country from our cities, there are not more than
 three or four inftances to be met with, of its having
 been propagated by contagion.    In the city hofpital of
 Philadelphia, there was no inftance of this difeafe be-
ing contagious,  in 1793,   1797  and 1798.  Clothes,
 impregnated with  the efiluvia  of a perfon who  had
 died of the yellow fever, might produce a  fimilar dif-
 eafe, but it would be only in confequence of thofe ef-
 fluvia partaking of the nature of putrid matters, de-
rived from any other animal fource.   The fame thing
may be faid of the effluvia emitted from a  putrefying
dead body."
  Dr. Mitchill, in a letter of Auguft 28,1799, fays—
" The experience of this feafon  is mofil powerful and de-
tided againfl its contagious nature.   I have heard of no
                  M                      inftance 
9o
A  TREATISE  ON
inftance that looks like catching it by infection.  Com-
mon feptic fluids, existing in the form of liquids in the
alimentary canal, or gaffes in the atmofphere, appear to
be the grand agents of mifchief."
  Drs/Huck, Hillary, Hunter, M'Lean, Clarke, Jack-
fon, Borland,  Pinchard and  Scott, phyficians to the
BritiSh army in the Weft Indies, and many more, de-
ny  the contagious  nature of  the  yellow  fever,  as it
there exifted.
  In the feveral accounts of this fever, as it  has ap-
peared in Philadelphia, New York, Bolton, and in the
other places on the continent, Since 1793,  it does not
appear that  the mortality has been greater among the
phyficians, nurfes, and  other attendants on the fick,
than  among the other inhabitants ;  although vaftly
more expofed to the difeafe, being from the nature of
their employment  almoft constantly among the fick,
dying,  and the dead.  We leave it to the ingenuity
of  thofe, who hold the oppofite opinion to ourfelves,
to  reconcile this fact with the acknowledged  equal
power  and operation  of  contagion  upon all  con-
stitutions.
   It feems to be a fact, granted by all the writers on
the fubject of the plague and yellow fever, that when
it becomes epidemic, it  has  invariably firfi appeared
 and, fpread  among the.poorer claSs of citizens.   This
could not befo uniformly the cafe, if it had been pro-
 duced  by fpecific contagion, becaufe  in  this cafe it
 would  be as likely to take rife firfi among the  more
 wealthy and cleanly part of the inhabitants,  as  with
 the poorer ; for fpecific contagion operates uniformly
 and indifcriminately alike upon all constitutions, fexes,
 ages  and defcriptions of people.  And befides, the fe-
 ver has been known to  appear, at one and the fame
 time, in all points of the compafs of a large city, and
 in  places quite apart of each other ; but, obferve, al-
 ways in places  where the atmofphere has been  mate-
 rially impaired, either by compact fituation of the in-
 habitants, or by noxious collections from them.  But
                                               this 
            THE  YELLOW  FEVER.         91

 this could not happen, if the  difeafe were originated
 by one Single atom of fpecific contagion (and this is
 all that  is neceffary if it be Specific) wafted thither in
 the fimbriae of a particle  of fmoke, or perhaps in  the
 chinks or Stitches of a failor's jacket!  How it comes
 here,  or what  it is when it  is here, we are not in-
 formed,  otherwife  than that  it is contagion ; a word
 which, inftead of conveying any diftinct idea of the
 matter of  difeafe, oftener betokens  the credulity or
 theoretic prejudice  of its advocates.  It would feem
 to be originated much in the fame manner  as  fome
 divines hold the world to be created—out of nothing.
 Indeed,  by a late writer of the hiftory of the plague
 and yellow fever, (who is really a man of extenfive
 information, and well read in  hiftory, as his book
 evinces) it is not allowed to be any thing ; confequent-,
 ly it is nothing.   " If (he aSks) the yellow fever is pro-
 duced by the effluvia of marShes, by putrid Steams, or
 by any thing elfe, how comes it to pafs, that it has been
 fo frequently in  the  United States, fince  the year
 1792, in  comparifon of  what it was for 30 years be-
 fore ?"  (Dr. RuSh has given a full reply to this que-
 ry, which I Shall infert by and by.)  Thus it appears,
 that neither the  effluvia of marines,  putrid Steams,
 nor  any thing elfe, can be  the caufe of fevers ; but it
 muft be contagion, "fpecific and immutable .'"-—uncreate,
 indefiruffable and eternal, and the definition would have
 been complete!   We are not  informed, whether  this
 contagion,  " not any thing," is animate or inanimate ;
 though we find,  from Dr. Waterhoufe, that it has
 fufficient agility to.beftride a particle offmoke, and, after
 thus travelling a confiderable diftance, commence  an
 attack upon the conftitution, with as much force and
 certainty of effect, as when, in  another inftance, it
 was tranfported in the curls of a wig !
  " In Short, (concludes Mr. Tytler, p. 470) contagion,
 being a power  certainly known to exift, though in-
 vifible and imperceptible, it is impoffible ever to prove
that  it is abfent ; neither, after the contagion of any
                                           difeafe 
9*
A  TREATISE   ON
difeafe has once got into a country, can we be allured
that it may not revive.  The experience, we may fay,
of* the whole world teftifies, that it does adhere par-
ticularly to clothing.   Dr. Lynd  thinks it may ad-
here to  the timber of Ships ;  and there is the greateft
reafon to believe, that it may alfo adhere to the walls
of apartments  in houfes.   The appearance of fever,
therefore,  without   any  new  importation,  cannot
prove that it has not  arifen from  contagion."  I am
aftonifhed !  Is  it poflible that thefe are the affertions
of the compiler of the " Medical Parts of the Ency-
clopedia Britannica!"
  Is contagion a power c* certainly known to exift ?''
and becaufe it is " invifible and imperceptible !"
  Mr. Tytler feems to laugh at thofe, who afcribe the
difeafe to  a particular constitution or temperature of
the  atmofphere, which  he fays " is fomething un-
known ; and when  people appeal to it,  it is  only in
other words  owning  their ignorance."-^-Now,  I am
fo ignorant, as not  to know nor fee the difference ber
tween what is  unknown,  and what is invifible and im-,
perceptible.   Can we have any experience of what is im
perceptible ?  and is there  '* the greateft reafon to be-
lieve, that it (contagion)  may adhere to the  walls of
apartments  in  houfes, to  clothes, to the timbers of
Ships,"  becaufe it is "■ invifible and imperceptible ?"
   " Contagion, being a power certainly known to ex-
ift, though  invifible  and imperceptible, it  is impofifible
ever to prove that it is abfent ; the appearance of fever,
therefore, without any new importation, cannot prove
that  it has  not arifen from contagion."  This, per-
haps, the author confiders a philofophical and logical
deduction.   Invifibility and imperceptihility is proof of
its prefence,  but to  prove it abfent, fomething elfe is
neceffary  ! 1—Well,  perhaps it  muft be annihilated 5
but this cannot be, for it is " immutable " and what is
immutable, cannot be changed or deftroyed.
   (Page 467.)  " From all this  (fuppofed facts) it ap-
pears how difficult a talk they undertake, who contend
                                                for 
          THE  YELLOW   FEVER.        03

for the domeftic origin of the yellow fever, without
contagion.   In all cafes, they mult have recourfe to
fomething vifible and obvious to the fenfes."—Yes, Sir,
and we leave it with you, and thofe of fimilar fenti-
ments, to trace the difeafe from what is " invifible, im-
perceptible, fpecific and immutable."
   With refpect to the time in which this invifible
and imperceptible contagion produces its effects after
its application to the body, " much muft  depend on
the quantity ;" that is, of what is invifible and imper-
ceptible.  But  this  affertion makes againft what has
been afferted of the fpecific nature and immutability
of contagion.   If it is immutable, it muft be invariable
in its effects, both as to the time they are produced, as
alfo, as to their number, kind and degree.   This feems
alfo to be Mr.  Tytier's conclusion.   " Thus the conta-t
glon of the fmall-pox,  whether existing in the matter
of a puftule, in the fmoke of burning clothes or paper,
or in  the efiluvia of blood, is invariably the fame, and
never produces any other difeafe."
   (P. 468.)   In order to  reconcile us to what has
been faid, and to do away what perhaps " may appear
rather in a ludicrous point of view, to thofe who deny
the existence  of contagion," we are told of the fur-
prifing and inftantaneous effects  of animal  poifons.
Remember the definition of contagion, (fpecific, im-
mutable, invifible, imperceptible)  and obferve how its
quantity, volatility, materiality, &c. are  fpoken of.
" If we confider the inftantaneous and inexplicable ac-
tion of the poifon of fcipents, and how little time they
produce a mortal diforder, or even death itfelf; when
we confider that contagion is only a volatile poifon,
and that it for the moft part takes up an inconceivably
larger time to bring on  death, than the bite of fome
venomous animals, we  cannot  be  furprifed  that  a
quantity of this volatile matter, inconceivably lefs than
that of animal poifon, Should be capable of bringing
on the diforder ; for the length of time may be fup-
pofed  to make up  for  the deficiency of quantitv.
                                              Yet, 
94
A  TREATISE   ON
Yet, if we confider the extreme  activity of fome ani-
mal poifons, the wonder at the fmall quantity of con-
tagion necefiary to produce a deleterious effect, will in
a great meafure ceafe.  It has  been  obferved, from
Dr. Mead, that the whole  qnantity of poifon, emitted
by a viper, when it bites, does not exceed the bulk of
a good drop.  The effect of the furia infernalis of Lin-
nceus  is  ftill  more to our purpofe.   It is an infect,
found in the forefts of Kemi, in Lapland, and likewife
in Sweden and  Ruffia.   This infect  falls down out of
the air, and, if it happens  to light upon any  uncover-
ed part of the  human body, it  almoll inftantly pen-
etrates down to the bone,  occafioning the moft ex-
cruciating pain, and death in a quarter of an Izour.  Now,
Should we fuppofe the whole  body of this infect to be
poifon, as it is poffible  that it is  not,  it is fo. minute,
that though  the whole were volatilized  into conta-
gion, it might be well fuppofed to adhere to  a wig, or
even  a more diminutive  part of the clothing; and
considering the virulent effect of even this fmall  quan-
tity of contagion, when communicated, it  would eafi-
ly follow, by fair calculation, that  a very minute pro-
portion of even  this fmall  quantity might bring on  a
dangerous difeafe."
  I fhould like to know by what means or inftrument
we  might calculate the danger of a difeafe,  brought
on by  " a very minute proportion of a fmall quantity" of-
invifibility or contagion of fever.
  1 do not believe  that this infect, the furia infernalis,
can penatrate and kill, thus fuddenly,  unlefs  it fhould
happen to fall upon fome important part or organ of the.
body, immediately connected with the  vital principle,
any more than  that whole  fore/Is of  Norway are burnt
up by the heat of the fun ;  both thefe facts reft upon
equally refpectable authority.
  " Contagion  is only a volatile  poifon ;  and for the
moft  part takes up an inconceivably longer time to
bring on death, than the bites of fome animals ;" and
" the length of time may be fuppofed to make up for
                                               the 
THE  YELLOW  FEVER.
95
the deficiency of quantity."  That is, if a quantity of
volatile  poifon, or contagion, " fpecific, immutable,
imperceptible, and invifible," be " concentrated" into
a "good drop" (invisible) it  will  kill  as fuddenly as
the bite of a viper.
   " From  all this it appears  how difficult a tafk they
undertake,  who  contend for the domeftic origin of
the yellow  fever, without contagion!!" Surely.:  and
we have  now" full Conviction with what wonderful
facility, difficulties, of Chimborazean magnitude, may be
pufhed  out oS fight, by the apparent agency and imper-
ceptible power.of an invifible contagion.
   " It  is  indeed too common for people to  laugh at
what they cannot anfwer."   Perhaps  if this mode of
confutation had been fully adopted by the author, it
would  in the prefent inltance have proved the molt
fuccefsful, if not  the only mode of obviating the ar-
guments  of thofe,  who contend  for  the domeftic
origin of  the difeafe.
     But to yturn.—
   Adverting to analogy, We find it abundant in the
fupply of argument, Supporting the opinion we have
advanced concerning the origin of the difeafe ;  and
thefe are  forcible and  conclufive in their kind.  It
might as  well be affirmed, that the  ruft and blaft of
certain kinds of grain were  the effect of the operation
of contagious matter, as that difeafes of fever are thus
brought about, which feem to be as much limited to
feafon  in  their appearance,  at leaSt in  their kind or
degree  of malignancy, as thefe phenomena of the veg-
etable world.  Certain  tribes of worms and infects,
which often make destructive  ravages  upon the fo-
liage of certain trees, particularly the apple-trees, and
alfo upon other fpecies  and tribes of vegetables, fome-
times to fuch  extent, as often to endanger a famine,
appear  and difappear only in certain feafons and peri-
ods of  time.   But this appearance and difappearance
ot thefe devouring infects, has, I believe,  never been
attributed to the operation  of contagion.   The more
                                            general 
 96           A  TREATISE   ON

 general opinion  is, that  their existence or return de-
 pends  upon fome peculiarity of feafon and tempera-
 ment of atmofphere ;  and  the fame thing I believe
 will be found true of the ruft and blaft of grain.   This
 circumftance fuggeits to us the idea, that  certain fpe-
 cies of difeafe, particularly the malignant fever, may
 depend upon  the fame,  or fome fimilar and general
 caufe ; viz. fome peculiar temperament or viciffitude
 of  atmofphere, either general  or local.  We Shall en-
 large upon this idea, after the  following forcible and
 conclusive arguments, againft the contagious nature of
 epidemic difeafes, are inferted.
   " It  is well  known,  that, in hofpitals,  camps and
 Ships, a very fmall proportion only of thofe, who fleep
 within a Short diftance of, are  frequently in conven-
 tion, or even in contact  with, perfons ill of typhus,
 dyfentery,  or fever, is  feized with thefe difeafes.  So
 far from infection being  invariably communicated in
 this manner, no inftance  of it  has ever been distinctly
 traced.   If  fuch cafes  had  ever been  recorded,  we
 muft  either reject them as  falfe, or abandon one of
 the fundamental axioms  of  philofophy.  For, what-
 ever has happened once, muft  happen often ;  it muft
 happen always in fimilar  circumftances.  But  in the
 Situations alluded  to, thefe  circumftances constantly
 occur,  and  the alleged effects do not follow.  It is not
 fair to conclude, that dyfentery is contagious, becaufe
 one perfon  happens to be taken ill, while in the neigh-
 bourhood of another who had  got the difeafe.  If the
 conclufion was juft, all within the infectious diftance,
 not labouring under a difeafe higher in degree, would
 be  fimilarly affected.  They would have  the  difeafe
 with as much  equality  of force, as children have the
 fmall-pox.   In proportion to the number affected, the
power  of contagion would  increafe.   It would pro-
ceed in a geometrical ratio, diverging from the centre
to every point of the circumference of a city, a camp,
an  hofpital, or a fliip.  It is  evident, then, that  in
thefe fituations, a contagion, which  had the power  of
                                        producing 
THE  YELLOW  FEVER.
91
producing its peculiar  difeafe, in  the  fame^ perfon,
more than once during life,  would never difappear.
But dyfentery, fevers, and the plague itfelf, ceafe in all
thofe fituations, without having affected  perhaps a
tenth part of the community*   They ceafe, too, when
they are epidemic, according  to fome periodical law*
which evinces, that they do not arife from any cafual
and uncertain  fource, like  the accidental application
of contagious matter."                              .
  There feems to be fomething in the atmofphere of  \
cities, and of all places of compact habitation, favour^  \
ing the origin  and fpread of epidemic difeafes.   This
is made evident by a variety of facts and confiderations*
  Dr. Rand has ftated,  that the atmofphere of thofe
places, where the difeafe was moft prevalent, in 1798,
(Bolton) was  fo  thoroughly impregnated with con-
tagion .(infection) as to be very perceptible  to the
fmell and tafte, exciting the fame fenfation as  a weak
folution  of  corrofive fubiimate of  mercury.  (Med*
Rep. vol.  II. p.  471-)
   Another accurate obferver of facts and natural phe-
nomena  informs,  that "The month of July, 1798*
was  pleafant, and by no means unufually hot, except
the firft  three days,  and the laft three days of the
month, when the air became remarkably calm,  and
the heat was exceflive to the 25th of September, when
a total change enfued,  with violent gales of wind
from different quarters.
   "The courfe of the wind was very regular, almoft:
every day, for  fix weeks.  Early in the morning, it
was generally light from the northern quarter, and
gradually veered to  eaft and fouth-eaft, with a light
breeze  fomewhat Stronger than  in the morning,
to  the   fouthern quarter, and  gradually   leffened
to a perfect calm  by the time  of  the  fun's  fetting,
which was constantly obfcured by a dark red tinge,
which increafed generally to fuch a degree, as to en-
tirely conceal  its  body before it funk below  the ho-
rizon, with the appearance of a black bank of fmoke.
                   . N                        The 
93              A   TREATISE   ON

The atmofphere feemed to have fo little motion,  dur-
ing the above period, as fcarccly to change its relative
fituation, except in a circle round the town.   Sounds
and fmells were propagated  in every direction, with-
out any apparent  check from the  current of air."*
   Cities,  for  the   convenience  of trade,  are for  the
moft part fituated in low and level places, and fuch as
are favourable to   the  accumulation  and retention of
filthy materials, the  unavoidable confequence  of com-
pact habitation.   It  is here alfo, that putrefactions of
all kinds, together  with  combuftions  in  houfes, dis-
tilleries, glals-works, and in  all the  various kinds  of
manufactories, carried on  upon   an  extenfive fcale,
take place,  by which the proportion of oxygene re-
quifite  to the healthy conftitution of atmofphere is
confumed, and its azote or  fepton  increafed.   Now,
it is a certain  fact, that this vital air, or oxygene, one
of the  conftituents of atmofpheric air,  is  as neceffary

                                                            to

   * Mr. Wcbfter is pofitive in the opinion, that at leaft the quality of atmofphere
is ftationary during the continuance of an epidemic difeafe.   (P. 143)  " Cer-
tain it is, that no force of wind whatever ever expels from a town, or leffens
the peftilential virus, without  the aid of other  caufes."  (P.  321.) " Is not
electricity the bafis of the common atmofphere, and immoveable  by wind ?
And does not a peftilential air confift partly in fome combination of this ele-
ment, with other aerial fubftances, which are not moved by wind ? This is fug-
gefted merely for confideration ; it appears to me improbable.   Froft deftroys
the peftilential condition of the atmofphere, and this is  fuppofed to act upon
the deleterious fubftances arifing from the earth, or human body.  Befides, a
peftilential atmofphere rifes  but a few feet above the earth,  which indicates
that its pernicious qualities are denfe and gravitating fubftances.
  " Indeed, two caufes feem to concur in the origin of peftilential fevers; an
electrical condition of the atmofphere, which renders the nervous fyftem ex-
tremely irritable, and theliody of courfe prone to fever ; and a collection of
morbid matters arifing from living and dead animals and putrefying vegetable*
Wind may remove the latter  caufe, if acceffible, which, however, is never the
cafe in large cities;  but cannot affect the influence of the former.  Froft his
accefs to all morbid caufes, and renders them inert.  It alfo reduces the ftimu-
lus, acting on the human  body, and renders it lefs irritable.  But the electrical
ftimulus remains.  Hence, although the progrefs of the fever is arretted by cold,
the type of it is vifib'le in the difeafes of the winter.  The irritability, from
electrical caufes, ftill remains ; and gives to the fevers of winter the peculiar
fymptoms of peftilential or typlus pleurify, and peripneumony."
   Mr. Webfter mentions morbid matter* from living bodies amonw the caufes
of peftilence. He is perfuaded that perfpiration furnifaes more poifon than
ftreefs and alleys.  It fills all clofe rooms, efpecially bed-rooms ; in clofe-built
ftreets, it infects the very atmofphere ; and a more  virulent poifon docs not
exift, than perfpirable matter in a condenfed and  fermenting llate\  This can
only be J^ftroyed by a liberal ufe of wat.r. 
THE  YELLOW  FEVER.
 to the fupport and health  of animal life, as of flame
 or combustion ; and it will  be found, invariably, that
 fibrous irritability and mufcular power will vary with
 the degrees of excefs or defect of this principle in the
 fyftem, imbibed from without.   Befides, all bodies
 have denfity and weight, only as there is more or lefs of
 the acidifying principle concentered in them.  If, then,
 this principle be diminished in the  atmofphere, and
 extracted from  fubftances and matters  on the furface
 of the earth, either by the above  mentioned proceffes
 of combuftion, putrefaction and animal refpiration,
 or by the exceflive  heat of  the fun ; thofe materials,
 innoxious only  when embodied and confined to the
 earth's furface, are, by the  agency  of thefe powers,
 levigated, become volatile,  float  in  the atmofphere,
 and quickly predifpofe to  difeafe ; which, under thefe
 circumftances, is eafily excited by the fmaileft derange-
 ment of the animal functions.
   Another fact it may be  well here to mention : The
 •quantity of oxygene, elaborated and given out by veg-
 etable perfpiration, becomes comparatively fmall at the
 period when putrid difeafes generally make their ap-
 pearance ; viz.  July,  Auguft  and September.  The
 affair of Calcutta is alfo to our purpofe.  Capt. H61-
 well, with  about  140 others, were,  by  order  of
 the governor, thrown into  the black hole of Calcutta,
 ventilated only  by  one fmall  window •, they were fo
 crowded and huddled together, that they could fearce-
 ly move.  The  refpirable  portion of the atmofphere
 was inftantly  confumed;  the  heat became exceflive,
 the perfpiration profufe,  and the thirft intolerable.
 The animal powers were foon exhaufted, and they all
 perifhed except the fmall number of  twenty-three,
 who,  when taken out, were  immediately feized with
 the typhus fever.  Now,  all this, it is evident, was
occafioned by  a want of pure air, or the vital portion
of it;  and fo great was the demand for, it, and fo
great  the difference of temperature  between the  at-
mofphere of this hole or prifon,  and the natural and
                                           healthy 
100
A  TREATISE  ON
healthy temperature of the body, that the oxygene
began inftantly to quit its hold and combination with
the gaffes and fluids of the body,  in order to efcape
and reftore the equilibrium; by  which means the
healthy arrangement of the fluids was'immediately
difturbed, and their diffolution effected, as is  evident
from the profufion of perfpiration, and alfo from the
eruption of biles in thofe who furvived the night,
   Difeafes °f debility or weaknefs are more frequent
in cities than  in the country ; viz.  among  females,
hyfteria, mcenorrhagia, fluor albus ;  thefe  are the
fooneft and moft effectually cured by exercife  and ref-
idence in the country.   Florid confumptions and hec-
tic complaints, on the  contrary, are relieved, fome-
times  cured,  by residence in  the city,  and  by fea
voyages.  The complexion of country people is florid
and robuft ;  in the city, it is pale and wan ; the fibrous
energy and mufcular force lefs vigorous and fooner
exhaufted.
   Dr. Clarke, in his treatife on the fever of Grenada,
obferves,  that " when  emigrants  fled  towards the
mountains, where the  air is very  pure, they always
avoided an attack of fever, or foon recovered if in a
convalefcent ftate.'*
   But putrid and malignant difeafes are not alone conr
 fined to cities, and thick fettled places; they are alfo,
and almoft always,  the conftant attendants of fleets
and armies ;  and why ?  not becaufe  they tranfport
fpecific contagion,  as  they carry  powder and ball j
but becaufe in this perverted,  I had almoft faid infer-
nal ftate  of man, the filth they accumulate  in their
clothing, bed furniture, among the materials for cook-
ing, &c. &c.  renders the  air  in their encampments
 as noxious as the climate  of Java, and in fome  in-
ftances as poifonous as the effluvia of the Bohan Upas.
 O ! brethren of the human race ! why will ye bite
 and devour one another ? the rather, why will ye notv
 turn away from wrath, affuage the fpirit of revenge/
 and, by cultivating  the benevolent and focial affecr
                                             tions, 
THE  YELLOW  FEVER.
IOI
tions,  endear yourfelves to Him, who is  equally de-,
firous of the good and happinefs of all.
   All the above facts, brought into qne connected
view, afford pretty full proof of what has  been affert-
ed ;  that there is  fome peculiarity of  atmofphere in
cities and  clofely inhabited  places, congenial to  the
origin and fpread of putrid difeafe.*   What it is that
produces this peculiarity,  is an important defideratum.
Dr.  Mitchill  thinks it is fepton,  the  peculiar product
of animal putrefactions, fimply in itfelf, or in various
degrees of combination with oxygene, forming feptous
acid gaffes, and noxious,  according  to the degree of
concentration of the acid principle in the feptous bafes.
   Dr. Clarke aferibes the fever of  Grenada, 1793, 4>
5, 6.,  to a peculiar derangement of the component
parts of the atmofphere, which he thinks was " effect-
ed by the ftrong light and intenfe heat  o.f  the fun,
having difengaged, or formed fpme combination with
its vital part,  or a certain portion of it, which being
fo united and rarefied, would rife far above that ftra-
tum of air, in which we, in lower fituations, breathe,
leaving the mephitic or heavier part near to the furface
of the earth.   The lofs of a fmall portion of vital air
would render this lower  ftratum very unfit for refpi-
ration,  and of courfe very unwholefome to live in :
the  air in refpiration, in  this  cafe, not having a  fuffi-
cient  quantity of oxygene, may occafion  a deranged
State of the fluids,  which I conceive  to be the imme-
diate ftimulus or excitement, or what  may be termed
the  proximate caufe of the fever.  And if the biliary
fecretian be  intended for the difcharge of the degen-
                                                erated
  * " Peftilence has always been the peculiar curfe of populous cities. Of about
aoo general plagues, recorded in hiftory, a few only have been fo violent as tfl
fpread over countries into villages and farm houfes ; almoft all hive been lim-
ited to large towns, evidently demonftrating, that they would never have af-
fected mankind, without the influence of impure air, generated in thofe places.
This  is a truth, as unqucftionable as it is important;  and on a conviction of
this,  hangs the fafety of men from that dreadful calamity.   Had Mead, and
Other eminent phyficians, taken the fame pains to lead mankind into truth, as
into error, we fhould long ago have introduced improvements into the ar-
rangement and ftructure of our cities, which would have fecured our citizens
from  nine-tenths of the infectious difeafes, by which they have Leen :'.irn:jJ
and diftreffed."  (fVeifer, p. 309. vol. II.) 
102
A TREATISE  ON
crated lymph and craffamcntum of the blood, as Dr.
' Maclurge thinks, in his differtation on the bile, the
great redundancy and degeneracy of the bile in this
fever may be eanly accounted for, on that principle.
This  derangement  may be the caufe of an increafed
determination of the fluids to the liver,  and as the
morbid animal procefs gains  ground, which it  docs
every hour, if not oppofed by powerful remedies, the
liver  becomes more and more diftended with blood,
and the biliary fecretion is increafed and hurried on
in fuch a rapid manner through the extremities of the
pori biliarii, that it  refembles grounds of  coffee rath-
er than bile, which, upon a narrow inspection with a
magnifying glafs, feemed to be diffolved blood, float-
ing in lymph or mucus.  When the blood,  diffolved
by this morbid procefs, meets with any obstruction, it
gufhes  from the nofe and mouth in almoft a colour-
lefs State,  and in fuch prodigious quantities, that the
patient foon finks into a ftate of total diffolution.
   " There appears to have been fuch an exrenfive and
peculiar deranged ftate of the atmofphere in the towns
in thefe iflands,  and in North America, that it is more
than probable this difeafe was produced by this general
caufe, it breaking out nearly  at the fame time in dif-
ferent places, than  that it originated only in one or
two towns,  and was carried from  thence  by  infection
to others, by either perfons or goods, as  has been fup-
pofed.  The regular return  and continuance of this
fever, in the months of July, Auguft and September,
every year, more or  lefs, fince its firft appearance in
thefe iflands, and in the towns in America,  feems to
me to argue ftrongly in favour of this opinion."
   The great  influx of Europeans,  and  from  north-
ern latitudes, and the concurrence of other cafual cir-
cumftances, occasioning this unufual depravity of at-
mofphere, was the only caufe of the difference of ma-
lignancy between this and the common bilious or au-
tumnal fever, in the opinion of Dr. Clarke.
   " The viciffitudes of  the atmofphere (fays  Dr.
M'Lean) constitute a  power,  great,  evident, and ex-
                                            tenfivc
«\ 
THE  YELLOW  FEVER.
105
 tenfive in its effects upon the animal and  vegetable
 world :  a fource, to which the epidemic and peftilen-
 tial difeafes of  living bodies may with certainty be
 traced.  Whereas, contagious matter is a power, that
 has uniformly been taken for granted, without ex-
 amination f of  which the existence, in epidemic and
 peftilential difeafes, is even difproved by a numerous
 induction of facts ;  and, if admitted, is incapable of
 explaining their phenomena."
   The facts and confiderations, already adduced, fep-
 arate of what might  be  further obferved, fhow fuffi-
 ciently clear, that thofe only are rightly denominated
 contagious difeafes, which invade the conftitution only
 once ; which act, with almoft equal effect, upon every
 variety of conftitution,  and  temperamentof body ;
 which always  bear the fame type,  and are  invariable
 in their characteristic fymptoms ;  and which are not
 changed,  in thefe refpects, by climate, or by any va-
 riety of atmofphere :  but thofe difeafes, which are. ei-
 ther fporadic or epidemic, according to the quantity
 and degree of heat, cold and moifture, or which vary
 with the ftates and conditions of the atmofpheric ele-
 ments ; which are confined to particular complexions,
 constitutions and climates ; which are capable of ev-
 ery degree of  variation in type and fymptom, from
 the mildeft form,  up to  the higheft degree of malig-
 nancy ; which invade the constitution an indefinite
 number of times, and with the greater malignity the
 ortener it has been attacked, are not fpecifically con-
 tagious ;  they may be called infectious, if by infection
 we understand the effluvia of putrefcent fubftances,
elevated by heat, and then denominated the gafeous
oxyd of azote ; or, combined with oxygene, forming
feptic acid gaffes.  Inalmuch as thefe materials, thus
produced, and diffufed in  the atmofphere, thereby de-
stroying its  falubrity, and  occasioning  fuch a de-
pravity as to  give  rife   to  putrid difeafes, either
fporadic or  epidemic,  according to  the locality  or
more general  extent of  the peftilential atmofphere,
                                                it 
104
A  TREATISE  ON
it  is accurate to fay,  that fuch difeafes depend upon
certain ftates or certain viciffitudes of the atmofphere,
together with fuch other caufes as produce debility
in the conftitution.
  The beneficial  confequences, which would refult
from a full and an implicit  adoption of the doctrine
above advanced,  are  numerous and important.  In
general, we fhould no longer find men wafting their
time and ingenuity in infifting upon an ideal  being,
a fomething and a nothing,  as  the fource of epidemic
difeafe,  and in tracing it from city to city, from con-
tinent to continent;  which,  when  traced to  where
they choofe to find it, will not allow it to be any thing
obvious to the  fenfes ;  cannot be known by  any
Chemical teft ;  is " imperceptible,"  &c. &c.   On the
contrary,  we fhould fee that the fource of mifchief
might be among ourfelves, and is the offspring, how-
ever monftrous, of our own vices ; by thefe it is nur-
tured ;  the parentage and  filiation is wholly ours.
We fhould be convinced, that there is not a city or
town, in  any climate, fea-port or inland,  houfe or
habitation in either, wherein malignant difeafes may
not originate.   The regulations, neceffary  to  cleanli-
nefs, in doors and out,  would be  unremittingly at-
tended to; and any thing that might tend to  deftroy
the healthy temperament of  the  atmofphere, either
generally or locally, would be immediately profcribed,
by thofe invefted with  adequate authority.   Phyfi-
cians would no longer approach the fick bed  with as
much reluctance and cautious fear,  as  if they were
advancing to the rack, or other apparatus of Popifh
inquifition.   On the contrary, they  would fpeak
words of comfort to the fick, cheer him with rational
hopes of recovery, difpel the frightful apprehenfions of
immediate  diffolution, and,  by  thus fortifying the
mind, by the invigorating power of hope, give effica-
cy to prefcription, and  arreft to the difeafe.  Still
more ;  " the adoption  of  this  theory, by recalling
phyficians from a wrong track of inveftigation, would
                                         probably 
           THE  YELLOW  FEVER.       105

probably be the means of enabling them to apply
principles to the cure of all epidemic difeafes, hitherto
fo often fatal, which would render them little more
dangerous than common fevers.   Inftead of wafting
time in tracing contagious matter from city to city,
they would endeavour to discover what are the par-
ticular States or viciffitudes of the atmofphere, which
produce epidemic  difeafes;  what are  the  caufes of
thefe  viciffitudes ;  and what  are the  beft modes of
counteracting their effects upon the human  body."
                  By  Dr. Rush.
   " IT  has often been aSked, Why did not the yellow
fever prevail in Philadelphia before the year 1793, partic-
 ularly in the year 1778,  when it was left in a more filthy
ftate,  by the Britifh army, than it has been  at  any time
fince ?  To this I anfwer,  that for the production of
 our  peftilential  difeafe, three things are  neceifary:
 1. Putrid  exhalations ; 2. An inflammatory confti-
 tution of the atmofphere ;  and 3. An exciting caufe ;
 fuch as great heat, cold, fatigue from riding, walking,
 fwimming, gunnjng, or unufual labour ;  intemper-
 ance in eating or  drinking,  ice creams, indigeftible
 aliment,  or a violent emotion of the mind.  The firft
 caufe acts but feebly without  the concurrence of the
 fecond, producing mild difeafes only, fuch as common
 remitting and intermitting fevers.   By the co-opera-
 tion of  an inflammatory conftitution  of the  air,
 we obferve not  only  common  bilious fevers have
 become malignant, but all thofe  difeafes which are
 occafioned by the fenfible qualities of the air, have af-
 fumed a  more violent  character.  This has been re-
 marked by moft of the phyficians of Philadelphia for
 feveral years paft.  The pleurify, rheumatiim, gout,
 hives,  and feveral other difeafes, require remedies of
 twice as  much force to fubdue them, as they did ten
 years ago.   On what circumftance this change of the
                   O                   atmofphere 
lo6            A TREATISE   ON

atmofphere depends, is  not known.   But the fact is
certain.   It was taken notice of by Hippocrates, two
thoufand years ago, and is mentioned over and over
in the writings of Sydenham.  The records of med-
icine  prove, that it has continued from one year to
fifty-two years in different countries.   Dr. Sims has
given a long and interefting account of thefe inflam-
matory conftitutions  of the atmofphere,  from the
year  1590 to 1782, in the firft volume of  the Man-
chester  Memoirs, from  which  it appears, that they
were  fometimes general over Europe, and at other
times confined  to particular countries.   The pefti-
lential conftitution  of the  air, in the United States,
began in 1791.   This I infer from the yellow fever
making its appearance that  year in  New York.  It
prevailed in Charleston, in 1792, and it has been ep-
idemic in one or more of the cities and country towns
of the United States every year fince.
   " As a further anfwer to the queftion,  it might be
afked, Why was not the fever imported oftener before
the year 1791  ?  It is feldom abfent from the Weft
Indies.  It raged in  molt of them  during the two
wars  previous to the prefent, and yet but one inftance
occurred of it in the  United States, in thofe two pe-
riods of feven years each, and  that was in Philadel-
phia, in the year 1762.  The intercourse between our
cities and the iflands,  during that time, was extenfivc
and conftant ;  particularly in  the war  between the
years 1756 and 1763.  Quarantine laws then exifted
in but few of  our cities, and where they did, they.
were feebly executed, or eluded every day.
   " It has been aSked,
   " Why does not the yellow fever  prevail every year, in
cities where the filth is always the fame, in its quantity and
quality ?  To this I anfwer, that  filth may be in two
States, in which it will not produce this difeafe ; viz.
a dry and a liquid ftate.  From exceflive heat, or from.
heavy rains, it is often in one of thofe conditions in
our cities.   When this is the cafe, they efcape a visi-
                                            tation 
THE  YELLOW  FEVER.       i©?
tation from this difeafe.  It is only when filth is acted
upon by a hot fun, in a moft ftate,  that it produces
fever.
  "Philadelphia (concludes Dr. RuSh) was once pre-
eminent over all the cities in North America, in plans
of public utility and  happinefs ;  She muft admit the
unwelcome truth, fooner or later, that the yellow fe-
ver is engendered in her own bowels, or She muft re-
nounce her character  for knowledge  and policy, and
perhaps with it, her exiftence as a commercial city.
  " May Heaven forbid this cataftrophe to the capital
of the United States! and in mercy command the de-
stroying angel of peftilence to  Sheath his uplifted
fword!  In fpite  of the  numerous  execrations, that
have been  heaped upon me, for opinions and conduct
upon  the  Subject of  this addrefe, by the citizens of
Philadelphia, her profperity is ftill the objeft of my
conftant folicitude.  Yes—dear  afylum of my an-
cestors ! beloved  nurfe and protectrefs of my infant
and youthful years !  may thy health, thy commerce,
thy freedom and thy happinefs, exift till time Shall be
no  more !"
  WE have been politely favoured  with an accurate
registry of  the variations of the weather, and tempe-
rature of atmofphere, from the ift of July to the ift
of November.   Nothing but the circumftance of hav-
ing already extended the Treatife beyond the prefcrib-
ed limits, prevents its being inferted entire.   Abridg-
ed, we find it varies but little from  that given by Dr.
Rand, for the fame feafon.
  "The  ftate of the atmofphere,  in the month of
May, was  warm and  pleafant.   Fahrenheit's  ther-
mometer ranged from 48 to 82 degrees, at 2 O'clock,
P. M.  Twelve days the mercury Stood from 60 to 82.
Nineteen days from 48 to 90, with alternate rain and
funShine.   Some  few perfons  laboured under rheu-
                                          matifm, 
io8          A  TREATISE,  &c.
matifm, fome with afthma ;  and few had the typhus
mitior this month.
  "June was pleaSantly warm, with the winds for 17
days from fouth and fouth-weft, three days fouth-eaft
and eaft ; four days the wind blew from the north-.
eaSJ, when  the weather was cool and cloudy,  with
rain.  The remaining  fix days, weft  and north.  It
thundered,  with  fmall {bowers,  the  3d and  29th.
Thermometer ranged  from 56 to 83, only one day
56.  Twenty days from 70 to 83.   Nine days from
65  to  70,    Fevers,  with inflammatory fymptoms,
pleurify, bilious and inflammatory fevers, ophthalmy,
and  few cynanche parotidea.
  " July was hot  and fultry.   The fouth and fouth-
weft winds prevailed 18 days.  Small fhowers,  with
thunder, 8th and  29th.  The range of the thermom-.
eter was from 72 to 96, excepting 3 days it defcended
to 67.   Typhus gravior, and  in  fome inftances the
yellow fever,
  " Auguft, the fouth^fouth-eaft and fouth-weft winds
prevailed 23 days.  The remainder it  varied  from
weft and north-weft to eaft and north-eaft.  It rained
the  5th, with thunder;  12th, fm all Showers ;  21ft,
cloudy  with thunder ;  26th,  rain.  Thermometer
ranged from 72 to 94 ; the 20th and 23d, 6f and 69;
healthy, except the contagious fever.
   " September, light breezes  from the fouth-weft,
fouth and fouth-eaft,  prevailed 22 days.   Very little
rain this month.   Part of this month hot and fultry.
Thermometer ranged from  56 to jy.   The  night of
the 29th, a froft,  The fever the latter end of this
month abated.
   " October, the  weft and north-weft winds blew 13
days ;  variable from north-eaft to fouth-ea{t, the re-
mainder of the month.  The 7th, a great Storm with
much rain ;  a fevere  froft  29th,  which arretted the
further progrefs of the contagious fever.  Thermom-
eter from 30 to 36."    (See Med. Rep. vol. II. p,  446.)
A  CATALOGUE 
" A  CATALOGUE  of  the  Names of  adult  Perfons,
   who died in Boston, during the prevalence of the Tel-
   low Fever, or Plague; beginning July 3 ift.
  1* N.B.  Thofe with this mark (x) prefixed  are fuppofed to have died of
the epidemic.  But it is very probable it may be  affixed to fome  who died of
other .ilforders ; and fo vice verfa.  It is to b,e noted, alfo, that the Catalogue
muft be very defective, as it was impoffible to  collect all the names.   So far as
it  goes, it may be depended on;  but there certainly muft be a. deficiency of
nui 'berg.
  " The names of young children were never brought into the Catalogue.
  " A few names have been inferted, of fuch citizens as manifeftly carried the
diforder out of town, and died after their removal.
  " It is to be lamented, that any embarraffments were thrown in the way, fo
as to deprive pofterity of a perfa Catalogue.  A few deaths by the fever hap-
pened previous to this date; but the number is not afcertained.  Many names
arc doubtlefc mif-fpelled ; and fome Chriftian names could not be obtained.
                                        « CALEB BINGHAM."
     Boston,  1798.
July 2\.  Thomas Frazier
          John Atkins
     22.  xjohn Hunt
          Elias Parkman
          Mercy Brazier
     23.  xjohn Bowman
          John Ewer
          John Knowles
          Sally Wheeler
          x James Waterman.
     39.  x Andrew Newell
          x Robert Paine
          x Benjamin Stone
          John O.den
          Jqhn Dennis
     29.  xjofeph Bragdon
          Rebecca Fobes
     30.  x Benjamin Luckis
          x, Wentwarth Downes
          xjofeph Scott
          xDonald Campbell
          xWilliam  P. Selby
          William Jofeph
■

July 31.   xSamuel Bradlee
          x Rachel Tarball
Aug.  1.   xjpfeph Whittemore
      2.   x Bartholomew Rand
      3.   xjames L. Homer
      4.   John  Hewit
      5.   Benjamin Loring
          xjohn Lebaron
      6.   xjames Pitts
      7.   xWilliam White
          x George Roberts
          John  Robertfon
          Samuel Holland
          ------Lochlin
          x Francis Smith
      8.   x A Sailor fron^ Fore-
             Street
         - xWilliam Thayer
      9.   xA Sailor from Long.
             Wharf      [Dock
     10.   xA Man found at T.
          x Duncan Mackinto/h
          Samuel Dill 
(   no   )
Aug. 10.
    n.
    12.


    14.


    16.
17-
19.

21.
22.
H'
24.
25.
26.
 Martha Callender
 x Henry Lovering
 xA Man from North
    Square
 xjohn B. Marfharl
 xjarrtes Gordon
 x Timothy Atkins
 Patrick Bryant
 x Mercy Wheeler
 xMrs. Davis
 xMr. Welfh
 x Francis Bigelow
 Rebecca Torrey
 A  Perfon from  the
   Alms-Houfe
 xA Man from  Fifh-
    Street
 William  Kimball
 AManfromtheAlras-
   Houfe
 xMary Atkins
 x Sarah Atkins
 x Matthew Clarke
 Elizabeth Whittemore
 xjohn Smith
 x Judith Adams
 ——— Watts
 Nabby Sewall
 xSally Thomas
xThomas Chamberlain
 xjohn Buckley
 xMehetabel Gree-
   nough
 xPrifcilla Patten
xLydia  Burrill
XMrs. Greenough
 x Elijah Adams
 xSukey  Howard
 x Samuel Barrett
xA Black Woman
 x Patty Hopkins
 xjonathan P. Barton
x Nathaniel Cade
x Horace Wells
Thomas Crafts
 Richard Gridley
xjohn Bafs
Amos Ballard
Aug. f],   Mrs. Frobifher
          A Stranger
          x Lewis Thomas
          x Thomas Temple
     28.   Benjamin Darling
     29.   xThomas Stimpion
          xAbigail Welfh
     30.  ' xThOmas Amer
          xThomas Curtifs
          x Dorothy Reynoldl
     31.   xShippie Townfend '
          x Sally Hufe
          Samuel'Barrett
          xjohn Ridgway
          x Nancy Lewis
          xDr. Gilbert Dencn
Sept.  1.   Mr. Hartwick'
      2.   x Benjamin Hatch
          x Daniel Ward
          xMary Ridgway
          Nancy Armftrong
      3.   xSufanna Patten
      4.   xWilliam Woods
          x Elizabeth Colman
      5.   xBetfy  Ridgway
      6.   Patty Cockran
      7.   x Samuel Coats  .
         xjohn Bull
         xjames Eaton
         x Eunice Whipple
      8.  x Ralph Pope
         xjohn Merry
         Lydia Wetherton
         xMrs. Cooke
         Jofep'h Joyce
    ro.  xSufanna Johnfon
         xClement  Collins'
           —<----- Pownal
    ti.  x-Gharles Moore
         * George Carey
        ' Phebe Aterhill
    12.  xjofeph Balch
         x Either Baxter
         xMrs. Flinn
         Job Wheelwright
         Chow Mandarin
    13.  x----Spear
         xAbigaii Bumftead 
(   III    )
 Sept. 13.  x----Sprague
          X Temperance Colman
     15.  xClariifa. K^ogers
          xMrs. Bromit
     16.  Philip Bolton (Black)
          xJof«ph Tennis
     17.  xBenjamin James
          x Mrs.----a Stranger
          xjohn Pindergrafs
     18.  xMary Thayer
          xMary Harris
          xMrs. Service
          xjohn Joy
     19.  xThomas Webb
          xJohn.Menzie
          xMrs. Foxwell
          xEleonora Gere
          ------Berry
     20.   xEdward Davis, junr.
          X; Samuel Hunt
          x Elizabeth Jamifon
     21.    ------Tuckerman
          xEleonora Berry
          x Rebecca Nichols
•         x------  Smalipiece
          x Eliza Feflenden
     22.   x Richard Fox
          xThomas Simmons
                      (Black)
          x------Shaw
          x Hannah Reynolds
     23.   x Kitty Lambert
          x Ruth Thayer
          xjohn Bryant
     24.   x George Lifjiermore
          x Samuel Speare
          x Margaret Spear
          xWilliam Menzies
          xjohn French
          x----Emery
     25.   Elizabeth Durant
          x Sarah Snow
         xMifs Fifty
         x Alexander Laurad
         xMehetabel Lolly
         xMrs. Poore
    26.   Mary Walter
Sept. 26.  xBetfy Rowfe
          Rofe Brewer (Black)
          x A Woman,from Capt.
             Weft's
          xA  Woman  from
            Fitch's Alley
          x Mofes Hafkell
     27.   xNoah WifwalJ
          xSarah Piper
          x Alexander Edwards
          Eleonora Reed
     28,   x Sally Thomas
          Mrs.  Glyde
          X2 Names unknown
          xMary Huntley
          Mary Armftrong
          x----Harris
     29.   x Gardner Baker
          xRachel Conant
          Ebenezer Stone
     30.   xjames Boyd
          x Nancy Howe
          xThomas Crawford
03.  1.    x Benjamin  Bolter
          xWilliam Heath
          x------Men zie
          xjofiah Bradlee v
     2.  xA Perfon  from Mid-
            dle-Street
          x Ditto from ditto
          xMr.  Crane
          Ann Patfhall
          Elizabeth Head
     3.   Elizabeth Magner
     4.   x Sarah Brailsf'ord
          xEbed Sprague
          Watey M'iNight
     5«-----Hamilton
          xThomas Orrifond
          Patty Wheeler
     6.   A Woman  from John
            Geyer's
     7.   Widow Tufts
          Sarah French
         xMrs. Perkins
         xCharity (a Black)
         *Mrs. Tough 
(   112   )
OS.  7.  Mrs. Oriphant
         xG. Cotting
     8.  Charles Waller
         A  Man  from Mr.
            Gooche's
         x Abigail Dyer
     9.  xWilliam Dyer
         xA Man  from Fifh-
            Street
     10.  x Rebecca Clarke
         xArad Brown
         xC. Briggs
         xlfaac Smith
         R.  Mafters
         John Barry
         xMifs Jarret
         xOne unknown
         xMrs. Tufts
     11.---Bull
     12.  xNathaniel Peabody
         John Roby
         xjofeph Shaw
         xWilliam Harrifon
         xA young  Woman at
             Mrs. Donnifon's
     17.  xHannah Criftie
oa. 18.
Nov.
21.
22.
24.
31-
 3-
 9.
10.
11.
12.
Trafk
Sufannan Read
X Thomas Criftie
xMrs. Marfh
Martha M'CHntock
Mrs. Rhodes
Mifs Vincent
Elizabeth Minchen
------ Shaw
------ Bartlett
Mary Palmer
Polly Williams
Polly Ruffell
Elizabeth Barrett
Mary-Ann Townfend
Elizabeth Ankers
William Larkin
x A Woman from Proc-
   tor's Lane
xThomas Patten
Rohert Davis
x Eunice Patten
xjohn  Apthorp
Bethiah Williams
Aaron  May
Stephen French
FINIS,