A SERIES OF LETTERS AND OTHER DOCUMENTS RELATING TO THE ILjUTE EPIDEMIC OR COMPRISING s 'Vhe Correspondence of the Mayor of the City, the ffoard of Health <, the Executive of the State of Maryland, and the Reports of the Faculty and District Medical Society of Baltimore, ALSO, ESSAYS OF THE PHYSICIANS, In Answer to the Mayor's Circular requesting information for the use of the City Council in relation to the Causes which gave Origin to this Disease—To which is added, the late Ordinance re-organising the Board of Health, Qc. <§*<\ PUBLISHED BY AUTHORITY Of the Mayor tcith the consent of the Authors, for the Benefit ofth% BALTIMORE SECOND DISPENSARY. oCl4 eopp=B(gl)t §>ecute&. ?8®€9®®®®*' fa o BALTIMORE! PRINTED BY WILLIAM WARNER, 18S0, T*^1 CITY OF BALTIMORE, Feb. 1st, 1820. To Edward Johnson, Esq. Mayor of the City of Baltimore. Dear. Sib, M THE Board of Directors of the Baltimore Second Dispensary believe that their Charitable object might be materially furthered if they could gain, for publication, such of the letters and other interesting documents as may be in your hands, and in the Health Office, on the subject of the late Epi. detnic Yellow Fever of this City; and since the poor embraced by this Dis- pensary have been the greatest sufferers, and have thereby called forth this display of Medical talent, which lies in your hands as so many dead letters, it is hoped a suggestion to the above effect would meet the general appro- bation of the different authors thereof. Indeed the Board have already as- certained that several of the most lengthy and valuable of these communis cations will be given up for this purpose, provided a general invitation so to do shall come from you. The Board therefore invite your co-operation and patronage, in order to secure, according to law, the above named documents, to be used for the benefit of this institution. Signed by order of the Hoard, J. W. GILES, Sec'ry. B. D. B. S. D, Dear Sin, I have received your favour, and feel great interest that you should succeed in your laudable exertions for the establishment and support of the Second Dispensary, and most cheerfully will comply with your request and send a Circular to the several Medical gentlemen who have written on this subject, and obtain their consent to publish them, which I have no doubt will be considered a valuable work to the citizens generally and particularly to the Students of Physic. With great respect your obt servt. February 4th, 1820. EDWARD JOH\SOJ\T. J. W. Giles, Esq. Sec'ry. to the Second Dispensary. (-CIRCULAR TO THE PHFSICIAMS.J, CITY OF BALTIMORE, February, isau. Deau Sih, THE Communication made by vou to me, respecting the late Fever, can be used to answer a very valuable purpose by being published with the others on the same subject, and the proceeds of the sale of the Pamphlet applied to the Dispensary. Not feeling myself authorised to use it without your ap- probation, I have to request the favour of an answer ; and will take care, should you approve, to send the proof sheets to you for correction. With great respect and esteem your obt. servt. EDWARD JOHNSON. L 4 | BALTIMORE, September 1st, 1819, To Edward Johnson, Esq. Mayor of the City of Baltimore. Dear Si*, IT is a fact that large quantities of pine cord wood have been used on the South East corner of Fell's Point instead of earth, for filling up to the proper level a considerable number of water lots, ends of streets,^ •Wharves, &c. This vegetable matter is not necessarily applied to the purpose of filling in, and I am clearly of the opinion that it is capable in hot seasons of gene- rating the remote cause of Yellow Fever—That it has generated the cause of all the Bilious Fevers which have prevailed here for many years back—That it is now generating the cause of the prevailing Fever, and finally that it is the most formidable nuisance in this quarter. This may appear to you a novel opinion, but my reasons for it are strong, and shall be furnished for your consideration if it should please God to spare my life until I have more leisure. Accept assurances, &c. A. CLEND1NEN, M. D. CITY OF BALTIMORE, Feb. 10th, 1820. Dear Sir, THE Manuscript which I sent you on the Yellow Fever is at your disposal;—upon the conditions which you were pleased to suggest. Accept assurances of very unfeigned respect, SAMUEL K.: JENNINGS (CIRCVLARJ BALTIMORE, December 1st, 1819. Dear Sin, WITH a view to be enabled duly to advise the City Council in provid- ing measures of precaution, relative to the Health of the City, calculating on the interest and disposition felt by Medical gentlemen on this subject, I respectfully request your answers to the subjoined queries. 1. Where were located the first cases of suspicious or highly malignant Fever, which occurred in your practice the past summer, what description of patients, as to mode of life, habits of body, places of resort, and to what particular source if any, and to what cause generally would you be inclined to ascribe their sickness ? 2. What nuisances either general or particular were within your observa- tions, that probably impaired the Health of the City, from what sources did they spring, and what measures would you recommend as likely to prove the cheapest, most expeditious and effectual for their removal ? 3. Do you consider the late Epidemic under any circumstances contagi- ous ? be pleased to particularise any and every strong case calculated to ' shew its character in this respect. An early attention to the above questions, with such other matter as yw may deem useful^ will be thankfully acknowledged by, Sir, Your obedient humble servant, EDWARD JOHNSON, Mathr. HB Edward Johnson, Esquire, Mayor of the City of Baltimore.. Dear Sir, A disposition to shew becoming respect to the circular communication of the Mayor of our City, more than an expectation of adding any thing to the many luminous reports which will be made by the learned gentlemen of our profession, has induced n\e to submit the following considerations. If a becoming diffidence of my own abilities had been wanting in this instance, a knowledge of the highly respectable communi- cations from almost every City in the United States, found in the Medical Repository and other similar periodical works, and in that excellent instance of American literature, the work of Doctor Ram- say, would have taught me, that no very valuable opinion upon the subject of Yellow Fever could be submitted, differing materially from the views taken in those publications. Indeed it would seem to me, that these works might have been considered sufficient to render the present enquiry unnecessary:—The deliberate conclu- sions of such men and of such physicians, bring to my mind con- viction, which the unanimous asseverations of a hont of ordinary men, would have attempted in vain. The amount of all these authorities, may be summed up in on© short sentence: which is, that" Intermittent, Remittent and Yel- low JFever are merely varieties of one disease." That this sentence contradicts the opinions of many other phy- sicians, both in Europe and America, I am well aware. In Great Britain a very large body of the faculty of that boasting Country, decided hy vote, that the Yellow Fever of the United States, was a contagious disease. And I am doubtful whether any of this learned body had ever attended a single case of the disease in question. In too many instances men undertake to decide upon questions af this sort, who are not qualified to judge. Until within a few B [ • ] years, malignant diseases of whatever sort, htve from time imme- morial been considered contagious, by the learned and thp illiter- ate. Of course, it was difficult to find any Physician sufficiently freed from prejudice, to approach the subject without a mind ready to exaggerate every thing like evidence of contagion, and to uu- derate all opposing testimony. The very fact, therefore, that individuals every way competent to judge of the matter, are now found opposing the doctrines of contagion, is of itself evidence of high authority, that nothing short of overwhelming truth could have removed their prejudices and changed their opinions. And a moment's reflection upon the condition and the concomitant operations of the human mind, when it must break loose all its old associations, and encounter the pre- judices of the whole world, will evince to any discerning enquirer the superior claims of those distinguished individuals, whose opi- nions I shall offer, as conclusive authority upon this subject. But before I proceed to the quotations which are contemplated, permit me to premise, that of the hundreds and the thousands, who deelare and believe the Yellow Fever to be a contagious dis- ease, very few have ever seen it, and those who hare ventured to look upon it, came to the sight, with all the horrors which must be felt in the field of battle; expecting every moment a shaft of contagion to transfix their liver; of course they were badly quali- fied to make a cool dispassionate enquiry : whilst our distinguished non-contagionists, have had rational cause to triumph over all their terrors and think like men. Doctor Ramsay gives a history of the Yellow Fever as it occur- red in 1699, 1732, 1739, 1745, 1743, I7a3 and 1755. " In all these instances" says he, "it was supposed to have been imported. But it never spread in the country, though often carried there by persons who died out of Charleston," Again he gives the history of the fever as it occurred after an interval of forty-two years, viz. in 179*, 1795, 1796, 1797,1799 and 1800, and remarks that with a few exceptions it fell exclusively on strangers to the air of Charles- ton, and was in no instance contagious. And he concludes the whole matter with this general inference, " We have no reason to believe the Yellow Fever, was either imported among us, or communicated by contagion." Doctor Ramsay in a letter to Doctor Miller of New York, dated 18th November, 1800, says, " That the disputes about the origin of Yellow Fever, which have agitated the Northern States, have never existed in Charleston. There is but one opinion among the physicians and inhabitants, and that is, that the disease was* nei- [ 7 ] ther imported nor contagious. This was the unanimous sentiment of the Medical Society, who in pursuance of it, gave their opinion to the government last summer, that the rigid enforcement of the quarantine laws was by no means necessary on account of the Yel- low Fever." " My private opinion is, that the Yellow Fever is a local disease originating in the air of Charleston." See New York Med. Repository, Vol. IV. page 218 and 219. Doctor De Rosset of Wilmington, North Carolina, describes the symptoms of Y'ellow Fever, as having accompanied the Marsh Fever of that place in 1796. He speaks of the town as being much exposed to the Marsh Effluvia, and of the summer as having been unusually hot and dry after a very wet spring: Of this fever says he, " I have no doubt in my own mind of its having originated among us, nay more, of its differing from our common bilioas re- mittent, but in degree; of it originating from the same causes and being aggravated by the circumstances of the season." " 1 did not observe one instance of its being contagious, nor do I believe it was so." " A few cases of our common Fall Fever take on all the symptoms of a violent Yellow Fever." See New York Med. Repository, Vol. II. page 143, 141. Doctors Taylor and Hansford of Norfolk, Virginia, say that the Yellow Fever of 1800 in its malignant form always originated on the banks of the river, or on low new made ground and in houses built on the docks. In all eases it begins with strangers and new settlers, affecting every one in proportion to his time of residence, and leaving the old inhabitants not wholly exempt, yet, proof against its destroying powers. " Persons from higher lati- tudes often fall victims, but with European strangers, the fever was generally uncontroulable." See New York Med. Repository, Vol. IV. page 205—6. This account of Doctors Taylor and Hansford, is confirmed by Doctors Selden and Whitehead, two other physicians of Norfolk, who speak of the exemption of the permanent inhabitants as a fact to be accounted for from the great similitade of the situation and climate of Norfolk, to those of the West Indies, where the same thing annually occurs. They add, that the atmosphere for two months was constantly heated above the 85th °- of Farenheit's thermometer and sometimes to the 9ith °. and 95th °. degree, but very frequently above the 90th °. These gentlemen add, " that part of the town where the malig- nant fever chiefly prevailed, stands entirely on made ground, re- claimed from the river by sinking pens of large logs, and filling them up chiefly with green pine saplings, which are slightly cover- ed over with earth or gravel. In some places large openings are •- t 8 ] left for the formation of docks, &c." fcorHow exactly they dr scribe the condition of Fell's Point!! " For several weeks alter the fever had commenced" they add « it was quite local." See New ¥ork Medical Repository, Vol. V. page 129. In 1801 these four physicians subscribed a statement which con- tained the following declaration," We know of no instance in which the disease has been communicated by contagion." See Med. Rep. Vol. V. page 225, &c. In the year 1798 Doctor Davidge made a publication respecting the fever of 1797 as it occurred in Baltimore. He states that the fever began in the ordinary form of Billious or Remitting Fever, which " was gradually lost in the severer degree of Yellow Fe- ver, as the season advanced In the month of August. That from that time till November the Yellow Fever alone was observed." He considers " Intermittents, Remittent and Yellow Fever as merely varieties of one disease." See Medical Repository Vol. IL page 83, 8*. Of the Epidemic Yellow Fever whieh occurred at Baltimore in the year 1800, the Faculty in a report to the Mayor says " after the most scrutinizing investigation the faculty has found no proof, or even cause of suspicion, that the fever which lately so unhap- pily afflicted our City was derived from foreign causes." They proceed " The faculty believe the following to have been the sources of the late Malignant Fever. First, The Cove which ex- tends from Jones' Falls to the interior of Fell's Point," the condi- tion of which they describe. "Second, The Docks in general but especially the interstices between the wharves, where the water stagnated and afforded a proper matrix for the generation of pes tilential effluvia." They also mention several other causes of more limited opera- tion, such as stagnant water retained in cellars, ponds and low grounds, in the City and in its vicinity; and finally the made grounds of which the wharves and the lower parts of the streets are formed, which if described fully, would be a transcript of that given by Doctors Selden and Whitehead of the made grounds and wharves of Norfolk. From these sources "we derive the first cases of the late fever, and from these fomented by the summer's sun, we believe to have been afterwards epidemic. We are most strongly impelled to ascribe our late Malignant Fever to these causes, from having ascertained that it did not exist in the high farts of the City, remote from exhalation, unless it had been car- ried there from the Point, or from the lower parts of the City." Doctor John Vaughan has given an account of the Yellow Fe- L 9 J ver as it occurred in the year 1798 in Wilmington, Delaware, which was published in the New Vork Medical Repository, Vol. III. page 368, &c. In this, he states that he had previously be- lieved this disease to be contagious. But the circumstances which in this instance had taken place under his observation, had led him to adopt the contrary opinion. He had evidence the most un- equivocal, that it had arisen solely from the noxious exhalations to whieb, the lower part of the town particularly, was exposed; " and he could not discover a single instance, in which the fever had been communicated to any person, who had not been withiu the reach of these exhalations." Wilmington was again visited by this fever in 1802; and in 1803, Doctor Vaughan published " A Concise History" of it, printed in Wilmington in 1803. In this work, he confirms his former views, and adds the difference of degrees of danger, upon visiting the infected district in the day time and in the night. Many persons who had frequently visited that district in the day time and in fair weather, without injury, sickened by a single ex- posure in the night time. " The non-contagious nature of the dis- ease was repeatedly attested by persons sickening after their re- moval from the lower parts of the town, and being nursed with every attention, and dying without communicating the malady to their attendants." He also informs us, that every instance of bil- lious or intermittent feyer, even of the most ordinary form which occurred after the middle of September, if not arrested within for- ty-eight or seventy-two hours, invariably passed on to the malig- nant grade of the disease. Not to waste time in noticing the instances of Yellow Fever which occurred in Philadelphia in the years 1699, 1741, 1747 and 1762, we all know the great mortality it produced in 1793. In consequence of "the great numbers attacked by it and the influence of preexistent opinions on the subjeet of contagion," it appears that the physicians as well as the inhabitants, without reflection or enquiry, concluded that it must be a contagious disease and that it had been imported from the West Indies. Doctor Hush though he also at that time considered it a contagious disease thought it had been produced by a cargo of damaged coffee. In consequence however of the publication of a ivork upon the subjett by Doctor Dewees, and of subsequent observations made in the yaar 17»7, &c. &c. Doctors Rush, Caldwell and eleven other Shysicians of the City of Philadelphia, having formed an opinion itfering from that of the majority of physicians there, and " being called upon by the Governor of Pennsylvania to state for the in formation of tha Legislature, the results of their researches an'd C 10 ] experience, respecting the origin, progress and nature of the Epi- demic Yellow Fever, &c." These geutlemen in 1797 in their an- swer say " We believe the fever which lately prevailed in our City, commonly called the Yellow Fever to be the Bilious Re- mittiug Fever of warm climates, excited to a higher degree of malignity by circumstances to be mentioned hereafter." They gave five reasons for their opinions, four of which I would hi-'hly approve, but the fifth viz. "That the common Bilious and yellow Fever are alike contagious under certain circumstances of the weather and of predisposition in the body," was certainly ex- ceptionable. After this these gentlemen with others, were again called on by the Governor. They declared in their letter, dated 3d December, 1798, " That the disease is not contagious in the West Indies, and rarely if ever so in the United States, in hot weather; at which time only it makes its first appearance in our country. So general is this opinion, that some physieians have unfortunately refused to admit the existence of the fever in its commencement in our City only because it was not contagious." At this time Doctor Rush had so strong a bias in faVour of that belief" that he could not relinquish the notion of an occasional or accidental occurrence of that quality, until very many proofs in opposition to it, and those of the most decisive nature, had been presented to his consideration." At length he obtained the fullest conviction on the subj; et, and in a letter to Doctor Miller, pub- lished in the New Vo'rk Medical Repository, Vol. VI. page 135 to 150 he gives a lengthy statement of facts intended to prove the Yel!ow Fever not to be contagious. Towards its conclusion he says "you will perceive from the facts and reasonings contained in this ietter, that I have relinquished the opinion published in my account of the Yellow Fever in the years 1793, 1791 and 1797, respecting its contagions nature." " I was misled by Doctor Lining and several West India v\liters." Afterwards in his preface to a subsequent edition of his Medical Inquiries and Observations he made the following decla- ration, "In the fourth volume the reader will find a retraction of the author's opinion of the Yellow Fever spreading by contagion. He begs forgiveness of the friends of science and humanity, ii the publication of that opinion has had any influence in increasing the misery and mortality attendant upon that disease. Indeed such is the pain he feeh, in recollecting that he ever entertained or propa- gated it, that it will long and perhaps always deprive him of the pleasure he mizht otherwise have derived, from a review of his attempts to fulfil the public duties of his station." [ u i Doctor Bancroft, of London, speaking of this recantation of Dr. Rush, says? " if the conviction of any one man can reasonably in- fluence the opinions of others on this subject, the preceeding de- claration by Doctor Rush, ought to produce that effect, made as it was, not precipitately or capriciously, but with slow and cautious deliberation ; not from the impulse of former prejudices, but in direct opposition to them—not from a vain desire of being consi- dered infallible," &e. &c. "To me" continues Doctor Bancroft, " Doctor Rush appears as being more estimable after this honest avowal of an error, than he would have been, had he never fallen into it; and I earnestly hope, that in similar circumstances I should most willingly follow his example." It is necessary that it should be noticed that the Yellow Fever in Philadelphia 1793 began in Water street, afterwards it appeared in houses adjoining other swampy grounds near Dock street,Kensington and Southwark, that there, as in the cities and towns further southward, it resembled the Marsh Fever in almost every circumstance, and that it left un- hurt, the French fugitives from the West Indies, and others who had long resided in hot climates. Also that it ceased immediately after frost. It is probable the Yellow Fever had frequently occurred in the City uf New York antecedent to the times of which we have any regular account of it in that place. In the year 1791 a considera- ble number of cases occurred in a part of Water Street near Peck slip, at that time noted for the filthy state of the neighbouring Docks. In 1794 it again occured to a greater extent. But the subjects of it, were persons who either lived or were employed near the slips, wharves and other sources r-f Marsh Miasma: which was also the case, in the three following years. In 1798 the disease prevailed as an epidemic, and according to the account of it, published by Mr. Hardie of New York in 8 vo. 1799, it occasioned the death of 2086 persons, in that City. The committee appointed by the Medical Society to enquire into its origin, symptoms, &c. reported that " it is not a contagious or catching disease." " That it is not communicable from person to person." See New York Medical Repository, Vol. 111. page 293. In 1800 in the neighbourhood of Water Street, and of the differ- ent slips, and other sources of miasmata, one hundred or more cases of Yellow Fever occured simultaneously and intermixed in the same situations with intermitting and bilious remitting fevers: more that fifty of the Yellow Ffc'er cases terminated fatally in a few days, many of them exhibiting the symptoms of the yellow skin, black vomiting and stools, hemorrhages, &c. On this occa- sion, no one pretended to ascribe its origin to importation. See New York Medical Repository, Vol. IV. page -'07—S. The foi-- [ 13 ] lowing year, about twice the same number of cases occurred, iu nearly the same situations and with similar circumstances. the year 1803 exhibited very hot weather, which began in July: and excepting five or six days according to Doctors Mitchell and Mil- ler, it was more intensely and uniformly hot, than they had ever known it, in that climate, for the same space of time. In conse- sequence of this, the Yellow Fever became more extensive than in anv former year. During its continuance, there were reported in- stances of individuals, sickening and dying in families, in which no cases recurred. Such an instance occurred in the debtors pri" son where the patient had been confined for the three preceeding mouths. Many aged and young persons whose condition actually confined them to their houses, and without any previous occurrence of any case iu the family became the subjects of the fewr. Many fled not only to the country, but to the towns of Newark, Eliza- beth- Town, Brunswick, &c. where they sickened and died, with- out communicating infection in a single instance, either to pbysi- 6icians, nurses or any of the attendants. Indeed there was a total absence of every thing like contagion even in the Yellow Fever Hospitals. See New^York Medical Repository, Vol. VII. page 183—4. And in 1804 Doctor Miller in a letter to the Governor, proved as far as the subject was susceptible of negative proof, that the fever in question, did not arise from any foreign or imported contagion. This letter was published in the printed documents relatiug to the board of health in 8vo. 1806, page 36. In 1805 the Fever oc- curred accompanied by circumstances so similar that they need not be repeated. I will add only, that this year afibrded still stronger evidence in support of the same important positious " That the fever has a domestic origin, that it is not imported." By proceeding further north we find that the Yellow Fever has also occured at New London in Connecticut. In 1798, after a hot dry summer it was attended with considerable fatality, eighty-one persons died. The first cases occurred near the water, and there was no appearance or suspicion of any contagion from the sick. See New York Medieal Repository, Vol. II. page 301—5, 872 to 378—also Vol. III. page 259. At Providence, the Yellow Fever became prevalent in 1797, also in 1800 and 1805, " It has uniformly made its appearance and committed its principal ravages in the South part of Water Street, or the Lanes or Alleys immediately adjacent:—and those solitary cases, which have occurred elsewhere could with very few excep- tions be traced to this devoted spot." See Medical Repository, Vol. X. XI. page 329 to 337. ( M ) Doctor Wheaton, in his " Brief Account of Yellow Fever, kc.'' informs us, that after an intensely hot sun, the thermometer in an airy situation ranging from 86° to 91°, the Yellow Fever made its first appearance on the 13th of August," and continued to rage to the 30th of September." One hundred and two persons were attacked, forty-five died. "Its early disappearance was effected by an almost universal desertion of that part of the town, and the kindly influence of a very heavy rain and tornado, which occurred on the 8th of October. In 1800, the first case of Yellow Fever occurred at Providence on the 15th of August, and the disease continued to prevail, until the 5th of October. Eighty-three cases were reported, of which fifty died. In this instance also the sickly district was deserted, probably more universally than before, with similar effects. In 1805,. the disease made its appearance as early as the 25th of July, after a very unusual duration of hot and dry weather. The Town Council directed an immediate and complete evacuation of this part of the town, and on the 10th of August, it had disap- peared. The people became impatient to return to their homes, and several new cases occurred in September. Doctor Wheaton adds, « Here as elsewhere, the YelloMr Fever has not been propagated by the sick, in situations otherwise heal- thy." It was not contagious, not even in the Hospitals. See Me- dical Repository, Vol. X. page 329 to 337. At Boston during the prevalence of very warm weather, in Au- gust 1796, at the South East part of the town, near to a consider- able extent of flats, which were daily exposed to the action of the sun, a fever began and spread from thence to the neighbourhood ot some of the docks, proving fatal to about thirty persons. Doctor Warren, an eminent physician there, in a letter to the American Academy of Arts and Sciences, declared that he had almost every autumn seen at Boston, a considerable number of similar cases, " not excepting the black vomit, nor the yellow skin" and that it was " what was properly termed, a Bilious Remittent lever. In the year 1798, during the prevalence of hot weather the thermometer was often above 90° and sometimes 96° of farenheits scale. In this instance it attacked those only, who lived or passed some time in ihe neighbourhood of a mill-pond, drained ot its water, so as to leave its bed exposed to the sun ; and in the vici- nity of several spacious docks, into which, there were thrown large quantities of vegetables, &c. refused at the markets. Not one of twenty who were first attacked, recovered. In all, three hundred died of the fever. The epidemie was completely chock** I 1* ) by an inundating storm from the north east. The weather was never known so hot, which prevailed from the latter part of July to the middle of September. Here as in all other places noticed above it was not contagious. See Medical Repository Vol. 11- j>age 360 to 363. The fever appeared again in Boston, in August 1802, and pre- vailed until the month of October, and " with greater malignity than in any former year; equalling the worst species of genuine plague; yet the range of the disease was quite Jimitted." So great was the malignancy, such incorrigible prostration attended it from its commencement, that indeed the patient might be said to be dying from the moment of seizure." It was confined neverthe- less " to the same parts of the town as in former years, and whol- ly to houses promiscuously situated at the heads of wharves, in the smith part of the town ; and it was remarkable, that if a patient under the disease was carried out of the range of the morbid atmos- phere, into a healthy part of the town, attended by persons there resident, the disease was not communicated in a single instance : but not so, if he remained on the spot where he took the disease." See N. Y. Med. Rep. Vol. VI. page 338—9. I will be excused in having given this extensive history of the Yellow Fever. It is a long and sad account of the distresses inci- dent to our cities. But it will be considered appropriate on the present occasion. And by the help which I have obtained from the perusal of a work published by Doctor Edward Nathaniel Bancroft, it has been somewhat convenient to condense a great deal of information, into a compass, on the whole, quite small enough considering its great importance. I have performed this labour the more willingly, because the work from which the several extracts are made, is very volumi- nous ; as you will perceive by the references; and because it is a work, which perhaps few men not of our profession, would take the pains to examine. Besides I understand some additional legis- lation is contemplated, in respect of this terrible disease; and as some of the most distinguished medical characters among us, have done honor to themselves and to the City, in judging rightly from the earliest instance of its occurrence, and publishing to the world their views of this disease, I could not do less than offer my con- tribution towards the preservation of that honorable reputation, of which without this labour I might have shared a dividend of gain or loss without having evinced my willingness to pariake with them, a reasonable portion of the toils necessary to maintain the one or prevent the other. ( IS ) From the consistency, I might have said, the uniformity of the** reports from all the Cities, I may with much confidence insist upon the identity of the disease in every place. And the joint opiuion of so many able judges supported by facts so unequivocal, prova with all necessary certainty, that Professor Davidge, used a lan- guage which needs no explanation, "That Intermittent, Remittent and Yellow Fevers, are merely varieties of the same disease;" and it remains only for me to state, that the few observations which 1 was able to make during the late affliction of our City„ were entirely consistent with this view of the subject. In the first family to which I was ealled, I had eight patients, apprentices to a respectable ship-joiner on Fell's Point. For some days previous to the commencement of the fever, they were all engaged in plaining a vessel at Price's wharf, in the neighbourhood of Wolf and Pitt Streets. The first of these eight cases, was like- wise the first instance of attack upon any of the resident inhabi- tants. The fever was incorrigibly malignant and terminate* fatally on the morning of the fourth day, with black vomit and stool, hceraorrhage, &c. The remaining seven were immediately removed to other houses, in more healthy situations, and were all preserved. It is worthy of remark, that the facility of their recovery appeared to vary with the distances to which they were removed from the water's edge, and to the elevation to which they were raised above the surface of the ground. I had several cases which were taken sick after their removal w Fever which prevailed in Philadelphia in 1797, and was confi ed to the districts of Southwark, and Kensington, was owing to the foul air of two ships, one fom Marseilles, and the other from Hamburg, which discharged in each of these sections of the City. The disease of that year was limited in its extent to the districts in which it first made its appearance. 5th. Particular regard should be paid to the storeingof the large quantities of timber, in the various lumber and ship yards. These masses of vegetable material can do no harm if they allow of free ventilation, and are not deposited in situations where they are im- mersed in water. 6th, As the City extends, lots should be procured by the Corpo- ration, as public squares, to favour the free circula'ion of air. I would particularly recommend the planting of trees generally ; for this purpose, some of our forest trees which are highly ornamen- tal, mav'be introduced, they would prove eminently useful in puri- fvin" the atmosphere, and would afford shade during the summer. They should be under the care and protection of the Corporation and such ordinances made as would ensure them from injury. 7th and listly, It has been observed by Count Volney that "the Americans boast with little reason of their general cleanliness, for the suburbs and quays of some of our cities surpass in public and private mistiness, any thing he ever saw in Turkey, where the at- mosphere is salubriously dry."—Is this the fact? Be it, or be it not, we are bound by all the laws of humanity aud interest to per- [ 32 1 petuate it as a libel by a strict and constant attention to universal cleanliness, both public and private. For this purpose I shall propose, 1st, Additional heavy penalties, to be laid on all citizens for re« teining about their dwellings or manufactories, offensive matters of any kind. 2d, The more general diffusion of the Hydrant water in'those parts of the City, where water from the City Springs, or from pumps that are pure, cannot be easily obtained—It should be uni- versally adopted for culinary purposes. 3d, An increased attention in watering the streets during the warm months.* May not streams be brought from the neighbour- ing heights, through aqueducts at a small expense, so as to furnish every part of the City with refreshing fountains? In reply to the question touching the contagious nature of Yel- low Fever, I give it as my decided opinion that the disease is un- der no circumstances contagious, and that during its prevalence here no case can be adduced to prove it so—on the contrary, no in- stance occurred where persons infected by breathing the noxious exhalations in those parts of the City in whieh the disease origi- nated, many of whom took refuge, and died, among their friends in the most populous districts that were not infected—not a case, I repeat, and they were numerous under the worst grade of the disease, imparted it to their attendants. In the City Hospital to which patients were daily removed, pau- pers in tilth and rags, many of whom died shortly after their ad- mission into the house, and under all circumstances the most fa- vourable to spread the infection, neither physicians, nurses, or at- tendants or any person in this large establishment, received the Yellow Fever. These facts have led to the following conclusions on the system of Quarantine regulations of the seaports of the United States. * This custom adds much to the comfort of our citizens during the warm months, and is perfectly salutary when attention is paid to keep the streets which are watered free from filth of every description ; if the streets be un- clean, the addition of moisture will accelerate the putrefactive fermentation and give origin to the cause of disease—Let it be remarked however, that there ought not to be a street in anv of the cities of the United States (if they wish to remain free from pestilential fevers) so dirty, as to incui this risk, for the dews of night, or the rain which descands from Heaven to mois- ten and refresh the earth may bring for them the seeds of misery and death. I 33 j 1. That where they have been instituted to prevent the Yellow Fever from being imported by contagion they are oppressive and injurious to the Commerce of the country.__But, 2. They are essential and should be preserved under the strictest rules to prevent the admission into our ports of ships with cargoes in a perishable state. Every large seaport should have at a pro- per distance, docks and storehouses, where vessels of this descrip- tion, and all vessels arriving in a filthy condition should discharge and be properly ventilated.* In submitting the foregoing observations to your attention, I have endeavoured to perform a duty I owe my fellow eitizens, un- biassed by favour or interest, they are the best result which I could arrive at for their welfare.—I trust they will prove both satisfac- tory and conclusive. If the great Author of nature has ordained that in those laws which regulate matter, certain causes shall produce effects, the agency of which is destructive to the life he has given; so in his unceasing wisdom and kindness, has he shed the light of reason on man, which improved by his industry, enables him to obviate the dreadful effects which result to his 'happiness, and existence from derangement in the physical structure of that globe, on which he is destined t« live " The means of preventing them," says one of our celebrated countrymen, « are as much under the power of human reason and industry, as the means of preventing the evils of lightning and common fire""—-Guided by these noble handmaids, as the chief magistrate of a rising and flourishing community of enlightened freemen, may it long be your enviable station to dis- pense to them, health and happiness. P. MACAULAY. North Gay Street, December, 1819. * After this communication .had been presented to the Mayor, I received and read with much interest and satisfaction the statement by Dr. P..sridig of the occurrences connected with the appearance of the malignant Velio w Fever in the City of New York. The similarity of our observations on the production of the cause during the past summer is deserving of miK.h attention. Dr. Pascalis'statement is richly entitlecl to the high consideration due to the record of a learned and eminent physician, whose judgment has been matured by extensive travel and research into the climates, in which the Yellow Fever makes its ravages, kotb in the old and new world. [ ** J BALTIMORE, December 29th, 1819. Dear Sir, YOUR Circular, officially addressed to me as one of the Medical Faculty, from whom you request Answers to several Queries, would have been sooner acknowledged, and received that early and respectful attention which 1 am anxious to pay, had 1 not met with so many interruptions from business, &c. As-1 had declined attending on Fell's Point during the preva- lence of the malignant disease of last season, 1 am not so well eaa- bled from personal observation, at that time, to answer those que- ries, perhaps, so much to your satisfaction, as some other physici- ans who were more immediately in practice in that part of the City, and who, with other Phys'ieians of the City will supply my deticieneies. Dr. Page was much engaged from its commence- ment until its termination—On his information 1 can confidently rely, having been connected with me in business from the year 1808 to 1810 ami had an opportunity of seeing the same disease in tSOS, which originated and was located in the same street, viz. Pitt street, in its most malignant form—A prompt removal of the inhabit-snts by my advice at that time, no douht saved many lives ; all other parts of the Point, and City generally (as in the last sea- son) with the exception of Pitt street, remained in unusual good health.—1 have therefore sir, no hesitation in asserting that the disease of last season was a Yellow Fever, similar in its causes, symptoms and cure to the Fever of 179+, 97 and tsoo. It appears to be generally acknowledged, that this is a disease peculiar to most seaport towns in hot climates and originates from domestic sources of vegetable putrefaction; and is not contagious, or communicable like other infectious d leases, out of the range of its aimospher---The Small i'ox and Measles, &c. so universally known to be infectious, can be carried to any distance from its source in all seasons, and states of atmosphere; but the Yellow Fever exists only in hot weather and extinguished by frost—Al- though with all the pains that can be taken by a vigilant Board of Health, we cannot calculate upon keeping clear of occasional vi- sitations of this distressing malady ; yet it is reasonable to expect that much may be done to prevent its occurrence, by a persevering atteniion to the removal of nuisances in the City, and foul ships after long voyages, or crouded with passengers, from our wharves. There is great reason to ascribe the first cases of our late sick- ness, to a ship which discharg d her whole ballast on Price's wharf at the lower end of Pitt street, which was so foul and of- fensive.that many in its vicinity were seized with immediate vomit- ing and sickness; and an alarming Fever was soon perceived to be L ss ] prevailing in that neighborhood with great mortality—This ship called the United States had been on a long voyage to the East- Indies and returned by way of Holland, where she took in upwards of two hundred passengers, and arrived here about the middle of August, and shortly afterwards hauled into Price's wharf, and be- gan to discharge her sand ballast, which, as the vessel made much water, was in a wet state, with much damaged rice and other pu- trid vegetable substances, (refuse vegetable stores, perhaps, laid in for the passengers) mixed with it: this offensive stutt'lay on the wharf for two or three weeks under a hot sun and continued dry •weather; and was filially haulled away in carts through the streets; the result was as before mentioned, from about the 26th of August till the commencement of frost. The nuisances in the City are of various kinds and have been a subject of much discus>ion, what is, and what is not a nuisance of s pos- F C 38 ] aibie to travel far without collecting much to reward the labour of pursuit. On the second head of your enquiries my incapacity to advise, would perhaps render total silence most becoming ;—It contem- plates the prevention in future of those formidable evils, by which Ve have recently suffered ; and certainly the complete occlusion of a calamity fraught with so many political and social ills, is an object worthy all the energies, and all the industry, which may in any degree favour its accomplishment. Considering it probable however, that opinions on this subject will be copiously furnished, hy gentlemen better acquainted than myself with those local consi- derations from which correct practical inferences must be drawn, 1 think it becoming, to avoid all recommendation of particular measures, for precautionary security. The malady against whose renewed incursion, we are meditating an effectual barrier, is an indigenous product; It has its birth place among us, and we must look to domestic circumstances, for the means of contravening its existence and propagation. It frequently happens that the active sourees of Endemic or Epidemic diseases may be located with precision, and it is fortunate that they are commonly confined within narrow limits. This consideration while it encourages the hope of obviating their growth, leaves us dependent for success, upon a careful survey of the places of their prevalence. That survey in relation to the late scourge of Fell's Point, I have had hitherto neither motive nor opportunity for making, and the neces- sity for such an undertaking at present, appears to be obviated, by the suggestion antecedently made, viz. that this part of the subject will receive all the discussion it merits, from gentlemen well qualified for the task by much personal observation. Before leaving this part of the subject, 1 might direct your no- tice to a few practical considerations of some weight, but in which 1 have been most probably anticipated by your own reflections, er the suggestion of others. It is in the first place, undoubtedly important to select a proper period of the year, for conducting this work of prevention, so far as it consists in the removal or correction of nuisances: It is equal- ly clear, that the best season for undertaking such a work is when the temperature is too low to favour the1 production and diffusion of Hoxious vapours. The winter and spring are the only time, (a few weeks of autumn excepted) when such work can be carried ou extensively, without danger to those concerned in it, or those by situation exposed to its consequences. Secondly ; Wherever it becomes necessary to obviate the accu- mulation of dangerous materials, by filling up places likely to he- C S3 1 come depositories of such ingredients, it is desirable, nay indis- pensible, to use articles neither containing themselves, the ele- ments of future mischief, nor having any capability of being made the instruments of offence. For this purpose I know nothing so much within reach, and at the same time so effectual, as sand and gravel; and the more free from foreign mixture, the better. Thirdly—It will no doubt be thought necessary to look well into the slate of our wharves and docks. To prevent the discharge of putrescent materials (especially putrid vegetable substances) ou our wharves, is an object worthy ail the attention that can be be- stowed upon it. Those articles may under favourable circumstan- ces produce serious local pestilence ; though perhaps not likely to extend far.—It is not less, perhaps still more important to attend to the condition of the docks. If it shall be found practicable (and the work appears easy) to disincumber the heads of the latter from those collections by which they are partially filled up, and a body of foul matters occasionally or constantly exposed to the ac- tion of the atmosphere, all will have been done, in relation to them, that is either feasible or necessary. A surface (whatever be the substances) uniformly covered by tiae water (or any water frequent- ly changed) never did, and never can, seriously invade health. Your concluding enquiry, in relation to the late Fever, regards the question of contagion. I have been long satisfied, both from the nature of the disease, and from multiplied facts falling within my own observation, that it is wholly unsusceptible of communica- tion from one body to another; the only medical meaning affixed to the term contagion. * If I were at liberty to speculate on the probable healthfulness. of our City generally, 1 should express a strong conviction that it is destined to enjoy a long and happy exemption from Epidemic Maladies :' or diseases of a diffuse and extensive prevalence. In looking carefully through the City I can discover no causes likely to create or foster Epidemic agents;—The natural sources of those gaspous poisons which perform the work of Epidemics, cannot now be found among us; neither does there appear to be any deposito- ries for the probable accumulation of materials constituting a fo- mites, whence those poisons could issue with sufficient intensity, to inflict a sensible wound upon health. A becoming regard to cleanliness, inculcates the necessity of removing impurities from our streets, lanes, alleys, &c. but it is not from partial accumula- tions of this sort, we are to derive serious or general maladies; Those things offend the eye and annoy the nose, but they do not strike at life. The laboratory of pestilence, must be more spaci- ous ; must be furnished with materials more abundant, and more fruitful of poison. Whatever may be the commercial advantages* [ «> 1 the gain or loss on the score of economy, which the recent exten- sion of Pratt and South streets may involve, the effect in relation 1 to health,must be great and unequivocal. The low ground through which South street penetrates, was the only extensive natural re- servoir, within the City, of stagnant fluids and putrescent depo- sits: The whole of that district rs now rising to the grade of Bel- videre street, and must cease to send its noxious products, among the surrounding inhabitants. Pratt street by shutting up all the docks which indented the City in its course, has closed the door . f, upon many copious springs of pestilential vapour. '* Although in seasons peculiarly unpropitious to health, we may" *^ have the causes of Fever generated among us to a limited extent, *f,jfl it is nevertheless extremely improbable, that even in such seasons, •} they can strike a blow that shall be extensively felt. Those re- marks all apply to that great seel ion of the City lying west of Jones' Falls;—In all the space thus contained I am unable to point out any spot (except perhaps a few places on the margin of +\ the Basin) likely to become a magazine of those miasmata whence Epidemic Fevers arise, and even those exceptions could under nd :A circumstances operate injuriously, beyond a very narrow range. As however all places of this sort are certainly subject to the ef- fectual control of a little well directed industry, they ought not to Stand as exception* to the general argument of probable healthful- 4 Hess. Of that portion of the City, lying East of Jones' Falls ;— J and especially of Fell's Point and its immediate vicinity, 1 am Hot prepared to speak. Business or curiosity have rarely led me in that direction, and I am ignorant of every thing except its ge- 'j neral features. Its natural circumstances are unpropitious to jj health, and I am afraid its inhabitants must occasionally encoun- 1 ter serious annoyance in this particular, before the efforts of art, or the progress of improvement, can interpose an effectual and permanent remedy. Whenever these shall have advanced so far as to have displaced from the surrounding spaces, the features of ,'< a morass, by substituting universal solidity and dryuess, we may then, and only then, look with confidence for its complete exemp- tion from those unhappy casualties, which we hate already so much reason to deplore. The great value of this appendage to the City renders its defective healthfulness deeply to be re-retted ; while the claims of its useful citizens call for every exertion which may tend to obviate the recurrence of its late calamities. I ought in conclusion to request your indulgence for the tardi- ness of my attention to the subject you have done me the honor to submit to my consideration- an unusual degree of occupation for Some days past obstructed my desire to pay it all the respect ♦ claimed by its importance, and due' to your wishes. Its consi- [ *i ] deration was postponed in the hope of finding leisure to give it the most mature examination, and if possible to contribute in some degree to the attainment of an object pre-eminently interesting— I hat leisure I have not found; but after much delta have at last written at interrupted intervals, and on a subject to which unfor- tunately I could bring but a slender stock of practical knowledge. What 1 offer however, will I am sure be received as an earnest of my respect for the claims of humanity, and the interests of our Very Respectfully, T. H. WRIGHT. , C « 3 BALTIMORE, February 15th, 1820. SIR, IF the communication made by me, respecting the late Fever, can in the smallest degree subserve your purpose, you are at full liberty to have the same published. 1 am with respect, Your obedient servant, J. B. TAYLOR, To Edward Johnson, Esq. Mayor of the City of Baltimore. BALTIMORE, December 26th, 1819. SIR, IN answer to your Circular of December 1st, requesting my opinion of the causes of our late Epidemick, I beg leave res- pectfully to observe, that what follows, is the result of impressions produced in the year 1803, when a student of Medicine, and re- siding on Fell's Point, and since strengthened by further reflection. I will not assert that the opinions are conclusive, yet they please myself, and 1 believe they will be found as correct as any that have preceeded them. 1st, The eases of " Bilious Malignant Fever" that first came un- der my care, were principally situated on the borders of the Cove, that connects the Town to Point. Two thirds at least,* were females of industrious habits, and who were very seldom beyond the limits of their immediate neighbourhoods; and who must have contract- ed the disease, from causes existing, in those neighbourhoods. 2d. Among the causes of Yellow Fever, Physicians have long enumerated a miasma, the result of animal and vegetable decom- position. That animal matter, suffering decomposition, may be- come capable of generating this gas; if I do not deny, yet I think it sufficiently obvious it had but little agency in producing the cause of our late Epidemick. It would be a libel on our vigilant police, to suppose that masses of animal matter could be suffered to accumulate in such quantities as to endanger the health of our City, and I think it but right to observe, that if masses of putrid animal matter, could alone, produce this disease, we should not have heard of Yellow Fever last, summer, and we would be ena- bled, effectually, to prevent its recurrence for the future We find that persons, whose occupations constantly expose them to an at- mosphere highly charged with the result of animal putrefaction, such as Butchers, Gluemakers, Tanners, &c. enjoy a greater L ±3 ] portion of health, during sickly seasons, than those who breathe a more agreeable atmosphere. 1 have never been able to trace Yel- low Fever to their neighbourhoods, but on the contrary, have always observed them to be more than others exempt from its ravages. This is not a recently observed fact; for Ambrose Parejr tells us, that a Plague (or Yellow Fever) which ravaged one of the Cities of Italy, was checked in its progress, by killing all the dogs and cats of the town, and suffering them to putrefy in the streets. Thus then, I reject the idea of animal origin, and although what 1 con- ceive to be the true cause of the disease, is not more difficult of ac- cess, yet old errours are stubborn things, and the doctrine of vege- table origin, will have to make proselytes vi et annis. From the foregoing, amongst a host of other considerations, I am induced to believe that the principal, or sole cause, of our late Epidemick Fellow Fever, to be, a Gas, the product of vegeta- ble decomposition, evolved in such quantity and highly con- centrated state, by a long period of intensely hot weather, with such a degree of moisture only, as was necessary to its formation. Such being my opinion of the cause of the disease, I beg leave to call your attention to some of the sources of this cause. In do- ing which 1 commence with all that portiou of the City begiuuing at M'Eldery's dock and extending eastwardly to Fell's Point, embrac- ing a Cove of almost one mile in extent, completely glutted with rafts, spars, plank and an excess of vegetable matter of every des- criptidn—Reflect that it has laid in this situation for years, and that. the evil continues to encrease with each succeeding year—that it is exposed to the alternate action of heat and moisture and that of ne- cessity'there must be an immense quantity of this miasma evolved, when we view the extent of its mischievous laboratory—Examine the situation of our wharves and the edges of our extensive Basin. How were our wharves constructed ? 1 have been informed, by an indiscriminate mass of cord wood, chips, shavings, and an endless variety of vegetable substances jumbled together, so as to admit as mueh tide water, as will favour their decomposition, and the conse- quent formation of this deleterious Gas. This fatal errour seems to prevail inall attempts to '• make ground," and is as pernicious in principle and fatal in effect, as it would be, to raise the scite of a Military station, on alternate layers of earth and gunpowder.— New York, and the little towus of Blakely and Mobile furnish am- ple proofs of the fatality of this general errour. Under these cir- eumstauces, when can we expect a deliverance from Vellow Fever? I should eonceive my labour but half done, were I not to point out as objects of suspicion, our numerous Lumber Turds. They arc, 1 am fully persuaded, fruitful sources of disease; and I can readily cooci;ive,Routributed their full share in producing our lat j scourge— L ** 3 Had no yard of this kind existed near Smith's Wharf, we should not have had to mourn the loss of some valuable members of society, nor have experienced any interruption in the commercial concerns of that busy spot. Having thus sir, stated, what I suppose to be the most active agents in producing the cause of our late Epidemick, the means which I would recommend for their removal are sufficiently obvious; but if you please I will bring them under one head—They are, to avoid the errour of using in wharfing, a supurffuous quantity of timber, and if practicable to use in its stead, stone.—To have re- moved all decaying timber composing our wharves.—To have an attentive eye to the state of our various lumberyards.—I would wish to see them removed beyond the limits of our City, particularly the populous part, and to let their situations be high, dry, and airy. The Cor? and all other similarly situated spots, to be purged of their noxious contents, so far as the same may be practicable. That all such timber be removed during the cold season, and be piled on high and dry situations so as to admit a free circulation of air through it, in order that it may become thoroughly dry before the ensuing sum- mer. That the Cove be as speedily filled up, with pure earth, as cir- cumstances will admit; and that all vegetable matter be excluded from its bed, and if practicable, the wharves, or edges be intirely constructed of stone.—As it is the practice of most families, to cause to be thrown into the streets the offal of their kitchens, 1 would re- commend that Hogs should be permitted to run at large: they are far superior to our scavengers; the former destroy—the latter only .encrease, the evil they were intended to remove.—All Cellars that retain water, should be cleansed. 3d. I have nevpr supposed Yellow Fever to be contagious j and if I had ever entertained that opinion, an attention to the progress of our late Epidemick, would have convinced me of the fallacy of such opinion. Thus, sir, have I endeavoured to answer the several interroga- tories of your Circular.—Believe me, nothing but a wish to add to the health and prosperity of our City could have induced me to make my opinions publick; and should they, in the slightest degree, have such effect I shall be glad of having communicated them. I am Sir, With Sentiments of Respect and Esteem, Your most obedient servant, J. B. TAYLOR. T* Edward Johnson, Esq. ' Y Mayor of the City of Baltimore. [ 45 ] Edward Johnson, Esq. < Dear Sir, YOU are perfectly welcome to make use of my Commu- nication in the manner proposed, and I only regret that the hurry and brevity with which it is written, will render it less interesting than it might otherwise have been. With the greatest respect, Your obedient servant, G. S. TOWNSEND. February 16th, 1820. BALTIMORE, December 9th, 1819. Edward Johnson, Esq. Dear Sir, AS it always affords me peculiar pleasure in evincing the in- terest I feel in the welfare of my native City, I cheerfully comply with the polite request, contained in your Circular of the 1st inst. in answering your several interrogatories. 1st. The two first cases that occurred in my practice bearing any marks of a malignant character, originated in Commerce street, a, few doors south of Pratt street; so early as the 27th of July. These patients were a Mr James Sinclair and wife. The former a Blacksmith by profession and both of industrious and temperate habits. They were attacked nearly at the same period and the symptoms of each were perfectly analagous. They both recovered. From some observations I made at the.time, 1 was inclined to be- lieve that the disease in those persons, had its origin, as well from the confined situation of the house they occupied, as from an ac- cumulation of filth in the yard and neighbourhood, which the sun's rays had rendered a prolific source for the generation of miasma. 2d. I do not rememher to have seen any other nuisance, than the one just mentioned that particularly attracted my attention, except in South Frederick street, to which I most earnestly beg leave to call your attention, not only for the irreparable injury that may ultimately accrue to that portion of the City, from its existence, but for the disgusting spectacle it cannot fail to exhibit to stran srers, as well as our own eifizens. G [ *0 3 The place to which I alude, is situated between Water and Pratt streets, comprising a nest of houses, tenanted by Negroes, and divided by an alley, very appropriately called «» Squeeze Gut!" if 1 pm\ be allowed to judge from the quantum of excrementitwus mater and stench with which it abounds! This "delectable" spot has ever since my recolh-ction been a scene the most loathsome and abhorrent that the imagination can pourlray ; disease and death have year after year, luxuriously rioted among the miserable and abandoned victims, who have there nestled together, and it may not have escaped your rememiiranee, that during the last summer, considerable alarm aud anxiety prevailed in consequence of some cases appearing there, bearing evident marks of the then prevail- ing Epidemic. I cannot however take upon myself the prerogative of recom- mending any other method of obviating the evil 'ban by calling your attention to its existence, for I ha\e sometimes thought, I couifl satisfactorily witness a conflagration of the whole of those te- nements, which would effectually cleanse a place so deleterious to the health and morals of the people. 3d. I cannot believe that the late epidemic, under any circum- stances whatever was contagious, and I do not know that 1 can advance a more striking or positive illustration of such a belief, than by adverting to the cases which came under my observation at the Encampment. Out of the whole number which occurred there, several, either from an antipathy to a removal to the Hos- pital, or the stage of the disease rendering it improper, were per- mitted to remain, during which time, no attempt was made towards a separation of the sick from the healthy; on the contrary a free and uninterrupted communication was permitted in all parts of the camp. Straugers w >re daily visiting it from curiosity or chari- table incentives, an! yet not a solitary case was known to trans- pire that cnuld not clearly and unequivocally be traced to the ori- ginal cause. Having thus briefly answered your different queries by such facts as I am in possession of, I remain with sentiments of the greatest respect, Your obedient humble Servant, G. S. TOWN SEND. C *? ] BALTIMORE, December iith, 1819. SIR, IN answer to your queries I shall subjoin a history of the two first cases of the Bilious Malignant Fever that came under my care, during the last fall. The first case was the wife of James R. Sinners, a delicate fe- male, about twenty-four years of age. She had laid in, 1 believe of her first child, at her residence in Ann street, Fell's Point, about two weeks before she contracted the Fever. As soon as she was able to bear the fatigue, she was removed to the house of her brother-in-law in Albemarle street, Old Town. The people, to use her husband's words to me, were at this time dying all around his place of residence on the Point. On Monday she was remov- ed, and on the Thursday following, (the 2d of September) the first symptoms of the disease appeared. In a few days this case ter- minated fatally. The disease here evident!} originated from local causes in the neighbourhood of her residence on Fell's Point. The second case, was that of Robert Holmes, who keeps a pub- lic house in Market Space, and is also a proprietor of Hackney Stages. He is a temperate man, about thirty-four years of age. In consequence of the illness of one of his drivers, he mounted the box himself, and on the Sunday previous to his illness, in a^bra- vado drove through the principal streets on the Point in which the Fever at that time prevailed; On Thursday the 2d of September following, he was taken with symptoms of the Bilious Malignant Fever. After a severe and dangerous illness of two weeks he re- covered. I should also have mentioned that Holmes had been se- veral times on the Point, and in the neighbourhood of the infected places during the prevalence of the Fever previous to the Sunday mentioned. The origin of this ease I have no hesitation in attri- buting to some local causes on the Point. As to what those local causes on Fell's Point may have been, that gave origin to this fatal disease, I can say nothing from my own knowledge, 1 shall therefore pass it over. Under the head of Nuisances I shall mention two. The first is a large collection of logs, bedded in putrid vegetable mud, and in an incipient state of putrefaction, in the Cove on the rear ot M'Eldery's Wharf, whieh, «« the tide ebbs and flows, are some [ *S ] times covered with water, at other times there is only such a de- gree of moisture, as when exposed to the violent and long continu- ed heats of the sun, which generally prevails with us in the sum- mer, may prove a fruitful and dangerous source of disease. The other is a collection of Huts and filth inhabited by Negroes in an alley, back of the lower end of Frederick street. As it regards the contagious nature of the Fever, I can say, that in no instance have I seen a single person take the disease where they had not previously exposed themselves in places infected by the Fever, nor any person attached to the families of those I at- tended, who took the Fever, although they or some of them were constantly around the bed side while the person was labouring un- der the disease. I therefore, can confidently say, that in no in- stance that came under my notice, was it contagious. With Respect, I remain yours, &c. MICHAEL DIFFENDERFFER. Edward Johnson, Esq. Mayor. [ 49 ] BALTIMORE, December 29th, 1819. SIR, IN answer to your queries, I beg leave to state that all the cases of Malignant Fever which I visited during the preva- lence of the late Epidemic, with only one exception, were distinctly traced to Fell's Point. The greater proportion of these cases were persons whose occupations exposed them to the intense heat of the season. The source of the late Epidemic is a subject of the greatest im- portance to the welfare of this City, and therefore requires the attention of all whose opportunities have enabled them to observe the rise and progress of that dire calamity. The infection of the air which gave origin to this disease was for some time evidently circumscribed within narrow limits, Smith's wharf in town, and Water's wharf together with Wolf and Pitt streets on the Point, were the situations in which its fatal influen- ces were first noticed. The enquiry is immediately suggested, What was the condition of those places at that time? In the rear of Smith's wharf is an unpaved alley made up of dock mud, shav- ings and other vegetable matters in a state of decomposition.—At Fell's Point similar putrescent materials were found to constitute a considerable extent of made ground iu the vicinity, where ihe first appearances of the Yellow Fever were discovered. These causes are deemed quite sufficient to have given origin to the disease, but there are many auxiliary causes which tend to render the air of the City unhealthy—First, The logs composing the wharves in many places are in a state of decomposition, so as to be offensive in the warm seasons of the year.—Secondly, Cellars in made giound, which are, always liable to be wet or damp.— Thirdly, Vegetable matter deposited therein and undergoing putre- faction—And-finally, the nuisances which arise from stagnant wa- ter in various parts of the City, together with the accumulation of filth in the streets and gutters, more especially in those parts of the City wh re the streets have not much descent. We might mention as an additional cause, the stagnant condition of the water in our Basin,frequently becoming so impure as to be destructive to the fish which inhabit it. 'The remedy for this evil is perhaps beyond our reach, nothing less than a current, produced either by a canal running from the head of the Basin to the waters of the Spring Gardens, or communicating with the Falls, could render its water* innoxious. [ 50 ] The general preventive measures which we would take the liberty to suggest are the following: 1st. Let all made grounds be well covered before theJ suing summer, especially in the vicinities above mentioned, and when ^cannot be made dry, let them be ditched or drained. 2dly. Let all the unpaved lanes, alleys and streets he immedi- ately paved. Sdly. Prohibit the filling up low grounds with vegetable sub- stances. 4thly. Let all wharves, or repairs of wharves, in future be con- structed after the plan of Pratt street wharf, while the logs wnicu constitute the foundation, are perpetually covered with water, they are not so liable to putrefaction. gthly. Cellars in made grounds should either be prohibited or Ihe proprietors or occupiers compelled to keep them dry aud clean. 6thlv The cutters should be kept clean throughout the year, if the habit be established, they will not be neglected at that period, when they are apt to become offensive and injurious. 7thly. All shipping should be forbidden the practice of throw- in" putrescent substances on the wharves. In reply to the question of the contagion of Yellow Fever, I do not know a single instance in support of that doctrine, and I do not believe that any well attested cases of contagion can be adduc- ed from any part of the world where that disease prevails. With the most respectful consideration, I have the honour to be yours, SAMUEL BAKER. Edkard Johnson, Esq. L »i ] CHURCH STREET, December 29th, 1819. Edward Johnson, Esq. SIR, IN reply to the Queries contained in your Circular of December 1st, 1 may observe, that the three first cases of Bili- ous Malignant Fever which 1 saw during the last season, were in one family, whose residence was in a healthful part of the Nor- thern Precincts; but these persons had been on board of a schooner (employed in navigating the Chesapeake) for more than three days, while she took in loading at Harris' Creek, and had inhaled during this time the feted exhalations arising from a parcel of pu- tred wheat, steeped in bilge water, which remained of a former cargo in the '• ruu,f or ceiling of the boat: two of them died with black vomit within two days after they landed. The other cases which I saw, had been removed from that part of Fell's Point near Donnell's wharf after the attack of disease; or had imbibed its causes while engaged in business at or near the same place, or while nursing their friends; and subsequently had the disease at their residences west of Jones' Falls. In no case and under no circumstances was the disease commu- nicated from a diseased to a healthy body. Persons of the most muscular temperaments and vigorous con- stitutions, whose occupations were in the open air were more ob- noxious to it, and especially drinkers of ardent spirits. 1 am in- duced to believe that the Malignant Bilious or Yellow Fever of Baltimore, during the last summer and autumn, was mainly pro- duced by the putrefaction of water, and also of vegetable matter— And am fully warranted in asserting that it is not contagious; that it is of a local origin; and that it cannot be imported or ex- ported. The Nuisances which chiefly attracted attention were, 1st, On Fell's Point, a large collection of matter which appear- ed to be principally vegetable, north of Donnell's wharf in an un- paved street, 1 think called Pitt street. 2dly, The diffusion and retention of the water of the Basin over a large surface of mud and earth in the Coves east and west of the Point. [ M 1 Sdly, The widely extended surface of moist vegetable matter, and the large pools of green and stagnant water on the point ot land west of Jones' Falls, near the Steam Saw Mill. 4thly, Wet Cellars. 5thly, The gutters of the paved streets from neglect to sweep and wash them. 6thly, Grog Shops and Taverns for the sale of ardent spirits. The recurrence of the disease under a temperature of eighty- two degrees of Farenheit's Thermometer, can only be obviated by removing the sources above noted wherever they may exist. Very Respectfully 1 remain, Dear Sir, Your obedient servant, RICHARD W. HALL. L 33 ] FELL'S POINT, 16th Feb. isso. Dear Sir, SEVERE indisposition prevented an earlier answer to your communication of the 9th instant. You have my free consent to use the communication alluded to therein, for the promotion of any laudable and charitable institu= lion you may think proper. With sentiments of respect and esteem, Yours most sincerely, SAMUEL B. MARTIN. Edward Johnson, Esquire, Mayor of the City of Baltimore. Dear Sir, YOUR Circular of the 1st inst. claims my earliest attention as far as the nature of my professional duties will allow; feeling as 1 do, a lively interest in contributing to the public good, as far and as correctly as my feeble abilities will enable me; ac^ companied with the assurance, that my only incentive is, an ear- nest desire to contribute, my share towards averting a calamity, truly awful, and, in its consequences, much to be lamented. In answer to the First Query, I shall briefly state that nineteen out of the twenty earliest cases of Bilious Malignant Fever, or Remittent Fever of suspicious character which came under my notice, can be traced in their origin to the water's edge, in other words to be more particular, to the wharves on Fell's Point and the immediate vicinity thereof, as will be seen by reference to the Appendix hereunto attached, which I have faithfully drawn up from personal observation, detailing the habits, places of resort, &c. &c. as far as practicable. 2. To the Second Query, I answer, that my attention to the origin and progress of the late Epidemic Fever, enables me with confidence to advance an opinion that it is of Domestic Birth, aris- ing chiefly from the putrescent materials which compose our docks, (which have in no small degree encroached on the navigation) H L 5i ] *hesc materials are left, during the recess of the tides, saturated with water and acted on by an intensely hot and unclouded sun or by the atmosphere in a highly concentrated state, and for want of the interposition of occasional refreshing showers, with which, during our most healthy seasons, we have been bountifully suppli- ed. These causes combine to favour the decomposition of all ani. mal and vegetable matters, emitting exhalations, which in their consequences we shall long have to lament. Whether the dead and putrid animal matters adhering to the logs composing the wharves have any agency in the formation of miasmata, I will not here undertake to determine; be that as it may, it is well ascertained that vegetable matters in a putrescent, or state of decomposition, are potent and necessary ingredients: But animal putrefaction can be borne or the fomes arising there- from may be inhaled with impunity, witness the employment of the Butchers in the midst of it. Many Farmers on the banks of our rivers, use putrid fish for manuring their lands and with impu- nity. But, Bilious Remitting Fever, indeed Yellow Fever has its origin in exhalations from made grounds far remote from the wa- ter's edge, as well as in ponds of water, swamps and mill-dams, &c. containing much vegetable matter, exposed to the combined operation of heat and moisture. To corroborate the foregoing po- sition, we have the testimony of the most eminent medical autho- rities in the United States, amongst whom were the venerable pa- trons of the science, viz. Rush and Ramsey, (of S. C.) The Me- dical Repository of New York, the Medical Journals of Boston, Philadelphia, &c. &c. all contain many well authenticated facts in corroboration of the foregoing, all acknowledging the same re- mote causes. During the late Epidemic, the tide has been observed to fall three feet; Ihe winds prevailed chiefly from the Southward, and I will also add a remarkable fact, that during the prevalence of a Northerly wind,new cases of the prevailing Fever were less frequent in my practice, and those on hand or under my care were at that time more manageable. The Soldiers stationed at Fort M'Henry, were not attacked with Yellow Fever until the gale (which commenced the 19th September) took place; which shews that miasmata may be conveyed to a very considerable distance by strong and continued winds. Further, I have to remark that the nigher the occupation or re- sidence of the persons, attacked with the late Epidemic Fever, was to the wharves, the more malignant was the character of their disease. [ OS ] •'" Europeans and persons from Northern Climates seldom survived the attack of the late epidemic, while, I do not know of one casa wherein a native of the West Indies suffered. As to the Contagious Nature of Yellow Fever, T have not in any instance known of a case which would give cause to justify such an opinion. The " Fever Ward" at our Hospital contained many cases of this disease of every stage and degree of malignancy, and there was no instance of one of the Physicians, Students or .Nurses, or even of those humane citizens (whose tender sympathies lefl them thither) who frequented that Institution from motives of use- fulness or information, becoming afflicted thereby. But you will, no doubt, have a more correct and particular account of occur- rences at that valuable Institution from the learned and respecta- ble gentlemen at the head of it. A respectable gentleman from St. Michaels (on the Eastern Shore) informed me, that during the prevalence of our late Epide- mic ; of five persons who arrived there from this City, (being attacked by the way) with Malignant Fever and terminating fa- tally after their arrival, not another person was infected : though they were carefully attended to, and visited by many without restraint. Here was an admirable opportunity of testing its con- tagimis properties, if any existed.—Likewise, I will add further proof from personal observation. A number of the families, that were in the habit of employing me as their Physician, removed during the prevalence of the Fever iito healthy districts of this City and its environs, viz. to Old Town, to Saratoga street ex- tended, head of Howard street near the Alms House, on the Har- ford road. &c. &c. &c some carrying with them one, others two, others three and even four ill with the (then) prevalent Fever and in no instance was the disease, in question, known to be commu- nicated, to any individual who had not visited the infected dis- tricts. 1 might spin this communication out to the length of an essay, were 1 disposed to collect facts from the most undoubted authority to corroborate the foregoing j but, enough, in my opi- nion has been advanced, to satisfy even scepticism itself; enough has been advanced to do away entirely the very erroneous, as well as highly injurious opinion, that "The Malignant Bilious or Yel* low Fever, is contagious." As to the Remedy. I fear an effectual one will he beyond the reach or powers of our Corporation, and I regret to be compelled to be so bold as to state it. The magnitude of the undertaking, saying nothing of the enormous expeuce, would be but a mere atom in the scale, whilst we have to combat with interests of a private nature, backed by a deep-rooted prejudice; It will be z 56 ] necessary to convince, ere we can convert such as it would seem ne- cessary for our purpose, to a correct view of the subject, before it would be proper or advantageous to suggest a rem dy for existing causes. But, it is in the power of our corporation to prevent the further formation of sources of disease in every section of the City : And I hope it will not be deemed indiscreet or arrogating in me, if, 1 call your attention to the method (for the'future) of build- ing and of filling in the Wharves now constructing in various parts of this City ; and to prevent vegetable materials, such as logs of wood, shavings, &c. from forming a part thereof and being moistened by the tides, form a prolific source for the generation of Marsh Effluvia, which may become concentrated during a hot summer, ami produce all the evils with which we were visited in the ever to be lamented summer of 1819. A wharf constructed below tide-water of stone, and the remainder of large timber, and the filling in to he of clay or sand, &c. would, in my opinion, not only be more conducive to health, but be an individual gain, in as much as it would do away the necessity of so much digging out by an expensive Mud Machine, thus preserving our navigation. Wharves constructed after this manmr, I can ven- ture to say, will, at the end of ten years, be of as little expense to the owners, as those constructed on the present plan, indepen- dent of the advantage of good health. The wharves at Fell's Point are not only built of wood, but are filled in with hundreds, nay I may add, thousands of cords of pine and other wood, and the interstices crammed with chips, shavings and many other matters liable to decomposition, abundant sources of disease ! ! The late examination of Kerr's, Waters', and other wharves, exhibited spe- cimens of a composition calling loudly for a corrective. 'The arks, logs, hulks and wrecks of vessels at the different wharves are also abundant sources of disease. I must also suggest the propriety of compelling those persons to repair the public streets, in a proper manner, who take them up for the purpose of conducting the water to their property ; as well as the Proprietors of the Water Works, near Fell's Point, to re- pair such streets, as require it, where the large water conductors are laid down, which has been much neglected for eight years last past at least, and forming troughs for the reception of slops suds, offals of kitchens, &c. and holding them exposed to the action of the sun to our great annoyance if not to our very great injury as to health. The condition of the unimproved parts of Pitt, Wolf, George and Lancaster streets, it woald appear require examination as to the mainer iu which they have been filled in : It appears to me they are con< posed (to a considerable depth,) of vegetable and vC 57 ] other putrescent materials requiring removal previous to being paved, lest we lock the enemy up. The owners or proprietors of vacant and other lots should be compelled to have the same filled up so as to throw their waters into the adjacent streets. Many of the gutters of our alleys, streets, &c. are so low that they do not throw oft'the collections in them from kitchens and other sources, but hold-them exposed to the ac- tion of the sun. It must be acknowledged that Hogs are excellent Scavengers, I would therefore suggest the propriety of an Ordinance forbidding Hogs to be penned up in styes, between the months of May and Nevember, within the limits of our City, which will correct a very offensive evil, I mean the practice of preserving slops in barrels, tubs, &c. exposed to the heat of the sun and emitting effluvia, if not a cause of disease (which I strongly suspect to be a fact) are frequently very obnoxious to neighbours and passing observers. 1 must beg pardon for occupying so much of your valuable time and hope you will do me the justice to impute it to an earnest de- sire to be useful to my fellow-citizens, which be assured, Dear Sir, being accomplished would be a source of heartfelt satisfac- tion, as well as the most satisfactory reward required by Your obedient humble servant, SAMUEL B. MARTIN. Fell Street, F. P. January 4th, 1820. L 5« J APPENDIX, Containing the Earliest Cases of Malignant Fever or Bilious Fever of Suspicious Character. No. 1. Captain P----m, Master of British Brig Osgar, at Wa- ters' Wharf, Malignant Fever, attacked 21st July, 1819—a gentle- man of steady habits, frequented Waters' wharf aud counting house or that of Mayer and Brautz chiefly. No. 2. W. P. B----s, Market Master, F. P. attacked about the same time with Case No. I. with violent or Bilious Fever of high grade, of steady habits, his dwelling adjoining Carr s wharf. Nos. 3 & 4, Mr. G. & Capt. B. Those two cases were marked with malignancy—Both correct temperate men, occupied about Wirgman's wharf and Wolf street. Those cases occurred about the same time with Nos. 1 and 2. No. 5. Miss B- A young Lady, attacked 25th July with vio- lent Bilious Fever, lived George street, opposite Tenant's wharf. No. 6. J. W——e. A labourer on board vessels at the wharves, at times intemperate, a blackman, attacked 25th July with Ma- lignant Fever. No. 7. Miss P. House keeper to Capt. S. Wolf street, one square from the wharf at the eastern extremity of Alisanna street, a vio- lent case and very suspicious—attacked on the 25th July. Nos. 8 & 9. Miss E. G. and Mr. J. G. Father and Daughter attacked on the 2Slh July with Malignant Fever of a high and alarming grade—Habits regular, and living in the vicinity of Pitt street. No. 10. S. Y. intemperate man—occupied about the County wharf, attacked 29th July, terminated in three days—a most ma- lignant case. No. 11. Mr. S. a free liver—occupied about the wharves—ma- lignant case, attacked *9th July, 1819. No. 12. Miss K. A correct and upright young Lady, a seam- stress occupied in the house of Mr R. Fountain street, at the wa- ter's edge, but removed to her father's in Happy alley, attacked with suspicious case (which proved malignant) 3lst July, 1819. C 59 I No. 13. R. F. Apprentice to G. W. corner of George and Wolf streets, near W'irgman's wharf, with Bilious Fever of suspicious character on the 31st July, 1819. No. 14. Wm. S----s, A labourer attacked while at work on board Brig Nelson, lying at Waters' wharf, with a^ Malignant Fever, ad August, his habits unknown. No. 15. Mr. G. A fisherman whose occupation was chiefly about the wharves, (when in the City,) was attacked 2d August with Malignant Fever which terminated his existence in four days, he was a man of intemperate habits. No. 16. Mr. K. attending the Market on the Point, violent Bili- ous disease, suspicious in character, 4th August. No. 17. J. C——m, A Pedler in Fruit, whose occupation called him to the wharves collecting fruit from the shipping. His Fever which commenced 5th August was of Malignant Character, an in- temperate character. No. 18. F. W----r, Attacked with Fever of suspicious charac- ter on the 6th August: he was occupied chiefly in his father's shop, corner of Wolf and George streets, one square from the wa- ter's edge. No. 19. Bill, A black man, native of the West Indies, and oc- cupied daily at labour on board ships—very intemperate as to mode of living, a most Malignant disease, commencing on the 6th August. No. 20. J. B----n, A slave to W. P. Esq. occupied daily at the ship yard on Price's wharf, attacked with Malignant Fever 10th August—intemperate. No. 21. Miss. G. Daughter of J. G. Wolf street, attacked loth August with Bilious Fever of high grade, symptoms of Malignant character—-dwelling Wolf street and front of Wirgman's wharf. No. 22, J. H. Hack Driver—intemperate habits—Malignant Fe- ver, attacked 10th August. No. 23. Mrs. D. H. Bond street, attacked IGth August with violent Bilious Fever of suspicious character. In the rear of this house is a wharf extending into the Cove. No. 24 J. M. Ship Carpenter, occupied on Patterson's wharf, a Bilious Fever of high grade, attacked loth August, ayoung man of temperate habits. C 60 1 No. 25. Miss H----, Attacked with Malignant Fever 12th August, living in Alisanna street, eastward extremity near Flana- gan's wharf. No. 26. Mrs. S. H----'s Negro Boy Ned, attacked 12th Aug. with Malignant Fever, his occupation about the ship yards—dwel- ling as No. 25. No 27. W. F----n, A temperate and regular Old Man, resid- ing on Patterson's wharf, attacked 14th August with Dysentery, characterised with symptoms of a most Malignant character. No. 28. Ns. L——'s Boy, corner of Pitt and Wolf streets, and in the immediate vicinity of the unimproved part of Wolf street, attacked with Malignant Fever 14th August, which in four days carried him off. No. 29. Mrs. S. H----'s Negro Girl Rhodey (see 25 aud 26) at- tacked t4th August with Malignant Fever. No. 30. A. T----e, Blacksmith, a regular temperate man, and worked daily at his shop on John Price's wharf, attacked 15th August with Malignant Fever. No. 31. J. T---re. Son of the above person, (see No. 30.) same disease and under similar circumstances. No. 32. J. C----r, Apprentice to A. T. (see No. 30.) attacked also with Malignant Fever, under the same circumstances with eases 30 aud 31. Those three persons were occupied at work in a shop between Wolf street (the unimproved part) aud John Price's wharf, as it were between two fires. No. 33. Mrs. C----, A native of the West Indies, Malignant Fever, attacked 16th August, dwelling in Lancaster street, back yard of which dwelling a nuisance, and the cellar under the house in a dreadful state. No. 34. J. D----, Apprentice to R. M. Blockmaker, on Ten* nant's wharf, attacked 17th August with Malignant Symptoms— soon recovered and went to Harford county where he relapsed and died. It would be needless to enumerate more of the many cases which came under my care, these will suffice 1 think, to shew the course the disease took in its commencement, travelling regularly along the course of the water and infecting the streets in the vicinity thereof. My most violent cases were near the waters edge or con- tracted there. SAMUEL B. MARTIN. I 6i j BALTIMORE, December 31st, 1819 SIR, YOUR favour of the 1st instant came to hand on the 12th, and indisposition has prevented me, since, from paying it an earlier attention. In reply to your First Query, I beg leave to state, that the first case of suspicious or highly Malignant Fever, which occurred in my practice the past summer was that of Mr. John ;.a l»orde, Whom I attended, at the beginning of August last, at in3 lodging? at Mrs. Vickery's, 4* Grauby street. There had not been, us yet, any mention of the prevalence of that disease in ouv City; However the first symptoms clearly showed the malignant charac- ter of his fever, of which 1 apprised his wife, trom the several questions 1 put to the patient concerning the source of his disease, 1 could get no other information but that he described it to his having walked a long time without his hat on, in tht night air, which did not satisfy me. On the fourth d-w, after his recovery, one of his friends who came to see him, informed him of the death of Mr. at Mr. P. Lanney's, Harrison street, where he lodged. This gentleman had been but a few days in town and was Supercargo of the Haytian Schooner Constancia, from then lying at Smith's dock. On hearing this news, Mr Laborde recollected to have been on board this Schooner, and to have breakfasted with the Captain and Supercargo the day before the latter fell sick. 1 was satisfied that Mr. Laborde got the infec- tion on board the Haytian vessel, and such is still my opinion. In order to be enabled to answer to the Second Query, I have visited our principal wharves which are justly considered as the hot beds of morbid infections. Those between M'Clure's and Smith's wharf are in good condition, except some few place> which preserve dampness and which require to be more particularly t-xa- mined. All that part of the river shore extending from M'Eldery's street to Fleet street, Fell's Point, appears to be in a proper state to emit, in particular seasons, pesti'ential exhalations and generate many diseases. It invites, therefore, the particular care of the City Authorities. Patterson's and the other wharves, as far as Pitt street are in the best condition ; but the small and narrow wharf or "utter which terminates Pitt street, has become the receptaele of all sorts of putrid matters brought down by the rains and the waters, which, almost fill it up. In hot days, at low water, the sun actim; strongly on these substances, miasmata of the most noxious kTnd must naturally be produced there, which are carried and spread afar when the wind blows directly into that street. C "* 1 The part of the town between Pitt street and Wolf street is low, preserves a constant dampness and is rendered more unhealthy by its exposure to the rising sun and by the timber yards established there, which must emit injurious exhalations. All the wharves extending from the latter places as far as Fountain street, are in a good condition ; but the surrounding grounds are low and preserve a constant humidity lodged under the fragments of animal and ve- getable matters, which being deposited there from the adjoining streets, remain in a state of stagnation on the surface of the ground, and may, in particular seasons, produce morbid infections. It is well known that banks of rivers, docks, wharves, marshes, low grounds, and generally all places preserving dampness, the sur- faces of which are covered with animal and vegetable substances, acted upon by a hot sun, generate constantly miasmata, which are more or less injurious to health, according to particular seasons, and produce number of diseases; but 1 contend that in our climate they do not produce the seeds of the Yellow Fever. The gene- rating source of the primitive seed of this disease is only to be found in hot climates, and the torrid zones, where caloric keeps constantly very high. The same may be said of the plague of which the Yellow Fever is one of the nearest branches and might be denominated with propriety the West Indies plague. But this infectuous seed or miasmata, can be and is transported to other climates, where meeting a favourable locality and season, it gene- rates the same disease. If this miasmata becomes united to ano- ther miasmata, or gets into an atmosphere, the constitution of which is bilious or of any other nature, then it experiences a de- generation or regeneration and induces diseases more or less ma- lignant or contagious ; and when places subject to a humid tempe- rature, in the vicinity of rivers on low and constantly damp grouuds, exposed to the rising sun, and inhabited thickly are vi- sited, once, by an epidemic of this kind, followed by great mor- tality, it may be expected that in such places the miasmata will accumulate and concentrate, become at last naturalized!, and will be exerted into action whenever the seasons be favourable. The seeds of the disease will not be extinguished but by degrees ac- cording to the diminution of the mortality. Respecting the Third Query, I shall observe that I have always considered the Yellow Fever as more or less contagious according to number of circumstances. This opinion is the result of many observations made in the anterior epidemics and is farther corro- borated by the case before related in reply to the first query. 1 h ive no doubt but you will entertain the same opinion after you will become acquainted with the first cases occurred iu the practice of other Physicians in the last epidemic. For the prevention and [ «3 ] destruction of this calamity, I shall propose two means. The first which is a preventive, and which I published twenty years ago at two different times, and again in the Patriot of the 17th of September, 1819, consists in enforcing a strict Quarantine on all suspicious vessels ; enjoining on every Physician the obligation of giving public notice of the first suspicious case of Malignant Fe- ver, particularly in critical seasons; in removing the sick out of town and also the most immediate neighbours. Such measures com- bined with the adequate measures to promote cleanliness in the town, to fill up the places where dampness is constantly preserved, and to remove all sources of impure air, will, in my humble opi- nion, be the only means of preventing this disease, or at least of stopping its propagation. The second means 1 beg leave to pro- pose, will operate the total destruction of this disease, and by re- storing confidence aud tranquility of mind, will put an end to alarms, apprehensions, vexatious quarantines and suspension of trade. It consists in a medicine which I have discovered and has proved to be a sure and certain cure for the Malignant Fevers. It has stood the test of many experiments, in one of which, I can affirm that out of 108 patients, 101 were restored to health, some in three days, others in four, five or six days the farthest. 1 can assert, without fear of contradiction, that this medecine is a cer- tain specific ; and on explaining this descovery my intention is to apply to the Mayors and Councils of the principal Cities of the United States for a subscription, the amount of which shall not be paid but after the most satisfactory proofs of the efficacy of this remedy. If it should not answer the description I shall give of its properties, nothing, of course, will be required. A part of the subscription money shall remain in the hands of the Mayors to be distributed to the poor and orphans. I have the honour to be, Sir, Your most obedient and humble servant. * J. J. GIRAUD, To Edward Johnson, Esq. Mayor of the City of Baltimore. [ 64 ] To Edward Johnson, Esq. Mayor of the City of Baltimore. THY Circular of the 10th instant, reque>tftig my approbation to publish (with others) my communication relative to our lats Epidemic, stating, *• It can be used to answer a very valuable purpose," &c. under this presumption, it does me pleasure to say, it is entirely at thy disposal. Very Respectfully, &c. J. BREVITT. Second Month 15, 1820. To Edward Johnson, Esq. Mayor of the City of Baltimore. YESTERD \Y I received thy printed Circular, (which is now before me) requesting such information of my knowledge and ob- servations of the late Bilious Malignant Epidemic, in this City, as to what regards its source or cause, nature and best mode of prevention. It always was my highest gratification to contribute, every thing within my limited means, for the general and individual good of my brethren, (for such i esteem all conditions of men) and am truly sorry I am nof in possession of more facts and information in the present instance; but the widows' mites were well received by our blessed Lord and Saviour Jesus Christ. I trust my small contribution will not be rejected an admission to the treasury of knowledge in the keeping of the Chief Magistrate of the City of Baltimore and the City Council. I presume I need not enter minutely into a physiological or pa- thological investigation of the nature of the bilious fluid which is allowed to be neither alkaline nor acid, but of a saponaceous qua- lity, extremely bitter, pungent, and of a strong tendency to the putrefactive proeess: the increased excitement produced by the high temperament of our latter summer months, increase (1 pre- sume) its secretion by the liver, and its tendency to the putrefac- tive fermentation, the more aqueous or thin parts are dissipated in increased persperable evacuations, and the more gross particles accumulate and take on an additional consistence and thereby plug up the emunetories of the liver, by which its regular and healthy course and discharge are obstructed. That large viscus the liver, the gall bladder and its duets, be- come gorged, enlarged and form a tumor externally discoverable [ 65 ] to the touch on the right side below and under the cartilages of the false or short ribs, which compressing the lungs, become op- pressive to respiration, more sensibly discoverable when lying on the opposite or left side : The bowels become costive and the i'cecee or excrementitious evacuations hardened, and of a lighter color, evidently shewing a want of the presence of the bile, whose pro- perties when healthy are purgative, and color of a bright rhubarb yellow, which from its absorption and distribution in the blood, give a sallowness to the countenance, oppression to the brain, a nausiated stomach, and a depraved or loss of appetite, so far for symptoms or diagnosis, to use the medical language, which in the present communication I have studiously avoided as 1 wish to be understood. The few cases that fell under my immediate care or observation (suspicious and highly malignant) are decidedly to my satisfaction without the least evidence of a contagious nature or tendency. On this head 1 am abundantly convinced our citizens and all others may rest perfectly secure. The cases of John Mott, Larkin Read, James Minsbridge and Robert Penlarick who were all of the most malignant, and decided character: the two last where under my own immediate care, the former under some of my professional brethren of the most respectable standing. They all died with every virulence of the highest grade of disease, not a single in- stance of contagion fiom any one of them, these alone are to me sufficiently satisfactory proof of the non-contagious nature of the highly Bilious or Yellow Fever, which prevailed in a part of our City, during our last summer months and first of the fall. Those who require more 1 have no doubt may be abundantly gratified by the united voice of our medical faculty which 1 esteem as a body inferior to no City in the union. The sources of all these cases are deciedly traced to the imme- diate vicinity of the water, as the lower part of the Point and the wharves confined to a distinctly marked atmosphere within certain circumscribed limits, beyond which the disease is not communica- ble. The cause I esteem to be putrid exhalations engendered in the mephitic effluvia of rotten vegetable and animal matter concen- trated in confined situations, thereby increasing their hurtful qua- lities, as holds of ships, damp cold cellars, nuisances deposited in low situations, as necessary vaults, putrid fish, fowls entrails and rotten vegetable matter deposited in the streets, and not immedi- ately removed, stagnant water in ponds or gutters, &c. Of the Prevention which may be considered in a few words, (viz.) Exercise, Temperance and Cleanliness: these under the blessing and will of God, who made us and all about us, which he governs ; we may presume will effectually prevent these severe visitations, (except permitted for our chastisement and purgation) [ 68 ] when it becomes our duty to bow in humble submission to his will concerning us, and supplicate him for power to amend our ways and to iive more conformable to the divine will, of which 1 fear we have been cgregiously deficient. As deposits of nuisances from our kitchens, &c. must necessarily take place, for to keep them in our houses or on our premises would be to propagate and establish inevitable and universal pes- tilence and death, more especially in our Cities: Our attention is then directed to the most immediate and effectual removal of them ; in spite of all our City Ordinances, and all the wisdom combined of our police to the contrary notwithstanding, I have no hesita- tion in recommending as the best possible mode a free and entire range to the Hogs at all times and at all seasons, as scavengers the Turkey bussard is far their inferior, the latter taking away putrid animal matter only, which further require to be deposited in the fields secluded from the busy haunts of men, to secure their accommodation, for the Cities they sedulously avoid, whilst the Hogs preambulate the most secluded holes and corners, gorge with voraciousness and rapidity every kind of garbage vegetable and animal, and remove them with the celerity of legerdemaiu. A hog running at large is a friend to every one he visits, whilst a hog con- fined is the most intolerable nuisance we can possibly conceive, is too well known to need definition.—And farther, as extreme po- verty aud indigence is well known to engender disease and sorrow, the provision against whieh exercises the liberality of our police and our citizens to avert. This would be an admirable and most stable provision, in as much as the poor man in the spring for his dollar, gets him a pair of rabbit size pigs, and orcaionally as he can spare bestows on them his five-penny piece, which with pick- ing up what would be a nuisance and cause of disease, they grow to the delight, and provision of the poor man aud his hungry off- spring: and the necessity of the subscriptions for winter provisions f.sr ihe necessitous poor, which is always insufficient, are here iii'ii>.:;r-s.h!y obviated without cost, and serves for the removal of the causes of disease and death : also when the poor man has raised his little pis*s to be Hogs, affording an helpless family three hundred weight of bacon, at this inclement season of the year- Is it not an abomination in the divine sight, that this possession (raised measurably from the scanty sparings of a scanty board) should be wrested from him by a legalized T***f under the sanc- tion of the Police ? Such things cannot but be an offence to that groat Being who is of too pure eyes to behold iniquity with appro- bation : This may be one great cause of the sufferings we have of late experienced. Respectfully, &c. JOSEPH BREVITT. Baltimore, 12th month 9, 1819. t 67 ] SIR, HAVING in view, in my answer to the questions which you addressed to me; no other object, but that of public utility, I feel justly penetrated by the benevolent application of it, which your humanity prompts you to make, use it in any way you may think proper, and believe me sir, to be respectfully and with esteem, Your very obedient servant, L. M. DUN AN. Baltimore, February tftk, 1820. SIR, AGREEABLY to your request I answer the questions pro» posed to me. To the 1st Question I answer, That, the first patients whom I had occasion to treat and who were really afflicted with the late Epidemical Malignant Fever, either resided or worked in the space comprised between Wilke and George Streets, F. P. 'Their mode of living differed only by their customs, an equal proportion being French, and the other native Americans. They were all so far as came to my knowledge, persons of sober habits, and were of both sexes, and the majority of them adults. In my opinion, their disease was produced by the absorption and inspiration of a Gas, peculiarly mephitical and local, which developed itself originally within a circumscribed space, aud was contagious to any person exposed to its inffnence, whatever might be their mode of living, or the nature of their work, and it dis- covered itself more or less rapidly or energetically according to the constitution of the patient, or from the quantity of the absorption or' inspiration of the deleterious principle. 2d'Quest. Here, I shall permit myself to enter into some re- marks on the situation of our City. From observations made in ages very anterior to the present, and even before the Christian tcra, men of knowledge, and especially Hypocrates, the father of medicine, have agreed in the opinion, that, all Cif'n-s situated like Baltimore, on a sloping ground exposed partly to the rising sun [ 68 ] and partly to the south ought to be healthy, its waters running In the same direction are salubrious and light, the inhabitants are gay and communicative, of an enterprising genius, and exposed only to the diseases inherent in the human species inhabiting the most healthful and mild climates. Agreeably to the following exposition, we should be exempt from all local Epidemics, if the happy situation of our City was not bounded on one -ide by the generative cause of all our afflictions; namely, the Basin. All the filth and offals of the City by the natural descent of her streets are carried and deposited into the Basin, the waters of which are agitated and renewed, but by the ebbing of the high tides, aided by a strong breeze from the south. We ought to Con- sider as of no consequence, the small stream of water called Jones' Falls, in the canicular days; it being at that season reduced to nothing, as we have observed it to be this year, during several months of drought. The influence of an intense and dry heat must put into a state of fermentation the animal and vegetable matter which is carried into onr Basin, its waters must be decomposed and changed in their nature, its miry deposit, produced by heteroge- neous bodies, is susceptible of forming gases the most inimical to health, especially if the diminution of the waters leave it uncover- ed and exposed to the action of a burning atmosphere, from thence arises, the corruption of the vital air, locally where the emana- tions lake place. Low situations and the borders of the Basin will always be the first infected, particularly if the waters retreat precipitately from where there is the least depth. Experience comes to the support of this observation. At the extremity of VVilke and as far as George street inclusively, there are*everal places and small docks where there is very little depth of water, in whieh, are rafts of pine timber for ships masts, laying in the summer season on a bed of mud, and when the causes before enumerated become coincident, they must produce a morbific and infectious principle. During a residence of twenty years in Baltimore, I have been Constantly occupied in discharging the duties of my profession towards my fellow-citizens, aud for the preservation of whose health I feel peculiarly anxious, I have observed with sentiments of great satisfaction, the increase of its salubrity, notwithstanding the rapid augmentation of a mixed and exotic population. This Sir is owing to the paternal solicitude of our City Council, and the rational measures which they have always adopted and put in ex- ecution. C «9 1 Persevere in levelling the sloping grounds of the City,restrain the waters of our Basin by wharves built with stone in a straight line, and where there is a good depth of water, form the least number of docks, possible, as the Waters in them are renewed with difficulty. This object of individual consideration, ought to give way to that of the public; If possible, do not expose any kind of mud to the action of dry and burning sun. In adopting these means you will have humanely done, all that can contribute to the preservation of the healthfulness of our Citizens. The topographical situation of our City requires, that her streets (particularly those eloping to the south) should be kept in the highest degree of cleanliness, to prevent any filth being carried into the Basin. The Wharf .Vas- ters ought to be very strict in their superintendance, in order, that no kind of damaged and corrupted provision, animal or vegetable, be thrown into the harbour. Prohibit the raising of filthy animals in the bosom of the City* If added to these several means of public salubrity, we could have a stream of water to fall into our Basin, strong enough to keep its waters in constant motion, and renewing them daily, then, our City would become the Montpelier of the United States. Gwinn'g Falls appear to me to be sufficiently elevated, to accomplish the object above mentioned, whenever the state of our finances will permit it, may that period not be far distant, is my most sincere wish. In answer to the third question, I say, that the disease pro-* duced by a developement of. noxious Gas which taints the atmos- pheric air, is Epidemical for all persons living within the sphere or rather ray of infection, but it is not contagions otherwise. Here fellow the preventive means I would propose—So soon as unequivocal symptoms of an Epidemic disease are discovered in a place, remove its local population, and interdict strictly all com- munication with the infected spot. Cause heavy detonations with cannon and fulminating powder to be made at the infected point. The beating of drums, aud every thing tending to agitate the air by continued and multiplied vibrations, only, are capable of pro- ducing a new combination of the local atmosphere and of prevent- ing the dissemination or spreading of mephitic miasmas. These different means should be employed immediately, and with suffi- cient strength and perseverance Circular fires alimented by re- sinous substances, may prove useful, by concentrating the column of vapour and compelling it to rise. Now Sir,I consider it to be my very indespensable duty, to detach you and our City Council, from all censure, as respects the evil [ 70 1 by which we were afflicted this year, your watchfulness, your con- stant desire in attending to every thing by which the public health mieht be promoted, have rendered the late Epidemic very partial, when compared to that of Eighteen Hundred. Out of fifty which I had occasion to treat I had but eleven cases of Fever, unequivo- cally Epidemic. Receive Sir the assurance of the respectful con- sideration, with which 1 have the honour to be, Your obedient humble Servant, L. M. DUNAN, D. M, Baltimore, JOicember 29tk, 1819* L n ] Dear Sin, I have no objections to make to your publishing my communication to you on the late Fever. But as this letter was written in a great hurry, and was not intended for publication, it surely cannot be very acceptable to the public. Yoars Respectfully, JOHN B. CALDWELL. Baltimore, February 15th, 1820. BALTIMORE, December 11th, 1819. Dear Sir, IN compliance with the request, contained in your Circular of the 1st of December, I shall proceed to answer the queries in the order in which they succeed each other. 1. The cases of Fever which came under my immediate notice, had their origin, located at the extreme end of the Point, with the exception of one, which owing to its rapid progress and other circumstances, I was unable to trace to its souree. The patients were of the lower class, were irregular in their habits, frequented taverns, and houses where the most abandoned resort. I would ascribe their sickness, to the effluvia arising from the masses of putrefying vegetable matter, accumulated at different places on the Point. 2. I consider the mud which was used in filling up the docks, in the improvement of Pratt street, to have been a nuisance of a serious character. The uncleanly state of many of the alleys and yards constitute another hot bed for the production of disease. The cheapest and most effectual means of removing these sources, I deem to be, the removal of all collections of vegetable materials, to keep the streets, alleys, &c, clean, and causing the lower classes of persons to be more attentive to the cleanliness of their houses and persons. 3. I do not believe the late Epidemic to have been contagious under any circumstances. 1 regret that time will not permit me to enlarge upon the above topics, so interesting to humanity and the welfare of our City, but I congratulate you upon the opportunity you will have of receiv- ing information from abler hands. Yours with respect, JOHN B. CALDWELL. C 72 ] BALTIMORE, March 26th, 1820. To Edward Johnson, Esq, Dear Sir, HAVING received your favor of the 10th February last, requesting my assent to your publishing a communication which 1 made to you in December 1819, on Yellow Fever for the use of the City Council, and mentioning that '• it can be used to answer a very valuable purpose by being published with others on the same subject, and the proceeds of the sale applied to the Dis- pensary," I have to regret exceedingly that 1 cannot agree to have said letter published at length, inasmuch as if was not writ- ten with that view, and is too imperfect to intrude upon the pub- lic I have however taken out of this communication some ex- tracts, which will make several pages, and if these can be of any use in your benevolent design, you are at liberty to publish them without using my name. 1 will correct the proof sheets in ca6* you think proper to publish the enclosed on those conditions. Yours Respectfully, &c. V.i EXTRACTS. \ « IF however it can he clearly shown that the immense mine of wood, which now lies buried near where this disease originated, as it were never to rise again, has had the most extensive agency in generating the remote cause of our late Epidemic, and that all other nuisances which have had any share in producing it are of the same nature, the generality of your interrogatories will be in ssome measure answered. That which is commonly called the remote cause of Yellow Fe- ver has hitherto been a terrible enemy of mankind, and has per- haps justly been said to " move in darkness," for certainly there is but little correct knowledge of its nature in the world, even at this enlightened age. It cannot be detected distinctly by any of / C ?3 ] our senses. Its consequences furnish the only infallible criterion by which we know that it exists or has been present. Hence it has been chased in imagination, (1 had almost said) from pole to pole, and although its traces are discoverable in most places, no country has had the magnanimity to own it as a native of their climate. Con- sequently the public authorities of almost every country have en- gaged in framing laws to shuc it out as an unwelcome stranger. AH this has been done in vain. The object has always been frus- trated. Humanity is still left groaning under the yoke of a tor- turing and cruel adversary. The statesman and the peasant, the male and the female, the white and the black, the young and the old, all wither and perish before his poisonous darts. He triumphs for a season in our summers sun—He vanishes in the fall only to return again. It is therefore but reasonable, viewing the subject in this gene- ral light, that he who has the most trifling regard for the human family, should enquire for the reason why every law which has been enacted in this case has failed to afford us security from this deadly enemy. But it would seem that popular odium must ne- cessarily fall heavily on the head of him who would attempt to charge those wise lawgivers in their * Legislative proceedings, with having started at a phantom, while they have left basking in security at the threshold of our own doors the proper parent of the true enemy. Nevertheless when the lives and property of our fel- low-citizens require the aid of every ray of light that promises to shine in upon this road of darkness it should not be withheld on that account. But should the ground travelled over aim at showing, that in every country, and in every city, and in every place, and on board every ship long at sea, where Yellow Fever is found to have ori- ginated the proper source of this cause exists there also, and jthat wherever the object is to save mankind from the jaws of one of the most tremendous of all diseases, these laws should be quite reversed, and so formed as to shut foreigners, natives, and all out from every such place while the disease prevails with viru- lence, and that certain nuisances should be ransacked to the bat- * This malady invaded the Legislature of South Carolina, while coolly de- liberating in their chamber, and destroyed almost one half of their members besides several other persons of distinctiqn, viz. Chief Justice Bohun, Rev- Samuel Marshal, Edward Rawlings Provost Marshal, John Eli, the receiv- er general, &c. in 1699, or 1700. So general were the sufferings (one way or other,) "that anxiety and distress were visible on the countenances of every- one." "Many of the survivers seriously thought of abandoning a country on which the judgments of Heaven seemed to fall so heavily." See Dr. Hewet. C W ] torn and similar ones prohibited, why should either the law-giver or the property holder turn a deaf ear to the voice of reason, which is built on stubborn facts, intimately connected with the fate of hundreds, who yesterday lived and moved but to-day are seen no more. As it regards the Yellow Fever of our country, it is believed the doctrine of contagion was first contradicted in this City. But notwithstanding the opinion that this doctrine is founded in gross error, has gained general ground among our medical men, the public feeling has not been altogether overcome. There- fore the calamities* arising from the relicks (if the expression be admissible) of this once popular idea, are such, as to call on you and every good citizen, in a language not to be resisted, to dis* countenance it in every step that is taken, whether it be official or not. You will however, not understand me here to wish, that the slightest censure should attach to the relatives or other humane persons whose business ii has been to attend ou the sick. On the other hand, let me bear honorable testimony to the contrary. But Sir, it surely requires an inordinate degree of refinement of feeK ing of family affection, and I will say of courage, for a female to hang over aud administer comforts to even the nearest relative, when she is under the impression that a risque is running thereby, which would be, if real, in degree, and nature, much greater and more abhorrent than that of facing an enemy in equal combat. Nor is it foreign to my purpose, that this whimsical notion should be turned aside—Should be buried never to rise, disgrace, and annoy us again. For notwithstanding, as before intimated, the doctrine is already scouted from the mind of nearly every man of common sen*e and understanding among us, who has seen the disease and has any knowledge of its nature, your earnest enquiry on that point shows that the full weight of injustice lately expe- rienced by this City, when that was made the plea, is felt by you, and it consequently merits attention. Men may err with open eves when their interest is at stake. This is only when the human heart is grossly depraved. Let us therefore have charity enough for our neighboring brethren to refer their conduct to want of in- * The idle speculators who deal in. contagion, will have a heavy load of this species of harvesting to carry with them to the Courts above, although they cannot gain the much sought for case wherein the Yellow Fever bas been communicated out of infected districts to carry to the Legislative Chamber. [ 70 ] formation—The offspring of indolence; for the light is left record ed as a rich legacy by their late fellow citizen the celebrated Dr. Rush, as well as others. With a view to satisfy you on this score as far as possible, it can be clearly stated, that not a solitary instance has arose (among all who were sent to the country and to parts of this City not in- vaded by the infectious air) wherein the late Vellow Fever or any one case of it could be shown to be referable to contagion, or in other words, wherein the disease appeared in any degree commu- nicable from person to person. If the nature of the disease was put out of the question altoge- ther, as this criterion has invariably resulted in the same vay wherever the disease has been known, it should have set the mat- ter to rest long since. For it is utterly absurd to argue, that a disease is contagious within a certain space or limitation of air and at a particular season of the year which is not so in all places and at all seasons. But Sir, there is quite as little evidence to be adduced that Yel- low Fever is contagious even where it has originated and prevail- ed in its worst forms and in all its varieties. On the other hand, it has appeared plain, that contagion has nothing to do with the production of it even there. The probability is there was more safety in the houses, no matter how many sick and dead there were to mingle with, than in the streets during the late fever. Bilious Fevers of the ordinary grade are perhaps universally referred to miasmata for their remote cause. If then Yellow Fever be Bilious Fever (which many Of the friends of contagion admit,) would it not be a grand philosophical contradiction to refer it to a different or second cause, no matter how high the grade may be esteemed ! But the practice of some men, who refer it to near a score of " indispensible requisites," such as " warm weather," a " particular season," a set of predisposing agents, a " peculiar constitution of the atmosphere," and so forth, and so forth, and at length turn round and tell us, that under these circumstances the disease is certainly contagious, is a species of philosophising altogether unwarrantable. By the term contagion we ought to understand, that a patient before U3 has been sickened by certain seeds of disease thrown off from the body of a person who has previously had the same dis- ease communicated by effluvia produced by the same disease in a third, and so on ad infinitum, as we find to have been the case with the Small Pox at all times and seasons back to the remotest anti- quity. This disease prevails alike in all countries inhabited by C w 3 man. Yellow Fever does not. But these high medical authorities Who sit down in their closets and wrap up nonsense into an impost ing shape, do not view contagion in this light. They can do noth- ing without marsh miasmata. And look ye at the consequences. Can there be any thing more irrational than to hold out that this patient has taken the Yellow Fever from one who has previously received it from a third who got it from marsh effluvia, one of the indispensable requisites, or that which makes the peculiar consti- tution of the atmosphere! If the disease was thus contagious effluvia is the original offen- der, and there should be but one opinion about removing its source. But will men have you to hang the effluvia, or cause of all this mischief, between heaven and earth for a season and give it no origin—no progenitor—no abode thereafter—neither author nor finisher ? or will you sit down and iold your arms saying that he is a *' demon that moves in darkness," and content yourself in do- ing nothing merely because he is sometimes merciful. Effluvia must have a birth, and if a birth it must have a progenitor with a resting place. And if effluvia be the cause of the disease once, it is again and again, and ever will be ; for there is no other doc- trine that will uot run counter to the laws of nature. Every one knows the mildest forms of Small Pox will generate that which is capable of reproducing the worst forms. Every one knows thafr-- Intermitting Fever will not reproduce the cause of itself, nor no other form of Bilious Fever. Neither will the worst form gene- rate the cause of its own or any other grade among the whole va- riety of Bilious Fevers. The cause of this disease is planted in man or received as a poi- son, but this cause is something foreign to his nature which cannot be reproduced by him. At the commencement of our calamity (as is usual) the disease was of the mild intermitting form, such as we always meet with in autumn. But before these persons had all recovered from this Bili- ous Fever, others in the same houses were taken with Yellow Fe- ver. Such examples (as shall be noticed hereafter) of gradation from low to high character, as could not have failed to satify the most incredulous (had they witnessed them) that the cause of the One was the cause of the other, have fallen under my care among the diseases which appeared on the Point as well as at other places. To assume it as a general ground that the remote cause of Bili- ous Fevers of every grade is the product of vegetable decomposi- * This fact contravenes the theory of some of the New York faculty. [ 77 ] tion entirely, is not a doctrine generally received. Yet most men will agree, that if vegetable matter is not palpably present in the production of the cause of all these diseases it is at least commonly so. And it is believed there is no respectable opinion on this head which does not inculcate the necessity for its pre- sence wherever these diseases are found to have originated. It would therefore be just to conclude, that an acknowledged offending agent can accomplish its accustomed effects, without the presence of a second agent expected to have the same operation. And un- less we admit that two substances or prime causes quite differ. ent in kind, do, when decomposed by nature, or by the operation of her elements, produce that which will have the same efteet, (which has never been ascertained as regards vegetable and ani- mal matters) there is at least no more necessity for calling into the account the assistance of animal matter than there is for searching out a peculiar constitution of the air, predisposing causes, &c. when the intention is to refer the disease to contagion at last. This disease has prevailed for near thirty years at a particu- lar season in one place. The cause of it must emanate from some permanent source. By its effects we know that it has existed here for this period of years at the same season of the year. The ope- ration of it has been at first most quick and powerful on strangers. Afterwards it has become strong enough to excite disease in the most robust natives, and in foreigners from the highest and healthiest hills in the world immediately on their arrival amidst it, without the aid of any of the above-named imaginary assistants. Instead then of a long residence in this contaminated air and warm cli- mate, rendering more susceptible of disease the inhabitants than strangers from cold latitudes, the opposite has been the true state of the case. Therefore the air cannot have been so constituted as to produce the disease, viz. the whole atmosphere. But we believe the cause was still in the air of this neighborhood. This appa- rent contradiction has always been such a stumbling block to the public, as to gain a preference in favour of contagion, and must be definitively explained. This may be effected in the following manner to your satisfaction. Yon know there is more smoke iu the air of this City than there is in the same space of country air. Yet the smoke is continually mingling with the air, and is carried off by it. The sources sup- ply this air with as much smoke as passes oft' into the general air, and occasionally it is suffered to accumulate for a short time. But the space of the City's air bears so small a proportion to the air at large, that there is more smoke at all times here than there is in the same limits elsewhere, at a distance from town. [ 78 ] It is believed with the best reason that this case is applicable to the generation and diffusion of the cause of Fever. From the beginning to the end it is emited from certain sources, and here grows stronger and stronger until it reaches its climax of power, but is always weakened and wasted the further it travels and the more it is mixed with the atmosphere. If we apply the proper article for extinguishing fires, the emis- sion of smoke is soon ended, yet the source is left in part, and is liable to be set on fire again and to emit smoke. But if the combus- tible materials are exhausted, aud the smoke ceases without the application of any thing to extinguish the combustion, no smoke will reappear, whether fire is applied or not, until the combustible materials are replenished. This will be the case as regards the cause of Fever on removing the source. Increase of temperature rouses into operation the processes by which latent causes are rendered capable of producing their dele- terious effects, and frost extinguishes these processes for a time, but if the materials are not exhausted, the increased temperature of the succeeding summer sets them into operation again. The source may be extinguished before a season is half over. In either ter- mination of the process by which the cause is emited, of course the Fever would terminate almost simultaneously The late Fever of Smith's dock and that of Philadelphia, furnish examples of this latter termination. The first is plain to all and occurs every sea- son on the coming of cold weather. By taking violent poisons in moderation for some time, and in- creasing the quantity, the human habit becomes insusceptible of the direct operation of such a quantity of the same article as would destroy life under other circumstance's. Here is a new law esta- blished (as it were) to the operation of this poison. The quantity which can be taken is regulated somewhat by the age and fibre of the person, as well as the powers of some habits, to work off and resist the poison The cause of Yellow Fever is in this respect entitled to the name of a poison, and those principles will explain all its effects. It may act directly according to " its own laws," or indirectly according to a second set of " its own laws". Besides, as vegetables taken in substance have a very wide range of different operations, their miasmata or products will also have different effects, for it is not reasonable to suppose this pro- oess will furnish for its product exactly the same thing from all vegetables. But if the cause of this disease were generating in the quarter above named in small quantities, for some time before its presenea I 79 ] was fully developed by the consequences (which is quite probable) the inhabitants had received it in a slow way for some time, and hence we had Intermitting Fever first among children, Yellow Fever next among strangers, and next to those c ises Remitting Fe- ver among the grown citizens, (females) and Yellow Fever among the boys and girls, and finally the malignant type took the place of all other forms of disease near to the source, while Intermit- ting Fever kept in the out skirts and should have been hailed by the citizens as the welcome messenger giving the intelligence of the great enemy's approach. This just outline of the subject might suffice to show that some powerful source of mischief was in this neighborhood this season, but in order to come fairly at the right one, it is necessary to con- sider carefully the situation of the place, and the diseases therein for the above named period back, and to bring collateral evidence. Experience and observation has shown that more or less Bilious Fever, of a character and grade not common to other parts of this City, has appeared in this place nearly every summer or fall *'or this period. And whenever this disease has oeen so atarmin ; as to excite public attention, its effects here have been deplorable in the extreme. In 1800 it raged here. In the year 1808, it was totally confin- ed to this place, and ravaged the whole of Pitt street. Lasi year it broke out here in its most malignant type but did but little mis* chief before the frost destroyed its cause. One or two cases oc- cur here annually. Now with what reason can a cause which has been thus per- manent (considering the whole space of time from the .mprovement of the place) be referred to such passive agents as have oeen ^'edg- ed whether they have been on board ships or not ? tor it would be. strange indeed if vessels should come to that spot of the harbour, at the same season, during such a series of years with the cause on hoard, and not to many other places both east aud west ol the tails. And if the inquiry whether or not it be possible that a source or animal matter, as permanent and lasting as the disease has been, could have existed here during this time, every man oi understand- ing would give it au unqualified negative. It would therefore appear to be hazarding nothing to defy all mankind to find anv thing so permanent and lasting, and so . kelj to have been the origiu of all these misfortunes as the construction of the wharves. But the matter shall not rest on this ground alone. For as the same method of improving is still pursued and threatens the City with total ruin, it is ol no trifling conse- C 80 ] quence. It is not contended however, that other sources capable of fermentation and of the generation of miasma for a few days, weeks or even seasons, have not been here occasionally; these have all been of the same nature and of trifling consequence. But Sir, probably you are now ready to ask me why similar wood mines in other places have not also generated the cause of Yellow Fever ? With equal propriety it might be enquired what the reason is, that we haye not Yellow Fever in the winter, in the spring, and all the year round! The cause begins as it were to be emitted in the spring, grows stronger and more plentiful through a considerable share of the summer, is strongest and in the greatest quantity at one place early, at a second less early, at a third late, at a fourth still later. At several places it does not get into action at all until the frost intervenes and checks the process which generates it. If then the quantity of this material were the same in these places this mysterious proces is modified by a variety of circum- stances, and may or may not be roused into activity as these contin- gencies inffuence the case. It might therefore be sufficient to argue,that in all instances where such nuisances can be pointed out as uot having generated the cause of disease, these modifying circumstances have so influenced the process, that the more powerful agents heat, drought, &c. had not had sufficient time to operate. But the premises on which the aforesaid objection to the doctrine of miasma is founded are radi- cally wrong. This cannot be received as an offset meriting argu- ment in explanation then ; most of these places did produce in the end more or less disease, and no doubt all of them some share of the cause. For example, the disease which appeared on the south west corner of the Point, where the cause is referable to a similar quantity of vegetable matter, commenced nearly as early as that of the east corner. The limits of each disease from each of these sour- ces were so circumscribed and their spreading so slow that not- withstanding they severally reigned as the independent and arbi- trary kings of disease m their own region, and unrelenting and in- satiate destroyed as they went, it was some time before the small intermediate space was occupied. So long indeed that there is as good reason to believe a third, a fourth and perhaps a fifth abet- ter stepped in and completed the line as that these two great rul- ers met and contendt d for an equal share of the spoil. Neither have, the diseases of this latter quarter been behind in grade, those of the former, for several years back at a late period of the fall season. The disease also had an independant origin in this City, first at Smith's dock, again near Pratt street bridge, Commerce street, [ St ] wW?1 H\ C°U?tynW^rf' F' P' F(,u"lai« st"et, Sugar House wharf near Hams' Creek, and out of the City in several p7aces AH these instances of origin may fairly be said to be examples of one depository ot vegetable matter becoming a laboratory of the cause in the same season and vicinity at different period?. *JJ!a -ime and manner in *nich ^e disease has appeared and spread, in most of the seaport towns in the United State!, and other dene!r;e,S.fSn",,a^ ?l uated> sh«"'d be received as cone usive evi- ofvpLlh,8 ^ °rlS,n' rd as lt is» ell known, similar quantities n«rno%t ll™T T J"* USed in many ofthese Places *'I ke purposps, this serves also to strengthen the argument respecting the nplnVy^orh^X"0-,, B? i?J Vtible. Sre not uS tbr fill ng afi thZc forf1;u,,d,D5 ^e foundations of houses and wharves iS for hev .IaP°rt t0WM- Vegetables are not absent from any town, nrp8i7, i'Tperab,e from towns and lhe waters ^S* "tier the present regulations. a The Vellow Fever has visited North America, in one decree or other, at the same season for more than a cent'ury, and I^s „0t been confined merely to seaport towns. We learn from Dr. Hewat and mortality as early as 1699 or 1700, by a disease which was afterwards understood to be the Yellow Fever.f In trolh" STif "i" i72f the summer was uncommonly hot," « the face of the earth parched," " the pools dried up," "when a diltemDW u^rfrT1^^ FEVER'" and '' -tptoffZ- hl 4« tV V"h,ab,tantS' rn 1733' as rcorded fcy the grand fa- ther of Dr. Prioleau, « the Kttoir Fever began to rage%arly in the summer, and continued until October." This was in Charles n°vn' «L*X^!l ^ iid "°* a,,ude t0 a^ other P"t of the cob. vL -,, «V!e ¥dlT FevV rased near,yas ™!ent m ™ the an, » « i» Jt? "V ebserved t0 fal1 most severely on Europe- nf it » « ? !i« and ,8' ma"y y°un5 Persoas a"d Europeans died ot it. In 1758 and 55, it appeared but did not spread." \t tins early period it is stated, that «in all these visitations (it, Charleston) ,t was remarked that it never spread" to nurses and other persons « in the country," or elsewhere, « though often car- ried there by infected persons." In other words, that it never was communicated from person to person, by the matter of con- * It prevailed about the same time in Philadelphia. tionIiiuL0KM?lly Ca!1Cd tHe,P1^ue by the inhabitant.. But from tradi. bXvcd tIT"?IT" v "'c0' aS U appeared in C^ston, *«» Delieved to be the Yellow Fever. See Kama's South Carolina, page. [ 82 ] tagion, out of certain limits of air, whatever the public opinion might have beeu with regard to the origin. According to the much lamented late Dr. David Ramsey, this fatal distemper " appeared also in 17*5, 1748, and all the years between these and 1792, but never so much as to excite public at- tention." " A few sporadic cases of it only," similar 1 suppose to the cases in Pitt street, F. P. in many years. « It raged that year and is 17*4, 5, 6, 7, 9, 1800, 1801, 2, 4 and 7, in its worst form." It appeared slightly iu 1803 and S. In the years 1793, 98, 1808, the disease is not mentioned at all. In 1806 it is only mentioned as having " occurred in a few cases under particular circumstan- ces." "In all its visitations it extended from July to November, hut was most ripe in August and September.'* Nor has it ever appeared ev»n in this hot climate in the winter after the frost had checked it. But in the hot season •' the Courts of Justice* were commonly shut up'' in former years. "Men fled from the City as from a pestilence." All this affliclisn in Charleston, has been the offspring of marsh miasma. Neither has the country in the vicinity of marshes and ponds been exempt from its baleful effects. Formerly the citizens of Charleston retired to the country for health, during the summer and fall mouths, but experience has shown that their lives were put in jeopardy there even when the City was healthy, and this turned the balance in favour of Charleston.! Other retreats such as sea is- lands, &c. have been resorted to since this change. But the most important discovery for the planter and even the citizens of Charleston, has been made in that state. Good health it seems can be eujoved within a very short distance of the most noxi- ous exhalations, if the southwest bide thereof is thickly lined with tall pine trees between the source and the citizens^. On these principles the villages of Waterborough, Springfield, Summer- ville, Pineville, &c. were commenced, and from the happy effects of • See George Chalmer's Political Annals, Page 541. t This is well known. The country people in the low marshy places went into the City to avoid high Bilious or Yellow Fever. See Dr. Kamsay, vol. 2. Page 97. i The manner in which these trees become useful is not understood. Neither is it known in what manner the poison exhaled is disposed of. It has been supposed that the growing trees absorbed it. But 1 think it most probable that these trees shelter the citizens in the same way that the walls of a gar« risen shelter those within them against cannon balls. I 83 ] the pines experienced at these place?, they soon grew up to their present respectable size. From such places as these the planter makes short excursions to his estate and returns before he has had time to receive the seeds of Fever. Such have been the improvements made in the health of Charles- ton, by destroying marshes, that notwithstanding the uncommon heat of the past summer and its southern latitude the \ellow Fever there it appears was " almost exclusively confined to strangers." Mill dams originate this disease in many places .Their water is stagnant; yet if a stream is large enough to set machinery in mo- tion the water is not so stagnant as might to you appear. But whe- ther or not it be from the dead vegetable matter overflown, in the first instance rendering the water destructive to the life of the stand- ing trees, not excepting such as live and thrive in perpetual ponds of water that has fell from the clouds and ponds which have no out- lets but by evaporation and filtration, it is a fact, that every living tree sickens, dies and soon falls into the water of these place's. And now (as is probable) the axe which fell great oaks, pines and all into the water, begins the work of death on the banks among mankind with aggravated rigour. The evaporated water in level places spreads some distance, and sows the weapon of disease and death wherever it goes. In the night it condenses into heavy dews or fogs and the cause is probably thereby better prepared to produce its effects. This corresponds with our case of late. The trade winds which serve to moderate the heat at Charles- ton are not felt in the upper counties in South Carolina. Hence the summer heat ranges from four to ten degrees higher at a dis- tance of 120 miles above Charleston. The uncommon calm and intense heat is probably still greater higher up. Miasmatic disease run into the highest grade there. A much greater proportion of deaths has been witnessed in situations previously healthy, during the second and third summer and fall seasons, near insignificant ponds with wood in them, constructed by persons not aware of their dangerous effects, for the purposes of'bathing and raising water to supply indigo vats, distilleries, cotton machines, &c. ike. Sec. than have befallen the people of Fell's Point of late. The slaves are less liable to take this malady than their masters, but far from being entirely exempt.* All must either retreat or encoun- ter a terrible risque. "Limited Epidemics" says Ramsay, "have been so destructive at differ- ent times to negro property, as to add much to the uncertainty of planter's estates." Eighty negroes given by an affectionate father to an only son, were in a few weeks reduced to forty-two, in 1780. "during the siege of Charles- [ 84 ] These incontrovertable facts added to those detailed by many others show at least that the product of vegetable matter (in a ga- seous state perhaps) and not the evaporation (fog) from pure wa- ter, is the cause of this disease. It matters not then by what name it is called—Our object is effected if bilious disease has been originated and propagated by it. But as the mortality commences at a corresponding season, and ceases when the frost comes, and as the sick and dead have had all the symptoms and appearances lately witnessed on Fell's Point among the sick and dead there, from what we call Bilious Malignant or Yellow Fever, it would seem very reasonable to consider these diseases the same. And if it is intended to take the united voice of medical men, whose opportu- nities of seeing and comparing diseases, have enabled them to make up an opinion, they have in many instances testified that these dis: eases are the same and are only modified by season, climate, &c. Long hot and dry summers favor vegetable putrefaction and noxious exhalations Wherever they are experienced and these ma- terials are found in a moist state. And awful would be the con- dition of our City (with all its vegetables and other appendages,) if the climate were uniformly hot and the seasons dry. Every local nuisance throughout the continent contributes some share in rendering the air impure. A foul condition of the air has been noticed in certain sections of nearly every country. But although at first sight, this has a show of being a peculiar * consti- tution of" the air" at large, it must be an error to receive it as such. This grows out of the great number of depositories of miasmatic ma- terials, which produce their several effects in their own neighbor- hood. If this poison were capable of rising high in the air and spreading far, (of whieh there is no evidence,; Heaven has happily decreed that winter as well as summer shall visit us, and this ba- lances the cause. r The air of 1800, it seems from the report of the learned facul- ty of medicine of this City, to the Mayor then in office, " affected ton" "many of the plantations in the neighbourhood of military operations" were " depopulated." Entrenchments were proper places for stagnant waters which would soon become filled with vegetable matter. \ . * To give this sweeping explanation for the origin of Yellow Fever is what Dr. Ramsay, in speaking of the Fever of Charleston says, "is virtually to acknowledge our ignorance." This loose manner of expressing ourselves when applied to Yellow Fever, is calculated to de more towards obscuring than enlightening the subject in the public estimation, and should be buried in the same tomb with its coadjutor the doctrine of contagion. [ 85 ] herds of horned cattle, dogs, cats and poultry*' as well as mankind. These diseases occured in certain local situations and not in every place where " the air" is inhaled to support life; and I apprehend they inusf have been distempers of place, which, although found in many parts of the country, were neither seen every where nor were they capable of being carried every where. The cause of them grew where the consequences were manifested. One of the diseases which affects cows when exposed to the opera- tion of powerful causes in hot climates it is fully believed is the very one before us although it goes by tht popular name of distemper. This malady prevails in south Carolina and Georgia, from June or July until frost, and sometimes kills whole herds. From its being al- together local several plantations there have got the name of distem- pered grounds. But this term is not applicable to a whole farm for there are certain fields on some farms where the disease is not known to have existed while others have a different character. In these fields the herds are carefully shut up during the sickly season at home. But if there is no convenient healthy field to be found on the farm they are occasionally exiled to other pastures. In this way many of these fine animals are saved from torture and death. If they have been raised on these plantations some of them will chance to escape even there. On the other hand, if " foreign" cattle, or such as have been raised without distempered grounds, are brought into them at this time, they are almost sure to die. Consequently this point is carefully enquired into, and has its proper effect when cows are to be bought, and sold, aud transported from place to place. The attack is ushered in by a palpable cold stage. This lasts several hours in some instances. During this stage of the disease the animal lies prostrate. A high fever now comes on, and drops of blood or bloody oil are seen to ooze from the skin. The eye is heavy and red. The urine is bloody—perhaps it is some- times pure blood, but in the advanced stage it is occasionally black. Hsemon hagies sometimes come on from the bowels The animal breaths with great labor, groans excessively and bespeaks a degree of agony not easily conceived. Becoming restive it springs up and runs headlong into any water that falls in the way. After drinking largely it lies down uever to rise again. If it does not get to water the dying scene is more tedious as well as more agonizing. This distemper is esteemed irremediable. Death generally takes {dace on the third or fourth day, nevertheless one or two out of a arge number may chance to recover, even without means, where the disease seizes on a large stock. M L 86 J Dissections have been often made and witnessed, but all that I remembered of the result, is, that an uncommon secretion of bile was seen in the gall cist—that the tallow (which the negroes take out in great quantities for making soap and candles) is invariably yellower than usual, and sometimes quite as much so as bees wax, and that the contents of the alimentary canal are quite dry; and the coats thereof inflamed. The color of the tallow is the best criterion by which to judge of the nature of this tremendous distemper. But all these facts would seem to show that it is not only a local disease, but that it is the very disease which affects man about the same time and place. They do show at least that this malady depends on miasma. This is of the vegetable kind, and is snuffed up by these animals while they prowl about iu search of food in swamps, mill dams, &c. &c. And every thing whieh has so important a bear- ing on this subject interests us ail. For the facts on which this statement respecting-this distemper and the fevers of the South are founded, I am indebted to a friend : iu some measure, but I have witnessed several of them myself. The report of the Faculty thus alluded to, with the excep- tion of a paragraph which admits the disease to be contagious in a domestic way, is still a good guide, and I beg leave to refer you to it. butl think as it is acknowledged on all hands that the name of Yellow Fever is not proper, and that its name furnishes a great stumbling block to the public as well as the young practi- tioner, and as the Faculty have dwelt upon the diseases of animals so much in this report, they had better have changed the name of this Fever. The Cow Pock is contagious in a domestic way, ami it Mould have been quite as philosophical to have referred this Fe- ver for its origin to the cow, or to some other animal, and to have given it a corresponding name as to have admitted this domestic kind of propagation by contagion. The emission of gas has been witnessed around the wharves where the Fever began last summer on the Point. The bubbles rose with a regularity of succession, and in a manner entirely different from the escape of sulphureted hydrogen gas, so of- ten noticed to rise from the muddy bottom. Their escape was quite' as equal as ever gas has been seen to rise into a glass receiver in .» chemical laboratory. The eseape was thus Visi- ble only when the front or abutment of the wharf Mas below the waters surface and closely built. There is therefore no knowledge of what may have escaped through the vacuum between earth and water.' Whether or not this gas had any smell could not be positively ascertained. In attending to its escape however, C 87 ] from time to time, and making efforts, such as need not be detailed here, with a view to discover the qualities of it, the ammoniacal smell, or rather a smell resembling muriatic acid gas—a sharp pungent stinging taste or sensation seated about the fauces, and an intoxicating effect on the head has often been experienced. The usual marsh miasmitic smell could not be detected here at this time. After frost it became plain for a few days to every one who attended to it. 1 will not try to account for this fact. This gas was strongest and less mixed with other air here it is helieved than at a distance from this source. In its flight it would seem to have lighted upon the heads of the unthinking as they moved through the streets and other places within its reach and to have filled damp houses, closets, cellars, ships holds, &c. &c. It has often been said (and correctly too) that in the progress of Yellow Fever the first and worst cases are generally met with in damp places, particularly in old sunk wooden houses, with unsound foundations, &c. &c. Here no doubt something is added to the powers of the cause if it is not generated in sufficient quantity to do the business single handed. Dry, close, brick, stone and other houses without cellars, made still dryer by being shut up with fires in their chimneys, conse- quently are not so likely to be invaded either from above or below by this dread king, who captures and slays under ordinary cir- cumstances whole armies of children and other persons. In this way,may be accounted for,the good health of some families • who of late, regardless of advice and importunities, chose to make " firey prisons'' of their onn houses, rather than submit to exile. The cause was so strong as to sicken all around them yet by firing their chimneys and .keeping within doors they escaped. Fell's Point at large is not unhealthy generally speaking. The two corners project out into the water of this place and suffer most from Bilious Fevers. But these make a very small proportion of the place. Probably not the hundredth part thereof. It was six weeks after the late calamity commenced at these places before it had .spread much more than one hundred yards from the place of origin. Nor did the disease ever originate more than two or three hundred yards from some portion of the water, encircling a considerable portion of the place. Towards the close it became stationary for some time. Powerful winds might have driven it further, but *« Heaven seemed to rule the storm," for we had no such winds in the necessary direction. C 88 ] The frost has conquered our enemy for a season, but if it is as warm next summer as the past has been, we may expect his fire to be lighted up again. For the prevention of similar occurrences, it is not my place to point out " particular nuisances," and " re- commend" their removal, further than leads to the true and grand author of this disease. That duty and many other important du- ties now totally neglected, should be the business of a responsible executive medical counsel, who would not wait for the next door "neighbour woman" to say this " Pig Stye," or that hot bed of vegetable filth is offensive, with a view to shift off his shoulders the mighty censure attached to having them promptly removed, The laws of our City do not make such officers responsible for the lives lost by this unwarrantable tenacity to popularity, but proba- bly the laws of a higher tribunal will. The quality of nuisance is enough for me to name at present. Wood, therefore, and all other vegetables in a moist and perish- ing state, during dry hot weather, long continued, in wharves, in ships, in ship yards, to a considerable depth in the earth, in all lots, (especially where the water stands long above ground,) in the foundations, cellars, &e. of all houses, in the streets, gutters, sewers, wells, privies, stables, slaughter houses, warehouses, &c. &c. are liable to generate in one degree or other the cause of eve- ry form of Bilious Fever from the mildest up to the worst grade of Yellow Fever. And certainly the rational course would be that of scrutinizing into every thing of this nature, and removing, all that it is practicable to remove. If it is not considered advisea- ble to undertake the removal of the great progenitor of the cause, •(the wood used for filling in) you "can try" to bid defiance to the monster, hy shutting up every window at which he dares to show his frightful face, and prohibit by law and penalty, the future use of vegetable matter for filling up if not for building wharves. If the above ideas are correct, it is obvious the introduction of more fresh water into the Basin would be an indirect method of improving the health of this City of no small magnitude. Health Sir, is all important to a great and growing City like this. Wholesome laws and improvements should relieve us of Yel- low Fev« r. The Board of Health, with you at their head, have already made the honorable and distinguished declaration that this disease is within the powers of the Corporation, and no doubt you will accomplish that which is so desirable and which is known to be in your power. The salvation of this City, as it respects another point to be in- volved in accomplishing such improvements as will secure us against this disease, is also in the power of the Corporation, t 89 1 In filling up the Cove, and the marshy part of Harris* Creek, the wash which now carries down from the hills above the Point, &c. such enormous quantities of pure sand and clay into the har- bor as has already ruined some of the best wharves, and cannot fail, if long continued in its present course, either to involve the City in heavy expences for removing the sand or to give to it but an ephemeral existence, by blocking up the harbor so as to make the wharves inaccessible to the shipping, would be found to further the health preserving objects considerably, without much expense if it were turned into these places. The natural course of this wash is into the Cove hut some of it can be turned into Harris' Creek also, and probably with less cost and trouble than those of removing as much sand as is lodged in one or two streets during a year w hen on its way into the Basin. This wash moreover fills many cellars with water, in the course it now takes, and is not only a heavy expense, but a serious nuis- ance in all points of view, whereas it might he turned to the best account for filling up. Since all have suffered in one way or other by our late visita- tion, the good sense and public spirit of your fellow citizens can- not fail to prompt them to move, hand in hand, with you in the accomplishment of every practicable improvement. It is not advancing too far therefore to congratulate you Sir, on the speedy approach of a new sera of things—when the stupend- ous structure, (or rather nuisance) the doctrine of contagion, as it regards Yellow Fever in this City shall be demolished in all res- pects—when the true cause will be received and acknowledged as our own ill begotten child—when we shall attack him as the most ferocious and cruel of enemies—when this author of our past evils and of probably future calamities, such as are consequent on the most destructive of all diseases shall cease to be fearful—when our character for good health shall be re-established, and property shall regain its wanted value—when quarantine laws, founded in error, shall neither oppress the honest merchant nor annoy the just foreign trader—when gloom and dismay shall deliver up their thrones to that chearfulnes and activity consequent on security from pestilence and a just spirit of emulation—and when prospe- rity aud good health shall move and be enjoyed in all our circles both east and west of the Falls. I should do violence to my feelings not to recommend to your most earnest attention the poor east of Hartford Run. You know they are numerous. C 90 1 Commerce is the main spring of this City. Fell's Point is as it were the key thereof—it is therefore important to all. But this same business which diffuses life, vigor and activity to the whole City, brings down upon.this part of the City most of these poor. They have all been, more or less, directly or indirectly engaged in commerce, and have felt its depressed state comparatively speak- ' ing, a thousand fold more than the merchant. This is independ- ent of their late suffering, and speaks a strong language in their behalf. Some thing ought to be done for them by way of providing relief for such as are in real distress. But their future health and happi- ness would be greatly promoted by "exterminating all nuisances of the character of tipling shops," by strengthening or improving the watch, and by providing employment for the idle. Street begging should be prohibited. Dissipated, lewd and worthless characters, who will not work, should be dealt with according to the existing laws. Great improvements in the moral character of this part of the City are already visible to all, and if this good disposition should be fostered, the general health will be very much promot- ed, and we will reap the superior advantages of morality. Yours Respectfully. , M. Q» L 9* 1 To Edward Johnson, Esq. SIR, I have received your letter of the l9t instant. The enquiries contained in it on the subject of " the late Epidemic" of this City merit the most ear- nest attention. With a calamity so signal as this Fever has been, still fresh in our recollection, all, should, exercise the utmost research with a view to discover its origin and cause. Unless we can be satisfied in these respects there can be no well directed measures adopted for our future security, and we shall always be liable to re- turns of similar scenes of torture, death and mourning. Viewed in any light this subject is important—It is full of interest. Life, health and prosperity are all involved in it. Nor is an inquiry into this subject less full of diffi- culties than it is full of interest. The learned are at variance in their opinions on it. There are no fixed rules—no generally acknowledged doctrines to regulate us. On reasoning from the same premises, diversified conclusions are drawn. Wild hypothesis and false theory, as well as absurd nonsense sometimes captivate the fancy and gain the ascendency over 'plain facts, and deductions urged with the most forcible and eloquent reasoning. " This" Sir, " is a melancholy and mortifying ex' position." [ 92 ] That diversity of doctrine is found to pervade every science is admitted, but that this circumstance offers any thing in extenuation of this case is denied—The " truth has come to light as respects the great point,''9 (the origin of this Fever) aud it should be cherished; and should not be obscured by a revival of exploded ideas and once popular prejudices. These incendiaries often usurp the throne of reason and bid defiance to ar- guments. Beside the imperfections in medicine which tend to render this subject difficult, the whims of the illiterate are to be encountered. In cities like this, local inter- ests, as well as prejudices, are involved in an enquiry into the cause of pestilence. And they have a power- ful tendency to defeat the truth—They throw a cloud over literature—they make men stupid and blind to their own fate, and they cause a spirit of resentment to spring up against the one who dares to point out a nuisance to the proprietor, and to stigmatise it with the character of destroying the greatest of blessings (health.) It is nevertheless a consoling circumstance that these unjust feelings of enmity and resentment can only ex- ist with men of little minds. With the liberal man of honor, full scope to impartial investigation will be al- lowed, and if that purity of motive which should actu- ate every one who attempts to say any thing on this sub- ject, is observed the author of any exposition as well as the executor of any measure having in view the general good, will be viewed in a very different light by him. L 93 ] Property without health is worth but little compared to its value when accompanied with this rich blessing. In adopting measures to preserve the general health you will preserve the health of the property holder and you will silence his clamours of consequence. But the indignation of many of the vulgar, must, and will, be excited in the first instance. This is a circumstance much to be regreted, yet it is not a sufficient reason for withholding one ray of light which promises to be useful. The truth is called for from the silent tomb—it is called for by the tortures of an immense multitude at home—it is called for by the inhabitants of sister cities, and it is called for by the public at large in a language uot to be resisted. There- fore, let the medical man, who regards the fate of his fellow man, sternly and resolutely fix upon and expose the ruinous consequences of the existing nuisances of this place, and let the Corporation fulfil their pledge to the public, and we may be secured against Yellow Fever* Perhaps Sir, on viewing this subject in an attitude so highly important, responsible and delicate as I do, a becoming diffidence would plead for me a sufficient apology if I were to decline pursuing it any farther. This inference is the more reasonable since there are so many aged and eminent physicians among us, from whom it is natural to suppose, you will receive every requisite information for the use of the City Council. But a sense of duty, heightened by the recollection of N C 94 ] the scenes which I have witnessed, and the part which I have borne in the misfortunes of this particular sec- tion of the City—a desire to pay that respect which is so justly due to your polite request—and an inclination to redeem the hasty promise which I have made to you, all urge me on to attempt that which my pen shrinks from; and which, should have fallen into abler hands. If however, it should be received as a correct princi- ple, that " in every disputation facts, with their analo- gies and arguments,with their necessary bearings should overbalance the weight of authorities," the following pages may be of some use, for they consist chiefly of historical facts and the application of certain well KNOWN NATURAL LAWS. C 93 ] THE SEASON. THE year which has now nearly terminated has been re- markably warm, dry and calm. In the months of January, February and March, we experienc- ed an unusual small quantity of rain, frost and snow. During these months the ice on our waters was inconsiderable compared with that of former years at the same season. In April and May, the weather was much warmer, as well as dryer than we are accustomed to experience. The farmers in ma- ny parts of the neighboring country sustained great injury by this heat and drought. The streams were so reduced as to stop sever- al mills. In June we experienced a degree of heat nearly equal to that of tropical climates. On the 1st of this month at 2 o'clock, P. M. the mercury stood above 74° of Farenheifs scale, and was never so low again during the whole month. On the 9th it stood at 96°. The mean degrees of heat for this month was 84*. The prevailing winds were from the S. E. quarter about four- teen days of this month. For the remaining days they were di- vided and blew from the N. W. N. E. and S. W. nearly an equal number of days. We had three rainy or showery days in this month, accompanied with lightning. The" water which fell amounted to 1 1-10 inch. In July the weather was still hotter. At 2 o'clock, P. M. on the coldest day (3d) the mercury stood at 74° on the hotest (31st) at 98?. The mean degrees during this month was 86°. There were several showers, during which, fell 2 2-10 inches of water: hut there was only one cloudy day during the whole month. The prevailing winds were much as in June, about one half be- ing from the South East. In August the state of the thermometer at 2 P. M. was as fol- lows : The highest (on the 14th) 100". Lowest (24th) 72°. Mean i6». N. W. wind* 3 days, N. E. 8 days, S. E. 14 days, S. W. 6 days. C 06 ] The rain which fell during this month was 4 S-tO inches. This quantity of rain was inconsiderable although it far exceeded that of the two preceeding months. During forty-two days of these three months, you perceive Sir, the breezes were from the South East. There was but little mo- tion iu the wind for tbi- period from whatever quarter it came. A constant calm, drought aud extreme heat, prevailed and character- ized the season I bus far. The month of September was not remarkable for any thing hut the stverity of the equinoxial gale. Neither was the month of October remarkable. The months of June, July and August of which 1 have given you the most particular account may be said to have ruled the Bilious Fevers of the season. And by a refer- ence to the records of the weather of these months in former years when Malignant Fevers have prevailed, you will find a great simi- larity to have existed. During the past summer the tides were considerably lower than usual. Several correct observers say that the water of our Basin has sunk three feet lower than it has been known to sink in ordi- nary seasons. The water was nearly motionless, and had a dark green and foul appearance. This appearance was most remark- able about the wharves and docks as shall be shown hereafter. TOPOGRAPHY OF THE CITY. ON turning around and taking a review of the places where this disease had its origin in this City of late, a superficial obser- ver will be able to point out but little that differs from many other parts of the Cily not invaded by this disease. There are notwith- standing most important distinctions to be drawn. These are in part natural but mostly artificial. Those who have suffered most from Fever, dwell on a soil made with their own hands, and with what propriety and judgment will be shown This City is located in the vicinity of several marshes. The Pa- tapsro has numerous necks, inlets and creeks connected with it, all along its course fiom this City to the Bay, a distance often miles. Here the ground at large lies low. The swamps abound with Tegetahles—These die and putrify annually, and furnish miasma m abuudauce with all its direful consequences* C 97 ] These marshes do not exist extensively nearer to town than two miles. The marshes located at Harris' Creek are nearer to Fell's Point than any of the others, and these are almost filled up by the wash from the high ground. The laud in this vicinity is alluvial. It is mostly made up of course sand. The neighboring country, off the water, is high and rough. The Falls, as you are aware is a small stream. Small as this stream is, it affords the chief of the fresh wa- ter with which our inlet or basin is supplied. It penetrates and de- vides the town, but its water may be said to be nearly stagnant be- fore it mixes with the basin water at large. During the drought of last summer this stream was reduced to a mere rivulet. The ground on which the great body of this City stands, is high and commanding, with a descent to the south It is solid and dry. The low ground around the waters edge generally, from Federal Hill to Harris' Creek, has been formed in part by the sand wash- ed off the high hills, but in a great measure by earth hauled down from different places for the express purpose of raising it higher than it had been thus raised by the wash. The ground in the neighborhood of Smith's dock, w here we had the first cases of this Fever, is low and wet. In this place large quantities of shavings and other vegetables have gradually raised up the alleys, lumber yards and lots of this place at large. Se- veral of the cellars here were found wet and filthy when the Fe- ver first appeared. OF FELVS POINT. A considerable proportion of the paved and unpaved street* of this part of the City, have a level appearance. Their decent is nevertheless sufficient to carry off into the Basin ail the rain and other water that should be carried off. This water in running off carries many filthy articles with it. Some of these level streets have been built on made ground; namely, ground reclaimed from marshes and the water of ths Ba- sin. This made ground lies chiefly on the east side of Fell's Point, between the water of the Basin and the two lower squares of Ann street, a space which comprises a mere speck of this place. The natural foundation here is clay. This artificial ground has beeu made, or rather raised, to the present level with sand, which has been hauled down from the neighboring hills, and mud (as it is called) which has been dug out of the water and thrown up around the waters edge by the mud machine. L 98 ] The artificial ground of Wolf street, at the lower end near the water, as well as the lots in that neighborhood, and the ship yards generally, located near to and binding on the water from this place to Fountain street, (a distance of four hundred yards perhaps) is mixed with shavings, chips, saw dust, and other vegetables. But these vegetable articles are not entitled to the character of perma- nent nuisances; their fineness of division being well calculated to render them speedily perishable. If they have once fermented and perished they leave innocent soil. The recent examination of Wolf street showed that the remains of these articles which lie in that place, had become innocent earth. They had fermented in the early part of the summer. And during decomposition, they had given off their poisonous ef- fluvia, and like a Bee, who had lodged his fatal weapon in his adversary and become forever disarmed, these articles were now reduced from the power of destroying, to complete innocence. At the lower end of Pitt street, where the disease first became manifest on Fell's I'oinl, the ground is natural, solid and dry. Here there was iu former years, a high ridge of land, which was used as the foundation of a fort. The cellars here, as well as the cellars around the wharves of this place generally, are dry and good. They do not become filled with the water of the Basin during high tides. The cellars a little off from the wharves are liable to become wet towards the close of winter; and still further off at I'lje foot of the hill, to be named hereafter, they are wet the greater part of the year. The water lots here are wharfed out and the shores secured against inundation. The greatest swells, except when we have vio- lent gales, are not sufficient to overflow the ground. There is no wet soil exposed to the action of the sun from this cause. The truth is, moisture was deficient in our streets last summer. The Cove, hereafter to be described, which is at a distance from the seat of the late disease, forms the only exception to this diffinition of the condition of the water lots. So far as the lots bordering on the water may be composed of mud, raised up from the bottom of the Basin, it has become a question, whether or not our soil is healthy. For my own part, I am of the opinion that this article is innocent and wholesome. The most of it appears to be sand, which has been washed down from the rising grounds into the water by the floods. As much of L 99 ] this ground as is composed of vegetable soil, may with propriety be called the inoffensive product of that fermentaiion by which the raw vegetables have given off the noxious effluvia which was ori- ginally contained in them. Having already gone through this pe- culiar fermentation and given off this poison, it is idle and absurd in the highest degree, to suppose the same vegetables thus dissolv- ed, broke down and changed, so as to leave nothing but their earth to be capable of undergoing the same process a second time, and giving off the same destructive vapor again. These vegetables have been exhausted of the poisonous cause which they once con- tained m them. This has been done by the first process. And they are now as innocent as sand. There are many facts which prove this opinion. Several of these have occurred, and they still continue to occur, in common For example: It is well know that the mod which was thrown up at the new dock, a few years since, and which lay there in great quantities spread abroad and exposed to the sun's rays, did not produce Yellow Fever-that which has been lying along the tails and along the Block of late years, has not produced thi?dis- ease-that which has lay exposed in like manner in the neighbor- hood of Pratt street, (where there are made grounds also) has prov- ed harmless although exposed to the hotest season. These facts have, in their result, astonished several, who, in the- ory, esteemed this mud the very kind of nuisance which was capable of generating the cause of this disease. Several other facts to the same purpose have taken place in this City, and are no doubt fami- liar to you. They need not be named in proof of this position. But I have witnessed several similar, and perhaps more powerful exam- ples in point elsewhere, some of which shall be stated to you. In the hot climate of South Carolina 1 have seen several lar«»e mill-dams opened at an early period of the summer season, ex- hausted of their water and the mud in their bottoms exposed to the action of the sun for the remainder of the summer, without Yel- low Fever, or even Bilious Fever following as a consequence. In- • deed it was the custom there with some of the proprietors of mill- dams, to dry them up in the spring, for the purpose of preserving their own health. If they did not pursue this course, the stagnant water in the dams being charged with vegetables; fermentation took place, and the vapor arising from an extensive surface origi- nated disease. Dry vegetables and mud on the other hand re mained harmless [ ioo ] These measures are not always necessary however. When the stream on which a mill-dam is erected is small, and liable to cease running in the summer, they are indispensible to health. But on large and running streams they are unnecessary, and of course not practised. An excess of fresh water over the vegeta- ble matter contained in a dam (although it operates in a different way from that of dryness) produces the same good effect. The ground which comprehends the greatest portion of all that part of this City lying east of the Harford Run is high. A great share off'it is known by the name of Fell's Point. [I have not the exact limits of this place.] Some of these high grounds, or hills as they are called, look down upon the whole City, the Har- bor, the Basin, the River and a considerable extent of the sur- rounding country. The Eastern Shore of this state can be seen from one of these hills on some occasions, as well as Kent Island and certain parts of the Bay. These rising grounds therefore, present us with situations for future improvements, possessing all the advantages and com- forts of fine prospects, salubrious atmosphere and convenience to the weight of our commerce. They are as yet but partially improved. Those who have inhabited these improvements have rested in perfect security during all the past calamities experienc- ed here from Yellow Fever. The very appearance of these hills is quite sufficient to convince me, that nature never intended that this fatal disease should reach the inhabitants, and that they should be hailed by us all as the abode of "natures best gift, health." Under such circumstances, our condition may be contrasted with that of the inhabitants of New Orleans, Charleston, Philadelphia, aud other large level cities. They have no high hills to retreat to in full view of their pro- perty on the wharves. We still have high ground enough for the inhabitants of a large City to retreat to, and transact business. The raw vegetables used for filling up, are the offending agents here at the present lime, and not those which have been already reduced to their different elements and of which there is nothing * remaining here but their earth. A large quantity of vegetable matter has been used for filling in the wharves of this place. This consists of pine cord wood, pine tops, old barrels, chips, shavings, &c. &c. The pine wood constitutes the great body of this article, and will be liable to ge- nerate miasma for a series of years, whenever a season bucIi as favors its generation occurs. There is no prospect of this wood becoming innocent until it is all dissolved, and its place supplied t ifli j hy earth—in other words, until it petrified. And this is a process which requires age after age to accomplish it. I will speak more fully of the construction of these wharves and Kjf their consequences hereafter. The shore of this part of the City is naturally winding and crook- ed; but, it is indented by a large number of wharves, docks, inlets, &c. formed by art. The whole of this place might be said to stand out in the Water, for probably the line of shore binding on the wa- ter is ten times the length of the space comprehended by running a line across the neck of land lying between the Cove on the east*j and that on the West, by way of Fleet street. On taking a view of the out lines of the shore or edges of the wharves at large, from the Cove on the east to the Blockf, it pre- sents us with a figure resembling the Apothecary's drachm mark (3) in extenso. The point which 1 shall call the south east eorner of this place is the first and most prominent turn on the back of this figure. This corner is quite narrow and stands Out in the water. Pitt street is the only street which leads to the water of this point* It runs obliquely down this neck of land in a south east course. The south west corner of the Point forms the last turn of the drachm mark. This place is also prominent and is much exposed to the heat of the summer, but not quite so much so as the former corner. The Cove, on the west of the Point, (and north of the Block, and south west corner, as aforesaid) lies between this place and the great body of this City. It is in fact a foul core in the heart of the City. On viewing its edges this place may be compared to the letter O. It comprises about twenty acres of marsh and water. About one third of this water washes the shores of Fell's Point. This shore, and the shore of that part of the Point described as resemb- ling the drachm mark, make an unequal circular line around the improvements of the place of near two miles. Thus you see Sir, we are nearly surrounded by water. But I am thus minute in order to show your council how much more the places, where the disease originated, are exposed to' the action of the sun than other places, as well as to show that the disease did not originate in the vicinity of the Cove. The places named will be seen on your plat of the Harbor. * Formerly called Morgan's Cove. J- This Block binds on the great Cove on the west of the Point. L ioa ] THE DISEASES OF THE SEASON. THE diseases of this year have been characterized by the name of Epidemics. Such diseases have no doubt prevailed in many parts of this country. But as we have had no disease which has "become general over the whole of this City, it is not fair to speak of the Epidemics of Baltimore The Yellow Fever as well as other diseases have prevailed on Fell's foint, but, the whole of this place has not been invaded. It would therefore, appear more appropriate to use the ord Endemic instead of Epidemic. If Epidemic is used the term can only apply to Fell's Point. From the commencement of this year to the present time gene- ral diseases have prevailed here. From January to Ji:ne scarla- tina, measles, cholera Infantum, whooping cough, dysentery, &c. all prevailed and succeeded eaeh other. All these diseases have not been owiug to the same cause which produced the Yellow Fever. It is however a fact, which should be well remembered, that a bilious habit was readily discoverable in the whole list of patients who suffered from these diseases here. Several cases of Scarlet Fever were attended with malignant symp- toms. These circumstances are mentioned in order to give you some idea of the rise and progress of the eause of the Bilious Fe- vers which shall be hereafter named. In the south east corner of Fell's Point from June to August Bilious, Intermitting, Remitting and Yellow Fevers became the prevailing diseases, and they, succeeded each other, as the season advanced., About the 22d day of July, the milder forms of Bilious Fevers be- gan to put on malignant symptoms, and they thus grew, more and more aggravated, until the whole of them wore the highest charac-. teristics of Yellow Fever. On this day, afire broke out here, to extinguish which, required extraordinary exertions. Many of the inhabitants having engaged in this labour, they, became debilitated thereby, and of consequence, they were rendered more liable to the inveterate operation of the cause of these diseases than they had been previously. These facts, furnished the most conclusive evidence that the Yel- low FeVer grew out of ordinary Bilious Fever, and of course, that it was only an aggravated variety of the same disease; and they should be marked down as the key by which to unlock the true author of our calamity. 1 am the more bold in urging this position, since it L 103 J will be found to correspond with the observations of many of the most able physicians who have detailed the result of their experi- ence in this disease, as well, in, several parts of the United States, as elsewhere. At this time the important question with regard to the cause of those anomalies, or, high-toned Bilious Fevers, was agitated. The idea of this cause being of foreign origin probably never en- tered seriously into tbe mind of any one who had a right to make up an opinion. There were nevertheless several who zealously sought for such an origin. Their enquiries, were, all in vain. The consequence was, that they abandoned their prejudices and precon- ceived opinions. It was fortunate for the subject, that no vessel had arrived under such circumstances as were considered necessa- ry to account for the disease in that way, and the good sense of the enquirers rejected the ridiculous alternative of taking the case for granted without good grounds. Several other persons sought for the putrid effluvia of hides and other animal matter to account for this disease. This was quite as irrational, and of course as unsuccessful an attempt as the former Some, contended, that an union of animal and vegetable effluvia was indispensable to the production of this disease. These were disappointed also, as. -night have been expected. Nothing ean be more absurd than to expect the same product, from materials so opposite in their nature, as are, vegetable and animal matters. But no animal matter existed here in a putrid state at this time. There were others, however, who conceived the disease to be ow- in" to vegetable effluvia alone. They sought for a source from whence this cause could arise. I was among this class of the in- vestigators into the eause—In other words, 1 searched for a natu- ral, rational and indigenous cause. It is acknowledged that the remote cause of Bilious Fever is ge- nerated, in hot seasons, on low, moist, ground, covered with decay- in" vegetables. The filth which is suffered to accumulate by the neglect of duty, acting in concert with situations naturally lia- ble to become unhealthy, may, and often does, furnish all that is re- quisite to the production of this disease. Such being my impressions at the time this disease appeared, I took pains to point out. all articles of the vegetable kind that I could discover, which seemed likely to become putrid and offen- sive. By removing such articles as seemed likely to be productive of miasma, 1 conceived, the disease might be checked. t 101 i It was at first hoped that this unfortunate section of the City Slight experience even spontaneously a happy deliverance from this disease, similar to that which had bten previously experienced at Smith's dock. An example which justified me in hoping for this relief earlier than frosts, had also occurred at Philadelphia. The disease had continued to spread and rage in the most agravated man- ner however from its commencement until about the 24th August; and deep despair began to bang o*er u's I now reported a large number of additional cases of'»Malignant Bilious Fever,'' pointed out their origin and urged forcibly, '• that some powerful cause cer- tainly existed about the lower end of Wolf and Pitt streets." At this time 1 had beheld the natives, of all ages, as well as the foreigners falling victims to this malady. The youths of both sexes were pecuiiuly liable to an attack Ihe debauched could not be paid to suffer, for of such there were but few if any to be found here. On the evening of the day on whieh this report was made, the Board of Health accompanied by your honor, came down to the place aforesaid, with a view " to search for the cause and exter- minate it if possible." The reports were regularly called for, and received after this time, for what purpose, or to what advantage, I know not. On this interview with yourself and the Commissioners of Health several nuisawces were pointed out. Among them were a few old and decaying arks, some hulks of vessels, some masts and spars ly- ing partially covered with water, and some foul ballast. Theso were esteemed moveable nuisances. The ballast of the ship United States having been recently landed on Donnell's wharf and found to be foul, it was also consi- der d a nuisance, although it could not be said to have had any share in originating the Fever. The Fever had existed several days previous to the arrival of this vessel. The removal of this arti- cle by water was recommended, lest the hauling of it through the Streets might impair the air for a time. The chips, shavings and other vegetables which have been nam- ed already, were pointed out, as sources, from whence, the cause of this disease was emitted. And such measures as were calculated to extinguish these sources of mischief and prevent farther exhala- tions from them, were named. This perhaps was my duty as a citi- zen,* but eertainly it would have come better from responsible * Several other Physicians also attended this meeting. [ 405 1 medical counsel. A Board of Health totally unacquainted with, the very object of their commission, could not be expected to do their important duties correctly. The execution of such measures as had been proposed, was soon attempted; and had progressed considerably,in a few days. And I am sorry to say what was done was at the expense of two valuable lives Frederick Reese and------Trimmel both took the disease while engaged in this business, and both died. Each of them left wi- dows, and the former several orphans. 1 have already recommended these destitute widows and children to your care. But I mention these circumstances here as an important lesson: for, this work might have been done at a proper season, in perfect safety—It might probably have been done even then, by so large a number of hands a3 would have made the exposure to the cause short, and the attack less certain at least. The ships at large were hauled off from the wharves in a short time. This measure relieved us of rotting hulks, and saved the hands on board such vessels as were in a;ood order from the effects of the noxious vapors whieh had been plainly manifested to exist about the wharves. The ballast and many other moveable arti- cles, were taken away by water. The shavings &c. were covered with earth and lime. A considerable quantity of lime was spread abroad, and strewed about in the gutters and several other damp places in this vicinity. But all this was done in vain. It availed as nothing. This dread- ful malady spread its ravages and grew more aggravated as the season advanced. It became a general disease of this place previ- ous to the last of August. It was now evident that something deeper rooted and more exten- sive than any physician or other citizen had named, still remained to be discovered, in order to account for this disease. From the above named interview with the board of health, I had taken great pains to prevail on the inhabitants to retire from this place. Aboot this time you were also importuned to use your in- fluence and authority to the same effect. Your co-operation as far as your influence went was given with advantage. In the mean time a disease of the same character, had sprung up at the south west or opposite corner of the Point. Here there were but few visible nuisances—None were seen above ground worthy of notice. [ 106 ] The fomidations in this quarter are natural, solid and dry. 'Chi streets are clean. The cellars good. No filthy nor foul odour*, can be perceived. The inhabitants are among the most wealthy. They are orderly—They are decent—They are cleanly. It is a gross libel to say that our first cases of disease on either corner of the Point, originated among the drunkards and disorderly. Even when the disease spread, such characters were not. the most suscep- tible of it. Yet their chance for recovering, when once attacked was but slender indeed. The Fever in this latter place, in its beginning, also put on all the inferior grades of Bilious Fever, and grew up to the highest grade of that disease. It spread along the water until it had met the Fever from the opposite quarter. Deep gloom and dismay,were now.pictured on every countenance. The enquiry what shall we do to escape this destroying enemy, was reiterated again and again. Many who had hoped for a speedy termination of the disease, and others who had determined to brave the storm, now shut up their houses and fled for safety elsewhere. There were nevertheless some, who were foolish and hardy enough to remain at home when it was iu their power to remove. The condition of the poor was now pitiable in the extreme. Their humble dwellings had been to them as sweet as the mansion house is to the rich man. Their prospects were ruined. They had not the means to procure similar dwellings elsewhere. Many of them laboured under chronic diseases, which made them view an encampment as the picture of death with all its horrors. Others possessed, it is true, superstitious foibles,and raised up unreasona- ble objections to removing. But this was natural to them as well as other men. The result of all this was, that many of them remained behind as a prey to a cruel enemy. And these detained others who were willing to endure the greatest hardships elsewhere, but were also willing to remain and nurse the afflicted. Amid all this confusion and universal dread of disease, the pre- vious question, why such should be our miserable condition, was frequently propounded. And well it might: for it was justly urged (hat vegetable fermentation was a process, which, under ordinary circumstances and with a moderate quantity, of the material, would extinguish itself; and of course, if the Fever was owing to that pro- Cess it would also subside with the fermentation, instead of running on until frost. The question therefore was not then solved to the satisfaction of any one. C 107 1 At this moment it was intimated to me by a wharf builder, (for ihe first time that I had ever heard it) that pine cord wood had hmn thrown into the wharves for the purpose of filling them up to the proper height. There being several large wharves on the south east corner of the Point where the Fever first commenced, I now directed my enquires into their condition. These wharves had been built thir- ty or forty years. Cord wood was cheaper at that time than the hauling of its bulk of sand. I made it my business to enquire what quantity of Wood-had been thrown in, &c. &c. No history of the improvements of this place having been recorded, my information could only be gained from the inhabitants. Many of these from whom information was to be expected had removed. At length I fell in with Richard Waters, Esq. who informed me with all the frankness and candor of a gen- tleman, that immense quantities of pine cord wood had been thrown into his own and other wharves in this neighborhood. '["Several- other wharves around the Point, and elsewhere, have been filled up in like manner/] By making a proper personal examination and further enquiry of others, i found, that in erecting these wharves they were encircled in the first instance by a row of piles, whieh had been firmly dri- ven down into the mud some distance out in the water with a pro- per apparatus. For the purpose of filling up a circle of piles, large pens or stacks of wood had been built up, fastened together, and sunk to the bottom with stone, and continued until the wharf was raised high enough to lay down a sufficiency of regular rows to ele- vate the foundation some distance above the waters surface. A thin stratum of earth was then placed upon this wood. This earth makes the wharf present the appearance of the most solid earth. A great share of this wood has stood above the water's surface at all times ever since these wharves were first constructed. At low tidi, still more of it has been out of watcf< When this examination was made the air had a limited circula- tion through the upper portion of the wood, between the water and the earthy covering. The water passed in among the great body or deeper portion of the wood under ground, to an unknown but considerable extent. These facts having come to light, it was obvious that every re- quisite for such vegetable fermentation as is quite extensive enough to account for the worst calamities from Yellow Fever, except in- creased temperature, had been present in this place at all times, r i u t I08 ] ■ever since these wharves had been erected; that, every summer's heat had been sufficient to set this process into operatiou in on? degree or other; and of course, that, more or less of the i ause of Bilious Fevers had been generated here during the hot seasons of the whole of this period. The diseases of this place had corres- ponded with this train of reasoning as far back as I had been re- sident here, and I had heard of similar diseases originating here for some time back. Hence it was that 1 formed the opinion respecting the cause of our affliction, which I transmitted to you on the 1st of September last. This the only rational opinion which could be formed upon the subject, you perceive, was new to myself. It was not with* held from you nor my medical friends any longer than the difficul- ty which attended the necessary investigation rendered indispensa- ble, whatever insinuations to the contrary may have been circu- lated. A conquest was now gained—Light had triumphed over dark- ness. Doubt and obscurity were reduced to plain demonstration. That which should have been known, acknowledged and improved upon, by those who had gone through the Epidemics which had devastated this same spot while 1 was young,was now for the first time seriously mentioned a6 the cause of these calamities. The advantages to he derived from a proper cultivation of this newly acquired knowledge were pictured before me in imagination. And amid all my difficulties these considerations occasioned some pleasing emotions. But on weighing the magnitude of the evil which had beeu thus opened to my view, and reflecting that no relief was to be expect- ed previous to cold weather, and farther, that the cause might not be removed for some years, and of consequence,that we should be liable to returns of this disease from year to year, considera- tions of an opposite cast presented themselves. Under existing circumstances it was plain that every hot and dry season would revive our enemy. Having thus far stated to you in detail, several circumstances which led me to discard every thing except the wood lying under the-floor of the wharves of this place, as incapable of producing Epidemic Yellow Fever, 1 now come to apply -principles, and en- quire Why such a disease should appear here in one seaso., and not in every season, and at this particular place, while the inhabitants living uear to other wharves, having wood in them, have remained healthy. L 109 ] The cause of Bilious Fever is termed Miasma. And when I speak of it 1 allude to a certain product of vegetable decomposition__or, if you please to the natural product of vegetable fermentation. It is a poisonous something generated during this fermentation. And it is directly, or indirectly, the cause of the whole rounds of Bilious Fe- vers. Miasma is therefore a terrible enemy of mankind, and fur- nishes a proper subject for legislative investigation, as well as sci- entific research. It is evident that the low tides—the constant calm—the great drought—but above all the unusual heat, of the last, summer in common with one or two other, similar seasons, which we have ex- perienced since the building of these wharves, have served to rouse into operation an uncommon degree of fermentation in this place. Other wharves similarly situated, as it respects the wood in them, have no doubt also felt the influence of these general operating) agents in some degree. But the projecting position of this point of land—the consequent greater exposure of it to the suns rays—■ and more especially the unusual quantity of wood which is con- tained in these wharves immersed in the water and standing above it in a moist state, have jointly offered several general and perma- nent facilities to vegetable fermentation here, which have not ex- isted at many other places where some of the same materials have been deposited. In order to favor this process in such places much depends up- on the fineness of division and the arrangement of the vegetable. The quantity of earth covering the article will operate for or against the process. 1 know of no other set of wharves as favourably situated for this process in all necessary respects, and as much exposed to the summers heat as those. Nor are there so many large wharves, in so concentrated an arrangement, and filled up in the same Way, about all the harbour. Those at the south west corner ef the Point will probably rank next in these respects. And when we come to compare the diseases there with those of the same nature on the south east corner there is but little difference, either as to the time of appearance or character of Fever. The water about these wharves had an uncommon dark green appearance during the prevalence of the Fever. The great body of the Basin water never had this evidence of foul and offensive qualities. But ultimately all the water from the Block, ox near, [ "f> ] to Patterson's wharf, eastwardly, to the whole extent of the im- provements, assumed this striking and obnoxious aspect, near to, and for a short distance out from, the wharves at large. This was plain to every common observer, and this is one of the strongest marks of decomposition of the wood. There were also other signs of fermentation and the escape of the product thereof in an serial form. But this appearance of the water attracted my notice and merits yours most. To give you a plain idea of this phenomenon you may consi- der it as a stubborn fact, that the coloring matter which this wa- ter held in solution, was sufficient to stain, newly dressed pine wood, and even painted surfaces. The only rational conclusion therefore is, that this water con- tained something in it which was foreign to its composition. Pure water has no such coloring. The next enquiry is how this color was acquired ? This will be easily solved on reflecting that it is the nature of every raw vege- table to undergo one change or other under all circumstances, and that in every such change something is given out. The solvent capacities of water even at low temperatures are considerable. Sound wood gives out to water some of its properties. What- ever is given off in this way by the wood and is held in solution by the water, is foreign to the water's composition; and thus dur- ing even a short contact of wood and water, the water dissolves and holds in solution some share of vegetable matter, of which you may be convinced by calling to mind how short a time it requires for water to acquire the taste of the wood of a clean bucket in which it is placed. It is not at all surprising therefore that the water which stood nearly still at this time, in contact with such a body of vegetable matter, should have become foul. It was highly charged with dis- solved wood. Heat, or increased temperature greatly enlarges the solvent powers of water, and decaying wood is easier dissolved than sound wood. But if this wood was even sound, the water which stood around it during the heat of last summer, could not, nor did it, fail to become charged to an uncommon degree with some of its pro- perties. The process of fermentation accumulates heat. But independant of an extensive fermentation in the wood, and the heat accumu- lated by it; heat was not wanting. Neither do 1 believe this kind of fermentation is always necessary to the formation of the cause of Fever. [ ill ] If, as many contend, the wood in this place did not ferment in mass, and become dissolved, or decomposed entirely, the process of fermentation could not fail to go on in the water, and such portion of the wood as became dissolved. The water mixed with the Wood, and held in solution, large quantities of vegetable matter at all events. The cause was therefore engendered without the wood being rotten throughout, although the soft and soluble portion of it was in a state of decay. Fermentation, you are no doubt well aware, progresses rapidly through various stages, when meal and other vegetable articles are dissolved in water ; and why should we not expeet the same thing to take place here ? We know there- fore, (and it is quite enough for us to know,) that every thing which was necessary for nature to effect her operations according to her own laws, and form miasma from this vegetable matter, and water was present here at this time. It might be said that this foul stagnant and offensive water held this vegetable cause in solution. But be this as it may, the broad and incontrovertible fact that the water of this place contained something in it which was not one of its constituent parts, stands as a firm rock for us to rest upon. To find how this water with its contents, rose into the air of its vicinity, it is only necessary to call your recollection to the pro- cess of evaporation. This is also an operation of nature. But this process is greatly facilitated by increase of temperature. As has been already stated, the mean heat * was unusually high during the summer months, but the heat accumulated here by fer- mentation, is to be added to the general temperature of the season. Therefore, this process, was at this time and place, such as may be properly compared to the raising of steam from the surface of a fluid contained in a cistern, which has been placed over a fire or heated furnace 5 and great quantities of this foul water with its coloring matter and poisonous qualities, must of necessity have been thus raised up into the atmosphere of this vicinity. It has often been a subject of enquiry, how Miasma is disposed of after rising into the air, as well as how it is raised. Whether it unites with the air or undergoes any change whatever after ris- ing from the water's surface, or not, has never been satisfactorily demonstrated. It would appear most probable, that this poison, after it rises, is merely held in solution by vapor—is suspended for a short time •The,mean heat of June was 84°. Of July 86*. Of August 86°. [ us ] in the air, and then gravitates to the earth. This opinion is war- ranted by the fact, that general miasmatic diseases are only found to originate near to water, and on low, moist grounds. Sporadic eases may originate on high grounds, but they are to be referred to evaporation also, arising there, from some local and limited moist) or wet, nuisance, of a vegetable character. These matters of opinion are however not necessary for our pre- sent purpose. They may be laid aside therefore. And it may be fairly said, we know there was something engendered here of late, which was at first held in solution by this water, and was sub- sequently raised into the air of this place. This will not be denied by those who have a right to say any thing on the subject, from personal observation, and from an acquaintance with natural laws. These laws, you, may say, are inscrutable. But the result of them is not. They have ever, and will ever tend to the same end. And let us see what the result is in this and similar cases. Upon this ground then it may be asserted, (and no man of com- mon sense will contradict it) that spme matter (miasma) whieh was foreign to the natural composition of the air of this place, floated about with it at this *ime. Some portion of whatever this air contained, was therefore of necessity breathed, or swallowed, by the people who came within its limits. And the properties of the foreign matter in this air must be decided upon by the effects which it has had On those who received it into their habits. What have these effects been? Has this foreign something, sickened the inhabitants ? Or has the air of this place supported and cherished the health of all, or of any, of those w ho breathed it at this time. This, is what, pure and wholesome air ought to do. But the poisonous effects of some article, which was not atmospheric air, were daily manifested in this place,until the processes just described bad been terminated by a law of nature, haying an opposite effect to those which favor the formation of miasma. Vapour condensed constitutes dew or fog. What color had the dew and fog of this place at this time ? The former had not that of *?the pure crystal dew drop of the morning." Nor had the latter that of the whitish mist which arises from pure water. They were both dark. The coloring matter in the water had heen exhaled. This much of the original contents of the water we know without argu- ment, or the application of principles, if we are allowed to believe our senses, rose into the air with the vapor. It might be said with ropriety that certain deleterious effects of this article were made iiowq to the senses likewise. For independent of this miasma exeit- I 113 ] in* Fever in many, all those who stood around these wharves and attended to the various phenomena of the place, experienced an uucommon smell and taste, a giddiness of the head, ike &c. And can any man demonstrate to you that this air contained other mat- ter which was liable to vanish as a dream or phantom, simply by the natural change of the season. As already intimated, it is a principle known and acknowled- ged, that low temperature, or cold weat'ier is unfriendly tq fer- mentation, as well as to all the other processes just described, by which miasma, or the cause of Yellow Fever, and all the other grades of Bilious Fever is made and raised into the air. Ya* por is now changed into frost, instead of dew or fog. Hence it is if our ideas be correct, that " these Fevers terminate on the ap- proach of frost." This is a necessary consequence. These are maladies of season it is well known. And how exactly do these processes spring up and subside with the natural season. I have now accounted for the origin of these Fevers here, and 1 defy all the philosophers of the City, to account for them on any other grounds, which will not run counter to common sense and ob? gervatiouo The spreading of this disease along the water's edge, is an important enquiry. Water when charged with foul and pestilential qualities such as I allege this water to have contained, is liable to move along the shore some distance in either direction, from the place where these properties were originally acquired. It is evaporated in all the places to which it is thus transplanted. More or less of the cause of disease is raised with it, and is sown in these vicinities also. But where materials, similar to those from which the ori- ginal deleterious properties of the water have been derived, are planted in other wharves, and other places, along the shore ; any strength which may have been lossed hy mixture with more pure water, is there regained. And vapor rises there, with its full share, of poisonous strength. And hence it is that this unwell come enemy sneaks along the water's edge step by step. The seeds of disease and death are thus raised and spread abroad along the banks, bordering on this strengthened slow moving water. And they do not penetrate into the high and central parts of cities. Thus you see Sir, that water which stands perfectly still, in contact with decaying vegetable matter, accumulates and concen- C ii* ] trates these poisonous powers. This is what is understood to be the effect of stagnant waters. But water in its perfect purity, or natural condition, never ferments, nor does any mischief. It must be charged with foreign matter before it will ferment. By reversing the above ease, and arguing from the same principles it will be found that water, however foul it may be originally, on moving and mixing freely with other and fresher water, will be- come so diluted and weakened, that vapor rising from it will not excite disease. As.an example in direct proof of this position, I will state to you that the Falls may be considered to have been a strong bar- rier to the spreading of our late Fever, from the Point to the great body of this city, lying west of this stream, and bordering on the water of the Basin. This stream of water has had its course changed of late, as^ though such change were intended to effect this desirable object. This has been done since our last general calamity from Yellow Fever. This water is now emptied into the Basin near to Patterson's wharf, F. P. through the draw bridge on the Block. On striking said wharf, and meeting the water from below, with its peculiar action against the wharves, this water is reflected back towards the head of the Basin. Indeed when the stream is high the current is turned as it passes through the bridge, nearly in this direction. But this stream was now reduced to insignificance. And it is highly probable, the supply from it, and from all other water running into the Basin, was not equal to the waste of water from the whole surface of the Basin by evaporation. In this case the water of the Basin preserved its depth, or rather its level, by supplies from the river. The motion of the water in the Basin was therefore from east to west, and it had a tendency to carry the water of the Falls to the head of the Basin. The dilut- ing effects of it there have proven salutary in a high degree. [This is suggested. It may be proven hereafter.]) But at all events the condition of the water which lay about the draw bridge, must have been better during the hot weather than that about the Point at large, owing to this constant supply of fresh water. And it has furnished a bad conductor for miasma. In other words, it has obstructed the foul water which lay here, in its movement L H5 ] towards the head of the Basin, above,the bridge, and into the Cove. No part of this cool water (of the Falls) could have reached the south east corner of Fell's Point duriug the great heat of last sum- mer, for the reasons just assigned—Consequently th'e water here would have become more stagnant and fout than the water above the mouth of the Falls, if every other circumstance relating to the situation of the two places had been precisely equal. But the correctness of the ground herein contended for, is still more forcibly illustrated by comparing the present with the for- mer condition of the Cove,* whieh lies between the Point and Town. Perhaps about one third of the shores of the Point bind on this water. It is now five years since the Falls were turned in their course by the Causeway or Block, on which the bridge is built, from a direct course into the Basin, to nearly a right angle towards this Cove. The fresh water of this stream now mixes freely with the water of the cove, and has a direct tendency to dilute cool and purify it, however calm, dry and hot, the season may be. This improve- ment even prevents the movement of the water from about the wharves of the Point into this place. The Cove water is conse- quently left pure and inoffensive in a great measure. How differ- ent then is the condition of this place now from that of former years ? This will appear plain on making a comparison relative to the diseases which have prevailed here before and after the change in the course of the Falls. More or less Yellow Fever has often originated on the borders of this Cove. The calamity of 1800, was chiefly referred to miasma arising from it. Whether the cause was then engendered in it or not, has never been settled. But that this plague was extended towards town, west of the Falls, by the poisonous vegetable effluvia aris- ing from this great reservoir of pestilential water, can scarcely be doubted. My own opinion is that the water from about the wharves (which I am informed had the same appearance that the water there lately had) moved round in this place and stagnated, and that miasma was generated more from this species of vegeta- ble matter, than from vegetables in the Cove itself. At all events^ * See Page 101. [ H6 ] the Cove was then a most formidable nuisance. Indeed Bilious Fevers, of a higher than ordinary grade, have originated there ma- ny seasons since the above named general visitation. During the very autumn preceding the aforesaid change of the course of the Falls, there.were at least two of the worst cases of Yellow Fever in Wilke street, near to this plaee, (viz. Scott and his wife.) Since this change in the course of the Falls, Bilious Fevers have been less common near this place. But last summer and fall the happy consequences of this improvement became most conspicuous, and the circumstances merit the strictest scrutiny. 1 believe there was not at that time, a solitary case of Yellow Fever, the ori- gin ofwhich, could te traced to this place. To the utter as- tonishment of all who reflected on the scenes of t800 here, the in- habitants of Wilke street and those, on, and about, the Causeway ge- nerally, as low down as Fleet, on Carolina street, who remained at home, continued healthy during the whole calamity. A few cases of mild Intermittent Fever did occur between the lower end of Carolina street and Trinity Church, and probably a case or two of mild Remittent Fever originated in the same range. But these mild cases show that although miasma existed there, it existed, only, in a diluted State, and that its strength was very dif- ferent from the miasma of this place in 1800. Having been called to a few cases of this description at an ear- ly period of our calamity, and having heard of others up the Har- ford Run, between Gough and Bank streets, in the family of one of the Hussay's, I anticipated the speedy approach of Yellow Fe- ver here. But it turned out that those cases had been occasioned hy some puddles or duck ponds of water, which were located near to the door, and were in so foul a condition as to kill the ducks of this neighborhood. These places soon dried up, and (although the mud at the bottom of them was afterwards exposed to the continued heat) no higher grade of Fever was known to prevail here between this period and the appearance of frost. I had to contend with Intermitting Fevers on Wilke street, fac- ing Mr. Hussay's Tan-yard, and found similar diseases in most places around this Cove ; but never could trace a case of Yellow Fever to it for its origin, during the whole time of our calamity. These are facts therefore which speak to the purpose, in a lan- guage much stronger than any thing that you can find iu the most polished volumes of theory. The only just conclusion which can be drawn from them would of itself bear me out. For upon what other grounds than those assumed can any one account for the difference of the diseases here, in 1800, and in lSiy* [ H7 1 I shall now consider the prevailing Bilious diseases of Pitt street, on the south east corner of Fell's Point, back to the date of the improvement thereof, and apply the important lessons which they furnish us with, as proofs, that the wood aforesaid has generated the cause of all the Fevers of this place of a Bilious and Malig- nant character, during this period. This enquiry must be general for I have swelled my letter too much already. From personal observation, and from evidence collected in dif- ferent ways, and from sundry persons, respecting these diseases, it appears, that some permanent source of miasma must have existed here all this while. That more or less of those diseases have existed here every summer or fall, is well known, and generally acknowledged. In the mildest seasons, the Bilious Fevers here have not been of the malignant form, but they have always assumed a character (as 1 have already intimated) not common to other places in the same season. Towards the close of moderately warm summers, there have been sporadic or occasional cases of Bilious Remitting Yellow Fever here. In the hotest seasons Yellow Fevers have become a general calamity. In 1794 and 1797 the Yellow Fever originated and raged here. In 1800 it had an origin here independent of the cases which were then referred to the Cove, and it spread general desolation. In 180S it originated in this place in September, and when, every other part of the City was exempt from ii. This was too late for it to spread to a great extent. The whole neighborhood from George street down to the water was nevertheless ravaged by it, before the cold weather checked its progress. Between this year and 1818 occa- sional cases of high toned Bilious Fever, attended with Hsemorr- hagies, dark evacuations, yellow skin, red eyes, &c. occurred here nearly every season. They fell heaviest on strangers. In ISIS a native and too strangers had the disease. The case of the native (viz. Richard Tear.) was rapid in its progress, and fatal in its termination. He died on the third day of his illness. The symptoms w'ere highly characteristic of the Yellow Fever which followed in the same place iu 1819. Prohably this case was owing in some measure, to miasma gene- rated from the wood which lay in a wet and perishing condition, in Wolf street, in the form of shavings, saw dust, chips, &c. and it consequently appeared with more violence than the two other cases, which were a little remote from this auisaaee. C H8 ] This opinion is warranted by what followed there during fha past summer. For there were several cases of this disease there then, which broke out in a short time after the first case took place at the lower end of Pitt street, (or at the wharves located there.) And until the general cause wa» fully developed, this Wood was thought by many to be the only existing evil. But in common with some other nuisances which were pointed out by the populace, although, this served well to point to the great source of miasma arising from similar materials at the wharves, it was,too trifling to account for the whole cause of disease.* In the present year, (1819) the Yellow Fever originated, as you are already aware, in this same afflicted spot. The first case of this disease in its worst form which fell under my notice, (in this City,) was on board the English Brig Neilson, then lying at Waters' wharf. (This was that of an Irishman of the name of Daily.) He was seized on board with this Fever, on the 25th July, and died there on the eighth day after the attack. This unfortunate foreigner had arrived here early in the sum- mer, and had taken his passage for Liverpool, on board this ves- sel. He did not call for medical aid until his ease was hopeless. Consequently the fatal termination was attended with such symp- toms as left no doubt of the nature of the malady. Several other cases soon sprung up about this and the neighbor- ing wharves. A death took place on board the George Washing- ton on the first of August. This vessel lay at Wirgman's wharf. The Ceres sailed from this wharf, and the Betty from Waters' wharf, about the middle of August, with from fifty to eighty pas- sengers on board both vessels Many of the passengers, and sever- al other persons, on board each of those vessels, were seized with the Yellow Fever shortly after sailing. A large number on board the latter vessel, died, vomiting black matter, before she had pro- ceeded out of the Bay. A less extensive but similar calamity was experienced on board the Ceres also. The disease having originated in the manner described on board the shipping, it soon seized upon-the natives residing here, and spread with the prevailing winds, one fourth of a mile, in a north west course, into the settlements on the low grounds. It also spread around the water westwardly, until it had met the Fever which had now sprung up on the south west corner of the Point; * See proceedings with the Board of Health. [ 119 ] and along the water to the north east as far as the improvements extend ; a distance of, four hundred yards perhaps. The Fever had spread over these limits, and originated in all parts of the space embraced by them some time previous to frost. It became stationary from some cause and never spread further. There have been several reasons alledged for the limits of im- pure air ceasing to spread. The friends of contagion suppose the removal of many of the inhabitants to be sufficentto account for this phenomenon. This is a futile position. If contagion had any thing to do with the spreading of the disease, we should have had the whole City, and surrounding country, infected, by those who re- moved from the Point with the disease on them. Other reasons (which I shall not notice) equally absurd, have been assigned. The probability is, the cause had now reached its climax of power, and was too weak to produce disease at a greater distance from its source. In the progress of this disease as aforesaid, a considerable number of the inhabitants on either side of the Point, continued to enjoy the best health. Although the cause, as has been already intimated, was spread or carried around the shore with the water; from this concen- trated point where it first became manifest, it moved from the south east to the north west, penetrating the thickest settlement, just as smoke arising from a steady tire is moved along in*ar to the sur- face of the earth by a gentle breeze, through forest trees, until it be- comes dissipated, and diluted, and then vanishes insensibly. When* ever the wind shifted round, and blew from the north west, the progress of disease, in that direction was impeded. During the gale in September, the disease did not spread on the Point, owing to the wind having this direction. But the garrison at Fort M'Henry, who were now exposed to the wind, which blew over the wharves, soon began to sicken in such numbers, as to make their removal from the Fort necessary to their safety. The rain, which fell about this time, had a good effect also. The water around the wharves and docks, very soon assumed a much less foul appearance, and lost its former strength, (if it is fair to judge from the consequences) for the disease not only ceased to spread, but raged with less violence for a few days. This is a fact, which corresponds with sundry other observa- tions, made elsewhere, as well as the doctrine held out in the L iso ] foregoing pages, when speaking about the good effects of the fresh water ot the Falls * Several writers, who have treated of this dis- ease, and have detailed historical facts, agree in this particular. Last summer this effect of rain was noticed at Mobile, where the disease was supposed to be owing to a quantity of wood, similar to that which has given us so much trouble at home. In many countries and all ages, baek to the remotest antiquity.disease has been as much the natural consequence of drought as famine. It is nevertheless a fact, that different local causes can be so far dried up, as to give out no vapor, and of course, so, as to become harmless, A certain degree both of moisture and heat, corresponding with the quantity of vegetable matter present, are necessary to excite the peculiar process which generates the cause. Thus you see, Sir, a large number of the cases here, were trac- ed for their origin to the air, immediately in this quarter. The cause of the eases which took place on board the Ceres and the Betty must have been generated about the wharves aforesaid, where the first cases originated, and from whence these persons had embarked. The seeds of disease were either received into the systems of those patients at the wharves, or on board these vessels after they left the harbor. The holds of ships, lying about Wharves, have often become filled with miasma, and after proceeding to sea in this condition, the Yellow Fever has reppatedly seized the people on board. It is highly probable that this has been the state of these vessels. But in any view of the subject,, the result seems to show, that at the edsje of' these wharves, the cause of the Yellow Fever, which is under enquiry, was first manifested, and became most strong and powerful. And consequently, if miasma has been the cause of th^se ca«es (which I apprehend no man feels disposed to doubt) this cause must have been generated at these wharves. This is a necessary conclusion. And inasmuch as similar exam- ples have repeatedly taken place here, for a series of years, un- der similar circumstances, they must*also be referred to the same cause and source. It is utterly absurd to refer these diseases to a cause, the source of which, has not been permanent. It must have existed here during the whole period of years in which these dis- eases have prevailed. * During this rain I attended to the course which the muddy water of the Falls took, and had an ample demonstration of its disposal, in the manner hereinbefore stated, when speaking of this stream. This discolored water, mixed with the waters of the Cove and Basin, while the water about the south east corner of the Point, was not changed in its appearance. [ 121 1 The wood in question, is the only source of miasma of this mag- nitude, and answering to this description. And to this wood must be referred all our past calamities from Yellow Fever. By compairing the miasmatic diseases of this place with the Fevers of other places, farther, important, lessons, corroborative of the foregoing statements, may be adduced. This is a part of the subject on which a volume might be written. 1 only beg your indulgence however, while I mention a few instances, wherein the causes and the diseases correspond with the case before me. It has been ascertained, that a quantity of wood, similar to that in question, has been used for the same purpose, in the wharves near to where the Fever prevailed in the City of New York last summer. The same I am informed may be said respecting the wharves in Philadelphia, where the Yellow Fever has originated in past years. Doctors Hansford and Taylor* in giving a history of the Yellow Fever as it has existed at Norfolk, and the circumstances attend- ing it, say, that " that part of the town where the Malignant Fever chiefly prevailed, stands entirely on made ground, reclaimed from the river, by sinking pens of large logs, and filling them up chief- ly with green pine saplings, which are slightly covered over with eartb or gravel." In Charleston, in Savannah and in Mobile, wood has unfortu- nately been too freely used for the purpose of filling up wharves. There are several other Cities and Towns, where the disease prevails occasionally, with regard to the condition of the wharves in which, I shall not speak. But wood has always entered into the wharves of our country at large, even for building them, in un- necessary, unreasonable and injurious quantities. At New Orleans wharves cannot be said to furnish a source of miasma. But vegetable miasma arises in great quantities from coves, marshes and swamps, in that vicinity. If 1 am not very much misinformed, there is a large marsh quite near to the place where this disease originated, in that City, last summer, as well as many preceding summers. The Bilious Fevers of this place, correspond with the Fevers of the same nature, in many places in the interior of our country. • See New York Medical Repository. E 423 1 Doctor Ramsay, when speaking of these diseases, in his History of South Carolina, says, " In their mildest season, they assume the type of Intermittents, in their next grade they are Bilious Re- mittents, and under particular circumstances, in their highest grade constitute Yellow Fever." This is the case as respects the diseases of Fell's Point, in Pitt, and Philpot streets. And this is a good general diffinition of the Fevers of that i-tat?. But it does not apply to every part of the State. There are certain healthy and certain sickly situations. The sickly sections are as local and as circumscribed as the infected parts of Fell's Point have heen of late. These diseases prevail on the borders of mill-dams, filled with lumber, in some of the upper districts, (in which the Doctor has not had attentive correspondents to furnish him with detailed accounts, such as he received from several other dis- tricts.) And here they put on " their worst grade." Yet mill- dams relieved of their wood, even in that hot climate, become in- offensive. The evaporation from them is innocent, (as before in- timated,) if the stream is large. The inhabitants of the whole southern section of the United States, who live near to mill-dams, filled with wood, and marshes eharged with vegetables in a putrifying condition, are liable to suffer, and do occasionally suffer, in summer and autumn, from Bilious Fevers comprising all the grades thereof. The Faculty of this City in 1800, in their report to the Mayor, have related several instances wherein this disease has appeared in the interior. Some of the examples, which were before them, occurred on the Ohio at Galliapolis, Mifflin County in Pennsylva- nia, and on the Gennessee Lakes in the State of New York." They state further, that a " similar disease" occurred in that year " in Harford County, on the banks of the Susquehanna; on the Canal, in Ccecil County ; in Charles County, in Dorchester County and in some other places" of this State. The inhabitants of Baltimore County, who reside in the Necks and near to the inlets, low grounds and marshes, above described under the head of Topography, and where vegetable matter al- ways lies in a perishing condition, are not strangers to this dis- ease.* Dr. Mace, who practises there, and Who has a right to *It is a common opinion, that the cause of the diseases of these places rises with the fog, so generally seen there. These fogs may carry some- thing of a poisonous nature with them, although they do not necessarily cause the Fever themselves. Fogs partake of the nature of the water from which they rise. And if we judge from the effect, which the water of the inlets there had last summer on the fish, it will be fair to say, that they did L 123 J know what Yellow Fever is, from having seen it here in 1808 has informed me, " that he never had so many cases of Bilious' Fever under his care, at one time, as he had last summer and fall—that several cases were attended with black vomit and stools, hsemorrhagies, yellow skin, and all the worst symptoms of Yel- low Fever." He sees «■ cases of Yellow Fever annually in these places. But they only originate quite near to the marshes." A disease of the same character prevailed last summer below this place a short distance; namely, at Canton and at Ceder Point. The whole population at Ceder Point consisted of eight foreign- ers and six natives. Bilious Fevers of different grades took place among these people. On the 26th June, one of the foreigners was seized with a Fe- ver of high grade. The life of this patient was in jeopardy for six days. In the mean time several others had sickened. And a fine little boy, (son of James Bate an Englishman) died on the third day of his illness. Twelve of these inhabitants had been attacked previous to th» 24th July. The foreigners all had a disease answering well the description of the Bilious Remitting Yellow Fever, which is detailed by Dr. Rush, as having prevailed in Philadelphia in 1793. The natives had mild forms of Bilious Fever. This settlement was nearly depopulated. Many of the inhabi- tants fled from it, on recovering, as from, the most deadly pestilence. The whole of these Fevers were owing to miasma1; and from the proportion of the population attacked, you will agree, that their sufferings were comparatively greater, than those, of the citizens of Fell's Point. When I say these diseases were owing to miasma, I do it with- carry with them, something prejudicial to health and life. For I am well informed, that immense quantities of fish were seen in the first instance sick, and afterwards dead, in many of these places. The same fact was observed about our wharves. Fish were seen inactive and floating about the wharves; and finally large numbers were found lying on the banks, near the Sugar House wharf, dead. L 1^ 1 out fear of contradiction.* For it is well known that numerous marshes, containing rotten vegetables, exist in this vicinity. Poi- sonous exhalations arise from them (and from Harris' Creek,) during every summer and fall. Those nuisances are permanent. Hence more or less Bilious Fever occurs in their neighbourhood every summer and fall. This is precisely the condition of Fell's Point both at the south east aud south west corners thereof. At the commencement of the diseases of these divisions of the Point this year, they were as mild as they have been in many fall sea- sons. In their worst form and at a more advanced period, al- though they were Yellow Fever, they were nothing more than such diseases as often prevail, in warm climates, at a distance from cities, in certain local places, filled with wood and other vegeta- bles. The great regulator of all those diseases in any City, or in any place, where wCt decaying vegetables, are found, is the existing de- gree of heat. This is a conclusion so well grounded in fact, as to bid defiance to theoretical disquisitions. It cannot have escaped your own observation, that this disease springs up, nearly at the same moment, in hundreds of places, at a considerable distance from each other, and that it dies away at the whole of these places as the season grows cold. It is self evi- dent therefore, that the Yellow Fever is indigenous to all those places, and depends on a cause of similar nature wherever it exists. This disease has originated at sea, under circumstances which are also plainly demonstrative of its domestic origin, and equally so of the effects of wood in producing it. Dr. Kollock has given a detailed account of this Fever origi- nating on board the United States Frigate " General Green," af- ter she had "sprung a Ipak at sea He supposes the cause to have been generated by some marine vegetables, which were mixed with slate and other imperishable ballast. This supposition is plausa- * It may be said by some perhaps, that animal and vegetable miasma com- bined, occasion the diseases of this place from year to year. But I know of no existing necessity for calling animal miasma into the account; vegetable miasma is indispensably necessary and no doubt all sufficient of itself. Be- sides animal miasma cannot be shown to have existed then all the time alluded to. The situation and result at Canton, were similar in all respects. L 125 ] ble enough, if these vegetables were in sufficient quantity. But the probability is, the wood of the vessel, as well as the water casks, had some share, perhaps the greatest share, in charging the water in the vessel's hold with the vegetable matter, necessary to fermentation and the generation of miasma. An instance similar to the above took place on hoard the En- glish Ship Hankey, after she had been nine months at sea. The disease destroyed three fourths of all hands on board. This is fully detailed by Dr. Chisholra. Dr Lynd details several instances wherein a few cases of Fever originated in this way, at sea, in the British Navy. He mentions one remarkable example of the effects of the vessels wood, as t am disposed to consider it to have been. This is that of a British Frigate on her way home from this country, " with a seasoned sound crew," many of whom suffered from Malignant Fever. They " became infected," (he says) " as it would appear, from the close- ness or damp below, occasioned by the hatchways being kept shut." Now, whatever water was in this vessel's hold would become highly eharged with the wood of the ship, and water casks, and there- fore the cause of Fever was generated in the hold. In hot seasons, old ships, in a leaking condition, lying in our harbor, might, upon the same principle, generate the cause of this Fever on board. On long voyages the same might occur, and I apprehend has often occurred, previous to, or about the time of the arrival of vessels. And in such cases, the inhabitants re- siding near to the vessels, are liable to sicken. But instead of this being a proof that the disease is communicated by contagion, it proves the contrary. Nor can general disease take place from such a cause alone. But no vessel had arrived here last summer, either with sick persons on board, or with nuisances on board, in time to originate this Fever. I speak positive, for I visited all vessels at this place, with a view to acquaint myself with facts as they existed. Vessels lying in crowded rows, in docks, and about wharves, may have had bad effects in two other ways. They may have rendered the water, in these places, more stagnant, and the water may have dissolved certain portions of their wood, and beeome un- wholesome in some degree. But their agency alone would have been insufficient. Having thus far endeavoured to direct your attention to vegeta- ble miasma, as the cause of this disease, and to the chief source R [ 126 1 From whence this poison has arose, it appears unnecessary for me to dwell on contagion, aud apply,evidence, calculated to prove di- rectly, that it has had no agency in producing the late Yellow Fever. If I have succeeded in establishing the ground assumed, this Fe- ver was not contagious. If 1 have not, contagion might as well be said to have originated it, as any ether cause which has been named. For there is nothing but the miasma which has been ge- nerated from this wood, capable of accounting for this disease, as it has appeared here from time to time But inasmuch as you have proposed the direct question, " do you consider the disease conta- gious under any circumstances," I am prepared to give this ques- tion an unqualified negative. Contagion, 1 believe, only exists as a cause of Yellow Feyer, in the minds of a few idle theorists. It would be perfectly useless to '»enumerate" to you, " all the cases which have fallen under my Care," calculated to shew the cor- rectness of this remark. Let it suffice, to say, that among all that I have seen of this disease, there has not been the slightest reason to suspect it to be communicable from person to person, either di- rectly or indirectly. Detailed accounts of the occasional visits of this Fever in our country, as far back as 1699, have been published, and in every instance it has been remarked, that it has in no case originated beyond certain limits of air.* Thousands have gone through this disease out of those limits, and where it could not have failed to be communicated to other persons, if contagion were the cause. This is all the proof that need be required on this point, by men who will suffer their reason to regulate them, instead of their prejudices and fears. I now come to speak of the best methods of preventing a recur- rence of this Fever, at this place. This is the most difficult, as well as the most important part of the subject. To me it appears, as advised by my friend Dr. James Smith, of this City, agent of Vaccination for the U. S. that the plainest aud * To say that the air makes the disease contagious, and at the same time to say, that the contents of the air is not the cause itself, is a species of philosophising truly odious. Contagious diseases are communicable from person to person, in the country as well as in cities. I am aware of ho ex- ception to this remark. [ 1*7 ] most direct method of obtaining future security, would be, to pursue a plan similar; or follow the pure and wholesome course, which was prescribed in such cases, by the great law giver of old, and provide by law, that every particle of the above named body of 'vegetable matter, shall be torn down and cast away. 4,in an unclean place without the City."* Have this done and we will be secur- ed against Yellow Fever. But no doubt you are ready to say, the extraordinary expence which would attend this measure, however desirable it may be, renders it impracticable. This is your concern. I have acquitted my conscience and fulfilled my duty, and I have done nothing more than my duty, by exposing the existing necessity for a mea- sure of such magnitude. And this is what you have repeatedly requested. I would further remark however, that he must be in er- ror, who thinks any price too great to purchase health. Health is all important—Its value cannot be estimated. You would think a man mad who would sit down and ask you, what sum of money, would be sufficient compensation, for your having the Yellow Fe- ver, so bad, as to be attended with black vomit ? But as respects the enormity of the expense, it may he said, that even the direct and indirect burthens and pecuniary losses sustained by our citizens at large, during our last calamity, (if the whole amount could be calculated,) no doubt exceeded the sum, which might have saved us from that, and similar visitations, for- ever, if it had been properly applied. Under existing circumstan- ces, we mayexpect this plague to visit us every future summer, similar to the past. And if such seasons and calamities take place often in succes- sion, our loss will be still more incalculable. It may amount to the utter ruin of the City. This part of the City has not to this time, overcome the ruinous effects of the Fever of 1800. And much less, could our pecuniary concerns sustain, a succession of such Fevers. But for what or whom are you to legislate in the case ? For money, or for life ? For individuals, or for the com- munity at large ? For yourselves, or for posterity ? Is not the inter- est of every individual who now lives in this City, or may live in it for many generations unborn, involved iu this business ? AH are to be benefited and secured; and all should hear an equal portion of the expenses required. * See Liviticus, chap. xiv. verses 40, 41, 42, 43, 44 and 45. L «8 ] The wharf owner is not answerable for what has arisen from the construction of his wharf. No law has existed prohibiting til- ling up wharves with wood. This has been done without knowing or foreseeing the consequences. The owners cannot remedy the evil. It must be done, if done at all, at the expense of the City at large. And in that way I am disposed to say, that it is prac- ticable to have our lives and fortunes secured against the inroads of Yellow Fever. With regard to any improvement that can be made in the wharves, with a view to secure us, in the " cheapest mode," pro- bably nothing positive can be said. Stone walls, such as have been built at Pratt street wharf, if they were substituted for the present walls around these wharves, would avail us nothing. The water and the air would still pass among the wood under ground. The aerial product of the fermen- tation of the wood, (if thpre be such a product,) would find its way through the water at high tide, and through the air at low tide,to the lower edges of these walls, and there it would escape into the common atmosphere. The water would become as foul and as poisonous as ever. And this is the most important point to be guard- ed against. Moreover, such stone walls as these, having piles for their foundations, would not stand the action of large shipping. They would be battered to pieces by the first gale. If any improvement of this nature is made, the wall must go to the bottom, or it will be useless. The water of the docks must he kept from the wood which lies under ground. It has occurred to me, that this might be done, by driving down two rows of joint- ed, tongued and grooved, square timber, or piles, at the distance of a foot or two from each other, and puddling the space between them with clay. This is a doubtful mode of securing us, and of course not so adviseable as the removal of the wood. I know of no improvement that can be made on the floor of the wharves. I have no idea that any portion of miasma finds its way out through the earth which covers the wood and forms these floors. Paving them would be a useless expense. Dry gravel is quite as good as pavement. The wharves should be kept clean. Yours, &c. ----------, M. D. FelVs Point, Baltimore, December 20th, 1819. L 129 ] APPENDIX. In suffering the foregoing essay to be published, the author has had no motive but that of serving the cause of distressed humani- ty. He conceives his name could add no weight to the production, and has therefore had it erased from the original. The printer having been so polite as to favor the author with the reading of all the former pages of this article, it has been found that several typographical and other errors escaped his no- tice when correcting the proof sheets, which, it is hoped, the rea- der will be liberal enough to excuse. --------------M. D. FelVs Point, Baltimore, May 29th, 182G. C 130 ] BALTIMORE, December 30th, 1819. To Edward Jouxsox, Esq. Mayor of the City of Baltimore. Dear Sin, I avail myself of this occasion to answer the ques- tions contained in your Circtilar of the 1st instant, on the subjeet of the late Epidemic. The first cases of Yellow Fever which came under my eare in this City last summer, were located near the water, on the south east portion of Fell's Point. These cases commenced in the lat- ter part of July, All the cases from this to the 20th of August originated in that portion of the Point comprising Pitt street; and the lower ends of Ann, George, Wolf and Lancaster streets. There were some foreigners attacked in the early part of the disease ; but young persons generally were the greatest sufferers. The largest portion of the first cases were among the apprentice boys, who were engaged in the various work shops in this neigh- bourhood ; but late in the season no sex, age, nor colour, was ex- empt from it. About the 21st of August, the disease also made its appearance on the south west corner of the Point, in Philpot street, and con- tinued to spread there until the place was deserted. Having attended to many cases of Bilious Fever of high cha- racter out of the City, I beg leave to call your attention to that circumstance, before I give you my opinion relative to the cause of the Fever of this place. These cases of Fever occurred at different places along the water's edge, between Fell's Point and the Lazaretto. Every inhabited place along this shore suffered greatly. 1 had about thirty patients at Canton, Ceder Point and the Sugar House, most- ly, iu the month of July. The family of Mr. Slater, who resided at Canton, all took sick about the middle of this month. They were immediately removed to his dwelling in the upper part of the Point, where ten of them lay ill at one time of a Fever, which car- ried with it many of the characteristic marks of Yellow Fever, such as black stools, yellow skin, heemorrhage, &c. Some of those who resided at Canton, Ceder Point, and the Sugar House, were foreigners. They sickened early. Others ef them were C *** ] from the Eastern Shore, and being more accustomed to the cause of this disease, they did not sicken until later in the season. But they were then severely attacked. One of them died of black vo- mit. Of those at the Sugar House, one was a foreigner, aud had a highly malignant disease, attended with hemorrhage for several days. This patient had not been on the Point, nor from home, during the sickly season. I am thus minute with those cases of Fever, to show the ana- logy between them and the Fevers which prevailed on Fell's Point shortly afterwards, believing that every person will agree that all the cases of Fever here related as originating at Canton, and in the vicinity of the water as near the Point as the Sugar House, were the offspring of Marsh Miasma. The water along the shore, and that of the various inlets, in that direction, is rendered poisonous by the great quantity of vegetable matter remaining in it, and un- dergoing that change by which miasma is formed. And this poi- son is there taken up by evaporation during hot and dry seasons, with the water in the form of vapor, and is then wafted along in the air, to be inhaled or swallowed by the subjects of disease. It seems reasonable therefore to suppose, that the Fever which prevailed at Fell's Point, was produced in like manner, by the va- pour arising from our dock water, which had been rendered poi- sonous by the wood of the wharves, aud the great quantity of tim- ber suffered to remain in the water. This does appear to be the case from the following facts. It is now a well known fact, that immense quantities of pine* cord wood, and other articles of the same nature, have been used for filling in most of the wharves, situated at the lower end of the Point. The dock water has access to this wood through the open- ings in the walls, built up with logs, to enclose this wood: the atmospheric air also*has admission to this wood during low tides. The water of the docks for some distance out was perceptably changed in its colourf and appearance, during the sickly season. * I would here remark, that the first suspicion of this body of wood used for filling in the wharves of this place, being a prolific source of disease from its connection with the water under the earth of the wharves, was sug. gested by my brother, and by him reported as such, in a written commu- nication to the Mayor, early in September. ■\I refer you to Mr. Edward Dickinson, an old respectable inhabitant of Ann street, for more information respecting this fact. He remained on the Point during the whole of the sickness of last summer, and that of 1800, and says he observed this- change in the colour of the water, at both these [ 182 ] This appearance of the water varied, according to its stillness, and the course of the winds. The Fever commenced near the water, and prevailed most along it, as far as Patterson's wharf. The progress of this disease west- wardly from the water, was slow, well marked, and seemed to de- pend on the south easterly winds for its quick or slow movement. From these facts I should suppose, that had the cause of this disease been generated in our streets, cellars or lots, the Fever would have made its appearance at many places at one time. No difference can be pointe 1 out in our streets at large. We have wet cellars over the whole extent of the Point, excepting those streets nearest to the water, where the cellars are generally deep and dry. And in those streets the Fever raged first and most se- verely. I was led at first from the similarity of the Fever which pre- vailed at Canton, the Lazaretto, and other places along the shore, to those cases of Fever which took place on Fell's Point shortly af- ter it appeared there; and these places being in that direction from which the winds generally prevailed, and the distance across the water being short, to suppose it possible, that miasma might be brought from there, to us, in sufficient quantity to account for the Fever here. But when this disease became so general and fatal on the Point, 1 was satisfied that the cause of it was generated near- er to us. And I am now of the opinion that the chief cause of the Yel- low Fever which raged here last season, originated from the wood in the wharves, and the other vegetable substances which had been suffered to remain in the water, during the heat and drought of the summer. That the water of our docks and around our shores, was pos- sessed of deleterious matter, was evident, for many reasons. Some of these have already been stated. But I "beg your indulgence while 1 add another fact, which shows the poisonous state of the water of our docks, and of the stagnant water along the shore, as low down as Colegate's Creek, (which is a short distance below the Lazaretto). Large numbers oX dead fish were to be seen float- ing about our wharves and thousands of them were washed on ihe shores of Canton and Colegate's Creek. From this and all the other facts stated, it would seem very probable, that the water periods, for about fifty yards out from the wharves. He further observed, that the sea nettles were not to be seen near the wharves at these times, as usual. L 133 J (being now generally still) had received its poisonous properties from the wood before described, together with the numerous spars* rafts and old vessels, suffered to remain in it. This water being evaporated by the intense heat of the sun through the day, was at night condensed into fog,* which carried with it through our streets, wherever it went, the cause of this Fever. In reply to the second question, I answer, that many nuisances may be pointed out in this part of the City, such as cellars, streets, and lots in which water is liable to stand and stagnate, until it is evaporated. These 1 consider to be general nuisances, and to have had their share in the production of disease as long as any moisture remained to be evaporated. But they would not have been sufficient to produce the diseases of themselves. They have aided or strengthened the principal eause. The landing of foul ballast, and the pumping out of bilge water at the wharves, may have added something to the then existing cause. These are practices which I consider very improper. They are highly offensive, and perhaps pernicious to the health of the citizens. As respects your third question: I do not consider the " late Epidemic" or Yellow Fever to have been " contagious under any circumstances whatever." 1 have attended to many cases of this Fever in different parts of the country, where the patients had it in the worst form, after removing from the Point, and afforded the best opportunity of testing its character in this respect—Yet I can assure you, that in no instance was there the slightest rea- son to suppose it contagious. 1 remain Sir, With great respect, Your obedient humble servant, W. H. CLENDINEN. * A considerable number of respectable citizens, who removed from the Point to the adjacent hills, and on the Philadelphia road in view of the Point, agree in their statement, that during the sickness, in calm, clear weather, they had repeatedly seen, between day light and sunrise, a dark fog- (as they expressed it) hanging over the Point. This exactly corresponds with the fogs whieh are so frequently seer, along the valleys up Harris' creek, and near Canton; and those which are so common in all low marshy coun- tries. Wherever they can be traced, there also Bilious Fevers are seen to prevail. L 134 1 BALTIMORE, 12 Month 15th, 1819. To the Mayor of the City of Baltimore, IN reply to the note which thou hast addressed to me, I shall be brief and general. My practical acquaintance with the late Epidemick was limited, because of the distance of my resi- dence, from that portion of the City, in which the disease pre- vailed. It is a serious matter to give instruction in things which influence publick happiness, and I should not have made the at- tempt, voluntarily ; but as thou hast desired me to join my views to those of my professional brethren, they are at thy service. I. A number of persons came under my care during the last autumn, labouring under the ordinary Bilious Fever, which I con- sider the same in kind with Yellow Fever; but in only one case did those symptoms arise, which demand the appellation of Malig- nant. This case was that of a stoutyoung negro,from Fell's Point, who was, I believe, generally healthy, and temperate. He re- covered. 1 have no doubt that his disease originated from effluvia generated by vegetable putrefaction, for I will endeavour to show in answer to the third question, that Yellow Fever can arise from no other source. II. Some of the most effectual measures, to prevent the future generation of the cause of Yellow Fever, are these: 1st, Where the water in docks is not much affected by the ebb and flow of tides, or where the wood is old and decayed, the sides of them should be removed, and stone walls built in their stead. I am not acquainted with the proportional expence of wood and stone walls to wharves; but I think that stone would be far more elegant and substantial. If it were universally substituted and the docks kept deep to preveut the sun's rays from acting upon the mud of the bottom, there would be little danger from wharves as sources of disease. 2d, During the hot weather, the streets, yards and gutters should be kept clean, and the latter daily washed. The washing might be performed with great facility, by suffering the publick hydrants, to be opened for a short period.each day. 3d. All ponds and marshy places, should be filled up with clean earth. An Ordinance, if none exist at present, should be made, ?o prevent any cavity from being filled with filth. When cellars [ 135 ] have clay bottoms, and are occasionally covered with water, an efficacious remedy for the evil, is, to dig a well to the sand be- neath, and fill it up w ith cinder, or some porous substance. When the water percolates to the sand, it generally escapes by subterra- neous passages. If no effectual measure could be found to carry off the water, the cellar ought undoubtedly to be filled up. 4th, It has been the opinion of some that a eanal from the Spring Garden to the Basin, by preventing the water in the latter froni becoming stagnant, would be extremely beneficial to the City. This is rather problematical: but if the canal would be useful in other respects the subject is worthy of consideration. 5th, The last precautionary measure, which I shall recommend. relates to personal conduct. Every species of intemperance should be avoided ; but there is one source of seduction from virtue, which seems to require the interposition of the law. I allude to Tippling Shops. Spirits, when taken into a system debilitated by the mi- asma which causes ihe Fever, rouse it into sudden and dangerous activity. Independently of the mischief which results from sup- plying the poor with this artiele, the shops keep them in a state of idleness. Their persons, their houses, their )ards, are conse- quently filthy, and subject them to disease. To make laws for the extinction of these vile establishments, in which avarice and hy- pocrisy prey upon intemperance, would be to legislate both for soul and body. It would be no more improper to suppress them, than to prevent men from keeping shops for the encouragement of suicide by poison. III. Changes of temperature, an epidemick constitution of the atmosphere, contagion, and animal and vegetable putrefaction are the only sources which have been supposed capable of causing Yellow Fever. 1st, Changes of temperature are no doubt exciting causes of this Fever, but that they cannot alone give rise to it was clearly proved by our late Epidemick. While the Point was subject to its worst ravages, the City was only slightly affected, and from circumstances of a local nature. Its proximity to the Point, made it liable to the same temperature, and the currents of air passed backward and forward. 2d, To the second supposed cause, the same remark may be applied. It would have existed in both situations. But the truth probably is, that it has only an imaginary existence. 3d, It is clear, beyond doubt, that the Fever had not a conta- gious character. The infected and the healthy portions of the C 136 ] City were divided by lines; and whatever was the condition of the sick, they did mt communicate their disorder when they were removed into the healthy district. The Hospital and Alms House, also, afford proofs of the validity of the non-contagious doctrine. During the whole season no instance of communication either tq the nurses, physicians or visitors ever occurred, although the cases of disease were numerous and violent. I consulted with the at- tending physician of the Alms House on the only two cases which were brought to it. They were placed in the wards among the Other poor, without any precaution and no infection took place although in one of them the disease was peculiarly malignant. It is probable that the doctrine of contagion in this Fever, has kept its station, from the perversion which old doctrines give to the eyes of observers. It was once even received as an axiom, that the common Intermittent Fever, was contagious. A conse- quence of the attachment to old notions has been, that when a Fever has been proved not contagious, physicians have dir ctly declared that it was not the genuine Yellow Fever, The follow- ing may possibly give some light to this subject, Dr. M'Lean, in his treatise on the Ye|l«w Fever of St. Domingo, tells us that the difference between that lever and the Epidemick which prevailed in Philadelphia in 1793, consisted in the contagious character of the latter. Dr. Rush had described it as being contagious, but a few years after he bad the candour to tell the world of his deception* The day of contagion in Yellow Fever has almost expired.—■ The last person in America who has supported the mischievous doctrine is obliged to resort to the hypothesis that it is contagious in an infected atmosphere only. Unfortunately for the author, this atmosphere must always be where the vegetable miasma exists, We may throw together hundreds of the sick in an healthy air, surely enough to infect it, and no Fever will be communicated. 4th, Effluvium from animal putrefaction is evidently innocent. Slaughter houses, privies, dissecting rooms and dead carcases prove this to be the fact. 6th, That the Yellow Fever arises from the proceeds of vegeta- ble putrefaction remains to be proved, but I will not trouble thee with the facts for that purpose. They have often been given and $q pne has ever disproved them. Respectfully, EZRA ." June 2d, 1820. L *« J BALTIMORE HOSPITAL, Sept. 14, 1819. To the Mayor and Board of Health, of the City of Baltimore. REPORT of Malignant cases admitted into the Hospital during the last seven days ending Monday evening, Tuesday September 7th,—8. Mary Ireland, admittei I 3d (! lay of disease- —recovered Susan Blackmore, 5th ditto ditto John Jackson 2d ditto ditto John Burns 3d ditto ditto John Thompson 4th ditto *William Blackmore 3d ditto died 4th. 'Samuel Burns 4th ditto died 6th. Anthony Newton 3d ditto died 8th. Thursday September 9th—1. Edward Colgan, admitted 1st day of disease—died 0th. FRiDAr September iOth—4. Sylvester Walter, admitted 2d day of disease—cured. Mary Van Ladin, 1st ditto Martin Hewers 2d ditto died 5th. John Handford 4th ditto died 6th. Sa vur dat September 11 th—2. Daniel Patterson, admitted 4th day of disease. Frances Jones 1st ditto convalescing. Sunday September 12th—6. Stephen Fulford, admitted 1st day of disease. Mrs- Holt ' 2d ditto Ann Small 3d ditto *James Carden 3d ditto died same day. *Fanny Cobbin 7th ditto deid 8th day. "Charles Reed 6th ditto died same day. Monday September IZth—1. Eliza Easier, admitted 1st day of disease. 22 admitted, 5 of which were then in articulo mortis marked *. Deaths of total, 9. [ 144 ] I have been induced Gentlemen, to lay before you this statement, in consequence of several malicious persons, having circulated re- ports highly injurious to the character of this Institution: reports totally unfounded. Many of the above cases were immediately from Fell's Point, where attended by Physicians until they thought* them expiring. That every attention is paid to them whilst here, I refer to se- veral respectable physicians. R. E. DORSEY, Residing Physician. It will appear strange that Dr. Dorsey should attempt to pry into the thoughts of Physicians with a view to defend the Hospital. Wherever com- mon sense abides such illiberal insinuations cannot fail to recoil on their author. One of the Physicians of FeWs Point. Office of the Boyd tfHealth, September 20th, 1819. L i*5 ] PORT OF BALTIMORE, 25th Aug. 181». THE Brig Peter Arnold, Little, from Havana, arrived here yesterday at 11 A. M. with Sugar and ninety-nine Bags of Coffee. The Coffee appears on examination to be in good order. On enquiry found one man who had a considerable degree of Fever. The Captain reports that he was taken with it on the day he sailed, has had neither vomiting or purging, except what was occasioned by the medicine he gave him.—On examining him to day, his fever is not increased, and he appears but little debilitat- ed. I will send him to the Hospital this day—The vessel is this day ten days from Havana. WILLIAM STEWART, Health Officer. The Mayor and Board of Health. The above is the only attempt which has been made to account for the late Epidemic by Importation ; and as the Fever has been shown to have existed previous to the date of this arrival the case is plainly against contagionists in its result. --------------, M. D. Mayor's Office, 3d September. [ 146 1 BALTIMORE, October 20th, 1819. SIR, IN compliance with your late request, I have the mortifica- tion to confess that I know no medicine that can effectually cure the Yellow Fever, all the resources afforded by Materia Medica have, I believe, been tried by the most skilful Physicians who, like others of an inferior merit, have very often been disappointed in this expectation. Temperance, a regular and rational mode of living, by invigorating the system, will help the action of medi- cines ; and if under such a circumstance, a man is attacked with the prevailing Epidemic, all means may prove useful in the hands of a prudent and experienced physician. I have the honour to be Your most humble servant, PETER CHATARD. [ 147 1 FELL'S POINT, BALTIMORE, 20th October, tsi9. To Edward Johnson, Esq. SIR, IN compliance with your request, I transmit to you a detail of the treatment of cases of the prevailing disease. By these cases you will be better enabled to form a correct idea of the ad- vantages of prompt medical aid, than by my opinion on the sub- ject. On Friday the 17th of August, 1819, at 10 o'clock, A. M. I was called upon to administer medical aid to J. D. a man of twen- ty-one years of age, who reported, that a short time previous to my visit he had been seized with sensations of coldness, langour, lassitude, &c. which symptoms were soon succeeded by severe pains of the head and back—by oppression or weight about the stomach, and by thirst and heat. His pulse were now found fre- quent, but depressed—The skin exceeding hot and dry—The face pale—The eyes red and shining—The tongue somewhat foul. He was anxious and restless—and upon the whole, the case exhibited all the usual signs or first symptoms of the Yellow Fever, as it now prevails. This being apparent, the only safe treatment was esteemed to be the most prompt and decissive. Bleeding was therefore proposed as a first and preparatory mean to the operation of medicine, as well as to unfold the circulation. This measure, was consented to, with considerable hesitation, on the parts of the patient and his parents. But the operation was performed—Thirty ounces of blood were drawn at a bleeding. While the blood flowed the pulse rose, or, in other words, the cir- culation became so far disencumbered as to play with more free- dom. The redness of the eyes passed off. I then administered three calomel pills, of twelve grains each, as a purgative—direct- ed a warm tea of the eupatoriura perfoliatum, (or bone set,) to be drank freely. The feet to bathed in warm water, and some other warm external means, calculated to excite perspiration, to be ap- plied, and left the patient. On returning at 5 o'clock, P. M. I found that the patient's me- dicines had not operated—neither had perspiration been excited. The symptoms of disease had now increased considerably in vio- lence. Six grains of tartar were now dissolved in a cup of bone set tea and administered—The tea was given in large quantities alone, by way of working off* the emetic. L 148 ] At 9 o'clock, I visited him again. This medicine had not ope- rated. It how became my duty to prescribe medicine for him dur- ing the night. Taking into view the desperate nature of the case, and recollecting the obstinate constipation of the bowels, in simi- lar cases, 1 prescribed, 1st, three ounces of salts and ten grains of tarter emetic, to be dissolved in warm water, and one sixth of the solution to be given every hour until the bowels were well eva- cuated. 2d, Thirty six grains of calomel, to be given in doses of six grains each, every four hours after the salts &c. operated. But if it so happened that no evacuation could be procured, other- wise the whole of the calomel to be given at once. 3d, The bone set tea to be continued. 4th, The warm bath and injections to be used. 8th, At 10 o'clock, A. M. visited, and was informed, that, he had takeit all the medicine and submitted to all the means direct- ed, on the preceding evening —that he had not vomited any—that his bowels had beeu evacuated freely a short time previous to this visit—that the stools were black, and that the Fever had grew higher and raged more vehemently all night. The pulse were now one hundred and ten, bold, strong, and full; the face florid, the eyes red and glossy, the tongue and skin dry. In short, most of the symptoms appeared greatly aggravated; yet the patient on being asked how he felt? said, "since the operation of the me- dicine I feel a little better." Four doses otpulv. antim. each eight grains, were now prescrib- ed—one dose to be given every four hours. The tea to be conti- nued. At 6 o'clock, P. M. He seemed belter; the bowels had been well evacuated, the passages still black. He now complained of sick stomach. His skin felt soft but not moist—His Fever had abated. The black snake root tea was now added to the bone set tea, and external means again directed for opening the skin and exciting perspiration. A saline mixture was also prescribed. This was composed of vol. sd. amnion, and sal. sodce dissolved in water and some spirit, nitri. dulc. added. This mixture to be taken in vege- table acid, a table spoonful at a dose, while effervessing. 19th, At 10 o'clock, A. M. He was much better, he had rested well, and perspired freely during the night, yet the stools were as dark as usual. Six doses of calomel and pidv. antim. of each four grains, were now prescribed, one to be taken every six hours. The other medi- cines to be continued. t 149 ] 20th, I found that he had discharged freely of black matter from the bowels during the last night. He now felt himself much bet- ter. The pulse indicated weakness. The snake root tea was con- tinued, and chicken water ordered for nourishment. 2lst, He was convalescing and anxious to eat—This he was cautioned against and advised to drink soup, gruel, sago and por- ter sangoree, 23d, This patient was well. In six days subsequently he re« sumed his usual avocation. Monday 23d August. 1819, I was sent for at 10 o'clock, A. M< and visited J. B. an apprentice boy, of fourteen years of age, who had worked on the south east corner of Fell's Point. He had been seized with a chill, about an hour previous to my visit, and was still shivering—complained of thirst, pain in the head and back- seemed anxious and restless, and threw himself from side to side on the bed. He was ordered to lie still—to cover himself up warm, to drink herb tea, and to have his feet bathed in warm water. At the same time 1 prescribed twenty grains of calomel as a pur- gative, and retired from the patient. At 2 o'clock, P. M. Yisited again, and found that his medicine had not operated, and that he laboured under a considerable degree of Fever. I bound up his arm and drew from it thirty ounces of blood. [He fainted.] I now administered twenty grains more of calomel—directed the herb tea to be continued, and left the patient. Six o'clock, P. M. Yisited him. His medicine had not operated, his Fever had increased, his eyes were now red, his tongue dry, his skin hot; he complained of pain, breathed with labour, sighed] often, &c. 1 administered two ounces of glaubers salts, and re- tired. At 10 o'clock, same evening, this afflicted boy's medicine had purged him copiously. His evacuations were dark, and (as he said) scalded him when discharging. He felt better—seemed ealm, and inclined to sleep. The Fever had abated—the skin was moist and less hot. 24th, At 10 A. M. Found him clear of Fever, and most other symptoms of disease. On asking him hew he felt, he smiled and said he was well. His medicines had continued to operate. u L 160 ] The evacuations had now changed and become natural in their colour. His tongue was moist—his gums swelled, red, aud ten- der. He wanted to eat. He was directed to keep his bed and encourage perspiration, by drinking largely of luke warm elder flower tea, with lemmon acid and sugar in it, and to take a teaspoonful of the carbonate of magnesia, every four hours. To eat nothing: but to drink Chicken water for nourishment. 26th, I visited this patient and found him convalescing rapidly. Directed the same means to be continued. 27th, I found him well, and discharged him from my care, Friday, 27th August, 1819, Having been sent for I visited D. M. a young man of sventeen years of age. 1 found that he had been seized while at work, with sensations of coldness, which were soon succeeded by a general soreness of the flesh, and by pains in the head and back His face was now flushed and swollen—His eyes red and shining—his pulse at the wrist scarcely perceptible— his skin hot and dry. The heart was now throbbing so as to be per- ceived across the room. The action of the carotid arteries, and in- deed of all the large arteries was astonishingly great. Being aware that the want of pulse at the wrist was owing to suffocated and excessive excitement, and not to absence of Fever, (in other words that his pulse were depressed) I tied up his arm, with a view of giving more room for action, by abstracting blood, and lessening the volume of it in the system. The vein would not rise nor fill. It was opened however, aud by working and rubbing the hand and arm I succeeded in drawing only six ounces of blood. I now had the patient rubbed all over in warm vinegar—His feet bathed in warm water, and bottles of warm water put about him in bed. Administered to him six grains of tartar emetic and twenty of ca- lomel, in syrup, at once, and directed warm water to be drank when the medicine began to vomit. I retired. In two hours 1 returned, and found that my patient had not vomited—that his pulse were much more distinct at the wrist— that the skin was still hot and dry. I now tied up the arm and drew away thirty ounces of blood, and administered at a dose twenty grains of calomel and ten of tarter emetic, to be worked off in the same way the first dose was to have been worked off. 1 left him. L i5i J At 10 P. M. I visited him again. On entering his room I wags met by his mother, who exclaimed, " Oh ! Doctor you have kil- led my son!!" " He has been puking for six hours, and his me- dicine has turned down upon his bowels and purged him almost to death." « JCpThere he lies as pale and as white as sugar, and not able to speak or move." I approached the bed, and found him in the act of vomiting and unable to raise his head oft' his pil- low. I felt his pulse and found they were very feeble but regular. His skin was dry ; he had vomited a great quantity of bile of a dark color, during the last four hours of his vomitiug. His alvine evar cuations had been copious and of a deep black color. I prescribed the usual saline mixture; to be taken in lemon acid. Balm tea to be used during the night for drink, admonished his mother to be quiet and attend to her son ; that he was in a good way, notwithstanding all her apprehensions. Saturday 28th, I visited this young man at 8 o'clock in the morning. His mother now reported that " he seemed a great deal better," but " that he stole a march on her last night, a few hours after I left him, and got to a bucket of cold water and drank 'till he was satisfied, and then went to bed and covered himself up warm, and got into so great a sweat that it has run through the bed ; and now his Fever and pain have left him, and he wants to eat, and seems quite well 1" It'appeared that the attention of his affectionate mother was called to some more of the family who were sick ; that the cooling galine draught had been omitted, and that the patient's great thirst had induced him to drink water in large quantities. But this water was far from being cold, havins; been standing for a part of the day and the first part of the night in a room, where there was an accumulation of heat above the extreme heat of the f weather, it Was in fact warm water—much warmer than I some- times recommended my patients in this Fever. His symptoms had now in reality become favourable. The only unfavourable symptom present was that of the strong disposition to eat—If his appetite had been indulged in eating, as it had been in drinking, the scene would soon have changed. The redness of the eyes had now passed oft—the tongue was more moist, but foul __The pulse beat regular and soft. I now prescribed the spiritus mindereri, with sweet spirits of nitre added to it; black snake root tea for drink ; admonished the patient to take no nourishment except a little weak chicken water without seasoning, and retired. [ 153 1 At 10 o'clock in the evening T visited him again, and fonnd that he had not had an exacerbation of Fever: his pulse were less than one hundred, his countenance was good, his skin was soft, cool, and moist. On enquiring how he felt, he answered that he was "easy and comfortable." I directed the same medicine and drink to be continued. 29th, I visited him at 10 o'clock, A. M. His bowels were now constipated, but all his symptoms of disease had greatly lessened in violence. I directed him to take two ounces of salts, and drink chicken water and thin gruel. At 6 P. M. This young man dressed himself, deserted his abode and road out to the country in a coach three miles—In go- ing out he called at my office : I furnished him with some magne- sia, and directed him to keep his bowels regular, by taking small and repeated doses of it—to nurse himself, and use no solid food for several days. Friday 3d September, the father of this patient reported that he had recovered. Fell's Point, 6th September, I was sent for to visit and prescribe for Mrs. C------. a poor widow, who had retired from her home on the Point, with several small children, and rented a house at the upper end of the town, but finding her means likely to be exhausted, she very soon returned to the Point again, (as she said) to be useful to the afflicted, while she obtained the means of sub- sisting her children by her industry and eeonotny, which she could not do iu the strange place she had left in town. At the time I heard this tale it would have been useless for me to urge upon this woman, on her own account, the advantages which the encamp- ment held out, for she was already attacked; but it became my duty to urge the removal of her children to this place, with a view to save their lives if possible. Accordingly 1 proposed having them sent there without delay. To this she objected in strong terms, saying she had rather bury them. Nor could I avail my- self of any language that would induce her to accept of this charit- able exile, so strong were her prejudices against it. By the report of this unfortunate and misguided woman, I learn- ed respecting her disease, that she was seized about three hours previous to my visit; with a cold chill, pains in the back and C 153 ] head, hut a mueh more excrutiating pain in the stomach, which she described as resembling an attack of the bilious Cholic, with which she had been afflicted in June. She had great nausea at the stomach, and frequently retched to vomit but did not raise any thing. Her eyes were red and shining, her face swollen and of a dark red colour approaching to purple, her skin was hot and dry about the body and head, but on the extremities it was cool and dry. The action of the heart and great arteries was excessive. They could be seen to throb by the bystanders. At the wrist the pulse were depressed and indistinct. The breathing was labori- ous—the thirst unquenchable. The patient complained greatly of an insupportable weight on the breast. She sighed deep and fre- quently. In short the whole rounds of the first symptoms of this case shewed the livery of the prevailing fever, in its most aggra- vated form. 1 prescribed for her after the following manner, viz. first, bleeding. To this she objected and could not be prevailed on to submit to it. Second, an emetic composed of tartarised an- timony and ipecacuanha—this 1 administered, and ordered it to be worked off with camomile tea. Third, three calomel pills, each ten grains, one to be taken as soon as the emetic ceased operat- ing, and the remaining two to be taken at intervals of four hours. The pills to be worked off with barley water, and retired. 7th, On visiting this patient I found her situation not much changed. The emetic had operated freely, but no bile had been discharged, the calomel had not operated sufficiently. The pulse were now distinct at the wrist. They were frequent and soft. The tongue was white on the edges, and had a brown strake in the cen- tre. I prescribed three ounces of salts and repeated the calomel. The salts to be taken at once, and the calomel as before. If the bowels were not evacuated freely in four hours, purgative glisters to be used and repeated frequently. 8th, At 10 o'clock, A. M. Found the pulse soft, frequent and in- termitting—The skin dry and hot—The eyes dull and heavy__ The countenance bad, and the tongue dry and brown. On enquir- ing of the patient how she felt, she replied, " that she felt much better, the medicine had operated largely, had relieved her of au immense load of black bile, and had carried off most of her pain. She was thirsty, but much more comfortable than usual." Ou turning round I now beheld (for the first time,) an old lady ad- Vancing towards me, and addressing me in broken English, sayingj " she had came last night to nurse this poor woman, and had been up with her all night." She assured me that the patient had, had twelve large evacuations in the night, of a substance resembl- L 154 1 ing black mud ; that she had passed a had night, but had slept sound from day light to this time. While I was conversing with this nurse the patient fell a sleep. 1 prescribed six powders of calomel, each five grains, one to be taken every six hours. And a solution of vol. sal. amnion, and sal. sadse, with a little spirits of nitre added, (to be taken in ve- getable acid, in an effervessing state, every two hours.) Elder flower tea to be used for drink. I also directed a tub of warm water to be set in the bed, the patient to lie on the back, to draw up the feet and put them in the warm water while she thus lay. The tub and patient to be well covered over with the bed clothes- warm water to be added frequently, and the feet to be kept in it until perspiration was excited. The tub of warm water to be re- moved then and bottles of warm water to be placed in the bed all around the patient—a bed pan to be used if she had occasiou to stool. 1 now left the patient. In the evening I returned and found the skin cool and moist— the pulse improved—the patient sleeping. I directed the same means to be used during the night, in such a way as to keep up perspiration, and retired. 9th, At 10 o'clock, A.M. She was entirely clear of Fever— the pulse ninety, regular, and firm. She now began to look yel- low, and complained of nausea at the stomach and said, "the acid which she was taking scalded her throat"—The tongue was moist and of a deep brown colour. On laying the hand on the stomach, the patient complained of great soreness. I now discontinued the medicines prescribed on the preceeding day, and prescribed a decoction of senna aud salts— A wine glass full to be taken every hour until the bowrels were well evacuated. (The bed pan to be used.) A large blistering plaster to be laid over the stomach—Carrot tea to be drank. I retired. At 10 o'clock, P. M. returned. The purgative had acted well— The stools were black—The patient felt the action of the blister- ing plaster and was less distressed in the stomach—The pulse as before. I now prescribed the carbonate of magnesia, to be taken in small doses through the night—the drink to be continued, and left her for the night in charge of the good old nurse. 10th, At 10 o'clock, A. M. I visited her. She was now exces- sively sick at the stomach, retching frequently, and occasion- [ 153 "j ally raising a small lump of dark matter resembling clots of blood. On asking her how she was, she said, that all her misery had left her except the sick stomach and sore throat. The throat she insisted must be " scalded with the hot sour steam which rose into it from the stomach." The countenance was now bad—-the eyes dim and yellow—the skin dry and of a deep yellow—The tongue had a dark brown and dry appearance—The respiration was laborious—the pulse were one hundred, regular and strong. There was more firmness in them than usual at this critical pe- riod of disease. The patient was anxious and restless. She expected to die and felt great concern for •' her poor chilaren." I directed the magnesia to be given in new milk, and the milk to be drank in large quaniities. 1 also directed a large bag of boiled Irish potatoes to be laid under the back of the patient as warm as she could bear them—the feet to be bathed as before, bot- tles of warm water to be laid about her, and retired. In four hours I returned again and found that my patient had thrown up about a pint of the usual coffee ground like black vomit. Her pulse were somewhat sunk but still better than usual in such cases. I now prescribed lime water. And directed a wine glass full of it to be taken in the same quantity of new milk, every hour. The magnesia; and the uew milk, for drink, to be conti- nued. At 9 P. M. I found her still vomiting black matter. The nurse had saved (and showed me) about a quart of it. The pulse were now sunk considerably, and the fatal scene to all appearance speedily approaching. The head hot, the extremities cold. The skin had but recently became moist although the warm applications had been faithfully applied. I directed the same means to be continued and in addition there- to ordered mustard and vinegar to be applied to the extremities and a plaster of the same articles to be laid over the stomach, on the place where the flies had drawn blisters. This to be conti- nued on her four hours. To be dressed as usual. 11th, She was better. The pulse were now much improved. The black vomit had continued nearly all night, but had now en- tirely subsided. The magnesia had operated three times—the stools were black. I directed the blister tt be dressed with cabbage leaves-—The lime [ 156 1 water and the milk to be continued. Carrot tea to he added to the. milk for drink. At 10 P. M. She vomited black again. The pulse were now one hundred and twenty, and feeble-The skin hot and *7. Ihe patient complained of pain in the bowels. It.addition to the means above named 1 now added one and an half ounces of caster oil. The persiration to be renewed if possible by warm applica- tions and drink. 12th, At 8 o'clock, A. M. She seemed much better. The vomittins of black matter had ceased again (1 was informed).at 12 o'clock at night, and had not since returned. ( I he stomach was still irritable.) The castor oil bad operated four times—the two first evacuations were of a dark colour, the last of a natural appearance. The tongue was now nearly clean—the skin moist— the pulse regular and one hundred and ten per minute. I he pa- tient had great thirst, the lime water, new milk and carrot tea were continued. At 10 P. M. This patient was still better. The same means were continued with as great regularity as pos- sible. 13th. 10 o'clock, A. M. She was not so well; the eyes and skin were uncommonly yellow. The patient very weak. She •i~hed often-but was not sick at the stomach. Her throat was sorer than it had been for the two preceding days The tongue clear—the pulse one hundred and twenty and feeble—skin dry— the evacuations natural. I now discontinued the lime water, and directed black snake root tea and a little chicken water to be used, and if the stomach became sick, a tea spoonful ot prepared chalk to be taken in white sugar and water. At 8 P M. The symptoms in this case were not worse than in the morning But the snake root tea had been rejected by the stomach, and some black flakes had been seen floating in the fluid which had been vomited. I discontinued the snake root tea and chicken water, and resum- ed the lime water,* new milk and carrot tea again. ♦This patient took in all eight pounds of lime water, a great share of hlch was vomited up. But its effects were good even when rejected by which was vomited up the stomach. [ 157 1 14th, The case was still doubtful, yet the symptoms had mo- derated somewhat since last night. The skin was moist. The stomach settled—The stools of a natural appearance. The pati- ent now complained of pain in the back. The urine was black and voided with great pain; The breath had a cadaverous smell. Ihe eyes and skin not changed in color. The countenance was more cheerful and bright. I now directed a tea spoonful of spirits of nitre, td be given in her drink, every four hours. An ounce of castor oil to be given at once, the stomach to be tried with a little weak wine whey. The lime water to be Continued. 15th, I was unable to visit this patient myself, but my medi- cal friend attended her, and he reported, that « she continued bet- ter," " The skin moist, pulse regular, tongue clear, eyes and skin very yellow." She was now directed " to take light nourishment frequently." 16th, She had not vomitted since I last visited her. Her urine had now changed from a black to a red color. The bowels were slow, the skin again dry—The tongue foul. The eyes had grown more yellow. She sighed often. Had called for nourishment fre- quently during the night and this morning, and very improperly ate a peach. She retained nothing on her stomach. Oh examin- ing the right side and pressing it with the hand she complained of great pain—The side felt hard and seemed enlarged about the re- gion of the liver. I prescribed cathartic pills composed of rhubarb and castile soap—to be taken at intervals of six hours, in sufficient quantities, to operate moderately. Fluid nourishment to be taken freely. 17, This case had not changed materially. The bile, &c. con- tinued. 18, More doubtful—The pulse one hundred and regular—pills to be continued. 19th, The skin was still more yellow, the pulse regular, ninety per minute, tongue moist but foul. The pills had operated—ute- rine haemorrhage, and hiccup had now come on, The pills, &c. were continued. 20th, The hiccup had ceased—the patient had drank chicken water with advantage but could retain nothing solid in the stomach since yesterday—the yellowness of the skin still very great—The soreness in the side not lessened. The hemorrhage was now more w L *58 ] profuse. I laid a large blister on !?>.? right side and continued the same pills. 2lst, There was no material change to be discovered since the preceding day. The blister had drawn well. Pills continued. 22d, This case did not seem much improved since my last visit. The patient was excessively weak, and troubled with hiccup oc- casionally, and still unable to take any nourishment of a solid na- ture. She objected to taking any more pills. I now prescribed the same medicine with the addition of aloes, to be taken in a fluid state, and she agreed to take it in that way. 23d, The skin was less yellow, and the patient's pulse better, but the stomach had rejected every thing that had been tried. She Was now quite weak. I discontinued the medicine, and directed light fluid nourish- ment. 24th, She was again to all appearances worse, spoke of dying. She showed signs of hyst ria, however I now got her to promise to take the saponacious pills again and in preparing them added some of the gum fcelida. 26th, I was informed she had been labouring under hysteria all the preceding night. She took no nourishment, nor would she take her pills, 1 gave her a portion of the tincture of gum fcetida, and directed it to be repeated occasionally until reliev- ed of fits. 27th, The hysteric fits still continued—The stomach retained nothing. The uterine hemorrhage had nearly subsided. The skin had become less yellow. Tincture of gum fcetida continued. 28th, She had a good pulse, her skin become less yellow, the hiccup and hysteric symptoms had subsided. The countenance had improved. But the stomach was still weak and so irritable that fluids could not be retained on it for a moment. I admini- stered a scruple of ipecacuanha as an emetic, to be worked off with camomile tea and left the patient in the care of her children, for the good old nurse had gone to bed sick, and the whole neigh- bourhood was depopulated. 29lh, The emetic had operated well, a large quantity of yellow bile had been thrown up. The bowels had been evacuated well, the stools had a black colour. On euquiring of the patient how she felt, she repiid that she was " so weak that she couid not turn in bed, but her stomach was greatly relieved by the puke whieh |_ 109 ] she had taken yesterday, and she felt like recovering." Her coun- tenance was now evidently more natural than it bad been since the attack. But 1 found the stomach to be very irritable. I directed her to drink new milk and barley water, and to take nothing stronger until I visited her again. 30th, I found her propped up in bed and every thing going on well. October 1st, she was still doing well, I allowed her a little cho= Colate at her own request. 2d, She was still improving, she had been sitting up on a chair in the morning for the first time since the 6th ult. « 3d, The patient was able to walk across the room, and begged for something to eat; I allowed her light nourishment. 4th. She was not so well, the stomach had rejected every article of diet that she had tried j she was low spirited and costive, her skin much less yellow. I ordered the pills composed of aloes, soap and fcetida, to be resumed. 5th. She was not so well. Had not been able to rise out of bed since my last visit. The pills to be continued. 6lh, She was less yellow but complained of great weakness and nausea at the stomach—no Fever, pulse 80, regular, but feeble. 7th. I found that the pills* had operated freely. The stools were dark in the beginning of the operation but had become natu- ral. The patient was much better. 8th, She was still better. 9th, Convalescing. 10th, Able to walk about the room again, but unable to eat auy thing. So irritable was the stomach. llth, I advised her to take lime water and sweet oil twice a day until the stomach regained its strength. 20th, I found her engaged at work. The stomach much strong- er—her general strength, improving. The yellowness of skiu had now entirely subsided and the patient had the appearance of good health; I discharged her eured. «--------——, m d;> [ 160 1 A CASE OF YELLOW FEVER, Taken from Memoranda written at the Bed side of the Patient, from hour to hour as it progressed, to its fatal termination. Dr. M. D. C. aged 23 years, a young man of good con- stitution—moral habits—intelligent mind, industrious, persevering, courageous, a native of the north of Ireland, but lately from the West Indies, had been for three weeks acting on the Point as an assistant in the Drs. C.'s office—was attacked, with the Fever pre- vailing there, in the night, between the 7th and 8th of September 1819. He first complained of pain in his stomach and bowels, which was soon after followed by a high fever with great pain in his head and back. Wednesday six o'clock A. M. visited by Dr. C. who found his pulse quick (120) full and tense—skin dry and hot—eyes red and inflamed—pain in his head very great. Bleeding was proposed to him: he refused to submit to the ope- ration alledginy; that his illness was not the prevailing Fever but an attack of cholic. Haifa dram of calomel was administered and he was advised to continue for his drink a solution of cream of tartar and molasses, of which he had drank freely during the night. Twelve o'clock visited by Dr. C. and three other physicians. This medicine had not operated—the symptoms of disease had in* creased in violence. The patient now consented to be bled. Sixteen ounces of blood were taken; but its flow was with less force than usual—the ful- ness of the veins did not appear to correspond with the strong arterial action then present. After the bleeding another half a dram of calomel was administered, and ordered to be repeated in four hours (if this and the first did not operate) acid and diluted drink directed to be usedfreely. Four o'clock P. M.—One dram of calomel has been taken without producing any other effect than a little nausea at his sto- mach. No abatement but rather an increase of unfavorable sym- toms. Twenty grains of calomel were now given, and it having been decided as most adviseable to remove him out of the infected at- mosphere where he lay—Three offers were made to him, and it was left to himself to choose, whether he would enter the general [ 161 ] Hospital, which was open for persons affecfed with Yellow Fe- ver—or accept of an invitation and take a room in a private house, situated in a pleasant part of the City: or otherwise allow himself to be removed into the country, eight miles distant. He prefered, and was highly gratified with this last offer, particularly as he was informed he could have the privilege of a large barn to lay in, where he could be soothed with a free and cool current of pure air, and he provided with every necessary attendance. He got up and dressed himself immediately, and as soon as a carriage could be provided, filled up with hay, and a matrass fixed in it, he was removed to the barn, where he arrived about seven o'clock, and felt himself much refreshed, and in no way fatigued by his journey, of eight miles, over a roughly paved turnpike road. Eight o'clock P. M. Visited by Drs. A. C. and J. S. who found that his medicine had not operated, and that there was no abatement of his disease, puise 115—Full and tense—Skin very dry and btirn- ing-hot—Head-ach very great—Eyes brilliant and red—Complains of the state of his stomach and of nausea from the calomel— restles, anxious, often turning over in haste from side to side in his bed; thirsty, the most free draughts of solution of cream tartar and cool water afford no relief, tongue whitish aud furred, but not foul; mind composed, not delirious, judgment sound and deliber- ate; thinks himself worse, than he was in either of two attacks of Yellow Fever, which he had already experienced this summer in the West Indies; one on shore and another on board of a ship, where he attributed his cure chiefly to the affusion of cold water, whieh he had thrown over him repeatedly by buckets full, and which he says quickly assuaged ; and he believes controled and cured his Fever—When spoken to he appears to be rather in good spirits, and although he considers himself in great danger, he is by no means disheartened—hopes to recover again; and is willing and ready to make every exertion in his power to overcome and subdue his disease. Opened a vein in each arm, but could not ob- tain more than six or eight ounces of blood—administered twenty grains more of calomel, and directed six grains of tartar emetic and two ounces of glanber salts to be dissolved iu six cups full of warm water, one cup full of which was to be taken every two hours until his stomach and bowels should be freely evacuated—This medicine was very disagreeable to him—the first portion occasion- ed some vomiting, and he threw up a quantity of greenish colored bilious matter, which he informed had no other taste than the mix- ture which he had just swallowed. Twelve P. M. Repeated the emetic mixture and salts—stomach more retentive—had taken freely of two milk wheys, vinegar whey, and solution of cream tartar—Ordered one dram of calcined mag- [ 162 ] nesia in a tumbler of water, aid allowed the cool aud diluent drink to be continued. Thursday Qth September, Six A. M. Soon after taking the mag- nesia, his medicine began to operate, and he has continued to pass every half hour, freely and without pain, very copious discharges of dark colored and extremely foetid bilious matter from the bow- els—during intervals,belween these passages he has generally slept composed—He is very sensible of the operation of his medicine (to the calls of which he is always attentive) and nses quickly out of his bed without any aid. For the last six hours there appears to be some abatement of his Fever, but not sufficient to justify its be- ing considered a distinct remission of his disease. Twelve A. M. During the whole of this morning his medicine has continued to act freely on his bowels, without producing any chang" whatever in the appearance of his passages, which are yet as black, copious and offensive as duriug the night. His countenance is more dull and heavy, his eyes drowsy, red and glaring—pulse yet full but slower, not exceeding one hundred. He expresses his astonishment at the great quantity of oft'ensive matter whieh he has discharged from his bowels, without appear- ance of its decrease. Gave a small dose of calomel, and directed a free continuance of the whey, and chicken water which has been using for a few days past. He is very anxious to try the affusion of cold water. Four P. M. The application of cold water thrown over him ap- pears to have a salutary and agreeable effect—But the coolness of his skin which it produces, is of very short duration. He gets out of bed and has buckets full of very cold water poured over him, every fifteen or twenty minutes. The evacuations from his bowels continue as usual—frequent, copious and foetid—pulse full and strong, one hundred and ten, heat of his forehead very great, eyes continued inflamed, and his head aches very violently— tongue more foul, occasionally is found dry and brown in the cen- tre, but whitish, moist and furred on the edges—does not complain of any pain in his back or limbs, drinks freely and with a reten- tive stomach. Seven P. M. Fever encreasing—more restless, more inclined to stupor—pulse more full and tense, skin very hot and dry. A vein was opened, but not more than two ounces of blood could be drawn. The arteries appear full, but the veins will not rise, nor bleed when opened except by drops. It being now evident that his disease will terminate fatally if some immediate change cannot be made in its course—it was de° L 163 J tcrmined to make, if possible, some immediate and foreeable im- pression on the stomach and skin, for which purpose six grains of tartar emetic were given to him, mixed in some water. Eight P. M Having slept ever since taking the above dose, he was roused up aud made drink in succession four tumblers full of warm water, before any emetic effect could be produced—by using his finger to irritate the palate, he now excited some nausea, anil threw up the water which he had just swallowed—but it was with- out any foreign discoloration by bilious or other matters. Ten P. M. The emetic tartar having failed to produce the ef- fect desired, twenty grains of ipecacuhana were given. Twelve P. M. Some slight efforts to vomit have been occasioned by the ipecacuanha, and there appears to be some abatement of Fever, but from the general aspect of the case there is very lit- tle hope remaining that any favourable change can be produced by medicine. Friday, lOfft September, Six A. M. Had several copious dark stools in the night, which were less fcetid—pulse eighty, with di- minished force, eyes still red, head ache continues, complains of nausea at his stomach, his strength much exhausted, but he rises without permitting any one to assist him, when he has occasion for the stool—gave a cup full of green mint tea, which he took, anxi- ously expecting, that it would relieve his stomach, but he soon complained of his disappointment, and refused to take it again, alledging that its " volatile" properties affected his head. Gave him in lieu of the mint tea a cup full of an infusion of the eupato- rium perfoliatum, which produced vomiting and gave him relief, but no bile was thrown up. His thirst being great an infusion of the red berries of the rhus coriaria was given him, and found to be very pleasant and suitable acid beverage. He drank of it sever- al times, and was pleased with the change, but it neither quench- ed his thirst nor afforded any permanent relief. JVine A. M. Every unfavorable symptom of his disease continu- ing. Blisters were directed to be applied largely to his stomach, and on the back of his neck, and to his legs and arms. Diluting drink to be continued, and to use speritus miudereri, saline mix- ture, &c. &c. At his own request the following was prepared for him, viz, sal. soda, and vol. sal. anunon. each one drachm, dissolved in six ounces of water ; add one drachm of vin. antim. and two of spirit. nit. dulc. a table spoonful to be given to him in the same quantity of lime juice every hour or two hours—of this medicine he took fre- [ 164 ] quently; but objected to the spirit, mindereri on account of tht sulphuric acid with which he supposed, from its peculiar taste, the vinegar had been adulterated. Nine P. M. The blisters have occasioned excessive pain, but do not draw. In some respects he is better than he was last even- ing : a considerable abatement of many of his most distressing symp- toms having taken place—There has been no perspiration observed since the commencement of his disease, if we except only an oily exudation on his face, particularly on the sides of his nose, this was several times observed, and when wiped off with the finger left a greasy mark on the skin. There are no spots or blotches, bubo's, pustules or sores, on any part of his body. He is fully convinced of his approaching fate—^regrets his unhappy absence from parents, whose remembrance occasions the filial tear to flow over his cheek. But is grateful for the personal attentions of the strangers into whose hands he has fallen pennyless aud unknown. Saturday lith September, 1819. A new paroxysm of Fever came on about the middle of the night, but the powers of nature had been previously so much exhausted that he resigned himself in confidence to the will of his Heavenly Father, and without any further struggle expired at 7 A. M. Soon after death, his body be- came very yellow—and on the same evening it was committed to the earth, in the Reverend Dr. Glendy's burial ground, in this City. Thus has terminated the human existence of a young stranger who, without fear, but with christian zeal, volunteered his servi- ces under the most dangerous circumstances to aid the poor of Fell's Point, while suffering under the ravages of Yellow Fever— His disease was not communicated to any of his attendants not- withstanding they were constantly by his bed side, making every exertion in their power however ineffectual to render him that as- sistance which he so highly merited, and which the nature of his ease required. [ 165 ] DAILY BEPOKTS, PROCEEDINGS OF THE ROARB OF HEALTH, fy. AUGUST 12th, 1819. Commissioners met. Present, Messrs. Hynson, Owens, Berry. Resolved, That Joseph Legard and Noah Fowler be appointed to collect all correct information, from Physicians, and others, that may assist the Board of Health in forming a correct opinion with respect to the health of the City. Health Office, Baltimore, Aug. lBth, 1819. To Doctor the The Public anxiety appearing to require a Daily Report of ie Health of the City, and the attention of the Faculty hitherto paid to the communications of this Board, induce them respect- fully to request an answer to the following questions, and such other information as may appear to you appropriate: 1. Have you any cases of Fever commenced within tj»e last twenty-four hours, and likely to prove dangerous ? 2. Any Deaths ? 3. Any Dangerous Fever, which commenced previous to the time above mentioned ? By Order, P. REIGART, Secretary. August 14/ft, Commissioners met: Present, Messrs. Hynson, Owens and Berry. . . Joseph Legard reports nothing new, from the Physicians, ot im- portance, for the last twenty-four hours. ' Noah Fowler reports several cases, upon the authority ot Urs, Murphy and Martin, of Fell's Point!!! August I6tt, Joseph Legard reports nothing more than some few cases of Bilious. _. _, Noah Fowler reports, on the authority of Doctors [Reese!] Mi*r- phy and Martin, several new cases of Malignant Fever, 3£ [ 166 ] August 17th, Joseph Legard makes the following report:—Dr. Jennings, 1 new case, William Conckey, malignant character. Dr H. Bond, l new case, son of Capt. Philips, malignant cha- racter. August i8th, Reports from thirty Physicians west of the Falls, only one new case of any note. Fell's Point—Drs. Clendinen, 3 new cases in Pitt street. Dr. Martin, 1 new case Remittant, corner of Lancaster aud Market streets. August 19th, West of the Falls, bnly two new cases of a Bili- ous nature. Drs. Clendinen report 1 new case in Pitt street, Fell's Point. August 20th. Board met: Present, Messrs. Millemon, Hynson and Owens. Issued an older to J. Gitchelto receive Joseph Gelibart's two apprentices into the Hospital. Nothing new west of the Falls. Noah Fowler reports nine new cases on the Point. August 2lst, Nothing new west of the Falls. Noah Fowler reports nothing new from the Point, the Physici- ans refusing to give any statement.* » FELL'S POINT, 24th August, 18191 To Edward Johnson, Esq. SIR, ftAviks been called upon by the board ofhealth to furnish them with daily reports respecting the Yellow Fever, which prevails here (a» they have alledged) I readily acquiesced in the first instance, and reported my cases—But I did not even wish to state my opinion on the subject in direct tern's. I therefore detailed the symtoms of such cases of disease as I report- ed—gave th6 names and places of abode of the subjects thereof, and occa- sionally intimated that the cases reported were of suspicious character. By the word suspicious I had reference to something which I have felt and still feel afraid is now brevnng. I did not mean, that this, or that, person was expected to have the Yel/ow Fever, but might have, some other disease!! This woo Id have ill become any man of my profession. The Yellow Fever is strongly characterized: the symptoms and appearances of it make impres- Hion on the mind of any physician who once Sees it, such as cannot be ef- faced or mistaken. These reports were made (I thought) confidentially—for the use and guid- ance of the Board of Health, and not for the public criticism ***and it has been with great surprise that I have seen them published; especially in the same style as reported, and with my name attached to tbem as responsible author- L i«r i August 23d, Joseph Legard reports nothing new west of In* Falls. Noah Fowler, no report except Dr. Page. August 2tih, Nothing new reported. August 25th, Joseph Legard reports nothing new. Noah Fowler reports two new cases by Dr. Elbert of Fell's Point. ' ity. This has led many to believe in the extensive existence of the Yellow Fever on Fell's Point, before it could be fairly said to have existed. When these reports wei;e issued, the cases whjch had occurred in this part of the pity, were entitled to no pther than the name of sporadic cases. And as spo- radic cases they could concern but few persons in the community : The only good which could be expected to result from reporting them was that of hav- ing their cause removed. This indeed -was, and still is, important. And this would make it the duty of every physician to report his cases daijy, no matter how muth his doing so might interfere with his private avocations. But not feel- ing willing to appear before the public, in the 'official light in which I was placed by the Board of Health, and share with them in all the good, or evil, which might, or might not, grow out of a necessary or unnecessary alai-m ; but above all not finding any good likely to result to. this place by way of removing nuisances, and checking the Fever; I have declined reporting cases, to the Board of Health. In l]te mean -while several additional cases have occur- red, and they merit your most earnest attention. The prevailing.disease is strictly a. miasmatic Fever. It wears all the Bih lious grades from the Idghest malignant down to common Autumnal Fever. It is in vain that yaw. will look for the cftuse of it beyond seas: The cause is of domestic origin, and I suspect that it is at the very threshold of our o-^n doors that wc are to look for it successfully. The weather is excessively hot; and it is an acknowledged fact that in hot seasons neglect of cleanliness, will favor tlte generation of the causes ofpestU lence on ground ftjing low enveloped in moisture and stocked with vegetables of a suitable kind. Of these we have a great, abundance in this quarter. I have already named-sundry nuisances to one of the Board of Health. He has very coaly and perhaps correctly remarked that " similar nuisances exist all over town!!" Several days have now elapsed and be has taken no measures to have these causes of disease removed. I am not so much of a skeptic Sir, as to say that the great body of this city ii of less importance than FelVs Point; but if this place were of no impor- tance in a commercial point of view (which few men will say) we should have pur health and lives attended to, and.protected: as a part of the same com- munity, although we reside somewhat detached from the wealth of this, city, v/e have a right to claim this much of your hands. C 168 ] August 26th, Nothing of importance west of the Falls. Several Doctors state that every description of disease is discontinuing. Fell's Point—Drs. Clendinen, since the 20th inst. 32 new cases. Dr. Murphy, 6! ! Dr Martin 1 for the last 2k hours. The Board of Health, in conjunction with the Mayor, met the Physicians of the Point at 3, P. M. to ascertain the cause of the prevailing disease. August 27th, J. Legard reports nothing unfavorable west of the Falls. N. Fowler reports 7 new cases from the Point. August 2Sth, 3. Legard reports nothing more than ordinary Billious cases west of the halls. N. Fowler reports 5 cases within the last 21 hours from the Point. August 29tk, Commissioners met, all present. J. Legard reports nothing unfavorable west of the Falls. N. Fowltr reports 27 new cases of malignant character. An order granted to Samuel Poor to remove all vessels lying at any wharf, from Barron's to Price's wharf 200 yards in the stream. August 30th, J. Legard reports nothing of malignant character. The following reports received from the Point—Dr. Murphy, 1. Dr. Allender, 4. Dr. Elbert, 2. Drs. Clendinen,* 5. Dr. Mar- tin, 7. Dr. Page, 5.—Total, 24. Something unusual is germinating here; probably a great calamity hangs over us. And if this disease once becomes epidemic, all your efforts to ex- tinguish it will be fruitless. Nothing but frost will be sufficient to stop its progress. It is impossible for any man to say whether or not it will become a general disease. Great efforts should be made therefore, with a view to avert this evil instead of folding your arms and abandoning us to our approaching fate ** * ****** It may soon become dangerous to perform any work, or transact any busi- ness here. The lives of those who remain here either idle or employed, may be jeo- pardized in a few days. Therefore if the Corporation have it in view to do any thing which contemplates restoring our health; let it be' done early on their own account. Yours sincerely, "------------M. D." * Oliver Bond, a student of Drs. \V. H. & A. Clendinen, died of the Fevei last night. To "Christian Slimer, Esq. You will remove, or cause to be removed, all vessels contain* ing water-mellons, lying west of Jones' Falls. By Order of the Board of Health. P. REIGART, Secretary. Health Office, August 31st, 1819. To Silvester Brown, You will remove all vessels lying at any wharf, from Coun- ty to Sugar House wharf. By Order, P. REIGART, Secretary. Fell's Point—Dr. Elbert, i. Dr. Martin, 4. Drs. Clendinen, 9. Dr. Allender, 3. Dr. Page, 2. Dr. Potter, 1. Granby Street.—Total 20. September 1st, No new cases of malignant character, west of tha Falls. Fell's Point—Doctors Clendinen, 5. Dr. Martin, 1. Dr. Allender, 1. Queen Street, near the Circus.—Total 7. September 2. No new cases of malignant character west of the Falls. Fell's Point—Doctor Martin, 1. Dr. Page, 1. Drs. Clendin- en, 8, reported on the 3d inst.—Total 10. September 3rd, No new cases of a malignant character west of the Falls. Fell's Point—-Dr. Martin, 3. Drs. Clendinen, 7. Dr. Page, 2. Total 12. September 4th, No new cases of a malignant character west of the Falls. Fell's Point—Drs. Clendinen, 4. Br. Murphy, 4. Dr. El- bert, 6. Dr. Diffenderffer, 1, Albermarl street, removed from Lancaster street, Fell's Point___Total 15. Drs. Allender and Martin, have gone to the country, with their families, and no report from them for the last 24 hours. September 5th, Joseph Legard reports the following : Dr. Hall, 2, contracted on the Poiut. Dr. Reese, 1, Mill street, near the Jail i! Dr. Page, l, Union street, O. T. contracted on the Point. Fell's Point-—Dr. Allender, 3. Drs. Clendinen, 4. Dr. Mur- phy, 10. L *?» 1 Drs. Jennings and Marrast, 4, of the same character of Fcves; which has commonly prevailed at Fell's Point.—Total 25. September 6th, No new cases of a malignant character west of the Falls. Fell's Point—Dr. Elbert 2- Dr. Allender, 3. Dr. Martin, 2. Drs. Clendinen, 5. Drr Murphy, 7___Tottil 19. September 7th, No new cases of a malignant character west of the Falls. Fell's Point—Dr. Martin, 1. Dr. Chatard, 2. Dr. Allender, 4. Drs. Clendinen, 5. Drs. Jennings and Marrast, 1, contracted on the Point.—To- tal 13. September 8th, No new cases, of a malignant character west of the Falls. Fell's Point—Dr. Elbert, 4. Br. Martin, 2. Dr. Allender, 3. Drs. Clendinen, 5. Dr. Paee 1. Dr. Buckler, 1, contracted on the Point, Market street extend- . ed.—Total 16. September Qth, No new cases of a malignant character reported west of the Falls. Fell's Point—Dr. Martin, t. Dr. Murphy, 3. Dr. Elbert, 2, Dr. (^'Conner, a.-rTotal 8. September 10th, No new cases of malignant character reported west of the Falls. Fell's Point—Dr. Allender, 2. Dr. Elbert, 1. Dr. Murphy, 1. Dr. O'Conner, 3,—Total 7. September Uth, No new cases of malignant character reported west of the Falls, with the exception of one case by Dr. Reese con- tracted on the Point. Fell's Point—Dr Martin, 4. Dr. Allender, 1. Dr. Clendin- en,* 6. Dr. Murphy, 4—Total 16. Dr. Elbert indisposed.! September 12th, No new cases of malignant character reported west of the Falls. Fell's Point—Dr. Martin, 6. Dr. Allender, 2. Dr. Murphy, B. Dr. O'Conner, 4. * Dr. M. D. Clark, a native of Ireland, who had lately been employed by the Drs. C. as an assistant, died of the Fever this morning. t He left the City about this time, and remained away, with his family* during the Fever. [ iyi j Dr. Reese, 1, M'Eldery street, contracted at Sinners' Hotels Fell's Point.—Total 18. September 13th, No new cases of malignant character west of the Falls, with the exception of one case by Dr. Alexander, Mar- ket street extended, contracted on the Point. Fell's Point—Drs. Clendinen, 22. Dr. O'Conner, 5. Dr; Martin, 10. Dr. Murphy, 8. Dr. Allender, 3. Dr. Townsend, 3, Encampment.—Total 52. September 14£/i,* No new cases of malignant character reported west of the Falls, with the exception of one case by Dr. Reese, Pratt street!! Fell's Point—Dr. Allender, 6. Drs. Clendinen, 5. Dr. Mur- phy, 6. Dr. Martin, 8. Dr. O'Conner, 2. Dr. Page, l. Dr. Townsend 1, Encampment, removed to the Hospital.—To- tal 30. September i5th, No case of malignant character reported west of the Falls, with the exception of one case by Dr. Fisher, South Charles street, removed from the Point, yesterday afternoon. Fell's Point—Drs. Clendinen, 6. Dr. Murphy, 8. Dr. O'Con- ner 2. Dr. Martin, 13.—Total 30. September 16th, No new cases of malignant character reported west of the Falls. Fell's.Point—Drs. Clendinen, 5. Dr. Martin, 8. O'Conner) 1. Dr. Allender indisposed.f (Dr. Murphy out of town.)—Total 14. September 17th, No new cases of malignant character reported west of the Falls. Fell's Point—Dr. O'Connor, 6. Dr. Murphy, 3. Drs. Clen- dinen, 3. Dr. Martin, 13. Dr. Readel, 1, Old Town contracted at the Point. Dr. Gilling- ham, 1, Front Street Old Town, contracted at the Point.—To- tal 27. September 18th, No new cases of malignant character west of the Falls. Fell's Point—Dr. Martin, 6. Dr. O'Connor, 5. Dr. Murphy, 0. Dr. Page, 1, Granby street, contracted on the Point. Dr. Reese, 2, Harford Road! removed from Wolf street, F P.—Total 19. * Dr. Henry Dorrey died of the Fever on this day. f Dr. Allender left town about the date of this record, and did not return »o practice again during the Fever. L «* 1 September 19th, No new cases reported as having originated west of the Falls, with the exception of one case by Dr. Richardson, S It a rn strf*f*t Fell's Point--Dr. Murphy, 5. Dr. Martin, 8. Dr. O'Connor, 9. Dr Perkins, 2, Dr. Hali, 2, removed from the Point. Dr. Brevitt, 1, French street. Dr. Townsend, 2, contracted on the Point. . ,. ., Drs. Clendinen, reported on the 20th, 13 cases, ending on the mornins of the 19th.—Total 39. "a September 20th, Fell's Point—Dr. Martin, 8. Dr. Murphy, 2. Drs. Clendinen, 4. Dr. Coulter, 2. Dr. Townsend, 1, Encampment. Dr. rotter, 1, Commerce street; originated west of the Falls. Dr. Baker, 1, contracted at the Point.—Total 19. September 2 Is*, Fell's Point—Drs. Clendinen, 6. Dr. Mur- phy, 15. Dr. Martin, 19. Dr. O'Connor, 2. Dr. Page, 1, Harris' Creek. Dr. Sinnot, 1, Hook's Town Road. Dr. Coulter, 1, Gough street. Total 45. September 22d, No cases of malignant character, reported, as havinir originated west of the Falls. Fell's Point—Dr. Martin, 5. Dr. Murphy, 4. Dr. Page, 1, Washington street. Dr. Reese, 1, previously reported by Dr. Martin. . _ T . T ., Dr. Brevitt, t, contracted on the Point. Dr. Jamison, a. Jail, do do, Dr. Handy, 1, Jail, do. do. Drs. Birckhead and Bond, 4—Total 15. September 23d, No cases of malignant reported west of the Falls. Fell's Point—Dr. Martin, 7- Dr. O'Conner, 8. Dr. Murphy, 6, Dr. Page, 1, Gough street. Dr. Taylor, 1, East side of Pratt street bridge. Dr. Coulter, 1, Happy alley. Drs. Birckhead and Bond, 1 East of the Falls- Dr. Siunot, 1, place not designated. J)rs. Cleudinen had 6 new cases this day, but not reported un- til the afternoon—Total 32- c September 2\th, No new cases of malignant character reported as having originated west of the Falls- Fell's Point—Dr. Martin, 14- Dr. Murphy, 11. Dr. O'Con- ner, 2. Drs. Clendinen, 6. m Dr. Reese, l, Mill street, near the Jail, contracted at the Point Dr. Townsend, 3. Encampment, lately removed from the Point. Dr. Jennings, 1, contracted on the Point. Dr. Donaldson, 1, con. iracted on the Point,— Total 39. L *7» j September 25th, Fell's Point—Dr. Martin 9. Dr. Murphy 4. Dr. O'Conner, 6. Drs. Clendinen, 6. Dr. Johnson, 3. Dr. Reese, 1, Britton street, contracted on the Point. Dr. H. Bond, l, contracted on the Point.—Total 29. September 26th, No new cases of malignant character reported west of the Falls. Fell's Point—Drs. Clendinen, 5. Dr. Murphy, 9. Dr. Mar- tin, 14. v J Dr. Coulter, 1, contracted at the Point. Dr. Dunan, 1, remov- em from the Point.—Total 30. September 27th, No new cases of malignant character reported as having originated west of Harford Run. Fell's Point—Dr. Johnson,* 5. Dr. O'Conner, 9. Dr. Murphy, 8. Drs. Clendinen, 5. Dr. Cromwell, l, contracted at the Point. Dr. Dunan, l, Fe- deral Hill, a Fisherman___Total 26. September 28th, Fell's Point—Dr. Johnson, 8. Dr. Ealer,t 3. Dr. O'Conner, indisposed. Drs. Clendinen, 5. Drs. Jennings and Marrast, 1, Federal Hill, a fisherman who has been down the river lately. Dr. Caldwell, l, Alms House. Total 18. September 29th, Fell's Point—Dr. Johnson, 2. Dr. Murphy, 5, Dr. Ealer, l. Dr. Page, 3, two Washington street, Fell's Point, and one Ex- eter street, Old Town, contracted at the Point Dr. Welsh, 1, contracted at the Point. Dr. Townsend, 1, Encampment.^ Dr. * His residence hitherto has been west of the Falls; he has now gone down to the Point to occupy the premises and attend to the practice of Dr. S. B. Martin, who has left the City to join his family. •j- Dr. Ealer, the only Apothecary remaining within the impure limits of air now began to report cases as an attending Physician. Of kine practicing Physicians who resided on the Point when the Fever first began to rage, there remained to the last but three: Of three who sub- sequently took up their residence there as assistants two died, and one con- tinued until the disease subsided, and then settled there permanently. From a few Physicians west of the Falls, (particularly Dr. J. Owen,) the sick re- ceived constant attendance during the whole calamity. t ANNAPOLIS, September 26th, 1819. SIR, Understanding that the number of unfortunate and distressed persons, who have been driven from Fell's Point by the prevailing Fever, and who are now supported at the expense of the City of Baltimore, at the place called the encampment, increases daily; and that the loan of all or a part of the tents belonging to the State, of which there are several hundred in Baltimore, might be of service : Although the executive may perhaps not Y [174 ] Alexander, 1. Dr. Brevitt, 1, High street. Dr. Taylor, 3, Front street, Old Town, contracted the disease near Pratt street bridge, one on M'Eldrey's wharf.—Total 17. September 30th,* Fell's Point—Dr. Johnson, 6. Dr. Mur- phy, 3. Dr. Dunan, 3, two on the Point and one on the Philadelphia Road. Dr. H. Bond, 1, contracted at the Point. Dr. Baker, 1, Gilford alley, contracted at the Point. Dr. Alexander, 1, North Calvert street, a Seaman. Dr. Page, 2, one Washington street, Fell s Point one High street, M'Eldery's wharf Dr. Taylor, 1, Prince street near Pratt street Bridge.—Total 18. October 1st, Fell's Point—Drs. Clendinen, 7. Dr. Johnson, 4. Dr. Dunan, 1. Dr. Handy, 1, Guilford alley, near Christopher Hughe's.—To- tal 13. October 2d, Fell's Point—Dr. Johnson, 6. Dr. Murphy, 6. Drs. Clendinen, 5. have a legal authority to dispose of this article of the State's property, I have no doubt the rendering such an accomodation to your City in its pre- sent distress, would be approved of and sanctioned by the Legislature. I wonld therefore venture, with the approbation of such of the gentlemen of the Council as I can have an opportunity to consult, to,furnish you with as many of the tents as you may require, upon a satisfactory engagement being entered into for their return. As Col. Howard, one member of the Council is in Baltimore, it might be respectful, and proper for you to mention the subject to him, that his opinion as to the propriety of this measure may be communicated. I will myself advise with Major Chapman, another mem- ber of the Council, who is in Annapolis. If you find it necessary to make use of the accomodation suggested, any communication you may think pro- per to make upou the subject will be respectfully and promptly attended to. I will ask the favour of you to put the inclosed order into the bands proper to direct its application to the object intended With much respect I am Sir, Your most obedient servant, Edward Johnson, Esq. C. GOLDSBOROUGH. SIB, I have the honour to enclose an order for the delivery of any tents or articles of Camp Equipage belonging to the State of Maryland, which may be required for the accomodation of our fellow citizens in the encampment. And remain very respectfully, Your most obedient servant, JOHN E HOWARD, Jun. His Honour the Mayor of Baltimore. * Dr. J. O'Conner died of the prevailing Fever on this day. L *75 ] Reese, 2, Bond street, F. P. Dr. Townsend, 1, Encampment. Dr. Coulter, 1, Carolina, street F. P Dr. Dunan, 3. one Fell's Point, one High street, O. T. one York street. Dr. Page, l, Alisanna street, F. P. Deduct from the above amount of new cases, the two cases from Bond street, previously report by Dr. Murphy.— Total 25. October 3d, No cases of malignant Fever reported west of Har- ford Run. Fell's Point—Dr. Johnson, 3. Dr. Murphy, 3. Dr. Clendinen, 5. Dr. Coulter, 1__Total 12. October 4£/t, Fell's Point—Dr. Johnson, 4. Dr. Murphy, 6] Drs. Clendinen, 5. Dr. Ealer, 2. Dr. Page, 1. Dr. Welsh, 2, one Bridge street extended, contracted on Smith's dock, one Green strent, O. T. Dr. Dunan, 1, removed from the Point.—Total 20. October 5th, Fell's Point—Dr. Murphy, 4. Dr. Johnson, 2. Dr. Ealer, 1. Dr. Dunan, 2, Federal Hill, corner of Hill and Goodman streets. Total 9. October 6th, No new cases reported west of Harford Run. Fell's Poiut—Dr. Murphy, 6. Dr. Johnson, 3. Drs. Clen- dinen, 2. Dr. Ealer, 1. Dr. Page, 3.—Total 15. October 7th, Fell's Point—Drs. Clendinen, 7. Dr. Johnson, 2. Dr. Murphy, 3. Dr. Ealer, 2. Dr. Dunan, 3, one French street, O. T. one Goodman street, one removed from the Point.—Total 17. October 8th, Fell's Point—Dr. Johnson, 1. Dr. Murphy, 5. Dr. Ealer, 2. Drs. Clendinen, 3. Drs. Jennings and Marrast, 1, near Hughs' Quay.—Total 12. October 9th, No new cases of malignant character reported west of Harford Run. Fell's Point—Dr. Murphy, 3. Dr. Johnson, 2. Dr. Ealer, 1. Drs. Clendinen, 3.—Total 9. October 10th, Fell's Point—Dr. Murphy, 6. Dr. Johnson, 2. Drs. Clendinen, 1. Dr. Coulter, 1. Total 10. October 11th, No new cases reported west of Harford Run. Fell's Point—Dr. Johnson, 4. Dr. Murphy, 5. Drs. Clen- dinen, 1.—Total 10. October 12th, Fell's Point—Dr. Johnson, 5. Dr. Murphy, 5. Drs. Clendinen, 2. Dr. Taylor, 2, returned from the country a few days since. Dr. Reese, 1, visited the Point.—Total 15. [ 176 ] This day the Board discontinued to collect the reports of the Physicians west of Harford Run. October 13th, Dr. Murphy, 3. Dr. Johnson, 2. Drs. Clendin- en, 4__Total 9. October nth, Dr. Johnson, 4. Drs. Clendinen, 5. Dr. Mur- phy, 3.—Total 12. October 15th, Dr. Murphy, 3. Dr. Johnson, 1. Drs. Clendin- en, 5.—Total 9. October 16th, Dr. Johnson, 2. Dr. Murphy, 4. Drs. Clendin- en, 2. Dr. Ealer, 2.—Total 10. October 17th, Dr. Murphy,* 2. Drs. Clendinen, 4. Dr. John- son, 3.—Total 9. October 18th. Drs. Clendinen, 3. October 19th, No new cases reported this day. October 20th, No new cases this day.—-The Board discontinued to collect the reports of the Physicians of Fell's Point,—Total 1,005. But this number is not supposed to include all the cases which oc- curred during the summer. ERRATA.—August 26th, read, Dr. Murphy, 16. FELL'S POINT, 1st November, 1819. To Edward Johnson, Esq. SIR, THE Malignant Fever of this place having now terminated, we of- fer you our final report comprising all the Bilious Fevers with which we have had to contend from the first of July to this date : It appears from our books, that we have reported to the Board of Health, 272 patients as having had Malignant Feteb. Of this number we sent two to the Hospital. The balance under our care 270. These we have divided into two classes. The first embracing such as applied within twenty-four hours of their attack, 144—of whom 12 died. The second class, such as applied from the 2d to the 5th day, 126—of whom 26 died. Total deaths 38. Total recovered 232. Beside the cases so reported we had 60 patients, who laboured under the same character of Fever, and 300 who had milder grades of Fever. Above one half of the first named patients sickened in the neighborhood of the City, before the daily reports were issued. The remainder fell under our notice subsequently, in the country, among those who had gone away in hopes to escape the disease—of those 4 died. A very large proportion of the latter character sickened in town, in July and August, and some at every period of the summer: But the greatest number of them, after leaving town, and taking up their abode near marshes—of those 5 died. Total of every grade 630—Of deaths 47. Recovered 583. W. H. & A. CLENDINEN. * Dr. Henderson, a native of Virginia, who had volunteered, his services, and aided Dr. Murphy, died of the Fever about the date of thi9 report. [ w ] Report of Interments in the City of Baltimore, from the first of January, 1819, to the first of January, 1820. JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER - NOVEMBER DECEMBER < Males. Females. Total. OF WHOM Coloured. 77 47 124 40 60 56 116 27 81 62 143 44 97 72 149 51 68 67 155 44 74 47 121 34 126 112 238 73 196 120 316 71 272 202 474 59 138 105 243 67 54 50 104 29 60 44 104 32 I 1,303 1 984 12,287 i 571 Total OF WHOM WERE Of the age of one year and under 516 Between the age of one and two years .... 252 From two to five years - . 129 five to ten - - 147 ten to twenty - - 291 twenty to thirty - 357 thirty to forty - - 191 ,_ forty to fifty - - 117 From fifty to sixty sixty to seventy seventy to eighty - eighty to ninety ninety to an hundred over an hundred Still born 71 39 35 27 9 1 105 OF THE FOLLOWING DISEASES Abcess Apoplexy Asthma Burn Cancer Casualty Child-bed Cholera-morbus Cholic Consumption Convulsions 1 21 5 2 4 17 18 125 4 272 89 Cramp in the stomach 3 Croup 57 Decay 88 Dropsay 41 Do. in the head 27 Drounded 31 Dysentery 21 Epilepsy 4 Fever 4 : Bilious 73 Inflammatory 2 Fever Intermittent 4 Malignant 350 Nervous 2 Remittent 2 Typhus 84 Flux 5 Fistula 1 Gravel 3 Gout' 1 Hemorrhage 3 Hives 3 Jaundice 2 Intemperance 46 Insanity 1 Inflammation of the stomach 1 : Lungs 29 : Bowels 1 : Brain 10 Lock-jaw 2 Measies 116 Mortification 26 Total 2,287 JcjJlhliiO : Murdered 7 Old Age 77 Palsy 7 Plurisy 41 Rheumatism 5 Scrofula 2 Small-pox 1 Sore throat 11 Spasm 3 Still born 105 Sudden death 16 Do. by drinking cold water 8 Suicide 3 Syphilis 3 Teething 27 Whooping-cough 78 Worms 59 Unknown 91 Total 2,287 By order of the Board of Health, P. REIGART, Sedry. L W ] Extract from the Mayor's Message. Gentlemen of the First and Second Branches of the City Council, THE awful visitation with which it has pleased Divine Providence to afflict a part of our City, during the past summer, and the many inconveniences experienced by all, any ways con- nected with the general prosperity and welfare, will impose ar- duous and important additional duties to be performed by you dur- ing your present session, as an investigation of the probable cause of the origin, and extension of the late calamitous Epidemic, and providing measures of precaution relative to the future health of the City, and removing every nuisance that may be suspected of contributing to the production or extension of disease, will cer- tainly be expected by our fellow citizens. With a view to be enabled to afford you all the assistance in my power, 1 addressed a Circular to the Medical Gentlemen of our City, requesting their opinion and advice as to the probable cause of the late Epidemic, and of the existence of nuisances, either ge* neral or particular, whereby the health of the City was probably impaired ; and what measures they would recommend, as the cheapest, most expeditious and most effectual for their removal. Calculating on the continuance of the strong interest felt by them on this subject, and so often manifested by their prompt attention to the many and troublesome communications from the Board of Health, during the time of the Fever, (with great pleasure I men- tion the able council and support which we constantly received from the Medical Gentlemen generally, during the time of the dis- tress :) Many of whom visited the Health-Office almost daily, to see in what manner they could become serviceable ; not the Junior members of the Faculty only, but such as by age and experience are considered as at the head of the profession. Very early in the disease anticipating its extension, preparations were made for the comfort and relief of those resident within the infected district, who were solicited and personally importuned to remove, without much effect, until the 27th day of August, when the character of the disease was clearly ascertained, and fifty-two new cases reported by the Physicians. The Officer commanding the United States Arsenal, near this City, being applied to, freely granted as many tents as we request- ed : and it is with pleasure 1 add, that this humane act has been highly approved by the War Department: The Governoj of Ma- ryland also, spontaneously tendered the use of those belonging to L 1*9 ] ihe state, so far as he could influence the disposal of them, accom- panying this tender with a handsome private donation, for the use of the poor. Two rope walks at the eastern extremity of the City & were also obtained, which with the tents, were soon filled with near a thousand people. To provide for their wants, and preserve order among such a population hastily collected together, and composed of almost eve- ry description of persons, a Committee of eight of our worthy ci- tizens, to wit: John Hillen, Joseph Townsend, Frederick Shaeffer, John Lee, Eli Balderson, Richard K. Heath, Lambert Thomas and George Decker, were appointed to manage the weighty con- cern. System immediately sprung from their exertions : order was introduced, cleanliness enforced, and provisions distributed, with a bountiful yet discriminating hand ; the necessary conse- qnence of which was that uncommon health was enjoyed, although a part of the time they were encamped was very inclement. When the sickness abated, it is but just to say, that they return- ed to their own houses in a very orderly manner, fully impressed with a sense of the beneficent efforts that had been made to pre- serve them from the pestilence, aud to provide them with the ne- cessaries of life. For the relief of the poor at the Encampment, the Commissioners expended articles to the value of eight thousand three hundred and •leven dollars, of which they have rendered a minute and detailed account. The resources for this disbursement were chiefly furnished by donations in money, and provisions by our citizens, excepting the generous aids received from George Town, (District of Columbia,) Tawney Town, and Union Town, in Frederick County. When the encampment was broken up, the articles on hand were distributed with discretion, and the amount of donations was so managed as to meet the disbursements. The highest encomium I ean pass, and the strongest expression of the grateful sense felt for the kind and friendly aid derived from their labours will be made by calling your attention to a report of their proceeding here- with presented to you. In adverting to this calamity I should commit an act of injus- tice, were 1 to neglect noticing the humane Mid magnanimous ex- ertions of the Medical Gentlemen, residing iu, or in the vicinity of the infected district, and those who volunteered their assistance when the disease had attained its greatest extent and' malignity; some time previous to which period the more wealthy of our cifi- [ 180 1 /ens and their families from within the district had removed, and very few remained except those who, by the deprivation of the usual means of support, or from extreme indigence, were able to afford but little prospect to the Physician of pecuniary remunera- tion, equal eveu to that which he might actually be called upon to expeud from his own means on their account: They still perse- vered and attended, indiscriminately, all, the rich and the poor, suffering no considerations to deter them from the indulgence of their philanthropise feelings. As the cases of affliction multipli- ed, the calls upon them increased, and their natural rest was de- stroyed, and their anxieties strained to such a pitch, their own lives appeared likely to become a sacrifice to their disinterested zeal. I had daily interviews with them, and could not but ob- serve that they were exhausted, completely worn out; and it ap- peared to me impossible, that the sick could mtich longer receive from them that prompt and steady attention the nature of the ma- lady required. In this situation of things my duty appeared obvious: supported In this, as in all other the most trying occurrences of the time, by the board of health, the Medical Gentlemen were encouraged to a continuance of their kind offices among a people whose confidence they possessed, and were promised the aid and assistance of other Physicians, as far as I could rightfully do, and the faith of the Ci- ty was pledged to indemnify them all for their attendance on the poor, which I entreated might be given as freely to them as to others. 1 feel it my bounden duty to declare my conviction that the Medical Gentlemen located at or near the infected district, and those who in the emergency stated, stepped forward to assist them with equal humanity and equal hazard to themselves, administer- ed to such as were the especial objeets of my care as to those of others who were able to render complete remuneration. For this generous conduct they have strong claims on our gratitude, and a right to expect pecuniary compensation, for their time and money expended. I feel it a duty likewise to notice the conduct of Noah Fowler, one of the City Bailiffs, on this trying occasion, whose la- borious and dangerous duti.-; of removing the sick, aud attending to the burying of the dead, wtre most faithfully and cheerfully per- formed, though at the expense of great bodily fatigue, and immi- nent risk of the loss of life. In the early part of the year the limited resources of the City, and the extreme difficulty of obtaining the requisite funds to meet, even current expences, occasioned a postponement of many works directed by the ordinances of your last session to be completed. The situation of Pratt street, at the time a perfect nuisance, and if not duly attended to likely to become the fruitful source of dis- L 181 j ease and death, required and received the unremitted attention of the City Commissioners and Fort Wardens, a id the mud and other filth was so effectually covered as to remove every apprehension of danger. The faithful and substantial manner of its completion affords general satisfaction, being entirely of stone instead of wood, there- by removing the fears and apprehensions of many, the Medical Gentlemen of our City considering our decaying wooden wharves as contributing largely in the production of miasma, and thereby en- dangering the general health of our City. January 3rd, 1820. Dr. Ashton Alexander, President of the District Medical Society SIR, THE committee to whom is referred by both branches of the City Council that part of the Mayor's communication, recommending an inquiry into the causes, and the adoption of the most effectual means to prevent the recurrence of the Malignant Fever with which our city was so unhappily afflicted during the last summer, sen- sible of the great importanee of this enquiry, and aware of the well grounded anxiety of our citizens on these interesting subjects, are anxious to possess the fullest and most accurate information rela- tive to them; they have therefore addressed this society, to the re- sult of whose deliberations they look with confidence for materials of a report, on which laws will be founded, that may in their ad- ministration, under Divine Providence, prevent a return to our city of this distressing calamity, and extend its beneficial effects to our sister cities. The committee respectfully invite the attention of the society to the following questions, and hope to receive the re- quired information at as early a period as the other engagements of the society will admit of. 1st. What were the causes, general and particular, which in the opinion of the District Medical Society, produced the Malig- nant Fever at Smith's wharf, and what at Fell's Point, in the summer of eighteen hundred and nineteen. 2d. Particularly, how far was the Fever to be ascribed to the heat and dryness of the season ; how far to the decomposition or de« cay of animal suhstances; how far to the vegetable substances; and how far to staguant water in any part of the city. / 3d. Was it in any degree, and to what extent, to he ascribed to the condition of Smith's wharf, the alley back; to Wolf street and Pitt street; to made grounds, cellars under made grounds; and th© situation of cellars generally, and to the lowness, or condition of back yards. 4th. Was it in any degree to be ascribed to wharves being built of wood; and is there any thing peculiar in the construction of the wharves near where the fever most prevailed. 5th. Was the fever imported; was any foreign substance of a hurtful kind brought to our city, which, in whole or in part, caus- ed the fever; is it contagious; were there any cases of contagion. 6th In what degree was the prevalence of the fever to be ascrib- ed to the habits, mode of living, &c. of the people in the infected parts of the city. 7th. What changes do you recommend in the organization of the Board of Health; what alterations in the ordinances relative to quarantine; what reform in the police and regulations of the city ; would not a rigorous inspection into the condition of the cel- lars, yards, &c. of the low parts of the city, particularly near the water, as early as March in each year, be beneficial, and a judi- cious precaution. The committee would be glad to receive from the society any other information connected with these inquiries, that would assist the committee in making a report, conformably with the reference to them by the City Council as aforesaid. Signed, DAVID BURKE, Chairman of the Committee, Baltimore January, 1820. To DAVID BURKE, Esq. Chairman of the Committee. <§"c. Dear Sin, I enclose you the answer of the District Medical and Chirurgi- eal Society, to your letter, addressed to it, through the President. JOHN B. CALDWELL, Sec'y. Baltimore, January 22d, 1820. C 183 ] The health of our city is a subject full of interest, and in th« promotion of.this grand object, the most active and zealous co-ope- ration of every citizen is demanded, and more especially of those who have made the preservation of that invaluable blessing the subject of their peculiar study. The society has viewed with the most anxious solicitude the recent appearance of the Malignant Yellow Fever amongst us; and since their co-operation has been invited by the constituted authorities of the city, they have em- braced the earliest opportunity to deliberate on that momentous subject. The society cannot help feeling deeply impressed with the mag- nitude aud importance of the trust assigned to them, and in order to meet its responsibilities, they have reflected much, they have listened to every suggestion which an ardent wish for the prosperity of our city could inspire, and carefully examined every proposi- tion tending either directly or indirectly to establish and perpetu- ate the general health. The result of their deliberations is res- pectfully submitted to the consideration of the Mayor and Council. The Malignant Fever which prevailed at Smith's wharf and at Fell's Point in the summer of 1819, in the opiniou of this Society, is to be ascribed to the decomposition of vegetable matters—This opinion is supported by the following facts—The alley back of Smith's wh-rf has been filled up with dock mud, shavings, and other putrescent materials—The same remarks will apply to the construction of Smith's wharf generally, aud also to those parts of the Point where the fever first appeared. It is highly probable that the logs composing the wharves in many places, have contri- buted in their decomposition to the production of the noxious cause. It is notorious to all who have made any observations on this sub- ject, that the disease raged with more violence along the course of the wharves and the made grounds in their vicinity, than in places remote! From a recent inspection of Kerr's wharf, and other wharves, it has been discovered, that from the decay of the facings of the wharf, the water has been admitted, so as to have formed subter- raneous pools. These may have found communication with the cel- lars in the made -rounds in the vicinity, and may have penetrated to the piles constituting the foundation of the neighbouring houses, and thus have been led up into cellars, which may be the depo- sits of various putrescible articles. The immense mass of materials iust adverted to, are buried from the eye of a superficial observer, these materials have existed, and others have been accumulating for many years. Why have they remained so long dormant? so long innoxious ?. While the heat of our summer remained moder- ate? the destructive principal was only partially evolved; but when the intense heat of the last summer penetrated the apparent- ly inoffensive earthly covering, and reached the subjacent mass of L 184 ] perishable materials, they were subjected to a temperature to which they w*re unaccustomed—a temperature which gave origin to the cause of the disease* Question as to the efficiency of putrid animal matters producing Fellow Fever. The society does not consider the putrefaction of animal matters competent to the production of Yellow Fever. Question of influence of back yards. The iowr.oss of back yards, especially when they become the deposits of kitchen offals and vegetable matters, renders them lia- ble to produce Yellow Fever. Question of contagion and importation. The doctrines of contagion and importation receive no counte- nance from this society—They believe that the ca'ise of the dis- ease may be imported; by this is understood a cargo of vegetable substances in a putrescent state. Question as to influence of habits, modes of living, Sfc. The habits, modes of living, &c. of the people in the infect- ed district, did not differ from those of other persons of the same rank or character in other parts of the city, where the disease did not prevail, consequently the disease could not with any pro- priety be referred to these circumstances as the cause. When a district is infected, all who breathe the air of that dis- trict may be considered as under the impression of the remote cause, {i.e. the noxious air.) The inhalation of this noxious air does not necessarily induce disease—It is often inhaled with im- punity ; but whpn by irregularity of living, excesses of any kind, want of sustenance or loss of rest, the system becomes debilitated, the disease js frequently excited, when it might otherwise have been avoided. Having adverted to the supposed causes of the late epedemic— the following suggestions are respectfully recommended to the at- tention of your body as calculated to mitigate the force, if not to prevent the recurrence of the dire calamity under which a part of pur community lately suffered se severely— 1st. In the organization of the Board of Health it would be im- portant to have at least one medical character, to whose counsel they might refer in all matters touching the health of the city— having at command an energetic police, vested with full powers to [ *85 ] remove persons and property in all cases where the public welfare and safety require it. 2dly. The most prompt attention should be paid to the docks and wharves, more especially to those in the vicinity of which the Fever first prevailed. The docks should be cleansed early in the spring, and the mud proceeding therefrom should, if deposited on the surface, be protected from the sun by a dense coat of clay or other earth. The wharves should be closely inspected and when perishable and putrescible materials have "been deposited in any quantity, tbey should, if practicable, be removed, or if that cannot be done, a heavy covering of day should be faithfully applied over the general surface of the wharf, and puddled along the logs down to the waters edge; after which they should have a thick stratum of sand and be firmly paved, with an elevation in the cen- tre, so as to permit the rain to wash off any impurities which may be deposited on the surface. This it is presumed will form a coat so impervious as to resist the transmission of the noxious efluvia. In future it should be subjoined that all wharves or repairs of wharves should be constructed on the plan of Pratt street wharf, with stone facings descending to low or beneath low water mark, so that the logs which support them may always be immersed in water, and under these circumstances they are less liable to decay. 3dly. The streets, lanes and alleys, which are unpaved, more especially such as are in the vicinity of the docks, should be well covered with earth and paved—and if putrescent matters abound, they should if possible be dug out and removed. Those already paved, which contain water, should be raised, and a more vigilant attention paid to the sewers and gutters generally. 4thly. Cellars iu made grounds should either be prohibited, or the proprietor or occupier should be compelled to keep them dry. Bthly. Heavy penalties should be inflicted on all persons who fill up low, wet grounds with putrescent materials. All made grounds should be kept dry, either by raising them so as to carry off the water, or by draining them. 6thly. The cove between Town and Point should be improv- ed, wharved out and filled up as soon as may be practicable The shores of the cove afford a prolific soil for the generation of the cause of Yellow Fever. The space between M'Eldery's and Jones' Falls is also in a situation requiring the attention of the corpora- tion. 7thly. It would be highly important to establish a regular and rigorous inspection of back yards, cellars and lots in made grounds, C 186 ] more particularly those near the water, commencing in March and continuing until November. Sthly. Measures should be taken to remove all offals or impu- rities of any description which may be deposited on the wharves or in the docks. 9thly. The quarantine regulations should be rigidly enforced in all cases where the cargo is damaged or the vessel is in a foul state, until a change of condition will safely permit her entrance into port—but these regulations should not deprive the passengers or crew of the privilege of free communication with the city. lOthly. As the city extends, lots should be purchased as public squares to favour the free circulation of air—The planting of trees is recommended generally : for this purpose some of our forest trees, which are highly ornamental, may be introduced; they would afford a shade in summer, and prove eminently serviceable in pu- rifying the atmosphere. 11th. It is respectfully recommended that the following laws be repealed; first, that restricting hogs running at large; secondly, that which makes it penal to throw kitchen offals in the streets— The propriety of this recommendation is founded on the fact, that hogs destroy vast quantities of such matters, which, if suftered to undergo decomposition, might prove pernicious to health. At the same time it is expected that the superintendants of streets will not permit any accumulation of these matters, which may become a source of annoyance to the citizens. By order of the Society, ASHTON ALEXANDER, Pres't. John B. Caldwell Sec'y. L 187 ] A Further Supplement to the Ordinance to pre- serve the Health of the City of Baltimore, and for the due performance of Quarantine at the Fort of Baltimore. I. BE it enacted and ordained by the Mayor and City Council of Baltimore, That there shall be annually appointed three Commis- sioners of Health and one consulting physician, and that the said Commissioners shall form and constitute the Board of Health. II. And be it enacted and ordained, That the Commissioners of Health, with the approbation of the Mayor, be, and they are here- by authorised and directed, to lay oft'and divide the City into three districts; each district to embrace such parts of the City as they ••may consider best calculated to secure the execution of the provi- sions of this Ordinance, and that the duties of each district shall be assigued by the Mayor to one of the Commissioners. III. And be it enacted and ordained, That the said Board of Health, shall meet as such, twice in every week, between the first day of March and first day of November in every jt i, and once in every two weeks between the first day of November and first day of March in every year, aud at such other times as they may appoint by their own adjournments, or may be called together by the Mayor or consulting Physician; and it shall be the duty of the consulting Physician to attend all meetings of the Board whenever required so to do by them, or any one'of them; the said board of Health may appoint a Secretary, and shall possess all powers and fierform all duties and have all the authority incumbent on, or be- onging to the late Board of Health or Commissioners of the City, in relation to the public health; and it shall be the duty of the said Commissioners to record all their proceedings as such, and as often as they act seperately in their respective districts, to report their individual proceedings at least once in two weeks to the Se- cretary, whose duty it shall be to record all such proceedings, whether they are those of the Board, or those of the several mem- bers thereof seperately in their respective districts. IV. And be it enacted and ordained, That it shall be the duty of the consulting Physician to give to the M/jyor and other City au- thorities, \M such professional advice uid information as they may require, with a vi v to the preservation of the public health ; to enquire into the health of the City, and whenever he shall hear C 188 1 of the existence of any malignant, pestilential or contagious dis- ease, to investigate such report, and ascertain as correctly as pos sible, the causes which produced said disease, to report the same to the Board, to suggest measures to arrest its progress, and to re- port to the Mayor, to the Board of Health, or Commissioner of the district, as the case may require, every circumstance likely to endanger the health of the City. V. And be it enacted and ordained, That it shall be the duty of each of the said commissioners to inspect, at least once in every two weeks, between the first day of March and the first day of November in every year, and at such other periods as the Mayor may direct, all the streets, lanes, alleys, wharves, warehouses, cellars, yards and lumber yards, lots and docks of his district, and all other places they may think necessary to examine and inspect, and to report to the Board of Health the general state of his dis- trict, once in every two weeks, and to enforce all laws and ordi- nances having any relation to health; to remove, or cause to be removed, all nuisances, to perform all such duties connected with the health department as are now usually performed by the Com- missioners of the City, and all others which may be required of* him by the Mayor or the Board of Health; and they shall have power to appoint, license and remove all night men at their plea- sure. VI. And be it enacted and ordained, That the Superintendants of Streets, shall be and are hereby placed under the direction of the Commissions of Health, and shall obey their order, and assist them in the execution of their office. VII. And be it enacted and ordained, That the Board of Health may, with the approbation of the Mayor, direct the removal of all persons from any part of the City where the consulting Physician shall be of opinion the public health would be endangered by the inhabitants remaining there; and every person who shall refuse or neglect to remove within forty-eight hours after receipt of a writ- ten or printed notice to that effect, personally served or left at his or her residence, shall forfeit and pay a sum not exceeding twenty dollars for every twenty-four hours such person shall so refuse or neglect after the said forty eight hours; and every person who shall without permission in writing from a member of the Board of Health, return to the district or part of the City from which the inhabitants may have been removed, shall forfeit and pay a sum not exceeding twenty dollars for each and every offence, and the like sum not exceeding twenty dollars for every twenty-four hours such person shall remain therein; and it shall be the duty of the Commissioner of the district to cause process to issue daily for the [ 189 1 recovery of all such fines ; Provided, however, that when such re* Uiovals shall be ordered, if the said Commissioners shall be satis- fied that the persons have not the means of removing, they shall be removed at the public expense to some situation to be provided! by the Commissioners for that purpose. VIII. And be it enacted and ordained, That if any person shall wilfully and knowingly obstruct or resist the Board of Health, or any of the members thereof, or any person by them appointed in the execution of the powers to them given, or in the performance of duties enjoined on them by this or any other Ordinance in rela- tion to the public health, such person shall, on being thereof le- gally convicted, forfeit and pay a sum not exceeding two hundred dollars. IX. And be ii enacted and ordained, That every person keeping a tavern, boarding or lodging house in the City of Baltimore, hetweeii the first day of June and first day of November, shall within twen- ty-four hours after any sea-faring man,or sojourner shall become sick in such tavern, boarding and lodging house, report in writing the name of such diseased person to the Mayor or Board of Health ? and no master of a vessel, or other person whatever, from any ves- sel lying in the harbour of Baltimore, shall remove any sick person therefrom before such person has been visited by the consulting Physician, Mayor or Some member of the Board of Health, and a written permit granted by the said consulting Physician, Mayor or member of the Board of Health, for the purpose of such removal; and any person neglecting or refusing to comply with the provi^ sions of this section, shall, on legal conviction thereof, be subject to a fine not exceeding twenty dollars for each and every offence- X. And be it enacted tind ordained, That the consulting Phy- sician shall receive an annual salary of four hundred dollars, the said Commissioners an annual salary of six hundred dollars eacfy and the Secretary an annual salary of four hundred dollars. XI. And be it enacted and ordained, That should either of the members of the Board of Health* or the consulting Physician, re- fuse or neglect to do and perform any of the duties imposed on them by this or any other Ordinance in relation to the pub ic health, such member or consulting Physician so neglecting and retusing shall on legal conviction thereof, be subject to a fine not exceeding one hundred dollars. XII. And be it enacted and ordained, That it shall he the duty of the Mayor, whenever the Board of Health shall report to hint that there is reason to believe that a contagious or malignant fere* A a L i&> 1 prevails in the City, immediately to cause the City Council to be convened, in order to communicate to them all the information which he may have received respecting the same, that the City Council may take such measures as may seem prudent and proper on the occasion. XIII. And be it enacted and ordained, That the said Commis- sioners shall reside iu the district in which they are respectively required to perforin duty. XlV And be it enacted and ordained, That the ordinance pass- ed the 10th of February, 1820, entitled « A further supplement to the Ordinance to preserve the Health of the City of Baltimore, and for the due performance of Quarantine at the Port of Baltimore," and also so much of all former Ordinances as is supplied by, re- pugnant to, or inconsistent with this Ordinance, be and the same are hereby repealed. Approved, February 29th, 1820. EDWARD JOHNSON, Mayor. L 191 ! CITY OF BALTIMORE, June 8th, 1820. SIR, I submit, for your consideration, the enclosed letters, and other documents, on the subject of the Yellow Fever at Mo- bile. If they can be of any use, either in aiding you, to devise measures, for the better preservation of the Health of this City; or, in completing the work which you have put to press, on this subject, with the views, (as you have stated,) of disseminating use- ful knowledge and benefiting the afflicted poor of this part of the City, they are at your disposal. Yours respectfully, A. CLENDINEN. Edward Johnson, Esq. FELL'S POINT, BALTIMORE, Dec. 26th, 1819. Dear Sir, H WING read with much concern and interest a letter* of yours, which was published lately in our newspapers, giving an account of the death of two of my professional brethren; and of the general ravages of the Yellow Fever at Mobile ,* and de- * FORT STQDDART, 15th November, 1819. Deaii Sib, Some time since you did me the favour to introduce to my ac- quaintance, your friend Dr. Lawton, an able Physician and mpst benevolent and useful man, whose exertions, both by day and by nijrht, in the cause of humanity during the prevalence of the Yellow Fever at Mobile, were unre- mitting But, alas ! he has himself fallen a victim to that disease, in con- sequence, no doubt, of the zeal with which he adhered to his profewional avocations, and sought to afford relief to others. Dr. Robinson (a brother of the Dr. Robinson who went to Mexico) remained at this post, and also fell. ' L m 1 tailing a most valuable fact, and plausible opinion bottomed on it, respecting the cause of the Fever; 1 am anxious to receive further information on the subject. You have already touched at some of Dr. Lawton's feelings had, a few weeks before his own death, been har- rowed up by the loss of his wife, in the prevailing Fever—and so anxious was he tq consult the sensibilities of her relations, that he attempted, as I am told, to have her body preserved in spirits for the purpose of being con- veyed to the place of-her nativity—but lie failed in the attempt. The mortality in Mobile has been greater, in proportion to the numbers, than I have ever heard of in any other place; and it has, no doubt, been partly occasioned by the encroachments made on the river, by the erection of log wharves, warehouses, and other buildings. It has, however, been a very sickly season generally tbrough the country. Cases of high and dangerous Bilious Fever have originated in various situa- tions ; and some have died of the Yellow Fever as high as Ft. Stephens and Fort Ctaiborne, fro/n 80 to 100 miles off Mobile ,- but 1 do not know that any case ot the Yellow Fever has actually taken its rise in those places. During the worst period, six or eight deaths frequently occurred in a day at Mobile, and it is said that as many as thirteen have died in a single day. This is an astonishing number for a place whose population did not probably exceed nine hundred, especially when it is considered that one third of ths stated inhabitants, at least, had left the place. Many, however, who have died, were transient people; and it is calculated by some that, including these, nearly as many must have died as are equal to one half of the regular popu- lation of the place. As to the weather, I am told, (for I was in the north,) that in July and part of August, there were incessant rains. Since that time there has been a continued drought. Some cases of Yellow Fever occurred in June. During the rains it was tolerably healthy; but, on the commencement of the dry weather, or soon after, the most serious period of the Malignant Fever began. About a month, or five weeks ago, some light frosts took place, and, though they were not suffieient to kill even the ground vines, many people who had left Mobile, ventured back. Several were seized and died after a short sickness ; others escaped in time. The Town is now pretty full; but 1 am told that few days pass without one or two deaths taking place. The weather, indeed, is excessively warm: my thermometer, 40 miles above Mobile^ has within tbe last week or 10 days, been frequently from 80 to 84, in a lage roem, sheltered by piazzas, on each side, from the sun, and the doors of which are large, and always open. Nay, it has been from 70 to 74 even before sun rise, when hung out of doors. I have had a severe and dangerous attack, but am now recovering. I am, Dear Sir, Very respectfully, Your most obedient Servant. . H. TOULMI?}. [ 193 ] ihe medical points, on which the great question relative to the ori* gin of this disease hangs, and as you are aware that this City has lately suffered severely from it, you need not wonder that our in- terest on the subjeet, as a community, should be excited in an un- usual degree. The desolating effects of this dreadful calamity have been most severely felt in the part of the City in which I re- side ; and although ii has pleased Heaven to protect me unhurt, I have lost a student, an assistant physician and some of my best friends, and have had my own family to sutler from the disease. Consequently as an individual, perhaps my conceru for our future safety is more acute than that of the public. Notwithstanding this disease never became general in this City, this has been the most extensive and mortal Fever experienced by its siuce the year 1800, The question whether or not this Fever is contagious has been reyived, and is warmly discussed in this and other places. Con- ceiving it to be a duty which I owe to society, and being called upon by our constituted authorities to give my opinion on the sub- ject, I am making some exertions to show, that the disease is in- digenous to our country, and has been originated and propagated here, by the miasma generated of necessity, from the immense quantities of pine cord wood, which I have lately discovered have been used long since for filling up water lots, wharves, &c. And I find from your letter that the state of the wharves, &c. at Mobile is so similar to that of ours, that it will be highly important to have this circumstance authenticated and the consequences compared. Having no medical acquaintance there, I have taken the liberty to write to you for information, (although a stranger,) and have nothing but the occasion to otter as an excuse. With this view therefore 1 beg leave to ask of you, 1st, a more particular account than the letter alluded to contains, of the construction of the wharves, and other wooden works, which are in a wet or moist state at Mobile? 2d, The kind of wood of which they consist, and whether or not it is wholly covered with earth and water ? 3d, The condi- tion and motion of the water about the wharves, &c. particularly as regards any change which may have taken place in its color ? 4ith, The extreme and medium heat of the season, as well in the interior as at Mobile ? 5th, The general course of the winds ? . nth, The point of the origin of the Fever, and the extent of its- progress, as respects distance? 7th, A more explicit account of the effect which the rains had ou the spreading of the disease, with your ideas respecting their influence ? 8th, The period at which the Fever proved fatal, when it'terminated in that way ? 9th, Any or all of the most striking symptoms, such as haemorrhage, black vomit, bloody or black urine, dark stools, &c. the type of the L 194 ] disease ? But above all, if cases originated in the vicinity of mill- dams, low marshes, or elsewhere, in the interior of the country, at the distance which you have hinted at, or any other distauce from town ? To receive a communication from you, or, any medical friend, in answer to the above queries, and containing any other interesting matter on the subject will, while it serves the cause of afflicted man, place me under lasting obligations. Your humble and most obedient servant, A. CLENDINEN. Harry Toulmin, Esq. FORT STODDART, (Alabama,) May 12thr 1820. Dear Sir, I think that your letter of December 25th, was two months on its way to this place: and when it did arrive, i was extremely ill. Since my recovery, 1 have been too negligent in replying to it, and I ask your pardon. I wish it may be in my power to throw any light on the object of your researches. 1. You request a more particular account of the construction of the wharves, &c. The western arm of the Mobile river, on the west side of which the town is situated, is very shallow at some distance from the shore : and the lots which run back from the Main street are so low and flat, that it was usual, before improvements took place, for the water to cover a considerable part of the eastern ends of them at high tide, especially wh>n the wind came from the south. In Spanish times these ends of the lots were unoccupied. Under the Spanish government, there was but one wharf. It was a mere platform, extending a considerable distance into the water, (which however was for several poles, 1 think, two shallow for a loaded parogne.) This platform was supported by posts, drove into the bed of the river, so that it afforded no ob- struction to the free circulation cither of water or of air. I believe t iw 1 that the town was first settled or established, between sixty or seventy years ago. I have been acquainted With it about fifteen years. I never heard of a case of the Yellow Fever, till within two or three years: and I am not satisfied that any existed till the last year. indeed as we made no improvements when we took possession of the place in the year 1813, nor for some time after, the place agreed as well 1 believe with the constitutions of Republicans, as with those of the subjects of his Catholic majesty. A considerable and substantial wharf was commenced four or five years ago. It was constructed by building wails of logs, all of pine timber, as you would build a log house, and filling up the space between the walls, with pine logs, pine tops, &c. covered ever with a thin layer of sand and dirt. Several wharves have since been constructed on nearly the same plan. But not only so, stores, warehouses, and even dwelling houses have encroached upon the bed of the river, or upon that kind of low ground which may be said to belong alternately to the sea and to the land. Where they have been erected in places generally covered by the water, they stand frequently on blocks : but where the water has been used to come only occasionally, there is a greater appear- ance of solidity, but not such as to exclude stagnant water, brought by the tide or the rain. Indeed there are no materials very convenient to Mobile, but pine timber and pine tops, sand and dirt. 2. Your enquiry whether the wood of which the wharves are con- structed be covered in part or entirely by water or by earth, is al- ready answered in substance. The wharves were so constructed as to be above the water at its usual state : but 1 conceive that no great body of earth covered the logs, of which they were com- posed. 3. As to the condition of the water, with regard to mobility and colour, I can speak only generally. The current of the river is naturally gentle. Though the water may be extremely high thirty or forty miles above ; it is scarcely known to rise by rain at Mobile. The wind regulates the state of the river there, more than the tide, or the freshes iu the upper country. Wharves stretching out from the firm land to the channel for ships, must render the water in a high degree stagnant. As to its colour ; I have made no remarks, but 1 am told it is very dark during the heat of summer. 4. You wish to be informed of the medium and extreme heat in Mobile and in the interior. Nothing is more delusive than ther- [ 196 ] mometrieal reports, unless a very minute description be given of the situation in which the thermometer is hung. Some years ago 1 remarked that my thermometer and Col. Bowyer's of the 2d re- giment j who then lived near me, would vary eighteen degrees, our distance from each being little more than a quarter of a mile*: and if a thermometer be hung even under the shade of a tree ; its' height will be governed in a great degree, of course, by the rela- tive situation of the tree, as to the other trees, and the presence or absence of venture on the circumjacent earth. The room in which my thermometer is usually hung is between four and five feet above the surface of the earth, twenty feet square, with a piazza or gallery eight feet wide, fronting the north east, and another, which is twelve feet wide, fronting the south west. There are other rooms at each end. In this situation the quicksilver has never riseu higher than 91°. It is very rarely, if at all, in the course of the summer higher than *»3°, and it is only for a short period that it is as high as that, i do not think that there is any material difference in the heat of the atmosphere, between my place of residence and Mobile (which is about half a degree far- ther south) except what may arise from the circumstance of the latter being an open town, and the former in a timbered country. But though the thermometer in a shaded situation does not rise so high in this country, as would naturally be expected by a person residing in a northern country ; yet so very great is the difference here between the heat in the shade and that in the sun, that mias- ma must be generated by the direct action of the sun, to a much greater extent, than ordinary thermometrical observations, would induce one to calculate upon. I have no memoranda made in the summer, to shew this difference, which I can now put my hand upon : but there is one which 1 made on the 25th of last month, a very warm day, when the thermometer in (he room I have men- tioned was at 8+°, but being hung on the side of the house (a wea- ther boarded frame house) facing the south west, it rose in a very short time to 119°. To-day at 3 o'clock, (P. M.) being hung in the same situations, it is at 79* in the shade and at 116° in the sun. 1 ought to remark, that during the last three days and nights, we have had heavy showers of rain, so that the earth seems pretty well saturated*: but it has cleared off, and the sun is not obstructed by the clouds. 5. As to the general course of the winds ; the south and south west winds are usually most prevalent in the summer season. They are certainly the most healthy winds. Sometimes, however, the wind * See an additional remark at tke end of this letter. L W ] will he from the north or north east for several days in succession. This I believe is always attended with unfavourable effects on ihe body, as well in the country as in the town. These winds, indeed, pass over extensive marshes on their way to Mobile : but they are pernicious in other situations. They check perspiration, whilst the sun is generally, during their pre- valence, very clear and fervent. Hence the weather seems hotter to the animal frame : but the thermometer, hung in the house, is really lower, than when the wind is south. 6. You request me to state the point of origin of the Yellow Fe- ver, and extent of progress as it respects distance. I have always understood that it commenced and more generally prevailed near the wharves and river, than in any other situation. It finally ex- tended however to the back parts of the town. On this subject you will meet with minute and valuable infor- mation in the able " Report of the Committee," which accompanies this letter.* Several cases occurred of persons carrying the Fever into the country: but I have not heard that in any instance it was communicated to others. 7. On the subject of the effect of rain on the disease; I conceive that it must depend a great deal upon local circumstances. [ believe that, generally speaking, frequent showers are favour- able to health in this climate : but where it falls in situations which will not admit of it running oft', and in quantities too great to be quickly absorbed by the earih, and, comiug in contact with vegetable matter, is slowly evapor ted by the sun, I think, that rainy seasons in the summer, have usually been found prejudi- cial to those residing in the vicinity of Such situations. The com- mittee have reported fully its views of its operation in Mobile. 8. As to the period at which the disease terminated fatally ; I am told that it was usually in from three to five days : though some died on the first, aud others continued till the seventh. 9. You request me to mention any or all of the most striking symptoms, such as hsemorrhages, black vomit, bloody or black urine, dark stools, and the type of the disease. The type was Remitting, and all the symptoms enumerated, were met with. The two last questions I have answered on the authority of a Physician, who though not residing in the place, has had sufficient ♦ See Page 200. Bb L A38 ] opportunities of makiug himself acquainted with the symptoms, and who attended some patients who brought the Fever from Mo- bile, up into the country. 10. Above all you enquire whether or not cases originated in the Vicinity of mill-dams, low marshes, or elsewhere iu the interior? There are no mill-dams so near to Mobile that their influence can have any effect, as 1 conceive, on the health of that place. On the other hand, there are mill-dams within from three to eight miles of Mobile, but 1 have not heard of any instance of the Yel- low Fever having occurred in the vicinity of them. There were many cases, however, of a very high Bilious Fever, which proved fatal to several persons, at a small town called Jack- son, on the Tnmbigby, about eighty miles above Mobile. Jackson is on high ground, but is adjacent to extensive swamps (or river bottoms) and within the influence, as I am informed, of a very large mill-pond. Many persons died out of Mobile of the Fever contracted'there. I was at Mobile, holding the Superior Court for that county, about this time last year. On walking down to the new buildings near the river aud to the new streets,! may say, which have been made almost in the bed of the river; 1 was struck very much with the smell, which even at that time arose from these new streets, and predicted confidently that the Yellow Fever would make its ap- pearance in the course of the summer. Circumstances unknown at that time, and which are detailed by the committee, tended to verify the prediction. Great exertions are now making by the Corporation, and exorbitant taxes paid by the inhabitants to ren- der the place more healthful: but 1 fear that there is more to be done, than can be done belbre the period of danger returns. A case apparently of Yellow Fever, occurred even in March last. A man of the name of Bryan, lately from Ireland, was em- ployed to make a ditch in a piece of marshy land on the Mobile river, about a mile above the town. During his sickness he complained, that when he first took off the outward crust of the earth, where he was about to make a ditch ; he was much affected by a very disagreeable effluvia, which arose from the broken earth. He felt unwell immediately, but it was two or three days belbre he became seriously ill. The wea- ther had been previously very hot: and he had moreover been caught in the rain... After he had been ill two or three days, his symptoms were, excessive vomiting and hiccup, subsultus, the skin uncommonly yellow, haemorrhage from the eyes and ears, discharges like coffee grounds, and what he puked up was of the [ 199 ] same description, pains in the head, eyes, neck and back, and eostiveness, which could not be removed till an injection was made use of. He took a dram of calomel every two hours, without its producing the least effect! The hiccup could not be stopped, and he had a great distress about the heart. He died about the fifth day from the time when he was taken. These circumstances were narrated to me by a Physician of great skill, who happened to be in Mobile when the unfortunate man was taken, attended him in his sickness, and has no doubt but that it was a clear case of Yel- low Fever. 1 have not heard that any other case has occurred this year. I believe, Sir, that I have now replied as far as my knowledge extended to all your enquiries, sufficiently copiously and I fear ra- ther tediously: and had 1 looked over all the report of the committee when I sat down to write this letter; I might probably without any loss to you, have abridged this communication. Independent statements however, of the same tacts, when they agree in the main, add to their credibility, and a concurrence in mere opinions connected with those facts, affords some presumption that the opi- nions have grown out of the facts. I was not aware that a short letter which I wrote to Mr. Meigs, of the General Land Office, relating to the Fever at Mobile, had been published, till 1 heard it from you : and even now 1 have not the pap r at hand to examine whether any thiug in that statement may require correction. 1 am dear Sir, very respectfully Your most obedient servant, Dr. A. Clendinen. HARRY TOTJLMIN. P. S. I have spoken of the difference in the heat at the house of my friend and ueighbnur (Col. Bowyer) and my own. I would ob- serve that my house was pretty well surrounded by verdure—his was open to the parade where the soldiers vvere exercised and which was regularly swept: mine was also somewhat more elevat- ed from the ground than his, and was a story and a half high where the thermometer hung. His was only one story high, and had galleries as well as mine : but his sitting room, I think, was open to the roof. These circumstances account for the difference in the state of our thermometers Perhaps it is not immaterial to remark, that the tube of my ther- mometer is on a wooden and not on a metal frame, as the latter I supposed would make the difference between the sin and the sbad/e greater tbau it really is. [ 200 1 RKPOHT OF THE COMMITTEE Appointed to investigate the causes and extent of the late extraordinary Sickness and Mortality in the Town of Mobile, The committee appointed to investigate the causes, and extent of the late extraordinary sickness and mortality in this Town. REPORT; That they have carefully attended to the duties assign- ed them, and have examined all the Wharves, the Docks, and Vessels, the buildings aud Lots near the River, as well as in other parts of the Town, and find in their examination numerous local causes, which under the co-operating influence of the late season, mi"ht, in their opinion, have produced the Fever, independent of the supposition of its Foreign Importation. Some of the most prominent we will mention; and first, the con- dition of the Wharves, built with hewn Timber, closely laid, con- fining the water within the outward dimensions of the wharves, and filled up with rotten logs, bushes, shavings, and other vegeta- ble matter, covered lightly with swamp mud or earth, presenting to view an immense mass, in the most noxious state of decay. Two of these wharves, about 450 feet in length, and 30 to 4o in breadth were commenced in the spring, and the work of filling them up with logs, mud aud bushes, was carried on during the Sum- mer, till the storm on the 28th July, and the sickness of the work- men put a stop to it. They were, however, nearly filled up to the length and breadth mentioned, and to the depth of 4 to 10 feet, and the surface of about a third part covered with pieces of wood, cut in convenient sizes for the purpose, and marsh mud.—When the committee viewed these wharves, the sight was most disgust- ing and the smell so offensive, that they felt their health endan- gered by delaying about them. The other wharves, five in number, also deserve more particular notice. Three of them appear to be made upon the same plan of the former, and with like materials, two are partly built upon piers, giving a more wholesome circulation to the water. One was built during the spring and summer, but chiefly destroyed by the storm of July, the others from one to four years since, each of them, affording a mass of decaying vegetable matter, from 200 to #00 feet in length, 25 to 30 in breadth, and 3 to 10 in depth, co- [ £61 ] vered with a thin layer of earth, or mud. Such a quantity of nox- ious materials collected together, in a state of decay, musl neces- sarily prouuce miasmata, and mortal disease. Water street is also observed to be filled up with the same kind, of materials, in manv places to the depth of from four to six feet, and computed together might afford a mass of such matter, several hundred feet in length, and fifty i i breadth, thinly covered with earth. The Lots adjoining this Street, on one side, are found to have been chiefly tilled up with rotten logs, green pine sapplings, and pine tops, with a thin layer of earth, and might comprise more than an acre of ground, thus tilled from one to two feet; and on the water side, the docks are observed to have been much clogged up with timber, drift logs and old Boats, which during the low summer Tides, and North wind, collected together in the docks, great quantities of sea-weed, and other filthy matter, in a state of decay, particularly under the stores standing over the water. The prevalent North wind, and low tide, during the months of September and October, left the docks, and a large extent of marsh mud about them, exposed to the heat of the Sun, and the water, variously obstructed about the docks and wharves, became itself stagnant and offensive. The committee also observe that many old Boats, or Barges* damaged during the storm on the 38th July, were suffered to re- main filled with water, as well as the schr's. Sally and Piper, at the wharves South of the Fort, during the months of August. Sep- tember and October, even to the time the committee visited them. The water in these Boats and Yessels, we scarcely need to add, was in a most putrid and offensive state. Several Lots upon Wa- ter Street were suffered to remain covered with stagnant water, filled up with old rotten logs, old casks, bushes, and in short aeem to have been receptacles for refuse and offal substances of every kind. The badly constructed foundations of the stores and building near the river, retaining beneath them much unwholesome matter, or stagnant water, affecting the Inhabitants with their deleterious damps and effluvia, must have proved a fertile source of disease, under the influence of the late season. To these causes we must add, the general condition of the back yards, and enclosures in the Town. All the prudential measures of an effective Police seem to have been totally abandoned, and the committee are compelled to say, that every part of the Town presented a striking proof of the extreme neglect of a large portion of our citizens to the ordinary duty they owe themselves and their neighbours—that of keeping their yards and possessions, clear from every species of filth, which may be injurious to health. Ponds of water in various parts of the Town were suffered to rv- |_ SOS 1 main, undrained after the rains, and became stagnant, thus affect- ing the air with poisonous exhalations. Dead animals, heaps of oyster-shells, and other offensive matters, were commonly observ- ed through the Town. Weeds were cut down and suffered to decay without removal. A store upon one of the n< w wharves contained a lars;e quantity of Hides during the months of August and Sep. tember, and the greater part of October, in a most offensive state. Such an outrage against the health of the Inhabitants is scarcely credible. In this general state of the Town, succeeding the violent Hur- ricane of the 2Sth and 29th of July, from the S. and S. E. which raised the water to an uncommon height, overflowing all the wharves, and the foundations of the buildings on Water Street, even to the height of several inches iu many store rooms; leaving, as the water subsided, a vast quantity of logs, drift wood, sea- wed and other vegetable matter in the streets and lots, much of which were ^offered to decay and infect the air. The docks were clogged up with like materials, and damaged Barges and Vessels. No attention whatever seems to have been paid to cleaning the dock, after the storm, to giv;> a free circulation to the water, too much confined before by the mode of building Wharves. The committee feel much regret that they are compelled, in discharge of the duty assigned them, to present such a view of the Town anterior to and immediately after, the storm in July; but the facts were obvious to all, wheth r citizens or strangers, and evince an almost unparalleled indifference in regard to our own health. In such a state of our Town, the most strenuous ad- vocates for Foreign importation of the Yellow Fever, will surely admit that there exsted abundant cause for less malignant fever. But we have to add to the causes enumerated, the potent influ- ence of a most unprecedented season. The late winter was gene- rally moderate, very dry and less severe than usual. The rivers Alabama, and Tombecbe scarcely reached the height of their banks; during the winter not more than half the usual quantity of rain fell. The spring was cool and chilly ; in March a severe frost which killed the early Garden Beans, Corn and other tender plants.—April, May and the early part of June, afforded light falls of rain, very seasonable for vegetation : winds generally South and S. West, June and July uniformly hot—greatest heat 92 degrees. The storm of July 28, terminated a long drought, and deluged the whole country around ; all the lesser rivers and creeks overflowed their banks to the height of winter floods. From the 29th of July to the llth of September, it rained with- out a day's intermission: and often descended in torrents. All the neighbouring swamps, and low grounds about the Town were fill- ed with water to a height unexampled at that season of the year. The sun at times burst forth with sultry, suffocating heat. The L S03 j brick walls, houses, furniture, books and clothing, all became mouldy, and the latter required frequent sunning to preserve them from destruction. On the evening of the 10th September, it cleared off, wind N. W. with hot !">un, and so continued for 6fi days, to November 16, the wind varying from N. VV. to N. and N. E.—during the whole of this period, there was scarcely rain sufficient to lay the dust in the streets : in November, however, the wind was occasionally S. and S. W—The effect of such an unexampled series of wea- ther, such an excessive drought following a flood of rain, in the month of August, with the influence of the combined eauses afore- mentioned, upon the human constitution, as exhibited in this Town, the committee will carefully relate. During the previous winter, spring and summer to the tirsl of July, the Town was healthy, and no unusual sickness appeared. In the latter part of July a number of violent cases of Bilious Fever occurred among persons unaccustomed to the climate, and some of a more questionable character, several persons employed as workmen, in filling up one of the new wharves, were taken violently ill, and died after a short illness of two or three days. About the same time two persons, usually employed about Dauphin Street wharf, Vvere taken in like manner, and died after a short illness. A number of Carpenters, and Sailors, employed about the wharf South of the Fort, and were much on board the schooner Sally, filled with stagnant water, and the Steam Saw Mill, where there was a pond of like offensive water, were taken with violent fevers and seve- ral of them died; But as the Physicians who attended all the persons alluded to, are dead, the particular symptoms of the fe- ver cannot be well ascertained. It is, however, known that Dr. Lawton, one of the attending Physicians, spoke of these cases, as Malignant Fever. Soon after these cases occurred, Snyder, an Engineer, at work on a Steam Boat, at the same wharf, died with violent symptoms of fever, after an illness of five days. Plank who attended Snyder, and was employed at the same place, and a Dutch servant boy, who lived at the house where Snyder died, were a few days after taken with like symptoms of fever, and died on the third or fourth day. All these cases, were, by the attending Physicians (now dead) declared cases of Yellow Fever, and it is in evidence to the committee that they died with black •vomit. Snyder died on the 7th August, and Plank on the 9th, several other cases of like fever occurred about the same time among the workmen, at one of the new wharves, and terminated fatally, after a short illness. At the two wharves mentioued, the unequivocal cases of the Yellow Fever, made their appearance, and about the same time, other cases occurred, which terminated fatallv, with persons usually about the stores, near the wharves and river, about the same period. A young man of the name of [ 204 ] Carson, died on the 2 n in all its fearful, deadly type. On the 16th, 17th and 18th. thirty persons are reported to have died. Alarm spread through the town, and those who could, conveniently, left it. Many, how- ever, remained, and those of the poorer class of people, who ei- ther lived in small crouded, filthy dwellings, or even without any, frequenting the grog shops near the wharves, lodging under the market house, or other places exposed to the damps and vapours of the night. In addition to these circumstances, many of them were intemperate. Among this class of people, which embraces nearly all those who arrived in town from the public works on Mobile bay, the Fever was observed to be dreadfully mortal—al- most all of them died. Of more than a hundred discharged at those works, who came to Mobile, it is believed that very few are alive. At certain places in town, there was a continual succes- sion of these people arriving and passing to the grave. Regard- less, through intemperance, of all the usual cautions for the pre- servation »f health—[they were often crouded into rooms with the dying and the dead, till they became themselves the victims of their temerity. We cannot doubt that this class of people greatly increased and spread the disease.* The old clothes, bedding, and such like articles, belonging to them were, after their death, thrown into the streets, or back yards, and there suftered to re- main to infect the air with their poisonous effluvia.] The want of proper attention, nursing and nourishment, to the sick (which could by no means be had) was a cause, ever to be lamented, of the great mortality attending this disease. Medical aid, also, was often negleeted till the disease had made a mortal progress beyond the power of medicine. In many cases medical aid could not be obtained when desired. Several of the Physicians themselves were sick, and the others unable to at- tend the numerous calls for their assistance—henee, many perish- ed without medicine, or Physician. • This paragraph is so much at variance with the general tenor of this report as to require no comment. C. Cc [ 206 ] The building used for a hospital for the poor was in the centre of tlie town, and probably contributed to spread wider the disease, and increase its malignity. Fear in many instances was observed to produce most unfortunate effects upon the patient, and defeat- ed its intended operation of medicine—Some, in dreadful appre- hension of the disease, seemed to abandon hope of life, and sunk into death. With all these causes lor the increased prevalence and mortali- ty of the Fever, it plainly exhibited in its progress and Various symptoms, the most malignant character. The number of those, Who recovered from an attack, between the 15th of September, and 10th October, the period of its greatest prevalence, was small j though the number cannot be ascertained. After the latter period, as cooler weather advanced, the disease assumed a milder char- acter, and more frequently yielded to the powers of medicine. In its Type and Symptoms it seems to have exhibited no pecu- liar characteristic marks or effects to distinguish it from the Yel- low Fever of other seasons and places, as described by Physi- cians ; unless it he the greater mortality which attended it, and that is believed to be justly attributed to the causes already men- tioned. Patients died commonly in one, three, or five days after taken, with all the symptoms of decided Yellow Fever. In the character of the disease, all the Physicians agreed, but different methods of treating were practised. The committee find difficulty in ascertaining " the extent of the sickness and mortality" with arithmetical exactness; although four of their number were continually in town, during the preva- lence of the Fever, and two others a considerable proportion of the time. For a while the disease seemed to be mostly confined to those employed about the the river and wharves, but in a few days after the prevalence of the north wind, and clear, hot sun (Sep- tember loth,) it spread rapidly through the whole town, and from that date seems to have affected the Creole inhabitants, people ot color, and even slaves. It is also noticed to have been equally mortal with the female, as the male population ; though the for- mer might be supposed less exposed to the influence of the general causes of the disease, but they were, perhaps, oftentimes more ex- posed to the Fever in their immediate attendance on the sick. The nimber of deaths from the 1st August to the 10th September, em- bracing every description of people, was estimated by the Physi- cian, who attended the Hospital, and the greatest number of the poor, and was probably better informed on the subject than any other person, at an average of l a day—-40 souls. This may be nearly correct: and of this number it is ascertained that »nly nine were inhabitants of the town, or embraced in any estimate of the population. These persons are known to have died of various diseases incident to the climate, excepting 5 or 6—who are sup- L 2<)7 1 posed to have died of Yellow Fever. After the above period, the Fevers assumed the predominant type and spread death and dis- may. From the 10th September to the termination of the Fever in November, 113 died, (four not of Fever;) making the nnmner ©four inhabitants, who probably died of the Malignant Fever i\5. From July 4th, to December 1st, the total numbers of dea'h, in- cluding those who died out of town, and those who died by casual- ties, was 137. The number of boatmen, sailors, workmen dis- charged from the public works, and transient persons, who died at Mobile, during the latter period named, is supposed, from the hest information that can be obtained, to have equalled that of the inhabitants, giving a total of 27%. But to give an adequate idea of" the extent of the sickness and mortality," it seems necessary to notice the population of the town at different periods of its prevalence; and here we must ne- cessarily resort to conjectural estimates. Iu the month of July, the resident population of the town is estimated at 1,300 souls, and ou the 10th September, 800, which were, in a few days after the known prevalence of Yellow Fever, reduced to 500, and it is to be remarked that a considerable portion of these were in the suburbs of the town, where the Fever did not prevail. But in a proportional view of the mortality to the population, exposed to the disease, the number of our citizens who died of other diseases antecedent to the prevaleuce of the Fever, boatmen; sailors, and other transient persons are to be deducted, which would shew the loss of our inhabitants by the recent Fever to be 115: and affords a proof of its dreadful malignity. It was observed that the suburbs of the town, at no greater dis- tance than one mile from the river, were as healthy, during the prevalence of the Fever, as more distant parts of the country ; and itis-not known that the disease was communicated, iu any instance, .< to persons out of the town, by the removal and attendance of the sick. Hence we infer that the disease is only communicable in the atmosphere where it originated; and even there, some pre-dis- posing causes appear to have been necessarily existing, as a num- ber of persons frequently in the room with the sick, the dying and the dead, in circumstances of the greatest exposure, never took the Fever. Some remarks on the general state of the country around, in re- gard to sickness or health, being intimately connected with this subject, as influenced by general and common causes, may not be deemed improper. At New-Orleans, Baton-Rough, Natchez, and perhaps, generally upon the Mississippi, as high as the latter place, the same species of Fever seems to have prevailed with great mortality. Natchez and New-Orleans, it is understood have suffered beyond any former example ; and iu fact, almost all our !_ 20S ] Cities upon the sea coast, from Maine to Louisiana, appear to have suffered in a greater or less degree from the same species of Fever; though they were favored by a long established and well regulated Police. In the interior of the country, upon the waters of the Tombeck- be and Alabama, the sickness and mortality was far greater than was ever known before. At Ft. Stephens, Jackson, Fort Clai- borne, and other places on those rivers, Bilious Fevers, of the worst grade prevailed ; and in many instances we are warranted in saying, that in type and symptoms it differed little from the Fe- ver, which prevailed in this town. The season has been a very uncommon one, and has produced as uncommon effects; and wherever it has operated upon local causes, it appears to have produced Malignant Fevers^ Jn the town of Mobile, art and labor could scarcely have combined a more destructive mass, for the production of Malignant Fever, under the operation of such a season, than is found to have been labori- ously collected together in filling up lots, streets and wharves : and the committee would do injustice to their own feelings, and their sense of the duty they owe their fellow-citizens, were they to sup- press a warning voice of the danger that awaits them: If they be not zealous and active in the removal of the numerous causes of dis- ease, daily trodden under their feet, daily presented to their view, while they walk the streets, disease will assail them in every quarter. While they s|umber in their bed, they will breathe the poison of death, Hill the yards and enclosures are cleansed__'till the streets and wharves are radically reformed; and then, by the blessing of God, we shall prosper in Health. Signed by Db. JACOB LUDLOW, Da_____MAJOR, DAVID RUST, EDWARD HALL, H. V. CHAMBERLAIN, and ADDIN LEWIS, PHILIP M'LOSKEY. OCT' In order that each fact and argument relating to the subject of this volume might have its proper weight, as originally intended, no selection has been made from the matter presented for publication. Indeed had it been esteemed either wise, or desirable, to withhold any part of it from the pubhc, such has been the arrangement that no one has felt himself author- ised to do so. Ihe charitable and scientific to whom the work is dedicated it is hoped, will readily excuse its imperfections, while they applaud the object, and deal fairly with its merits. ' ^ FJNI& INDEX. Page Allender, Dr. Joseph.........*7l Alexander, Dr. Ashton, a Report signed by him - - - 183 Atmosphere, never so constituted as to produce fever - - 84-135 Apology, for not publishing a letter at length • - - 72 , for not reporting cases to the Board of Health - - - 166 American cleanliness - .-.----. 34 Board of Heakh, proceedings of the, &c......165 Baker Dr. Samuel, a letter of - - - - - - - 49 Ballast, of the ship U. S. - ... 30, 35, 104, 141 Bancroft Dr. referred to - - - H» 14 Brantz Lewis, observations on the weather by * 24„ 25, 26, 27 Brevitt Dr J. two letters by - - .... 64 Bloody oil seen to ooze from the skin of cows .... 85 Block, near the draw bridge ..... 98, 99, 100 Case of fever at Mobile in 1820 * . - - - - 198 ----of Dr. M. D. C. ........160 ---.ofJ. D..........u7 ---of J. B. - - -..'--- 149 ---ofD M. -.......130 ---ofM C......... 153 Caldwell Dr. J. B. - • • * v- - - - 71, 182 Charleston, retreats of ,.....„ 82, 83 Causeway, Healthy ....---- 116 Caldwell Dr of Philadelphia, report signed by him noticed - 0 Chesapeake, three cases of fever, in navigators of the - - 51 Clark Dr., death of .,.---: - - - 171 C. Dr. M. D. case of ..„..--- 169 Canal recommended - - • - - • 49, 69, 88, 135 Chatard Dr. Peter, a letter of ......146 Clendinen Dr. A. a letter to Edward Johnson dated Sept. 1st 1819 of 4 ------------- ditto to ditto of 10th December ... 137 -------i----- ditto to ditto of 8th June, 1820 ... 191 -------------ditto to H. Toulmin, of December 26th 1819 - 191 Clendinen Dr. W. H. letter from ■•;.-««. 130 Clendinen Drs. W. H. and A. report - - - . - 176 Chisholm Dr. - - . - - - - - 125 Contagion, not the cause - - 48, 17. 32, 55, 73, 74, 75, 125 ■" the cause ......... 61 . the doctrine of, when first controverted - - 71 Copy right - - ...-.■> . . - - - - 1 Corporation, Yellow Fever declared to be in the power of the - 88 Cow Fever.........83, 84, &c. Coloring matter in the dock water .... 109, 110,111 Cove Morgan's, and great Cove .... 35, 43, 101, 116 Coulter Dr. John, letter of - ..... 34 Colegate's creek, fish dead at ...... 132 Davidge Dr. on the fever of 1800 noticed. Report signed by - 8, 139 Dark water -......- 109,131,195 Dewes Dr. - - - .. . . . --. . 9 D'Rosset Dr. extracts from ....... 7 Dead, burying of the, in the night -.....142 Demon that moves in darkness ...... 76 Dispensary second, benefit of the • - - - - 1, 3, he Piseases of the season ..«-... 102 [ 209 1 Discovery of the cause of the fever - - - 4,107,131,137,193 DiffenderfFer Dr- Michael, letter of ..... 45- Dickinson E. a reference to --.....1J1 Duck-ponds, remitting fever occasioned by ... 15, 106 Dunan Dr. L. M. letter of - -......&7 Drums, Sic. recommended as a preventive of fever ... 69 Dorsey Dr. R E. a Hospital report by ..... 143 Dorrey Dr. Henry......... 171 Ealer Dr. Peter of ...... - . 173 Encampment, of the - - - - , - , 173, 178, 179 &c. ----------r- fever at the ..--..-- 46 Extracts of a letter by —M. D. ------ 72 Elbert Dr........... 170 Eulogium on the Drs. of Fell's Point - - . . - 179, 180 Facts of more weight than authorities - - - - 94 Faculty of Baltimore, a report of the, (in 1800) noticed 8, 84, 86, 122 ------ of Great Britain, decision of noticed . - - - 5 Falls the, prevented the fever from spreading . ... 114 ----the course of changed - - - - - - 114, 115 Fever at Smith's dock in 1819,, report on .... 138 -----at Philidelphia ......78, 104, 138 -----at Fell's Point, first report on the ----- 165 -----at Ceder Point, and Canton near Baltimore 123, 124, 130, &c. -----at Fort M'Henry........54, 199 -----at Mobile.......- - 191,200 -----at Fort Stephens, Fort Clairborne &c. . -, - - . 192 -----at Hussey's in Baltimore- . • - - - 15, 116 -----at sea on board the Ceres and Betty - - - - 119, 120 -----at Waters'wharf f>n board the Neilson ... us »-----at sea on board sundry ships --:--- 124 -----at Fell's Point &c. in 1794, 97, 1800, 8 &c. - - 117 -----accounted fo«" by vegetable miasma (of wood used for building wharves).....72 to 139 and 191 to 208 -----accounted for by contagion ..---- 61 - near mill dams .-..---- 83 -----at Galliapolis, Ohio - - - - - - - 122 ----- on the Genessee Lakes New York - - - - 122 Female bravery - - - - - - - - _ - 74 Fires-bon recommended as a preventive .... 69 Fish sick and dead in water - - - - 49, 122, 123, 132 Fire, exertions to extinguish, an exciting cause - - . 102 Fogs, uncommonly dark - - - - - - - 112, 138 .,, carry the cause of fever with them - .- - - 122, 138 Fowler Noah, of .......'"" *°^ , ----- explanation of his report that the Physicians refused to give a statement......- 166 Gas Sulphureted Hydrogen seen rising in bubbles ■ - 30 ---emitted not sulphureted by Hydrogen - - - S6 Dillingham Dr. Ezra, a letter of ...... 134 Gerrard Dr J. J. a letter of - -......61 Goldsborough Charles Gov. a letter of.....173 Hall Dr- Richard W. letter of ------- 51 Heat, mean degree of, in June, July and, August - - 95, 111 -----observations on, .... 22, 23, 24, 25, 26, 27 ------------------in the vicinity of this City, - 25, 26, 27 -------------------in Mobile and Fort Stoddart, 195, 199, 202 &c. Harris' Creek, marshes at -->".... 96 Health General, of the City - ., ... - .- . ' . 39 [ 210 1 Page. Hewett Dr. his account of the first fever of Nortljttgerica. noticed 81 Hogs, to run at large as a preventive - CSS^T 66» 186, itC; Henderson Dr. death of _..----- *7» Howard John E. letter of - - - - - - " *'* Hospital City, - - - - - 32, 35, 143, 166 he Health Law.......- - . - J»£ Ingratitude of the Corporation in 1800 - - - - - ^ Inhabitants of infected districts, to be removed - 18, 184, i»» Jennings Dr. Samuel K. letter of 3d January 1820 - 5 _____I------------- ditto of February 10th 1820 - - * _____-------------a report signed by - - - l^O Johnson Edward letter by, to the Secretary of the 2nd Dispensary o _____________Circular by, to the Physicians, December 1st 1819 4 _____._______do. by to do. February 10th 1820 3 -------------extract from a message of - - - - 1'™ Johnson Dr Harry, of ........173 —J. D. case of - - - - - - - - - - ]% Kerr's wharf - - - - - - = - - 29, 56, 18* Kollock Dr. a case of fever originating at sea, by - - ' - 124 Little minds men of 92 Legislative body poisoned by miasma .... 7* Legard Joseph, appointed to collect daily reports &c. - ^°5 Lynd ^' • " : ■ " " ' " " *>" m M 18" 286 Laws Quarantine : - - - : 32, 63, 76, 15- ^«o Law respecting nuisances - - -.....1°° Lawton Dr. death of - - . - - - - - - 191 Martin Dr. S. B. M. a report signed by " * : ' " „ two letters of - - - - - - 53 Appendix ------- 58 retired in favor of Dr. Johnson . - - 173 Mayor's message extract from - - - - - - - 278 Medical counsel, to be added to the Board of Health - 88, 104, &c. Meteorological observations - - - : - 25,26, 27 Sec. Mill dams originate the Yellow Fever..... 84 Miscellaneous matter 138 Mitchel Dr. and Miller Dr. noticed ..... 12 Mucatilay Dr. Patrick, a letter by ------ 23 Mortality bill of - - - - •- - - - 177 ««-----M. D." extracts by .......72 essay by - - -'-..- - - 91 Appendix by - - - - - - - - 129 Note by - - -...... 142 three cases of fever by ----- 147 a letter by ------- 166 a remark by ..--.-- 145 Mobile Fever at, by Toulmin - - - - - - 191, 194 by a Committee of Physicians - - - - 200 Malignant symptoms, when first discovered - - - 102 Manure compared to a Bee without sting - •'',-' - - - ■ 98 Mud shewn to be innocent ........ 98, 39 Natural Laws applied - ^ 109, 110, 111, 112, 113, 114, 115, &c. Neilson Brig, at Waters'wharf, fever on board - - - 118 Necks along the Patapsco ........ 96, 122 North America first fever in ------ - 81 Norfolk fever there, by Drs. Taylor and Hansford - 121 Nuisances, the. most formidable of the - - - 4, 8, 56 131, 137 similar to ours at Mobile ..... 193 O'Connor Dr. John, death ot"......•> 174 [ 9H ] Page. Owen Dr. John, of bis attending on the Point • • • • 178 Page Dr. remarks on .---.-.- 34, 35 Pascalis Dr. 'of -••'■-«•*••- • °3 Physicians, of the Point only three continued well and to attend to the last ..... ... 133 Post of danger and not of honour .... - . . 36 Prospects, fine, on Fell's Point ....... 100 Proceedings of the Board of Health, &c. - • - - - 185 Potter Dr. Nathaniel........17, 140 •« Physicians, one of the of Fell's Point," a Bote by 144 Peter, Brig .......... 146 Physician Consulting, appointed ...... 187 Poison, Miasma compared to ....... 78 Quarantine Laws ... 32, 63, 73, 89, 182, 186, &c. Ramsay, Dr. David, extract from - - ♦ - 122 Reese, Frederick .... . 105 Reese, Dr. D. M. reports of - - - 165, 169, &c. Reports Daily, of the Physicians ..... 18o Rush, Dr. noticed . - - 9, 10, 11, 34, 54, 75, 136 Stewart, Dr. VV. A. letter of 145 Smith, Dr. James, part of Scripture pointed out by, - • 127 Season, of the ...... 95, 196, 199 Small Pox, remarks on the contagion of the ... 76 Smoke, the spreading of miasma compared to - • 77 Spreading of the Fever, along the water , - 113 ------------------. in the thick settlements 35, 119, 130, 131, 132, 8cc. Springfield, Village of ------ 82 S. a case of Fever by - - - - - • 164 Taylor, Dr. J. B. two letters of - - - - 42 Townsend, Dr. two letters of 45 Topography, of the City ..... 69, 96, &.c. -----------of Fell's Point ..... 97 Trees slain by miasma ...... 83 - prevent the miasma from -spreading - 3, 82, 186 Toulmin, Harry Esq. letter of, dated 15th November, 1819i - 192 -----------------ditto ditto 12th May, 1820 - 194 Vaughan, Dr. extracts from - - - - 8, 9 Vegetable Miasma, not generally considered to be the only cause of Bilious Fevers - - - -77, 124 ----------------the cause - - 77, 136, 137, 184, &c. " Unclean place without the City," - • - - 127 Walls of stone for wharves, not approved of ... 128 -----------——----- recommended « • 50, 56, 134 Water, the color of the, a firm rock to rest on ... Ill ------ uncommonly dark, - * 109, 131 & 195 ------ the Fever spreading along the, accounted fop 113, 131 ----- putrefaction of 51, 111, &c. Waterborough, of ----- - 83 Wash of the Hills of the Point ..... 88 Wheaton, Dr. extracts from - - - . . 13 Widow's Mite - - - - - - 64 Wolf Street, F. P. . 15, 29, 35, 51, 56, 98, U7, 130, 140, &c. Wood Mines, the reasons why they do not always produce Fever 80, 109 -----in ships, produce Yellow Fever at sea - - 124, 125, &c, fellow Fever, country - - - - 15, 25, 82, 83, 122 -----------domestic contagion of the • - 69, 87, 136 -----------in Wolf street, Baltimore, in 1817, 18 - - 29 Zane and Fenby, shops of - ... 141 , .:J '.v^.-TV^ v... *,"-i#r