UNITED STATES  OF AMERICA
^ *   .
FOUNDED  1836
WASHINGTON,  D. C.
OPO  16—67244-1 
 
 

APPENDIX.
. AN ESSAY si^uli

    ON THE    ■ \  \.   (J
PESTILENTIAL OR YELLOW FEVER,
                  i
      AS IT PREVAILED IN PHILADELPHIA

            IN THE YEAR


   EIGHTEEN HUNDRED AND FIVE

      BY CHARLES CALDWELL, M. D.

6.U~G>2/ 
••    V*

S 
                     6  %&'*#«£.




              AN  ESSAY,  &c.




                 INTRODUCTION.

  There are, perhaps, but few subjects in any department
of human knowledge, and certainly none in medicine, that
have given  rise to more controversy than that of pestilential
epidemics.  Wherever these diseases  have prevailed in mo-
dern times, one of their constant effects has been, to beget
dissention not only among medical  characters, but through-
out whole communities, relative to their nature and origin.
Nor has this circumstance proved to be the least of their
concomitant evils.  By rousing in the minds of men passions
unfavourable to the discovery  of truth and the promotion
of public good, engendering in them mutual jealousies and
distrusts, banishing from  public measures that union and
harmony which ought to characterize them, and thus throw-
ing obstacles in the way of the best concerted plans of pre-
vention and removal, it has never failed to add to' the sum of
general distress, and to swell the amount of human mortality.
Many persons have regarded these pestilential epidemics as
calamities indigenous in the places where they have prevailed,
whereas others have strenuously contended for their  intro-
duction from abroad.  Of  these characters,  the former have
naturallv recommended preventive measures founded solely
on a proper attention to domestic or internal causes, while
the latter have, as naturally and with equal warmth, insisted
on the necessity of attempts to attain the same end by closing
entirely, or  very watchfully guarding, every avenue of com-
munication with certain neighbouring or distant places, from
whence the diseases were  supposed to have been derived.
In the midst of such conflicting opinions and councils, it is
no wonder that all endeavours to do good should have gene-
rallv proved abortive.
 
     Weje. it rieee,S|arv to adduce testimony in favour of these
   rem^rlsTlt ip%nt "^^^y drawn from the medical records
   of most of the countries of the old world. England, France,
   Spain, Italy, Holland, Germany, and Russia, would be found
   rich in materials for this  purpose.  The Wesf-India islands
t   ancLsoH^e' of'thj^r^pvinces of Spanish America might be ren-
   dered no less'tnrjutary to the same end.  Even Turkey, Egypt,
 % and the Barbary States, where the very name of science is
   almost forgotten, furnish numerous facts in verification  of
   what is here  advanced.  These places have been  all  occa-
   sionally subject to the ravages of pestilence.  In each of them
   have the foreign origin  and communicable  nature of that
   disease been  positively  denied by  some, and  as  positively
   maintained by others; and in each  of them does the contro-
   versy appear  to have produced injurious  effects.
     But it seems to have been reserved for the United States
   to carry this controversy to its highest pitch, and to experience
   from it the worst of evils it is capable of inflicting. To such
   an extent has it been pushed, and with such obstinacy  has it
   been maintained, that,' besides the loss of human life which
   it has occasioned, some  of our best interests as  a people
   have been nearly sacrificed to it.   To  the physicians of the
   United States,  therefore, it more particularly belongs  to at-
   tempt its  decision, not only because their country has  most
   at stake on its issue, but because they are furnished with the
   most ample and the best  collection of materials for the un-
   dertaking.
     Were the  subject of the origin and nature of  pestilence
   wholly disconnected with any influence on our welfare as a
   nation, yet  still, as a mere philosophical question, it would be
   worthy of attention.  For the discovery of phvsical truth, in-
   dependently  of its beneficial and widely diffused  effects on
   mankind, is alone a very grateful reward to. the  votaries of
   science.
     But when  we recollect,  that on the  final  decision of this
   controversy will depend  the  nature and  permanency of our
   quarantine  establishments at home, as well as of those which
   may affect us in foreign nations, its importance cannot fail to
   rise in our estimation as lovers of our country.  This consi-
   deration will  also lay  before  us in proper colours the neces-
   sity of endeavouring to bring the matter to a conclusion as 
5
speedily as possible.  For we are daily suffering from the
present undecided state of public opinion on this subject.
  But this is not alL  There is yet another view of this ques-
tion, from which no  inconsiderable share of its importance
arises. On its correct decision will depend the measures ne-
cessary to be pursued with respect to persons labouring under
pestilential diseases.  If these diseases be really contagious,
such  persons  ought to be immediately separated from the
healthy part of the community, and all access  to them, ex-
cept by their attendants, strictly prohibited.  But if they be
not, such  a step would  be unnecessary, cruel, and even cri-
minal. For a removal  of the sick from' the soothing atten-
tions  and tender solaces of friendship, is not only in itself an
afflicting privation, but  darkens their prospects  and reduces
their chances of recovery, and should never be  practised ex-
cepi-under a necessity the most urgent and imperious.  But
such  a necessity can  arise only from the public safety being
endangered by an active contagion.
  Hitherto our domestic establishments, for the preservation
of the public health  from pestilential diseases, have been
founded and  administered almost exclusively on the belief,
that these diseases are introduced from abroad and  propaga-
ted by contagion.  Such  of their regulations and arrangements,
therefore, as have an exterior relation, have  been rigid to  a
fault, while their  interior department  has been greatly ne-
glected.  In consequence of this, commerce  has  been grie-
vously oppressed, those immediately concerned in  it often-
times  greatly  embarrassed,  the  aggregate  wealth of the
community affected, and many individuals connected  with
shipping reduced to poverty for want of employment. •
  Nor does the evil terminate here.  Several of the nations
of Europe, adopting  our belief in  the contagious  nature of
our diseases,  have erected systems cf quarantine similar in
principle to our own, and directed then- operation in a parti-
cular manner  against the shipping from our ports.   If, say
they, the*  pestilential diseases of the  United States  be as
contagious as the inhabitants  of those states-represent them,
our health and safety are endangered by the freedom of in-
tercourse  that subsists between them and us. Their shores
are infected, and it becomes us to provide for  our security by
subjecting their vessels  to a suitable ^quarantine.  Thus,  both 
6
 at home and abroad, our commerce is regarded with  an eye
 of jealousy: it is considered as an inlet  to  contagion, and is
 laid under restraints and exactions which cause it to languish.
   If, however, the pestilential diseases, which we have lately
 experienced cannot originate in our own country:  if they be
 necessarily  the growth of tropical climates, and of  such only,
 and be introduced among us through the channels of com-
 merce, and afterwards propagated by contagion, our systems
 of quarantine, instead of being abolished, or suffered to un-
 dergo any relaxation in their measures, ought to be  continued
 in force, and even rendered  more strict and rigorous.  For
 we have learnt from experience, that, in their present form,
 they are not sufficient to protect us from pestilence. Indeed,
 if this disease be introduced among us from the West-Indies
 ;tnd other tropical settlements, it is evident that nothing short
 of an absolute interdiction of intercourse with those  places
 during a part  of the year will remedy the evil. On the same
 presumption the nations of Europe are perfectly right in
 adopting the  most  prompt and decisive means to close a
 channel, through which such a  deadly poison might gain ad-
 mission to their shores.  From this view of the subject, a
 strict and unrelenting quarantine  is a measure  justified by,
 and  even growing out of, the  great principle of self-preser-
 vation.  On our part, therefore, it ought to  be  submitted to
 without a murmur.
  But should  it ultimately appear, that our  pestilential dis-
eases are neither contagious in their nature, nor peculiar in
their origin  to tropical climates; should they be found to be
the natural offspring of all warm climates, and the occasional
offspring of most temperate ones, and wholly incapable of being
propagated  from one country to another, either by commer-
cial intercourse  or through any other channel; under such
circumstances what will be thought of the wisdom and expe-
 diency of our  numerous quarantine establishments? Will not
these establishments be reprobated, as having wantonly vio-
lated  the rights  of individuals, burthened commerce  with-
out a cause, weakened the spirit of mercantile enterprise,
and, to a certain extent, checked  the growing prosperity of
our country? must they not be  regarded, both in their erec-
tion and administration, as so many monuments  of error and
misguided zeal, that should no longer be tolerated  in an en- 
7
lightened country?  And will not even those nations  of  Eu-
rope, who have viewed us of late as an infected people, with
whom it was dangerous, at certain seasons, to hold a free and
open intercourse, be led to a discovery of their error, to ac-
knowledge the injustice and injury they have done us, and,
finally, to do away  their quarantine establishments that are
directed against us?  From this  view of things, may not  a
similar  fate await even the  quarantine establishments  that
have existed for ages in  various  parts  of Europe,  for the
purpose  of  excluding from those  countries  the  plague of
Asia? .
  We hope that a few facts  and observations calculated to
throw further light on these  subjects, will  not be  deemed
foreign from the object of the present  essay. Though these
facts and observations wil} relate more particularly to the
pestilential diseases of the United  States and of the West-
Indies, yet they will be applicable also  to the pestilence of
the old world.
  We do not mean to hold up the ancients as general guides
and  instructors for  the more enlightened physicians and phi-
losophers of the present day.   We  know  that the moderns
greatly surpass  them in their knowledge of nature.  Yet
there are many points  on which the  opinions of these fathers
ought not to be disregarded.  For the faithfulness and accu-
racy of their observations on diseases, as far as they extend,
many of them are  models which the most enlightened mo-
dern need not blush to imitate.   Let us,  then, take  a brief
survey, as far as facts have brought them to our knowledge,
of the sentiments entertained by  the physicians and sages of
antiquity, relative to the contagious nature of pestilence.
  The earliest account we have of pestilence is contained jn
the Old Testament.  Moses,  the first  of the Jewish histo-
rians, has left some brief notices of the pestilence that pre-
vailed in his own times. That great prophet and  leader was
not  alone an historian and a lawgiver: no doubt can be enter-
tained  of his having  been  also  acquainted with  medicine;
for we are assured by a sacred writer,  that  he was deeply
versed " in all the learning of Egypt," where medical science
was  certainly cultivated during the vassalage of the Hebrews
in that country.  L is evident from his  mstuc .o.   to his
followers, relative to the mode of cleansing lepers and other 
8
 infected persons, that he had, at least, paid particular attciv
 tion to the subject of contagion.  He says nothing, however,
 respecting the contagion of pestilence. But it is not probable
 that a phenomenon or property of that  disease, so essential
 and so prominent as this, could have escaped his notice, had
 it actually existed.  Nor would he have declined speaking of
 it, had it come to his knowledge. It was his province to act
in some measure as pastor and guardian  to his less enlighten-
 ed  countrymen, protecting them from evil both moral and
 physical.  In conformity  to the duties of his station, he ap-
 prized  them of  the  contagious nature  of leprosy,  and in-
 structed them in the method  of escaping that loathsome
 malady. Nor would he have failed to act a similar part with
 regard to pestilence, had he  considered  it as a disease that
 was propagated  by contagion.  For, as pestilence is much
 more fatal in its effects.than leprosy, no  reason can be assign-
 ed  why he should have been so solicitous to guard the Is-
 raelites  from the  latter complaint, and have left them wholly
 in the dark with  respect to the mode of escaping the former,
 had he  conceived  them  to  be both communicated in the
 same way. Hence we may infer, that, in the time of Moses,
 the pestilence of the east was  not regarded as  a contagious
 disease.  Nor have we any intimation of its having been af-
 terwards  considered as such  by the Hebrew sages, during
 their residence in the promised  land.
  Ancient Greece and the neighbouring islands of the Me-
 diterranean were subject to an autumnal pestilence precisely
 similar  to that  which  we have lately  experienced  in the
 United  States. This assertion  is founded on various passa-
 ges in the writings of Hippocrates.*  That great physician
 has  delineated the leading  and characteristic features  of
 ouf autumnal  pestilence or yelloxv fever, with  a degree  of
 accuracy that would nqt discredit the ablest physician of the
 present  day. But he is totally silent on the subject of conta-
gion, nor does he once insinuate, that he even suspected the
 disease  to  be of foreign origin.  He was  accustomed  to read
 nature much more than books, to set a higher value on what
 he saw himself,than on what he only heard from others, and'to

  *  Seethe folio edition of the works  of Hippocrates, in Greek and La
 tin,  by Anutius Fcesius. 
                            9

treasure up and record  facts rather  than opinions.  Under
the guidance of this true spirit of philosophy, he travelled
with a view to improve  himself, and to instruct and benefit
his country.  He appears to have visited many places for the
express purpose of studying the origin, nature, prevention,
and treatment of  their malignant or pestilential diseases.
During thi6  tour  of inquiry he  never failed to find in the
climates and situations of these places, in the season of the
year, and in the customs and manners of the inhabitants them-
selves, with  other  circumstances entirely local, causes  suffi-
cient to account for all the complaints they experienced.  He
does not appear to have suspected these complaints to have
been derived from any foreign source,  and, as to the  term
contagion, it  does not,, as far as I have examined them, even
once occur in the original of any of  his writings.  Had the
pestilential diseases of Greece  been communicated by conta-
gion  from person  to  person,  so enlightened,  patient,  arfd
experienced  an observer  as Hippocrates,  would  certainly
have  discovered  the  fact;  and,  having discovered it,  he
would have deemed it too important not to be put on  record.
As far, therefore,  as negative testimony can be relied on, we
have the authority of the father of physic against the doc-
trine  of pestilential contagion.  A simi^ir silence on  this
subject  being observed by the other physicians of  ancient
Greece, gives us reason to  draw a similar inference relative
to their opinions.  They appear to have had no suspicion that
the autumnal pestilence of their country was either introduced
among  them from abroad, or  propagated  by contagion.
Viewing nature with an unprejudiced eye, and having their
minds free from the influence of systems and scholastic  dog-
mas, they found the physical causes  of their own country
adequate to  the production of all her diseases.  Hence, as
often as they speak of any  pestilential calamity, they seldom
fail to attribute it  to some intemperature of the elements,
the prevalence of unwholesome  winds, the malign influence of
the heavenly bodies, or the  effluvia arising from large masses
of putrid matter.  It does not appear, as far as my inquiries
have extended, that any eminent physician of the time, con-
sidered either of the famous plagues of Athens as a disease •
introduced into that city by contagion.  Nor do  even the
                            b 
10
Greek historians  themselves  venture positively to  decide
on  them as such.
  Passing on  to  the time when  Rome had succeeded in
making herself mistress of the world, we find that imperial
city herself and many of her provincial towns, as well as her
armies in the field, oftentimes suffering from pestilential dis-
eases. Nor do  these diseases appear to have been  in any
material respect different from those that we have lately ex-
perienced in the United States. They were similar in their
leading or  characteristic  symptoms, occurred at the  same
season of the year, terminated on the commencement  of cold
weather,  and w^re  sometimes even  more  extensively de-
structive  in their ravages.  They appear, from every cir-
cumstance left on record respecting them, to have been the
genuine yellow fever of Rome  and her dependencies. Though
these scourges were oftentimes declared by the weak and
superstitious to have come immediately from the  avenging
hand of heaven, they were rarely, if  ever, supposed to have
been derived from  a foreign  country. Those persons who
were most  competent to  judge rightly on the subject, were
uniformly of a contrary opinion. They considered pestilence
 as  a calamity resulting from physical causes, that were con-
 stantly in  operation  in their  own country,  no less  than in
 others.  They oftentimes  attributed it to the stench arising
 from the bodies of the slain, that  were suffered to putrefy on
 the field of battle.
    It thus appears that the medical records of ancient Greece
 and Rome, though  they  may not expressly oppose  it, give
 at  least no sanction to the doctrine of pestilential contagi-
 on.  Yet many of the physicians of these two republics were
 eminent for the accuracy of dieir observations, and their cor-
 rect histories of diseases.  The doctrine, then, of the commu-
 nication of pestilence from one country to another, and of its
 subsequent propagation by means of contagion, must be re-
 garded as  the offspring of more  modern times.  By many
 characters of the present  day, it  is supposed to have been
 originally broached by some  bold theorist in medicine, and
 adopted by others without sufficient examination.
    But although it is evident that the pestilential  or yellow
 fever has oftentimes prevailed in the south of Europe, espe-
 ci.iily in the countries bordering  on  the Mediterranean, and 
11
not unfrequently in higher latitudes, it must be considered as
more particularly the growth of tropical climates. All tropi-
cal climates, however, are not alike  subject to  its ravages.
The West-India islands, and some of the  maritime  parts
of Spanish America, lying in the same  latitude,, seem  to be
more peculiarly the hotbed of this disease.  In these places,
strangers from high latitudes are more or less subject to it
at all seasons of the year. Although they are most liable to
it when the summer heats are highest and  most  oppressive,
they are not entirely secure from it,  in case of the action of
strong exciting causes, even when the weather is in its  mild-
est and most salubrious  state.   Nor is it (as some writers
contend)  to  be  regarded as  a disease lately introduced into
those regions from the shores of Asia or Africa.  It  is the
legitimate endemic of the tropical section of the new world,
(more particularly  of the maritime parts of it) and has been
the constant scourge  of  strangers who have  visited  it, ever
since it was first discovered  by the  Spaniards.   Columbus,
when on his second voyage of discovery, lost, in the island
of Hispaniola, a  great proportion of  his followers, by a dis-
ease of such violence and malignity,  as he had never before
witnessed.  From  the circumstances under which that dis-
ease occurred, the rapidity with which  it ran its course, the
nature of its symptoms, and the great mortality that attended
it, there exists not  a doubt of its having been the true pesti-
lential or yelloxv fever of the present day.   A yellowness of
the skin,  dark discharges from the stomach and  bowels, and
hemorrhages from different parts of the body, were comprised
in the  dreadful catalogue of  its symptoms.  In  establishing
their dominion over the  West-India islands and some  parts
of South  America, the  Spaniards appear  to have found a
more formidable enemy in this disease, than in the arms and
opposition of the undisciplined natives.
   From the first settlement of the Spaniards in the West-
Indies, till some of these islands fell  a  conquest  to the  arms
of Great Britain, we  know but litde of their true  history.
That portion of it,  however,  which has come to our know-
ledge is sufficient to convince us, that they were oftentimes
a prey to pestilential diseases.
  As early  as the year 1655  the  British succeeded in wrest-
ing Jamaica from  the sovereignty of Spain.  During the 
12
tourse  of the  war which rendered  them  masters of that
island, they lost, according to the account of their historian,
more troops by the pestilential endemic of the place, than
they did by the sword of the enemy.
  From the conquest of Jamaica  by Great Britain till the
present time, we have been at no loss for authentic and cor-
rect documents respecting the state of that part of the globe.
From these documents we learn, that although the different
West-India islands have been sometimes more and at other
times less afflicted by the  pestilential or yellow fever, yet at
no time have they been entirely free from it. Strangers from
high latitudes have fallen victims to it every year.   In 1691
and 1696, it  produced uncommon mortality  in  Barbadoes,
notwithstanding the declaration of Dr.  Warren, that it was
never known in that island till the year 1721.
  Some writers have  asserted, and many individuals still be-
lieve, that the pestilential or yellow fever never prevails in
the West-Indies, except during the  existence of war, when
the nations of Europe pour their fleets and armies into that
torrid region.  This is certainly a mistake, (though  a very
imposing one), and admits  of the following satisfactory  ex-
planation.  The pestilential endemic  of the West-Indies
spares the natives of those islands, as well  as  foreigners
long accustomed, to the climate, and confines itself to persons
lately arrived from higher latitudes.  Sailors and soldiers im-
mediately  from  Europe  fall necessarily  under this latter
description, and are, therefore, fit subjects for the disease.
But these are  sent in much greater  numbers  to the  West-
Indies during a war than during a peace establishment. They
are also much more exposed to fatigue, to the  inclemency of
the weather, and to other  exciting- causes  of  disease. The
proper subjects of the  pestilential fever,  then, being  increased
in number, and the causes which bring that disease into action
being both multiplied  and augmented in force, its prevalence
and the mortality  attending it, cannot well fail to increase in
a corresponding  ratio.  War, therefore, has  no connexion
with the actual existence,  but only  with  a more  extensive
prevalence, of yellow fever in the West-Indies. It only feeds
the flame of pestilence, and renders it more  fierce and  de-
structive,, by supplying it with  a  greater  abundance  of  the
most suitable fuel.  Another reason why war  and  p'estilence 
13
in the West-Indies are so generally associated together is,
that during hostile commotions  in  that quarter, the eyes of
Europe and America are steadily fixed on the scene of action.
The natural  consequence of this is, that pestilential occur-
rences, and many other events are then observed and put on
record, which, in times of peace, would pass unnoticed.
  Yellow fever  may be regarded  as the  vestal fire of the
West-India islands.  Its spark was implanted in the climate
and general state of that part of the globe, by the hand of
nature herself, and its flame will never cease to burn and de-
vour, while it cari find proper materials to  feed on. As long,
therefore, as foreigners from high latitudes shall continue to
crowd to those  torrid regions, whether for the purposes of
war or commerce, so long will the ravages of that disease be
perpetuated.  During certain seasons and periods, however,
it rages with greater violence, and produces more mortality
among the same number and description of foreigners,  than
it does during others.  This is sometimes  owing to a higher
degree of irregularity  and intemperature in the weather, but
more frequently to a peculiar and  hitherto inexplicable  con-
stitution of the season, coinciding in its action with  that of
the general state and condition of the atmosphere. The occa-
sional existence of these pestilential constitutions, in climates
both tropical and temperate, is an event that has been noticed
by physicians of observation ever  since  the  days of Hip-
pocrates.
   But, as already remarked, the pestilential or yellow fever
is not confined  to  tropical situations.  It  occurs  also occa-
sionally, during a certain season of the  year,  in  the  higher
latitudes of the  new world, as well as of the old. Whence is
its source in these temperate climates ?  Does it arise in them
from the operation of physical  causes existing within them-
selves?  or is it  introduced  into  them by contagion from the
warmer regions of the south?
   To render satisfactory answers  to these questions, it will
be necessary to inquire, first,  into the origin or causes of
this disease in intra-tropical situations. Having endeavoured
to satisfy ourselves on this head, we will  return to some'of
the more temperate climates of the globe, where yellow fe-
ver occasionally prevails, and inquire whether or not during,
and previously  to,  such prevalence, these  places  experience 
14
 the action of the same physical causes, which give rise to the
 disease between the tropics?  If, on such inquiry, we actually
 find the same causes operating with the same intensity in
 both regions, we may then fairly conclude, that they must,
 in both regions be productive of the same  effects.  Under
 such circumstances it  will be evident, that pestilential fever
 is as really a native of extra-tropical  as  of intra-tropical cli-
 mates, with this difference, that in the latter, it is a perennial
 evil, whereas in the former,  it only springs up occasionally,
 and is of but short duration.
   Upwards of two thousand  years ago, Hippocrates laid it
 down as  a  general principle, that  endemic  and  epidemic
 diseases necessarily arise  from the  atmosphere of the places
 where they prevail, that  being the only mediumor instru-
 ment, by which nature can act at once  on  all the  inhabi-
 tants in common.  Nor have  modern pathologists been able
 either to refute the maxim, or to add to its  excellence. So
 manifest and  forcible is  its truth, that  it almost deserves
 the name of an axiom in medicine.  To the atmosphere of
 the tropics, therefore, must we look for the source of yellow
 fever,  the true  endemic  of that region.
  What, then, is the general characteristic of an intra-tropi-
cal, as differing from an extra-tropical, atmosphere ? I answer,
 it is a high and long continued temperature.  Though this is
 certainly the leading and most essential characteristic, yet it
 does not of itself produce  pestilential fever, by its own imme-
 diate action on the human system. It gives  rise to this dis-
 ease indirectly, by means of the poisonous  gas  which  it
 produces, when acting in  conjunction with moisture, on dead
 animal and vegetable substances. Still, however, it must be
 regarded as nature's prime mover in the process.  It would
 seem, therefore, that wherever we find  an atmosphere pos-
 sessing a temperature sufficiently high, provided that tempe-
 rature be long continued, and be aided by moisture in its
 action on large masses of dead  animal and vegetable sub-
 stances, there yellow fever may make it  appearance. Let us,
 by this rule, examine those countries and places in temperate
 climates, where that disease has occasionally prevailed.
   In the north of Europe, where the  winters are severe and
 protracted, and the summers short and cool,  yellow  fever
 has, comparatively, seldom occurred.   But the case is very 
15
different in other countries within the temperate zones, marked
by seasons of a different character, and possessing a different
state of atmosphere.  I allude more particularly to the United
States, where, during a certain portion of the  year, our at-
mosphere is as warm as that of intra-tropical  regions.
  The ravages of pestilential or yellow fever, particularly in
our large  maritime and commercial cities, are known to have
been frequent and deplorable. But at what season have these
ravages commenced? Not during  the winter or spring, when
our atmosphere was cold or temperate; but towards the lat*
ter part of summer, after a considerable continuance,  and
even during  the actual operation, of tropical heats.  Nor
have these ravages ever failed to  cease, after our heats had
fairly yielded to the approach of winter. The longer our au-
tumnal heats continue, the  more  protracted  is  the reign of
yellow fever, when it has once  made its appearance.   This
truth was completely established  by  the occurrences of the
year 1793.   During  that year we experienced a most dis-
tressing drought, accompanied by uncommon  heat,  from
early in August till the beginning of November.   The con-
sequence  of this was, that the pestilential fever then prevail-
ing ran on till the same late period,  and was even attended
with the  greatest mortality during the month of October.
During all our other pestilential sermons,  the case has been
different.  Owing to the summer and autumnal heats having
been checked at an earlier period, the disease has uniformly
experienced  an earlier decline.
  But our inquiries on the  subject must not terminate here.
By pushing them further we find, that yellow fever not only
does  not  appear in our commercial cities till  after a long
continuance of great  heats,  but that it does not appear in
them at all,  except  during  our hottest summers.  In other
words, we do  not  experience  the ravages of that disease,
except during those summers, which, in point of atmospheric
temperature, bear the  closest  resemblance to intra-tropical
seasons.
  The establishment of this fact,  which I conceive to be of
the utmost consequence in an inquiry respecting the origin
of pestilential or yellow fever,  is easily effected, by giving
a comparative view of the general temperature of those
summers, in  which the disease has, and of those in which it 
16
has not,  prevailed in our cities.  This I shall endeavour to
do, as far as relates to the city of Philadelphia, from a care-
ful  examination of a very accurate meteorological journal
kept by a gentleman of this place.
  It is necessary to observe, that in intra-tropical countries,
particularly in plains and maritime situations, the mean tem-
perature  of the atmosphere is about 80 degrees of Fahren-
heit.  In  these places the mercury seldom  rises above 90
degrees,  or  sinks  below 70 throughout the year.   Accord-
ingly, therefore, as the temperature of our several summers
in this place, continues as high as 80 degrees of Fahrenheit,
for  a greater or less proportional part of their duration, in
the same  ratio must they be said to resemble,  more or less
perfectly, real tropical seasons.
  It is well  recollected by our citizens, that the summer and
autumn of 1793 (the year in which yellow fever  made its
first appearance,   and produced the  greatest mortality, in
Philadelphia) were extremely hot  and dry.  The  state and
temperature  of the atmosphere  were  of a character  truly
tropical.  But as I  have no actual register of the weather for
that season,  I cannot include it in my comparative view.
  Within the last eleven years, that is, since the beginning of
1796, vellow fever has prevailed in  Philadelphia six times,
namely, in 1797,1798,1799,1802,1803, and 1805. In 1796,
1800, 1801,  1804, and 1806, we were  exempt from it.  Of
these eleven years, I have had access to a correct meteoro-
logical journal of the summers  of only eight, viz. of  1796,
1798, 1799,  1801,  1803, 1804, 1805, and  1806. Out of these
eight years,  four, as above stated, were marked by the pre-
valence of yellow fever, namely, 1798, 1799,1803, and 1805;
whereas in the other four, viz. 1796,  1801,  1804, and  1806,
that disease  did not make its appearance. Let us now, taking
the mean of tropical heats, namely, 80 degrees of Fahrenheit,
as a standard, compare the temperatures of these eight dif-
ferent  summers with each  other, the hour of observation
being 3 o'clock p.  m.
  During the whole  summer of 1796 the  mercury rose to
the standard of 80 degrees for only twenty-four days, and we
had no yellow fever.  During the summer of 1798 it rose to
the same standard for as many as forty-one days, and we had
yellow fever.  During 1799, for forty-five days—fever  again, 
17
During 1801, for  thirty-two days—no fever.  During 1803,
for fifty-one days—fever.  During. 1804, for ti irty-two days—
no fever.  During 1805, for sixty-eight days—fever.  During
1806, for thirty-four days—no fever.
  These  several  summers, with  their  temperatures and
effects as  to the production of yellow fever, in Philadelphia,
may be thus arranged in form of a table, viz.

  Summer of 1796, Thermometer 80° for 24 days—No yellow fever
     do.     1798,    .....   80°    41      Yellow fever.
     do.    1799,    .....   80°    45      Yellow fever.
     do.    1801,    .....   80°    32      No yellow fever.
     do.     1803,    .....   80°    51      Yellow fever.
     do.    1804,    .....   80°    32      No yellow fever.
     do.     1805,    .....   80°    68      Yellow fever.
     do.     1806,    .....   80°    34      No yellow fever.

  This simple statement, as far as it goes, seems to operate
with demonstrative force.  It sets forth, in  a  manner the
most clear and satisfactory, first, that yellow fever cannot, or,
at least, does not break out in our  city, except as the conse-
quence of a long continuance of tropical heats; and secondly,
that such a continuance of these heats has very seldom, of
late years, failed to produce it. It teaches us  that if, during
the course  of the summer, the temperature  of the atmos-
phere does  not rise to 80 degrees  of Fahrenheit, for more
than thirty days, no apprehension need be entertained of the
appearance  of this disease; but, that if, on the  other hand,
the temperature attain such an elevation for forty days, or
upwards, the public health is seriously endangered.
  Notwithstanding these facts  and  inferences,  I am not of
opinion that yellow  fever is always and necessarily the off-
spring, either directly, or indirectly, of great heats alone. In
several of the hottest  parts of the  world it is  altogether un-
known. Long continued droughts seem to contribute  at times
to its production.  But, what has a much more powerful and
essential  agency in producing  it,  is,  as already observed,  a
peculiar state or constitution of the atmosphere, which has
been  very properly denominated pestilential.  In what this
constitution consists, philosophers  have not been able to as-
certain.   It is sometimes  very circumscribed, and  at other
times very extensive, in  its limits.  It has been oftentimes
confined to a single city or two, and, in other  instances, has
                            c 
18
 extended over a whole country. Some writers have supposed
 it to be produced,  at  least, in part, by  heat, and  partly by
 the influence of other  causes.   But,  be its nature and origin
 what they may, the existence of a high temperature of the
 atmosphere is a " conditio sine qua  non," of the production
 of pestilential fever. Hence, that disease, in some form, is a
 kind of staple calamity of tropical climates, and breaks out in
 temperate ones only during the hottest seasons of the year.
   Indeed from the earliest ages of the world to which  his-
 tory extends,  the common observation of mankind, when not
 perverted or over-ruled by some imposing  authority or fa-
 vourite hypothesis, appears  to  have uniformly  connected
 great  heats and pestilence together  as cause and  effect.
 Hence, among the ancients, the the pestilential rage of Sirius,
 or the dog star, was a kind of proverbial expression, because
 that luminary was  always associated by them with intense
 summer heat.  Even, at present, the  dog-days are considered
 by many as having something in  them peculiarly unfriendly
 to health.
   Diodorus Si cuius assigns  the uncommon heat of the season
 as one of the  causes of the  second great plague of Athens.
 This heat, he says, acted on ponds of stagnant water, which
 had fallen in rains during the preceding  winter, and still lay
 adjoining  the walls  of  the city. This excessive heat he attri-
 butes to the. absence, during that season, of the Etesian or
 northerly  winds, which usually fanned the states of Greece
 throughout the summer, and kept the  atmosphere in a tem-
 perate  condition.
   Poets, who, though  devoted  to works  of imagination, are
justly ranked among the most accurate  observers  of nature
 have in all ages represented pestilential fevers as the offspring
 of heat.
   Thus Homer, with his accustomed sublimity and beauty,
 ascribes to the agency  of Apollo,  {the sun) the pestilence that
 prevailed  in the Grecian army while encamped before  the
 walls of Troy. The  descent of that  enraged god from
 mount Olympus, when meditating vengeance on the Greeks
 for the insult they had  offered him  through the person of
 Chryses, his venerable priest, is inimitably described in  the
 following  passage. 
19
         " Breathing revenge, a sudden night he spread,
         " And gloomy darkness roll'd around his head.
         " The fleet in view, he twang'd his deadly bow,
         " And hissing fly the feather'd fates below.
         " On dogs and mules th' infection first began,
         " And last the vengeful arrows fix'd in man.
         " For nine long days through all the dusky air,
         " The pyres thick flaming shot a dismal glare," &c.

  In this beautiful and expressive  allegory, the poet, under
the figure of Apollo's wrath, evidently points  to the intensity
of the solar heat, as  the cause  of the  calamity  which  he
describes.
  Virgil, whose knowledge  of nature surpassed that of most
of his contemporaries, represents the  excessive heat of the
season as the cause of a pestilential disease, which swept off
a number of the followers of  jEneas in the island of Crete.
Of this severe, calamity the  poet makes his hero speak in the
following terms.

         " When rising vapours choke the wholesome air,
         " And blasts of noisome winds corrupt the year:
         " The trees devouring caterpillars burn;
         " Parch'dwas the grass  and blighted was the corn:
         " Nor 'scape the beasts; for Sirius from on high,
         " With pestilential heat infects the sky;
         " My men—some fall, the rest in fevers fry."

  Lucretius, in an excellent description of a pestilence, con-
tained in the  sixth book of his poem " De rerum  nature,"
ascribes that calamity, in part, to the " mortifer iEstus," the
destructive heat of the season.
  Tasso,  in his  " Jerusalem Delivered," describes a pesti-
lential fever which  attacked  the christian  army, commanded
by  Godfrey of Boilloign,  before  the walls of the holy city.
He says the disease prevailed about midsummer, and, in the
following lines, plainly attributes it to  the influence of heat
and drought.

        " But now, receiv'd in Cancer's fiery sign,
        " The sun, with scorching rays, began to shine,
        " All nature pants beneath the burning sky,
        " The earth is cleft, the less'ning streams are dry;
        " Alone the wind from Lybia's sands respires,
        " And burns each warrior's breast with secret fives.*' 
20
  Let the impression be  derived from  whatever source  it
may, whether from observation,  from  books, or from the
general  belief of mankind on the subject, it is certainly true,
that we associate the idea of heat with pestilence as naturally,
as we do with flame or with solid bodies  in a state of igni-
tion. We no more look for pestilence in winter, than we do
for snow in summer or sunshine at midnight.
  It must,  indeed, be admitted that Great Britain and most
other European  countries situated in high  latitudes,  have
been frequently subject to pestilential diseases. But it  must
also be  admitted, that  such diseases have  prevailed in those
countries only, or, at least, principally, during summers and
autumns characterized by unusual heat, and, for  the  most
part also, by excessive drought.  Some remarkable irregularity
in the seasons has been  uniformly observed to precede or
accompany these calamities, as often as  they have  appeared
in the northern  parts  of Europe.  I  believe it may be laid
down as an established truth, that  during  their regular, and
what may  be denominated natural seasons, these  countries
have never suffered much if any from pestilential  diseases.
For the production and propagation of these diseases, whether
in Europe  or the United States, the summers must assume
a tropical character.
  From the facts and considerations laid down in the pre-
ceding pages, the following inferences appear to be deducible.
  I. Pestilential  or yellow fever  is not,  as some imagine, a
disease  of recent origin: nor is it peculiar  in its origin either
to  Africa  or to  the continent  or islands  of the new  world.
It was  known to the physicians of Greece  and Rome long
before the discovery of America,  and  was  never  suspected
by them to have been introduced into  Europe either from
 Africa  or  any other tropical region.
   II. The  existence of  yellow  fever in the  West-Indies,
 is at least cotemporary with the original  discovery and set-
 tlement of those islands, by the adventurers who followed the
 fortunes of Columbus.  The stories, therefore, propagated by
 certain writers,  and believed  by many  weak  and  credulous
 readers, respecting the  introduction of  that disease  from
 Siam,  Boullam,  and elsewhere,  into Barbadoes,  Grenada,
 £;c., are to be regarded as mere fables, the offspring ol igno-
 rance, prejudice, or an intention  to mislead. 
21
  III. Yellow fever is more peculiarly indigenous in intra-
tropical and other very warm legions of the globe. When it
appears in more temperate climates, it is always in the sum-
mer season, and is then to be  considered as the remote
effect of inordinate heat, accompanied frequently by exces-
sive drought, and a peculiar constitution of atmostphere, with
the  nature  of  which we are not  yet  acquainted.  Were
countries situated  in  such climates always favoured with
moderate and seasonable summers, pestilence would cease
to  be their scourge and their terror.  Even in the West-
Indies, and other intra-tropical regions,  seasons somewhat
cooler than ordinary,  are  generally marked  with a partial
exemption from this disease.

OF THE  CONSTITUTIONS AND DISEASES OF THE YEARS 1804
                        AND 1806.
   As a further preliminary to an essay on the pestilential
 epidemic of the year  1805,  a brief account of the weather
 and diseases of the summers of  1804 and 1806  may not be
improper. Sketches of the constitutions and diseases of these
three successive seasons will form a contrast interesting and
 instructive. They will show  that during the summer of each
 year, the nature and character of the prevailing diseases cor-
 responded  with, and exhibited an affinity to, the temperature
 and general character of the weather. That mild summers
 were  accompanied by mild  diseases,  and an  intemperate
 summer by very violent diseases. Hence  it would seem to
 follow,  as  a natural inference, that the  constitution of the
 weather of each season was  the cause of the character which
 the diseases of that season assumed.

 OF THE CONSTITUTION AND DISEASES OF THE YEAR 1804.
   The spring  months of the year 1804 were  uncommonly
 cool, in consequence of which vegetation was greatly retar-
 dedt The vegetables and fruits of the season did not appear
 in the Philadelphia markets, till some weeks after the usual
 time. March and April were marked by a few  inflammatory
 complaints of a mild character, which yielded very readily to
 the customary modes of treatment. May being wet as  well
 as cool, intermittents  and slight bowel complaints began to
 appear  towards the close oi the month, particularly in the 
22
 out-skirts of the city, while its centre and thickly inhabited
 parts remained unusually healthy.
   The month of June continuing very wet and cool, with a
 prevalence of easterly and northerly winds, intermittents be-
 came more common, intermixed with some remittents, and
 a  few dysenteries, all of them of a mild and manageable
 character.  The cholera of infants began  to prevail, but with
 less mortality than in common years.  Comparatively speak-
 ing, the practitioner met with little obstinacy in these several
 complaints.
   In  July the weather became warmer, though still moderate
 for the season, but the rains continued to be  frequent and
 copious.  Throughout  this month the  intermittents and re-
 mittents were more severe than during the preceding,  more
 dysenteries occurred among adults, and more violent chole-
 ras among  children.
   August  maintained the general character of the season,
 for the moderation of  its weather, and the quantity of rain
 that fell. During the whole  month, there were not, perhaps,
 at any one  time, more than two or three  dry days in succes-
sion.  Such frequent falls of rain, succeeded as they usually
 were by northerly  winds, could not fail to preserve the tem-
perature of the atmostphere in a moderate state. Throughout
 this and the  following month, intermittents and remittents
 increased considerably in number and somewhat in obstinacy.
 They continued, however, very tractable,  were attended with
 but little mortality, and by the end of October had nearly
 disappeared.
   Taking the whole  of this summer together, it  was  the
 wettest and coolest that had been experienced in Philadelphia
 for many years. It bore a strong resemblance to the summers
 in England, Ireland, and some of the northern parts of the
 continent of  Europe, except that it was  marked  by more
 copious, though perhaps not  more  frequent,  falls of rain.
 Corresponding to  this resemblance, its diseases were  cha-
 racterized  by that mildness,  which is  so common to  the
 diseases of high European latitudes. It was a true  northern
 summer, and gave birth to none but northern complaints; for
 intermittents and remittents are the  usual summer diseases
 of the highest latitudes. A stranger to any continuance  of
 tropical heats, it was wholly exempt from tropical diseases. 
23
  In speaking of the prevalence of intermitting and remitting
fevers, in the summer of 1804, I would not be  understood
to mean, that these diseases prevailed throughout  the  city
generally.  This was by no means the  case. During the
whole season, they were, except some scattering cases, con-
fined  entirely to the outskirts and suburbs.  The disease, in
an epidemic form, did not make its way into the heart of the
city. It lay more particularly in the  western extremity, adja-
cent to a number  of brick-ponds, and  other reservoirs of
stagnant water.  It was bounded in  its extent eastwardly by
seventh  street,  eight street, ninth street,  and tenth  street,
accordingly as the compact  buildings and  regular improve-
ments of the city extended,  in different parts, to greater or
less distances from the Delaware.  For it did not prevail, ex-
cept in accidental and insulated cases, in any neighbourhood
where the buildings were close and  the streets paved.
   The profuse rains that fell during this season were  injuri-
ous to health in the outskirts of the city, but highly serviceable
to it in the interior and better regulated parts. In the former
places, owing to the unevenness of the ground and the want
of proper drains, the water necessarily stagnated  and contri-
buted to vitiate the atmosphere by unwholesome effluvia, and
to surcharge it with chilling  exhalations: but, in the latter, it
was immediately as  it fell  conveyed off  by the pavements
and gutters, without rendering the atmosphere  injuriously
humid, sweeping along with it all corruptible and dangerous
materials.
   Hence it  was  remarked,  not without some surprise, by
many  of our citizens,  that  our gutters, sinks,  and sewers
were uncommonly free from any offensive smell.  This ex-
emption from stench in the  city, was, no doubt, owing, in
part, to the coolness, no less than to the wetness, of the sea-
son. Yet I think it probable; that were the same quantity of
rain to fall during even  our  hottest summers, it would, by
washing from our streets all putrid  filth, prevent the  occur-
rence of yellow fever.  For, although in most intra-tropical
countries, the wettest are generally  the most sickly seasons,
yet this  is the case only in the neighbourhood of places where
the waters that fall are  suffered to stagnate.  The mere fall-
ing of rain,  independently  of the  putrefactive  process to
which it may contribute, or  the noxious  vapours which it 
24
may liberate  from certain spots of earth  impregnated with
corrupt materials, cannot be productive of pestilential fever.
The occurrences of the summer of 1804  demonstrate, in a
manner the most impressive, the importance of a cool tem-
perature  of the  atmosphere,  connected  with public cleanli-
ness. They show that much might be  done towards  the
preservation of public health, by daily cooling our streets and
houses, during  the summer  season, by artificial showers
thrown from hydrants or fire-engines, and by as often cleans-
ing our gutters  and sewers, by discharging through  them
forcible currents of pure water.
  It is worthy of remark, that, as the epidemic intermittent of
1804 prevailed only in the suburbs and  extremities of  the
city, where the houses stand detached from each other, so
the pestilential epidemics of hotter and drier summers, have
raged only in the more compact and thickly inhabited parts.
Th<r cause of the former of these circumstances has been al-
readv assigned;  that of the  latter  appears equally obvious.
Although the temperature of our summers in the United
States is  very high, yet the general character of our atmos-
phere is not in all respects tropical, without the aid of certain
adventitious causes. These causes  exist abundantly in  the
closely built parts of our large cities.  Here the free circula-
tion of the air is greatly impeded, while the reflection of the
sunbeams from  the pavements of the streets, and from the
windows, walls, and roofs of the houses, raises  the tempera-
ture of the  atmosphere  several degrees  above  that of  the
atmosphere of the surrounding country.  But an atmosphere
stagnant and  intensely hot,  constitutes, in the  very  worst
sense of the word, the atmosphere of intra-tropical regions.
No wonder, then, if in the stagnating and heated air of the
compact parts of large cities,  tropical diseases should break
out and prevail, while the outskirts of  these cities, and  the
surrounding country,  where the atmosphere is less confined
and less heated, are entirely free from them.  This is  the
very result we would be naturally led to expect from such a
state of things,  were we to judge from  first principles  alone,
without the aid of observation and experience. Air and  wa-
ter are, in some respects, analogous to each other. Stagnant
water becomes unfit for the purposes of man;  so does stag-
nant air, and that in a very short time.  That they may retain 
25
their purity and wholesomen-ss, they must  both be  kept in
constant motion.  The extremities and thinly inhabited parts
of large cities in temperate climates, appear as ill calculated
for the production and  spreading  of pestilential  fever, in
hot and dry summers, as the compact  and well  regulated
parts are for the  production  and spreading  of intermitting
fever in wet and cool ones.  Each situation  must necessarily
favour the production of a disease corresponding to the cha-
racter and qualities of its atmosphere.
  But the year 1804 was marked by the footsteps of another
very formidable disease,  which ought not to be passed over
without some notice, particularly as nt prevailed, during a
part of the time,  with a true epidemic sway. I allude to the
casual small-pox, which,  in that year, spread more generally
and produced more mortality in and around the city of Phi-
ladelphia, than it had done during  any  other equal space of
time, since the first introduction of  inoculation as  a populaf
practice.  This fact offers but little encouragement to the
well meant project of those  physicians who  meditate (I fear
with more zeal and  benevolence than knowledge  and fore-
sight)  the entire  extermination of small-pox by  means of
vaccination.  Indeed if small-pox be capable of breaking out
and prevailing as a true epidemic, the project of entirely ex-
terminating it by any means within  the power of man, would
seem to border somewhat on Quixotism: it is, at least, too
gigantic ever  to be  accomplished.  That the small-pox did
prevail as an epidemic  during part of the  year  1804, is a
belief which I am induced to adopt from the following con-
siderations.
  I. At the time when  it  was most  general and  violent,
Other febrile diseases were scarcely  known.   It appeared for
a while to have gained such an ascendency in the atmosphere,
that all other acute complaints retired from  before it.  But
to reign unrivalled and alone, is a prerogative that  belongs
only to a true epidemic.
  II. Many persons who had  considered themselves un-
susceptible of small-pox, from having been frequently exposed
to it with impunity, were attacked  by it  this year,  without
having been subject to any known exposure at all.  Three or
four instances of this kind occurred in my own practice, and
I was  credibly informed of several others.  A  family, in 
26
which there were  six children, lived  in a neighbourhood
where I had been in the  habit of inoculating  for the  small-
pox annually for  several years  previously to the year 1804.
These children always escaped the disease, although  it was
once or twice in the house adjoining that in which they lived,
and repeatedly on the opposite side of the street. But, in the
year 1804, they were attacked by it,  at a time v/hen no per-
son in the neighbourhood was labouring under it, nor could
any of them give the least account of the source from whence
it was contracted.
  III. During this year,' small-pox was not only very gene-
ral in its prevalence, but malignant and mortal in an unusual
degree. This was another strong epidemic character: for it is
uniformly observed, that all diseases are more obstinate, violent,
and dangerous,  when they prevail epidemically, than when
they  occur only in  sporadic cases.  The reason of this is ob-
vious. When a disease occurs only sporadically or by accident,
as it  does not,  in  the first instance, originate  from atmos-
pneric influence, there  is  of course  nothing  in the general
state  of the atmosphere calculated to  protract  its duration, or
augment its violence. But the state  of things is widely dif-
ferent when a disease prevails  epidemically. In this case, the
same atmospheric  agency which contributed  to produce the
disease, being still  exerted on the systems of the  sick, must
operate like fuel to the fire of their complaint, increasing its
violence,  and protracting its  duration.  It is thus that an in-
termitting fever, which,  in spite of remedies, would run on
for months in the unwholesome atmosphere of a low marshy
country, the place  of its origin, can  be cured in a few days,
if the patient be removed to an elevated and healthy situa-
tion, where the atmosphere of the  place is  not  in  unison
 with the nature of  the disease.
   IV. In the  spring of the year 1804,  an instance of true
 variolous  re-infection fell under my notice.  The circum-
 stances of  the  case  were as follow.  I inoculated  the sixth
 child of a woman about thirty-five years of age, who had been
 herself, when an infant, inoculated with success. Her father
 who is still living,  recollects that she  had several regular and
 well formed pocks on different parts of her body. In addition
 to this evidence, her other  five children had been success-
 fully inoculated, all of whom  she had herself nursed while 
27
under the disease, without experiencing any ill effects from
such exposure.  The infant  which I inoculated for her this
season, was yet at the breast.   It had a very heavy eruption
of pocks on its face, particularly about its lips, with a consi-
derable number in its mouth and on its tongue. The mother's
nipples were,  at  the time, chapped  and very sore.  About
eight or nine days after the maturation of the pock, she com-
plained to  me of a red streak  running from the  nipple up
along one of her breasts, accompanied by a small but painful
swelling (which  I perceived to be glandular) under the arm
of the same side. I immediately told her that she was inocu-
lated, and would, no doubt,  experience some degree of fever,
which would, perhaps,  be  succeeded  by a  slight eruption.
She laughed at my " strange fancy," as she termed  it, and
proceeded to inform me of what I  have  already stated, re-
specting her previous inoculation, and  exposure in nursing
her other children.  Something  occurred to prevent me from
visiting her again for two days, when she at length sent for
me.  On entering her chamber (for she was now confined to
it) she told me that I had been correct in my opinion;  for,,
that on  the evening  of the  day I had  last visited  her,
she  was  attacked  with a chill, which was succeeded by  a
fever, head-ache, and  pain  in  the  back,  and that she had
now several pimples about her  face and neck, which she be-
lieved to be genuine pocks.  This was, indeed, the case; for
these pimples, as she called them, went through the regular
stages and changes of variolous pustules, except  that they
did not attain quite the customary size.  The indisposition,
however, was slight, and, in a few days, my patient regained
her ordinary health.
   From the preceding facts and considerations,  it appears,
that, in the year 1804, there was in the systems of our citi-
zens an unusually high state of susceptibility or  predisposi-
tion to small-pox.  On what other principle  can we account
for such a  general spread of  that disease, for  its unusual
violence, and for its attacking  many persons, who had es-
caped it all  their lives  before, though frequently subject to
exposures  apparently  much more hazardous? But whence
could such a state  of  susceptibility  or predisposition arise,
unless from a variolous constitution  of  the atmosphere ? for
the atmosphere is the only common medium that can act on. 
                          28

and produce corresponding predispositions in, the systems ot
a whole community at once.   But the true character o;  an
epidemic disease is, that it arises from or depends on some-
thing peculiar in the state or condition  of the  atmosphere,
and attacks a great many persons  at the  same time.   Agree-
ably to this-, the small-pox of  the year'1804 appears to have
been, in the true sense of the term, an epidemic.
  Respecting the final extinction of small-pox, it is and ever
has been my belief, that that end can never be attained, either
by vaccination, or any other means, until mankind acquire a
perfect knowledge  of, and controul over, those physical cau-
ses, that give rise to morbid constitutions of the atmostphere.
For if a peculiar constitution of the atmostphere can  greatly
facilitate the propagation of a  small-pox,  it  seems but reason-
ably, that a higher degree of the same constitution should  be
capable  of producing that disease de novo. And there  are
even many facts on record which  seem to evince that this is
actually the case. But as well may we attempt the extinction
of common catarrh,  as of any other disease arising  like it
from atmospheric influence. It is,  I  think, nearly five years
since vaccination became  general among the practitioners of
Philadelphia; yet we have as many instances of casual small-
pox now, as we had before the introduction of that substitute.

 OF THE CONSTITUTION AND DISEASES OF  THE YEAR 1806.
  The constitution and diseases  of 1806  bore a strong  re-
semblance to those of 1804,  except that the year first men-
tioned was by far the healthiest  of the two, and was  not
marked by the prevalence  of small-pox.  During the three
spring months, which were unusually cool, windy, and dry,
catarrhs and other slight inflammatory  complaints were at
times so common, that they might be almost said to  be epi-
demic.  They rarely, however, required medical aid, and,
when they did, yielded readily to the  common modes of
treatment.  They were not  in any instance  that came to my
knowledge, accompanied  with mortality, nor even  with
danger.
  Early in June the rains came  on, and  continued to fall
in frequent and sometimes very  heavy  showers throughout
the  three  summer months. They were very nearly, if not
quite, equal in quantity, to those of the  summer of 1804. 
29
As a natural consequence of these, the husbandman was re-
warded with a plentiful  harvest, and with an abundance of
all the  fruits and vegetables of the season.  Such frequent
falls of rain, accompanied by a considerable prevalence of
northerly winds, could not fail to weaken the force of the solar
heats.  For it is a characteristic  of our climate, that when a
shower, but more particularly a thunder-storm, occurs in the
afternoon or evening of even the hottest day, the temperature
of the  atmostphere experiences a sudden and very considera-
ble reduction.  It oftentimes  falls in a few hours from  80°,
85°, or 90° to  70°, 65°, or 60° of Fahrenheit, and some-
times lower. Nor does it, in general, regain its former height
in less than three, and sometimes five days. Frequent show-
ers or  gusts, therefore, are incompatible with high and  long
continued heats.
   This sudden change in the summer temperature of our
atmostphere, on the occurrence of rain, has never been sa-
tisfactorily explained.  Some have supposed  it to  be owing
to an  immediate and abundant absorption of atmospheric
heat, in consequence of  the great  evaporation of the  wa-
ters diat have  fallen: but this cause is altogether insufficient
to account for the phenomenon. For the coolness of the atmos-
phere oftentimes commences even before the rain has begun
to fall, and continues,  long  after the evaporation which it
causes has been completed.  It  is generally accompanied by
a very dry instead of a humid state of the air.  Besides, it is
not unfrequendy produced by the mere passage of a thunder-
cloud over us, without the precipitation of a single drop of
rain.
   Others have attributed it to a sudden conversion of a large
portion of sensible into latent heat, by some unknown agency
of the electric fluid.  But this explanation appears to be equally
exceptionable  with the other. For it is unphilosophical to at-
tempt to account for an occurrence in nature  by ascribing to
any physical agent or principle, a power which that agent is
not known to  possess. But it remains yet to be proved, that
electricity possesses  the power  of converting  sensible  into
latent  heat.  No such effect has ever  been produced by
it in any experiment in which it has been  employed. Besides,
the phenomenon sometimes  takes place, unaccompanied by
any strong electrical appearances.  A  third opinion  is, that
this coolness  arises  from ihe arrival of a vast  body of cold 
30
 air from a remote northerly region. The wind, on these oc-
 casions, blows for the most part form  the  north-west.  It is
 supposed  that this wind, having  traversed a vast tract of
 country interspersed with lofty mountains, and covered per-
 haps, in parts, with ice  and snow, is  the  sole cause of the
 cold we experience.
   But this explanation, however plausible, is evidently falla-
 cious.  The change which our atmosphere undergoes, on these
 occasions, is oftentimes too sudden to  allow us to search for
 its cause  in  a distant region.  According to the common
 velocity of wind,  several days would be necessary for a large
 volume of cold air to  travel from  the remote  place,  whence
 it  is supposed  to proceed.  But the change of temperature
 oftentimes occurs in the space of a few minutes, although
 the wind  had been previously blowing  from the southward
 for several days.  Nor  is this all. The phenomenon in ques-
 tion is not only too sudden in its occurrence, but too  limited
in its extent, to admit of the present explanation. A thunder-
 storm produces but a very local derangement in the state of
 the atmosphere.  It, perhaps, rarely in any  way affects a tract
 of country more  than  a  hundred miles square. But a phe-
 nomenon so circumscribed can have no effect in  drawing a
 body of cold  air from a region at the distance of several hun-
 dred leagues.
   Others again have supposed this change of temperature to
 be owing  to the  sudden descent of an immense stratum ol
 cold air from the higher regions of the atmosphere.  For it
 is  known that in these regions the cold is severe at all seasons.
 This stratum, say they, being precipitated either by its own
 weight, or by some violent commotion in the region from
 which  it descends, displaces or mingles with and  cools  the
 wamer and lighter stratum that lies in contact with the  sur-
 face ofthe earth.
   Though we do not pretend to decide with confidence re-
 specting  the cause of the phenomenon  under  consideration,
 yet we acknowledge ourselves  more inclined  to favour the
 latter explanation,  than  either  of  the  preceding ones.  We
 think it  more probable, because more conformable to  the
 laws and operations of nature in other analogous cases. Falls
 of rain seldom produce any considerable change in the tem-
 perature  of the weather, unless they be  accompanied by gusts 
SI
jt wind occasioning a violent commotion in the atmosphere.
Hence thunder-storms, in which these gusts and this commo-
tion  are most  powerful, and which,  from the  tumult and
uproar that attend them, cannot fail to  mingle the higher and
lower strata of the atmosphere together, produce this change
in the highest degree. Gentle showers, in which even a grea-
ter quantity of rain  may fall, have  in general but a  slight
effect on the temperature of the air.
   It is  known  that deep waters will  not freeze during the
coldest weather, if they be agitated by violent gales of wind.
The cause of this is obvious.  Ice  is water in a crystalized
state;  and we know that a certain degree of rest in the fluid
is always necessary to the process  of  crystalization. But
this  is not all. In very deep waters, the central and lower-
most strata are never reduced to the freezing point.  This
effect is produced only on the superficial or uppermost  strata,
on which the air has a more immediate influence. But  in the
commotion which these  waters  experience from severe gusts
and  gales of wind, they  are disturbed to their very bottom,
and  all their strata are mingled together.  The superficial and
colder  strata are precipitated,  while the  lower  and warmer
ones rise and occupy  the suiface.  This agitation and com-
mixture, while they keep the surface  of the water at a tempe-
rature above the  freezing point, must  necessarily render the
lower strata of it  colder than they would be, during a tranquil
state of that element.
   So, likewise, in the wild commotion which the atmosphere
experiences during our thunder-storms, all its strata are min-
gled together.  The uppermost and colder ones descend to
the surface of the earth, while the lower ones ries and com-
municate their warmth  to higher regions. Such appears to
us to be the best explanation of the phenomenon in question.
Among the  inhabitants  of alpine countries,  it is  a fact as
familiar as  any other, that in  stormy weather,  the  cold air
descends from the tops  of the  mountains, and cools the at-
mosphere of the  vallies.  Hence the great and sudden vicissi-
tudes of temperature, which the inhabitants of these vallies
oftentimes experience.
   Even in tropical climates  severe hurricanes  are  always
productive of cooler weather.   They have also  the  effect of
arresting, at least for a  time, the -course of the pestilential 
32
diseases of those regions.  This latter circumstance admits of
an easy and satisfactory explanation. The tropical  pestilence
arises, as has been already mentioned, from a contaminated
state of the atmosphere.  This  contamination, however, is
Confined exclusively to that stratum or portion of the atmos-
phere which is contiguous to the earth. The more elevated
strata  remain  as  pure and untainted as the air of the heal-
thiest climates. This we infer from the extreme healthiness
of mountainous  situations  even within  a  few degrees  of
the line.   But the hurricanes of the tropics  rage with such
unbridled fury, as to produce a complete revolution  in  the
atmosphere.  They snatch up and whirl  aloft the lower and
contaminated stratum of air, hurrying  down the higher and
purer ones to supply its place. Hence the coolness  and salu-
brity tha< succeed these frighful convulsions of nature. And
hence the simplicity of the process by which nature can ar-
rest one of her deadliest scourges.
  But to return from this digression. The frequent and pro-
fuse  showers that fell during the summer of 1806,  contribut-
ed greatly to keep the atmosphere  in  a  mild and pleasant
temperature.  Nor was this their only beneficial effect, with
regard to the healthiness of our city.  They acted the part,
and made amends for the negligence, of scavengers, by wash-
ing the gutters and sweeping the offals and other putrid mat-
ters from our streets. In consequence of this, the atmosphere
preserved its purity, and our citizens experienced from the
sinks,  sewers,  docks,  and other  places where filth is  apt to
abound, nothing of that stench which  proves  so offensive in
very hot and dry  seasons.
  If we have  respect to the aggregate quantity of heat that
occurred, the summer of 1806 was, perhaps, fully  as cool as
that of 1804.  For, though in the first mentioned year there
were more days in which the thermometer rose to 80 degrees
of Fahrenheit, than there were in the  latter, yet these days
were greatly scattered, not more than  three or four, and in
general not more-than two,  of them occurring in succession
at any one time.  Besides, in many  oi them, a heavy shower
of rain or a thunder-storm came on in the afternoon, which
rendered the remainder of the twenty-four hours  cool  and
pleasant. Such frequent interruptions as these produce a vast
diminution in  the general quantum  of the heat of  any given 
33
period. Ten successive days of dry and continued hot weather,
during which the thermometer ranges from 75 to 85 or 90p of
Fahrenheit, will throw out a greater body of heat, than twen-
ty scattered days, in  which,  though the mercury may rise,
for a few hours, equally  as high, yet it suddenly sinks again
for the remaining twenty-four hours, in consequence  of  a~~
shower or thunder-gust in  the afternoon.  This is* a circum-
stance  of which we should never lose sight, in making an es-
timate of summer heat.  Without a strict attention to it, it is
impossible to strike a just medium.  But, more particularly,
without this, we cannot possibly arrive at  any correct con-
clusion relative to the effect of heat on the healthiness of the
season.  For it will be  observed, that it is a continued suc-
cession of hot daysy and not a certain number of them occur-
ring in a scattered and broken manner, that can prove de-
structive to  health. Davs are occasionally felt even in the la-
titude of 60 degrees north, as hot as those experienced beneath
the line.  But  they are few in number, fall out scatteringly,
and their heat  is never of  more  than a few hours' duration.
Hence they are innocent in their effects on the human sys-
tem, while th^heats of the tropics are fraught with destruction.
   Corresponding  to  the temperature  and character of the
season, the  diseases of the summer of 1806 were compara-
tively few and  mild.  The cholera of infants was less general
and less fatal than usual.  A few intermittents,  remittents,
and bowel complaints occurred among adults, but they were
generally of the most benign and manageable kihd.  As the
summer  strongly resembled the summers  of  the  north  of
Europe,  so likewise did the diseases to which it gave origin.
The one manifested nothing of tropical fervour, nor did the
other partake of tropical malignity.
   Though  such was  the mild  state of diseases in  general,
yet this mildness was not  without  its exceptions.  Various
cases occurred  during the  season, which, though not truly
malignant, proved extremely obstinate,  tedious,  and some-
times fatal.  They commenced with the intermitting or re-
mitting form of fever, but  assumed  after some time  the
typhus or chronic form.  This unfavourable change  appear-
ed to be  owing to the  neglect of  early and sufficient evacua-
tions.  For, when such evacuations were effected, the change
                           e 
34
seldom toot place, but the disease was generally brought, in
a few days, to a fortunate termination.
  From about the tenth or middle of September till near the.
last of November, these diseases became more frequent and
obstinate.  Within this period they proved fatal  to several
very useful and distinguished citizens. It was remarked that
they were productive of most mortality under the direction of
those physicians, who were most sparing in the letting of blood.
Practitioners who made  a more liberal use  of the lancet,
were much  more successful in their treatment of them.
  This disease assumed in many  instances  the  mask  of
colic, and proved,  under that character, no  less  obstinate,
than when it appeared in its more open and common  form.
In  a few  cases  that fell  under my  own  notice (and  I
heard of several  others) this colic pursued a true  intermit-
ting type, the paroxysm occurring regularly every night. In
one  instance, however, it came  on only every other  night,
the disease  being a true tertian. This might be denominated
the colicky state of intermitting fever,  and subjoined  as an
additional varietv to  those  states or forms of the  disease so
abiv described by  Alibert.  It called for bloodletting and ca-
thartics to a very great extent.
   Notwithstanding the obstinacy and violence of  these dis-
eases, they  could not with  propriety be  called malignant.
They still accorded  very perfectly with the  character and
constitution of the season. They were the  diseases of a tem-
perate, not  of a  tropical  climate-—the  diseases of Europe,
which are more slow and obstinate, not of the "West-Indies,
which are more violent  and rapid*   They bore a strong re-
semblance to a form of  autumnal  fever which, though not
unfrequent  in England,  appears  to be still  more common
in some  parts of France.  They were such as had also been
familiar to the older practitioners of Philadelphia, previously
to the pestilential fever of the year 1793. A hot and dry
summer would have ripened them into true pestilence.
   The events of the years 1804 and 1806, when duly weigh-
ed, and considered in all their circumstances and relations,
are interesting and important in a very high degree.   Taken
in connexion with those  of the year 1805, (of which we will
treat presently)  they speak a language .which the weakest
capacity cannot misunderstand, and unfold truths and prin- 
35
 ciples of which the inhabitants of the United States should
 never lose sight.
    It will be recollected that in  the year 1805, the  health-
 law for the city and county of Philadelphia was precisely and
 in all respects the same, as it had been in the year 1804. It
 was also administered by the same officers, and was enforced
 with equal rigour, as far as respected the quarantine of ves-
 sels from sickly ports.  But the  summer of 1804 was uncom-
 monly wet and cool, and Philadelphia escaped pestilence. The
 summer of 1805, on the other hand, was in <n equal degree
 hot and dry, and  she  experienced that disease in great seve-
 rity.  In the  summer of 1806 the measures of the health-law
 relative to the quarantine  of vessels were greatly mitigated,
 and they were also executed with a mildness altogether un-
 known during the two former years. In the apprehension ot
 many, therefore, a door was thrown open for the admission
 of pestilence.  But the season,  again was wet and cool, and
' Philadelphia was again exempt from that calamity.
    What was the true cause of the immunity of our city from
 pestilence during these two  wet and cool seasons, and of her
 heavy sufferings from it, during the hot and dry one? Was
 not her intercourse  with the West-India islands as free, ex-
 tensive, and direct, during  the years  1804 and 1806, as it
 was during the year 1805? Certainly it was. During the year
 1806 in particular it is known to have been  even much more
 so, because the West-India trade was subject to a lighter qua-
 rantine. Were not the  islands alike infected by pestilential
 diseases during each of these seasons?  It is well known that
 the difference in this respect, if indeed any difference existed,
 was very  inconsiderable.   The exemption of Philadelphia
 from  pestilence, then, in the years 1804 and 1806, was owing
 neither to the  uncommon healthiness of the West-Indies,
 during these two  years,  nor  to our impeded intercourse with
 those islands.  It arose entirely from the wetness and cool-
 ness of the seasons, and from the  cleanliness of our streets,
 in consequence of the frequent  and overflowing falls of rain.
 The pestilence of 1805,  on the other hand, was not to be at-
 tributed to any  unusual freedom of intercourse  with sickly
 places, but to the hotness and dryness of the season, co-ope-
 rating with the filthiness and impurity of our streets. During
 «ich  year the diseases corresponded precisely with the na» 
                           36

ture a»d character of the summer.  In  1804 and 1806 we
had cool European seasons,  which, as was  to be expected,
gave rise to mild European  diseases.  But in 1805 we had a
perfect tropical season,- of which tropical diseases were  the
natural consequence.  This plain statement sets forth, in the
most  satisfactory and impressive manner, the importance ot
public cleanliness with a view to the preservation of public
health, while it  shows in a manner equally conclusive,  the
inutility and folly of our quarantine establishments.  . These
expensive and oppressive establishments, have the unhappy
effect of burthening and gradually destroying our commerce,
without-contributing in the smallest degree to the security of
our health.  During very hot and tropical summers,  we will
be perliaps always more  or less in danger of pestilential dis-
eases, notwithstanding our quarantines, and  during  wet and
cool ones, we will have nothing to dread from such diseases,
though these institutions were totally abolished.
   An occurrence that took place in Philadelphia in the year*
1801, still further confirms the connexion between very hot
weather and pestilence.
   The three summer months had been cool and pleasent, and
the falls of rain, though not  very profuse, had been sufficient
for all the purposes of nature. Corresponding to this consti-
tution of the weather, the diseases of the season had been
mild and manageable. Contrary, however, to general expec-
tation, September commenced with uncommon heats, which
continued  without abatement  till the tenth of the  month.
Throughout this whole period the thermometer seldom sunk,
during  any part of the twenty-four hours, below 78° or 80«
of Fahrenheit,  and it  sometimes stood  as high  as  88°.
Not a drop of rain fell, nor scarcely a cloud appeared to in-
tercept  for a moment the scorching sun-beams* The conse-
quence  of this uninterrupted series of hot  and dry weather
was, that,  about the middle  of the month, a  pestilential fever
broke out near to the drawbridge, and, in a short time, swept
off upwards of twenty of the inhabitants. There was no at*
tempt to trace  this disease to  any other source, than  the
heat  of the weather operating on the filth of the neighbour-
hood where  it appeared. Though it was greatly checked in
its course  by the cool weather of October, it did not entirely
disappear till the beginning of November. 
CONSTITUTION AND DISEASES OF THE YEAR 1805.
  The aspect and occurrences of the year 1805 were widely
different from  those of  the  years  1804 and  1806.  The
reader must, therefore, prepare himself for a view of scenes
that will form a contrast, not only striking  but  gloomy and
painful, with those of which he has just taken leave. Instead
of a mild and tractable, he will here be called to the contem-
plation of a pestilential and malignant disease, and instead of
general recoveries, he will witness frequent instances of dis-
solution. Though his attention will be still confined to the
same  spot on which  it was fixed during our review of the
constitution and diseases of the years 1804 and  1806,  yet
such an unexpected change will appear in the face of things,
as might almost induce him to disbelieve the fact. He might
even  seem  in imagination to have been transported as  by
magic,  from the temperate and healthful climate of Great
Britain,  to the burning  and malignant  sky of  Hispaniola,
and to have exchanged the mild  complaints of the  former,
for the destructive pestilence of the latter region. For such
and so great was the difference between the temperature  and
diseases of the summers of 1804 and 1806, and those of the
summer of 1805.
   During the first  months of the year 1805, the  small-pox,
protracted from the  preceding year, continued still to prevail
to a considerable extent. As  the spring  opened that disease
declined, in the  course  of the summer it  became*still less
frequent, and, on the commencement of the pestilential or
yellow fever, of which we will presently speak, it disappeared
so entirely, that, during  the autumnal months, it became im-
practicable to procure matter for the  purpose of inoculation.
This circumstance alone affords  strong proof of the small-
pox having prevailed as  an actual epidemic: for  it is an inva-
riable and indeed a necessary law of epidemics, that two of
them never can prevail  in the same  place  at once, but  that
one always disappears, on the commencement of the other.
Different intercurrent or sporadic diseases,  which arise from
as many different causes, may exist in the same place at the
same time. But as all epidemics have their source in certain
morbific states or constitutions of the atmosphere, and as the
atmosphere  cannot  be marked by more than one morbific 
38
state or constitution at once, the co-existence of  differenl
epidemics in the same place is altogether impracticable.
  The spring months, and  till about the 14th of June of the
year 1805 were somewhat cool for the season; the prevailing
winds  were easterly and northerly, and the  rains that fell,
though not very abundant, were  sufficient for the purposes
of vegetation.  Towards the latter part of this period, inter-
mittents began to prevail,  attacking many persons  indiscri-
minately, but more particularly those who had suffered from
the  same disease during the preceding summer and autumn.
Such annual attacks of intermitting fever are common occur-
rences. In this instance, again, the prevailing disease corres-
ponded very accurately with  the  nature and  temperature of
the prevailing weather.  The season was  as  vet moderate,
and the complaints were, therefore, mild, as if proceeding
from the action of weak causes. These circumstances inspir-
ed  a general hope, that this summer, like  the last, would be
temperate and pleasant, and would produce nothing but the
common diseases of temperate climates.  The correspondence
hitherto observed between  the weather and the existing state
of  disease, seemed to lay  a  rational foundation for such a
hope.  But these prospects  proved as fleeting and delusive,
as  they had been  fair  and  promising.  For, in a short time,
the whole aspect of nature  underwent a change.
  On the 14th of June the intense summer heats commenc-
ed.  These were  accompanied by a severe drought, which
began  on  the 20th of the same month, and continued without
any intermission, except a  few very slight sprinklings of rain
that barely moistened the surface of the earth, till the 28th
of August.  During this burning period,  not only the rains,
but even the common dews of the season ceased to descend.
Except in marshy and humid places, and  in the  immediate
vicinity of streams and other bodies of water, there appeared
to be no moisture in the ground  to ascend in vapours during
the day, and return again in a condensed form during  the
coolness of the evening.  Nor did the heats cease  with the
termination of the drought..  The rains that fell towards the
close of  August and in the  first  weeks of September, had
(contrary to the usual  course of things) but very little effect
in reducing the temperature  of the  atmosphere,  which still
remained  high till near the time of the autumnal equinox. 
39
  In the months of Jury and August, the heats during the
day were uncommonly oppressive, and, as there were no falls
of rain, they suffered but little abatement even during the
night, a circumstance which  greatly augmented  the  general
quantum or mass of heat for  the season.  For, as alreadv ob-
served  in  another place,  during those  summers that are
accompanied by frequent showers and thunder-gusts, though
the day be intensely hot till noon, yet, if one of these show-
ers or gusts occur  in  the afternoon, it generally reduces
the temperature of the atmosphere very considerably during
the night, and  perhaps for the space of several succeeding
days.  During  such a season,  though the weather may be
at times extremely hot, yet the quantum or  aggregate mass
of heat, to which every thing is exposed, must, by these in-
terruptions, be greatly diminished.  But no such interruptions
occurred during the summer now under consideration.  The
heat of that season,  like the heat between the tropics, was  a
vestal fire which blazed without intermission.
   It is remarkable, that during part of the summer of 1805,
even our most cooling winds  appeared to have lost their cus-
tomary  effect in lowering the temperature of the atmosphere.
On one day, in particular, the mercury rose to 91  degrees
of Fahrenheit,  while the  wind blew from the north-west.
This is  an occurrence to which but very few parallels can be
found, in the meteorological  journals of the United States.
This, at least, is the case with respect  to those years, the
journals of  which I have had an opportunity of examining.
As the summers  of 1804 and  1806 were the  wettest and
coolest, that of 1805, taken  throughout, was much the hot-
test and driest  that has been  experienced in Philadelphia for
many years.  Perhaps the oldest of our citizens cannot call to
mind its parallel.
   Every thing possessing  life  appeared to  languish under
the fiery inclemency of the season.   The vegetable kingdom
was foremost in manifesting the severity of its suffering. The
husbandman saw,  with painful emotions,  the hopes of the
year ready to be blasted, and even  experienced  some solici-
tude about the means of subsistence. The grass and smaller her-
bage became sapless and parched, like the leaves of autumn.
For several  weeks the fields and even meadows  exhibited
scarcely a shade of verdure,  more than they do in the depth 
40
of winter.  Indeed the face of barrenness  dwelt on whole
tracts of country, which but a short time before had been
luxuriantly clothed in vegetables.
  But it was not the weaker vegetables alone, that suffered
from the fierce intemperature of the season.  By such a con-
tinnuace of heat and drought,  the fruit and fruit-trees were
greatly injured, and even the forest-trees themselves did not
escape unhurt.  The growth of the Lombardy poplar was less
rapid and luxuriant than in common years, and the foliage of
most trees, particularly of those that grew on high and  dry
situations,  exhibited a sickly aspect. Such as stood  in  low
and humid places appeared more healthy ani vigorous.
  Nor did the animal kingdom escape without injury. Besides
experiencing that languor which necessarily  results from the
action of a burning sky, and an  arid atmosphere oftentimes
filled with dust, many  of them were deprived of their custo-
mary nourishment. This was particularly  the case with  such
herbivorous  animals as black-cattle, and sheep, whose  food
was not only diminished in quantity, but injured in its quali-
ties, and rendered  much less nutritive than when watered by
plentiful falls of rain. Owing to the drying up of springs, rivu-
lets, and other watering places, cattle suffered greatly, in many
instances, for want of  drink. In several parts of the country
it even became necessary to supply them food as regularly as
if it had been the depth of winter.
   I do not know that  in the country, domestic animals were
affected by any epidemic  complaints. But in cities the  case
was  different.  It  will  hereafter appear, that in Philadel-
phia, besides  languishing under  the exhausting influence of
an  over-heated atmosphere, some  of our domestic animals
suffered from a different and more deleterious cause. They
became participators  with there owners in the  pestilential
disease about to be described.
   Even man himself,  protected by all the improvements de-
vised by his philosophy, and supported by all his fortitude,
was ready to sink under the inclemency of the season. While
thus oppressed and relaxed by its  enervating influence, he
ceased to deem incredible the accounts given of the  debility
and indolence of the inhabitants of certain tropical countries,
whose heats are always intense,  and whose  soil  yields v ith-
out cultivation the means  of subsistence. During this extra- 
41
ordinary continuance of heat and drought, the appetites of the
citizens of Philadelphia, particularly for solid  food, were
impaired,  while their  thirst  was  rendered excessive and
their discharge of perspirable matter preternaturaUy  pro-
fuse. In consequence of this, their strength was necessarily
more or less diminished, and with it the powers of their
systems for resisting the action of morbific causes.  They be-
came, therefore, more liable to the attacks of pestilential or
other diseases. This liability was in too  many instances in-
creased, and, no doubt, in some, converted into actual disease,
by the improper use of wine or ardent spirits, taken under  a
pretext, or perhaps with a real expectation, of supporting or
renovating the declining strength.
  One or two of the immediate and obvious effects of such
a dry and hot season, in the city of Philadelphia, deserve to
be noticed. Owing to the extreme dryness of the streets, and
the action of a perpetual concourse of foot-passengers,  horses,
and carriages, the dust was reduced to an impalpable  power.
The slightest wind, therefore, threw clouds of it into  the at-
mosphere, which was oftentimes so overcharged  with it as
very sensibly to affect respiration. This inconvenience, though
felt  by all, was more particularly troublesome to persons pos-
sessed of very irritable lungs. By absorbing moisture when
taken into the mouth,  the dust also contributed to increase
the  thirst of  the citizens;  and by making its way into the
lungs, and occupying a certain extent of space in the cavities
of that viscus, it necessarily lessened  the proportional quan-
tity of respirable air taken in at each act  of inspiration. The
full  effect of such a privation on the  human system, nothing
but  a further and more intimate knowledge of the economy
of life can enable us to determine.  It must certainly, howe-
ver, be in its nature morbid.
   But though extremely troublesome and somewhat injurious,
the  dust was by no means the most offensive or noxious sub-
stance that was mingled with the atmosphere. The intempe-
rature of the  season gave  great activity to  the process of
putrefaction, in all places where putrefactive materials abound*
ed.  But,  unfortunately, there  were too many places  of this
description within the limits of the city and suburbs.  Those
persons charged with the superintendance of the public  health,
had their views too firmlv riveted on another quarter, to at-
                              f 
42
tend to the pressing and obvious duty of domestic cleanliness.
The necessity o» preventing the importation of disease from the
West-India islands, was the only theme on which they dwelt;
and, accordingly, infected ships, sickly crews, and forbidden
cargoes, haunted their imaginations so  incessantly, and so
wholly engrossed their time, that they found no leisure for a
thought or  an  action relating to  any thing else. Such was
their fanaticism on the subject of the introduction of disease
from abroad, that they would at any time  leave the  carcass
of an animal putrefying in the street, and filling the air with
a poison truly pestilential, to go in quest of a sailor sick only
of a last night's debauch, or to meet at the health office, for
the purpose of  passing a resolution to prevent the most clean
and healthy West-India vessel from entering our port."
  From these circumstances, together with an entire  want
of purifying rains, our  city became  extremely foul, and the
atmosphere in  a  high  degree contaminated  and  offensive.
The stench arising from .the putrid  substances lodged in the
gutters, sewers, alleys,  and docks,  was  in many places, to
persons unaccustomed to it, quite intolerable.  It was, per-
haps, more offensive, particularly during the latter  part of
July, and in the month of August, than any thing of the kind
experienced by our citizens in former years. Strangers fresh
from the country, where they had been accustomed to breathe
an atmosphere  pure in itself, and  free from any odorous ef-
fluvia except those arising from vegetables, could not walk
the  streets  near  to  the  Delaware  without  experiencing
great  inconvenience.  They even  expressed  their surprise
how  the citizens could  bear such a stench  without com-
plaining, and how they  could live  any  time in an atmosphere
so  impure, without losing their health.
   But, on this subject it is to be recollected, that impressions
disagreeable and painful,  at first, may by custom be rendered
imperceptible or even  pleasing, and that the human system
possesses such a power of accomodation to circumstances, as
to become able to bear for a time,  with seeming  impunity,
the aotion  of  poisonous  substances, whether  in a gazeous,
a liquid, or a solid form.  Hence it is, that the natives of
warm climates, as well as those emigrants from higher lati-
tudes  who have  long resided in them,  very  seldom  suffer
from the pestilential diseases which these climates produce. 
43
From constantly breathing a heated and contaminated atmos-
phere,  their systems  become  so-far  reconciled to it,  that
they  experience neither injury nor  inconvenience from that
heat and those noxious exhalations,  which prove so fatal to
strangers newly arrived from  colder climates. And hence it
is, that  in Philadelphia, and other large cities of the United
States, the old and  settled inhabitants  are  not, in common
summers, so liable to sickness, as strangers  who  have  just
changed a  country for  a city residence.   Indeed it is no un-
common thing for persons of this latter description, like those
who emigrate from  a temperate  to a hot climate, to experi-
ence  a seasoning from such a change.
   Soon after the commencement of the heat and drought, in
the month of June, the cholera  infantum, which had previ-
ously made  its appearance,  became uncommonly  prevalent
and mortal.  Its ravages during part of July were perhaps un-
precedented in the  city of Philadelphia. Upwards of sixty
children fell by it in one week.  Had  the name of pestis in-
fantum been substituted for that of  cholera infantum, the
malignity and mortality of the disease  were sufficient to have
justified the change.  The terrible  aspect of this complaint
excited in the minds of several physicians serious apprehen-
sions for the fate of the city at  a more  advanced  period of
the season. These  physicians regarded  children as the out-
posts of the community,  destined, from the  weakness and
 susceptibility of their  frames, to sustain the first shock of the
 impending epidemic.  For this cholera or rather pestis infan-
tum, is nothing  but a febris maligna  introversa of children.
It is, in other words,  the endemic of the season, determined
to the stomach and  bowels, from causes peculiar to children
of a certain age.
   During  the summer under consideration, as well as in that
of all former years, this disease was confined more particu-
larly to the children of the poor, who are subject to numerous
and strong exciting causes.  The children of those in better
circumstances, being exposed to fewer exciting causes, were
much less  generally as well  as less severely affected, even
although they  remained in the city during the whole season.
Hence  cholera infantum is not necessarily incident to children
in Philadelphia.  Were these  tender  subjects supplied with
suitable aliment, and properly guarded from exciting causes, 
44
the prevention of much misery, and an incalculable saving of
human life would be the certain effect.
  The intermittents that  had appeared in the earlier part of
the season, ceased almost entirely on the commencement of
the extreme heats in June. But  they were soon succeeded
by  another form of disease equally troublesome. Early in
July bowel complaints, assuming in  a few instances the form
of dysentery, but generally that of diarrhoea, betame  uncom-
monly prevalent among adults. They were, for a short time,
truly epidemic. Nor could their prevalence be attributed to
any obvious cause.  The atmosphere  had undergone no sud-
den  change  with regard either  to  its temperature or its
humidity.  Yet the sudden  appearance connected with the
universality of the disease  showed  it to  be necessarily of
atmospheric origin. From its attacking, in numerous instan-
ces, several persons in the same family, and that in  regular
succession, it had as much the appearance of being contagious,
as its pestilential successor, of which we will presently speak.
The occurrence  of this disease, together with all the circum-
stances  attending it, increased the  apprehensions of those
physicians who  had paid attention  to the  phenomena and
laws of epidemics. These observers of nature had learnt, that,
in general, heavier epidemics are preceded by lighter ones.
They remembered that in 1793,  1797, 1799, and other sea-
sons, the  pestilential  fever had immediately followed an in-
fluenza, which, though slight, had prevailed very generally
throughout the city. From these considerations they  did not
hesitate to regard the bowel complaint just mentioned, as
premonitory of the approach of a more serious calamity.
  On some occasions a pestilential fever has been known to
be preceded  by an  unusual frequency of apoplexy,  and in-
stances of sudden death from the  other causes.  This was the
case in  New-York in the summer of the year 1803.  On the
ground of these premonitory appearances, Dr. Miller of that
city, expressed to me, both in  conversation and by letter,
strong apprehensions that the constitution of the season would
prove pestilential. The events which soon  followed,  evinced
but too clearly the soundness of the doctor's judgment, and
his accurate knowledge of the laws of epidemics. Lancisi also
speaks of a pestilential fever in Rome having been preceded
by a kind of apoplectic disease. Several other instances of a
similar nature are on record. 
45
  The appearance of these epidemic harbingers, in an early
part of the season, very clearly announces the existence of a
constitution of atmosphere unfriendly to health. Under such
circumstances there is  always great  reason to apprehend,
that, during the progress and by the influence of the summer
heats, which may succeed, particularly if they be very intense,
this constitution  will be ripened  into one truly pestilential.
Though we are not able, in the present state of physical sci-
ence,  to  trace with accuracy the particular steps  by which
nature effects  this progressive change, yet that she oftentimes
does effect it,  is a truth which rests on  incontrovertible facts.
For much valuable and  interesting matter relative  to the
gradual formation of true pestilential constitutions, we refer
the reader to Webster's " History of epidemic and pestilential
diseases"

OF THE PESTILENTIAL OR YELLOW FEVER OF THE YEAR 1805.
  We will now  proceed  to the  immediate consideration of
the pestilential or yellow  fever, which prevailed in Philadel-
phia in the year 1805. For the better elucidation of this sub-
ject, it will be treated of under the nine following heads, viz.

  Section I. Of the rise, progress, and decline of the disease.
  Section II.  Of the origin and causes of the disease.
  Section III. Of the contagious nature of the disease.
  Section IV. Of the means of preventing the disease.
  Section V.  Of the history of the disease.
  Section VI. Of the causes of particular symptoms.
  Section VII. Of  the prognosis.
  Section VIII.  Of the morbid appearances discovered,  on
     dissection.
  Section IX. Of the treatment of the  disease. 
46
                      SECTION I.

  OF THE RISE, PROGRESS, AND DECLINE OF THE DISEASE.

  The first cases of this disease that attracted public notice
occurred towards the close of July, near to Catharine street
wharf, in the  district of Southwark.  I have  said  the  first
cases that attracted public notice, because,  previously to this,
a few sporadic cases had appeared in different and even dis-
tant parts of the city, one* of which I had myself visited at
the request of the attending physician. This case terminated
fatally on the  fourth day, with black vomit, and other symp-
toms of high malignity. No notice was taken of it by the Board
of Health, although two of the members of  that body actually
visited the patient during her illness. A few days afterwards
the goods of the deceased, including even the bed on -which
she had died, were  disposed of at public sale; nor did either
the purchasers or  any of the inhabitants of  the adjoining
houses sustain the slightest  injury from the event. No other
case of the disease appeared in that neighbourhood afterwards
during the season.
  Four cases of malignant fever occurred, in the first instance,
in the vicinity of Catharine street wharf, namely, one on the
twenty-sixth,  one  on the twenty-seventh, and two on the
twenty-eighth  of July.  The  person  who sickened on the
twenty-sixth of the month was named  John Davis, and lodg-
ed in a small  tavern kept by John  North. He was  removed
on the thirtieth to the Philadelphia almshouse,  where he died
a few days  afterwards, with  a yellow  skin, yellow eyes, and
the black vomit. The case of this patient  was  never noticed
by the Board of Health, for reasons which will be hereafter
unfolded. Of the other  three persons, two were sent by the
Board,  on the same day of the month with the above  removal,

  * A woman named A.  Person, who lived in Fourth street, one or two
doors below South street, and was attended by Dr. Stuart. She died seve-
ral days previously to the appearance of the disease at  Catharine  street
wharf As early as the fourteenth and fifteenth of  July  of this year, Dr.
Hartshorne, of the Pennsylvania hospital, visited three out-patients of that
institution, ill of malignant or pestilential fever.  The  names of the patients,
together with that of their disease, are  recorded on the books of the
hospital. 
47
to the Lazaretto, where one of them died, and the other re-
covered. The third was conveyed into the country, where
he also recovered. The reason of my noticing these  four
cases of disease in so minute and circumstantial a manner,
will appear in a subsequent section. I need scarcely add, that
the occurrence of them at  this critical period of the season,
and the indiscreet manner in which three of them were an-
nounced by the Board of Health,  created great alarm.
   For about  a week  after these  removals every thing re-
mained quiet, and the agitation of the public mind began to
subside. But this subsidence resembled that of the waves, on
the first deceitful pause of the tempest. A more  powerful
and continued blast was fast approaching to awake a high-
er and more  lasting tumult.  The Board of Health,  with a
want of discernment not very honourable to them, began to
fancy that they had actually performed a wonder little inferior
to one of  the labours of  Hercules.  They first persuaded
themselves, and then endeavoured to persuade their  fellow-
citizens, that by  a single  well timed and well devised  act,
they had completely extinguished the fever for the season,
and saved  the city from the  danger that threatened it.  But
physicians  who viewed the subject through a different medi-
um, and judged of it from  different principles, formed a very
different opinion. They discovered at a glance the commence-
ment of a pestilential disease, which nothing but the occurrence
of cold weather, or some entire change in the prevailing consti-
tution of the atmosphere could check. In conversation with one
of the medical members of the Board of Health, I myself as-
sured him in unequivocal terms,  that the city " was inoculated
for the season," and that all his efforts to arrest the  course
of the disease would be fruitless. He received my declaration
with great  indifference, except that he was surprised at my
want of faith in the preventive powers of the Board.  I have
no doubt but the gentleman retains a perfect recollection even
of my words on the occasion; nor can he, I think, have for-
gotten the  perverted construction  which he afterwards very
illiberally attached to them, nor the unwearied pains he took
to torture them to ,my injury in  the line of my profession.
   To Dr. Physic  and  several other medical characters, who,
in consequence of living at a distance from the seat of the
foregoing cases, had no opportunity of observing for them- 
48
 selves, I also expressed a conviction that the disease  would
 make its way through the city, as in former years, and would
 be checked only by the usual causes.  From the delivery of
 this opinion I pretend to no discernment or foresight beyond
 what is possessed  by many  others, who, placed under similar
 advantages for observation,  would have formed similar views.
   The next subjects of the  disease were in the house of Mr.
 Caleb Bickham, who, with  several  houses intervening, lived
 at least twenty paces distant from the  nearest of the houses
 occupied by the persons previously attacked, and whose fa-
 mily had never had the least intercourse,  either  directly or
 indirectly, with the sick, or with the families, or dwellings
 in which they had resided.
   The next subject again of any note  was a young woman,
 the daughter of Mr. Hosey, who  lived at the distance of
 sixty or eighty paces,  in nearly an opposite  direction, from
 the habitations of the persons first attacked. This unfortunate
 girl had never been near to any of the sick, nor to any thing
 that had been  about their persons or  in their houses.  She
 died on the fifth or sixth day of her disease with symptoms
 of great malignity. It was  found, on  inquiry, that all these
 persons had been  exposed  to strong exciting  causes.   This
 indeed is generally the case with those who suffer first from
 epidemic or endemic diseases.
   It was now about the 20th of August. From  this period
 the disease began  to spread through the neighbourhood in a
 manner so irregular and desultory, that its course can be nei-
 ther followed nor  described. It did not proceed with regula-
 rity either  from house  to house, or from person to person. It
 seemed to select,  as its proper subjects, those persons, who,
 from imprudence or necessity, were  exposed to the strongest
 exciting causes.  It exhibited none of the characters or phe-
 nomena of a disease spreading by contagion. For many per-
 sons, constantly confined to the chambers of the sick, escaped
 unhurt, while others,  without the slightest exposure  to any
 supposed source of contagion, became its victims. It is par-
 ticularly remarkable that none of the nurses of the sick suf-
 fered till a considerable time after the  commencement of the
 calamity.
   During this period the Board of Health  appeared  to be
wonderfully on the alert, spending a great part of their time 
49
in the sickly neigbourhood.  Yet in reality they were doing
nothing, except issuing hasty and crude memorials and re-
commendations to the public, making certain arrangements
which they never carried into effect,  and  disquieting the
minds of some of their fellow-citizens by threats of compul-
sory removal, which they  had no power to  execute. They at
length opened the doors of the city-hospital, and entered on
a plan of crowding it with sick, alike inconsistent with wis-
dom and humanity.   But  as  my own mind recoils from  a
review of some of their  harsh proceedings, I will  not  give
offence to the reader by  recording them.   I will only add,
that these proceedings roused the indignation of those citizens
against  whom they were particularly directed, to such a pitch,
that, from motives of personal safety, the  Board of  Health
were  forced to abandon them. Removals, whether of the sick
or of the well, were  no longer acts  of  compulsion,  but of
choice.
   As yet the disease was confined principally to Water street
and a few adjoining alleys, the air of which seemed best cal-
culated  to favour its propagation.  A few scattering cases,
however,  appeared  in Front  and Second  streets.  These
might be considered as the advanced guard of the enemy,
and gave certain notice that the main body was close in their
rear.  About this time, I myself attended a case of the disease
even as far to the westward as Third-street.  The subject of
it was a child, that had not, for many weeks before, been ten
paces from its father's door,  nor had it  had the least inter-
course with any sick person.  It recovered,  but not without a
severe struggle, and  some of its symptoms wore a very ma-
lignant aspect.
  By the middle  or  twentieth of September, the disease had
become  epidemic over a large proportion of Southwark, and
a small  section of the southern extremity  of the city itself.
Along Water street, in particular, it  had  extended in  scat-
tering cases nearly as far to the northward as Walnut street.
It is worthy of remark, that on every occurrence of malignant
fever in the city of  Philadelphia it has  appeared to  delight
most  in the air of  Water street, which runs along the low
around of the river Delaware.  On some occasions, when  it
was scarcely Irtiown  in the higher streets of the city, it has
prevailed to a very considerable degree in  Water street, and 
50
  in the houses on the  east  side  of Front-street, which are
  known to constitute the west side of Water-street, and must
  be therefore subject to the influence of its atmosphere. This
  was particularly the case in the years 1799 and 1803.  In the
  former of these years, not a family that remained in the city
  on the east side  of Front-street, between  Pine and Spruce
  streets, escaped the disease, while most of those on the west
  side immediately opposite continued healthy.  The inferences
  to be drawn from  these facts are reserved for a subsequent
  part of this essay.
   At no period did the malignant fever of the year 1805 ex-
 tend as an epidemic in the city,  farther from  the  Delaware
 than to Second street, nor in the district of Southwark, than
 to Fourth street.  All cases  that occurred to the westward of
 these limits were  to be considered as accidental or scattering.
 Within these limits safety consisted only in  flight, or  in care-
 fully avoiding every thing that might act as an exciting cause.
 For, even till the entire disappearance of the disease,  some
 exciting cause was  necessary to bring it into action.  It must
 be acknowledged, however, that during the time in which the
 epidemic constitution of the atmosphere was  at its height,
 that is, during the time in which most people sickened, a very
 slight cause was oftentimes sufficient for  the purpose. Before
 this constitution had acquired its full force, and after it . ad
 passed  its meridian and was on the decline, a more powerful
 cause was requisite to produce the same effect.  This is a
 characteristic of all epidemics.  And  that epidemic constitu-
 tion of the atmosphere may be said  to  be  most exquisitely
 formed, by the influence of which many persons sicken  with-
 out any obvious exciting cause.  Perhaps such a degree  of
 perfection and strength is attained only by that kind of con-
 stitution which gives rise to influenza.  We are told that  in
 eastern countries  an exciting cause is  always necessary fof
 the production of the plague.*
   By the last of September the epidemic had gained its ut-
 most boundaries.  Though it afterwards attacked many per-
 sons residing within the area which it then occupied, yet the

  * Diseases really contagious occur without any exciting cause, except
 that of their own poison.  This circumstance seems tp constitute  an es-
sential difference between  diseases produced by a moib fie constitution
 of the atmosphere, and those arising from the action of an animal poison 
51
dimensions of that area did not appear to be in any measure
enlarged. This disease has always,  in Philadelphia,  ceased
with the close of September, to extend its limits, except in the
year 1793. During that season the whole of October was dry
and unusually hot.  In consequence  of this, the epidemic in-
creased not a little both in extent and mortality during that
month. This fact very forcibly evinces the necessary depen-
dence of the disease on heat. In 1799 even a cool September
checked it, whereas in 1793 a warm October added  greatly
to its extent and violence.
„  Early in October the epidemic began to decline, in conse-
quence of a few days of  cool weather, accompanied in the
country with frost. Though much weakened, it was not yet
extinguished. On the other hand,  it even revived a  little,
again, on the weather  becoming warmer.  This  temporary
declension and revival were twice afterwards  repeated from
the same causes. With such reluctance  did the disease re-
tire, and so  difficult was it to dislodge  it from  its  strong
holds, that it did not entirely disappear  till the  close of the
month, notwithstanding the occurrence of several frosts  so
severe as to form ice in the gutters. It evidently withstood,
for a time, the action of colder weather than  it had done in
former years, and  contended for its  empire with greater ob-
stinacy. In consequence of this many persons were attacked
by it, who, relying on the change that had taken place in the
weather during the first weeks of October, returned prema-
turely  from their asylums  in the country.
   After the  epidemic had fairly passed its  meridian, and
was on the decline, its attacks were  less malignant and  dan-
gerous than they had been at an earlier period of its course.
From  the tenth of October it  was accompanied in general
with as little  danger,  and much less  obstinacy, than, a com-
mon remittent. But the malignity and danger of this disease
were also graduated by its distance  from  the river. Persons
residing about Third and Fourth streets, although attacked
when the epidemic was at  its height, were in less danger than
those who lived in Front and Water streets.  I think  I  lost,
during the whole season, but four patients  to the westward of
Front street, three of whom were, when I first visited them,
in such an advanced stage of the disease, that there was no
ground to hope for their  recovery.  The same circumstance 
52
was observed in 1803, as well as in preceding years, and dc
monstrates the  existence of a concentration of the predispos-
ing cause oi the disease in the eastern and lower streets of
the city. But such  a  concentration is  most likely to  occur,
near to the principal source or birth-place, of that cause.  The
deleterious effluvia  of a putrid body are always most abun-
dant and offensive in  the immediate vicinity of that body.
  The removals of the  citizens into the country, though nu-
merous, were neither so general, nor attended with so much
consternation, as on former occasions.  Most persons seemed
to leave their homes with more than usual reluctance, and to
return to  them with uncommon eagerness.
  From the commencement of the disease, a constant inter-
course was kept up  between the healthy parts of the city and
the sickly parts of Southwark, notwithstanding some strange
prohibitory measures, and threatening proclamations of  the
Board of Health. The  citizens did not entertain the same
dread of the disease which they had manifested in preceding
years, and the Board  had, at an early period, rendered them-
selves too odious to some, and too despicable in the eyes of
all, to have any influence either by their remonstrances or
their  mandates. In consequence of this, many cases  of the
fever were introduced into central and healthy parts  of the
city. These cases excited, at first,  no small  degree of alarm
in the minds of the  neighbouring inhabitants. But they were
found to terminate, sometimes favourably and sometimes un-
favourably,  without  communicating  disease either to  the
families in which the sick lay, or to  any individuals who,
from  motives of friendship or otherwise, had had free access
to their chambers. This was observed  to be, not an acciden-
tal but an uniform occurrence, to which there was no excep-
tion; for in no instance did the disease spread from the sick
to the well, in consequence of cases being thus  introduced
into healthy neighbourhoods.  The  inhabitants of these
neighbourhoods escaped uninjured, notwithstanding so many
supposed  sources of infection being scattered among them.
Numerous facts of this description forcing themselves on
the observation of our citizens, shook to its foundation  the
belief of many of them in the old and fashionable doctrine of
contagion. But pf this we shall speak more fully in a subse-
quent section. 
53
  It might, perhaps, seem from what has been advanced in
certain parts of the present section, that in the more northerly
and  westerly parts of the  city, there were no cases of pesti-
lential fever  except those that had been introduced from
Southwark or the neighbourhood of Water street.  Such an in-
ference, however, would betray the reader into an error. Many
sporadic cases occurred,  even  in those parts of the city, in
persons who had not been exposed to either of these sources.
Such cases were always the result of very powerful exciting
causes.  Nor does it appear to me  improbable, that, during a
part of the season, such causes might have produced an at-
tack of fever in some measure malignant, in the person of
any  one  who resided in a closely inhabited part of Philadel-
phia. I am persuaded that the constitution of the atmosphere
of the whole city was of a pestilential nature. This constitu-
tion differed in  different parts of the city only in its degrees
of perfection or strength.  In some parts, as  in Southwark, it
attained such perfection as to  predispose the inhabitants on
whom it acted  to violent attacks  of pestilence from slight
exciting causes; whereas, in the more westerly and elevated
parts of the city, it was so weak that it predisposed the inha-
bitants only to slight attacks, and that not without the aid of
very strong  exciting causes.  I believe  the same thing  was
true with respect to the  whole of Philadelphia during most
of those years  in which  yellow fever has prevailed in  any
part of it in an  epidemic  form.
   I  have been unable to  satisfy myself either with respect to
the number of persons that sickened or of those that died of
the pestilential fever in the year 1805. The Board of Health
attempted to collect an account of the cases as they occurred;
but most physicians actually engaged in the  disease refused
to report to them, in consequence of the  extreme impropriety
of their  conduct towards the sick.  I believe, however,  that
the  disease attacked a greater number  of persons,  and  was
productive of more mortality than in any preceding year, ex-
cept 1793, 1797 and 1798. It appears from a report of the
physicians who  attended the  city-hospital, that, between the
twenty-seventh  of August and the thirty-first of October,
that institution  received  into its  wards three hundred  and
forty-six  patients, most  of whom were  labouring under
malignant fever. Were a conjecture on such  a  subject ad- 
54
missible, I would say, that the aggregate number of sufferers
from this fever could not have been less than twelve or fifteen
hundred.

                     SECTION II.

       OF THE ORIGIN AND CAUSES OF THE DISEASE.

  The subject of this section  involves considerations of great
moment to the welfare of our country, and should therefore
be treated with a degree of attention and a sense of respon-
sibility corresponding to its  importance.  In approaching  it,
the inquirer should carefully  banish from his mind all preju-
dices and preconceived opinions.  The discovery of truth and
the promotion of science and of the public good ought to be
the sole objects of his regard. With this intent, facts  should
be related faithfully without  discolouration or  concealment,
and nothing  admitted on the ground of conjecture or hypo-
thesis.  Under such impressions do we  enter on, and by such
rules are we  determined to conduct the present inquiry.
  We  foresee that our principal,  probably our  only, contro-
versy respecting  the origin and causes of the pestilential fever
of the year 1805, will be with  the Board of Health. Previous-
ly, therefore, to advancing our own opinion on the subject, it
is right that we should at least pay that body the compliment
of stating and examining theirs.
  When the fever made its  appearance towards the close of
July, the Board  were  extremely  anxious to  establish  the
doctrine of its importation from abroad. With this view they
adopted a measure, for the craftiness and policy of which they
were entitled to  some degree  of credit.  Sensible that the cur-
rent of public prejudice  on this subject ran strongly in their
favour, and  appreciating, with more than their usual discern-
ment, the importance of first impressions, they immediately
declared that the disease had  been introduced from the Laza-
retto by means of contagion.  But as it belonged to them alone
to close the gates  of that institution, and prevent, during the
season, all intercourse  between  it and the city that might
prove dangerous to the health of the inhabitants, it was neces-
sary that they should shield  themselves from  the charge of
any  neglect  or  misdemeanour in  office. They  proceeded, 
55
 therefore, to assert, that the persons who had brought the
 fever to the city, had clandestinely made their way, by night,
 to the shipping riding quarantine at the Lazaretto,  for the
 illicit purpose  of smuggling coffee: that they had there con-
 tracted the disease from an infected vessel, and communica-
 ted it to their  fellow-citizens on their return to the city.
   In examining into  the  authenticity of this charge, four
 distinct heads  will present themselves to our consideration.
   1st. At the  time  when the  pestilential  fever appeared  in
 Southwark, was there any infected or  sickly vessel  riding
 quarantine at the Lazaretto?
   2d. If so, had this vessel any coffee on board?
   3d. Had the persons first attacked by the pestilential fever
 been actually at the Lazaretto?
   4th. Had any persons, subsequently attacked by the fever,
 had an intercourse with those who  were primarily attacked?
   We will proceed to the consideration of each of these heads,
 in the order in which they  are here laid down.
   1st. At the  time when the pestilential fever appeared in
 Southwark, was there any infected or  sickly vessel riding
 quarantine at the Lazaretto?
   No,  there  was not.  The  only  sickly, or  to  adopt the
 more fashionable phrase, the only  infected vessel that had ar-
 rived at the Lazaretto, previously  to this period, was the
 schooner Nancy, William Lake, master, last from the city of
 Santo Domingo. She  arrived  at  the  quarantine ground on
 the  twelfth of  July, nearly two weeks previously to the ap-
 pearance  of yellow fever  at  Catharine street wharf.  The
 captain himself and one seaman were the  only persons sick
 on board of her, both of whom were removed, immediately
 on her arrival, to the hospital at the Lazaretto.  The vessel
 was than cleansed and purified agreeably to the directions of
 the Board of Health. After having  passed through this pur-
 gatory process, which  was completed in less than three days
 after her arrival at the Lazaretto, the Nancy could be no lon-
 ger considered  as an infected vessel;  or if so, it was in conse-
quence of some error, defect, or mismanagement in that part
 of the quarantine establishment which relates to the purifica-
 tion of shipping,  and which it was incumbent  on the Board
 of Health  to remedy.  But  there-  are  two substantial argu-
 ments to show, that the Nancy was  not now an infected, but 
56
 a pure and safe vessel. First, the mate and part of the crew
 that remained and slept on board during her detention at the
 Lazaretto, continued  healthy: and  secondly, some of the
 members of the Board of Health were themselves on board
 of her, and even passed through and examined (as they  con-
 ceived their duty  directed) all the  most suspicious parts of
 her, without sustaining the  smallest injury.  But this could
 not have been the  case, had she still been the repository of a
 pestilential poison. For surely the members of the Board
 possess no charter of exemption from the influence of such a
 poison more than other men.
  The persons who were the first sufferers from malignant fe-
 ver in Southwark, were said to have visited the Lazaretto about
fve days previously to the time of their attack.  But at that
 period, the Nancy could not be viewed in any other light,
 than as a pure and healthy vessel.  Nor was there any other
 vessel then on  the quarantine station, that  had been at all
 suspected of contagion. Even admitting then, that these cha-
 racters  had actually gone down to the Lazaretto, and  in a
 clandestine manner gained  access to  the shipping at qua-
 rantine,  what mischief could have  resulted from such  an
 event? Did not the members of the Board of Health often-
 times visit these same vessels publicly; and did they not re-
 turn immediately from them to the city and mingle with their
 families  and friends without either contracting or communi-
 cating disease? That  they did is a fact notorious to every
 one. It is not very probable, then, that a single visit to these
 vessels would infect three persons, while fve others (the num-
 ber of which the Board of Health consist) escaped during the
 whole season, notwithstanding repeated visits.
   2d. Had the schooner Nancy any coffee on board ?
   She had not more than one bag, as appears both from the
 manifest of her cargo,  and from the testimony of the officers
 resident at  the Lazaretto.  This bag was  landed with the
 rest of the cargo, and no attempt was ever made to bring it
 to Philadelphia in a fraudulent manner. It was part of a pri-
 vate adventure, and did not reach the city till long after the
 commencement of the fever.  Indeed it appears from testi-
 mony which cannot be doubted, that there were not  more
 than three or four bags of coffee smuggled into Philadelphia
 during the whole season.  These were taken out  of the ship 
57
Louisiana, then lying at Newcastle, and arrived in die city
at least four days after the appearance of yellow fever at Ca-
tharine street wharf  They were conveyed immediately  to
the Northern Liberties,  and the persons  concerned  in the
transaction neither lived  in, nor had  any intercourse with,
the district of Southwark where the disease made its appear-
ance. Should any of these facts be controverted, we are pre-
pared to establish the truth of them by the oaths of respectable
and disinterested witnesses.
  3d.  Had the persons first attacked by the pestilential fever
been actually at the Lazaretto?
  From the best testimony which  can be collected on the
subject, it appears clearly that they had not.  The names  of
these persons were, Peter Young, Joseph George, and Tobias
Smith. Of these, Peter Young, and Tobias Smith were sent
down to the hospital at the Lazaretto, where the former died,
and  the latter recovered.  Joseph George  was  removed into
the country, where he also  recovered, but has not since re-
turned to  the city.  Peter Young during his illness, declared
repeatedly to the officers of the Lazaretto, with the solemnity
of a man  conscious that he lay on his death-bed, that, pre-
viously to his sickness he had never had the  slightest  inter-
course either with the Lazaretto, or  with any vessel lying
at quarantine.   Tobias Smith,  the surviving patient, when
examined  on  oath by  certain members  of the Board  of
Health, answered precisely to the same  purport. He has
since declared, in my presence and  in that of  several other
gentlemen, that  he had  never been  at the  Lazaretto, nor
even in sight of it, till sent thither by the  Board of Health,
after the  commencement  of  his  illness. The  master  of
this  lad is also willing to declare  on oath, that for several
weeks previously to  his sickness, he  had not, at any one
time, been long enough absent from home, to have gone to
and  returned  from the  Lazaretto,  either by land  or  by
water.
  Nor is  this all.  J. Williams, mate, and a seaman  whose
name, I think, is Samuel Milch, remained constandy on board
of the schooner Nancy, while she rode quarantine at the La-
zaretto.   Both  of these men are willing to make oath, that,
during the time of said quarantine, no person from Philadel-
phia or elsewhere, except those concerned in the administra- 
58
tion of the health-law, were either  on board, along side of,
or even near to the vessel.*  Dr. Dorsey, the Lazaretto phy-
sician, adds his testimony to  the above, and, in strong terms,
declares his disbelief of any illicit intercourse between this
vessel and the city.
  With such a weight of testimony against  them, and with-
out a  single fact in their favour to counterbalance it, it is not
a little surprising that the Board of Health should have pub-
licly declared, that the persons first attacked by yellow fever,
had been  at the Lazaretto, and that for the purpose of smug-
gling  coffee. Yet such a report was actually propagated  by
that body, or some of j£s members, and, unfortunately for the
cause of truth, has made a deep impression on  many weak
and credulous minds. It might seem uncharitable to insinuate,
that the Board of Health were themselves the fabricators of
a story  so weak and unfounded; yet it is no less difficult to
conceive,  how the glaring fallacy of such a  tale  could have
escaped the discernment of men whose duty it was to inquire
into its  authenticity. It is left to the  members of that body
to extricate themselves from this dilemma  in such way as
they  may deem  most  consistent with truth and  their own
reputation.
   But what will these  gentleman say to the case of John
Davis, who sickened at Catharine ^street  wharf before either
Peter Young,  Joseph George, or Tobias  Smith, and died
shortly  afterwards in  the alms-house, with black  vomit  and
other highly malignant symptoms?  Why,  truly,  they have
very prudently chosen to say nothing about it; because they
could in no way whatever implicate the  subject of it in the
charge  of having clandestinely visited the  Lazaretto  or the
shipping  at quarantine.  This man was by occupation a dea-
ler in  oysters, and had been assiduously  engaged  in  this
business for a very  considerable time previously to his attack
of yellow fever.  I have been able to trace  his history for at
least  four weeks  preceding  that event, and am prepared to
prove, by indubitable testimony, that he  had not been at the
 Lazaretto within that period. It is altogether probable  that

   * J. Williams, the mate, actually has made oath to this purport. A copy
 of his deposition is in the possession of captain Eggar, quarantine master,
who administered the  oath himself, and heard the declaration of the'
 deponent. J. Williams was a man  of reputation, and was under no temp-
£ation to depart from the truth. 
59
he was never nearer to that establishment than the  eastern
channel of the river Delaware, which is distant from  it about
a mile. The  shipping are known to ride quarantine in the
western channel, which is at least half a mi'e from the  eastern.
  4th. Had any persons, subsequently attacked by the fever,
had  an intercourse with those  who were  primarily attacked?
  I  have  been diligent in my inquiries  on the subject of this
interrogatory, and am able to reply decidedly in the negative.
I dare challenge the Board  of Health, and all their adherents
to disprove or even controvert my  assertion.  It has been
already observed, that the second class of sufferers from the
pestilential fever were in the families of Mr. Caleb Bickham
and  captain Hosey. But it can be established on the oaths  of
Very respectable characters, that neither of these families had
ever had  the slightest intercourse with the families of John
North, or Samuel Chrissman, where the first cases of the
disease made their appearance. There was never, on any oc-
casion, a single  visit exchanged between these families.
The persons  alluded to  are still living, and will themselves
testify to  the truth of what is here stated.
  Having finished the first division of  this section, which
was  to consist in  a  statement and  an examination of the
opinion of the Board of Health,  respecting the origin and
causes  of the late pestilential  fever, I  shall now proceed  to
the second division, namely, to lay before the reader, (which
will  be done  with  great deference) my own opinion on the
same subject.
  Under  this division I do not know that I shall be able  to
advance any thing new, as to principles.  All I can promise
is, to make a fair,  candid,  and, I hope, satisfactory  applica-
tion  of principles already known, to the case in  question.
  On the origin of the early sporadic cases of the disease it
would be  useless to dwell, as these  were, at most, nothing
more than mere specks  in the horizon, announcing  the ap-
proach of the embodied storm. A minute inquiry into this
would not, therefore, throw much light on my general sub-
ject. On the other hand, if the general subject  can be satis-
factorily elucidated, there will be no difficulty  in accounting
for these particulars.
  I  am one of those who believe the  pestilential fever of the
year 1805, which made its appearance at the corner of Catha- 
60
rine and Water streets, to have been exclusively of local and
domestic origin, and to have arisen from the poisonous exhala-
tions emitted by a  very large bed of putrid oysters and oys-
ter-shells that were suffered to lie on Catharine street wharf.
The purpose for which these substances were thrown on the
wharf, is of no consequence.  Their existence there, is a fact
notorious to all the surrounding neighbourhood, as well as to
hundreds who reside in other parts of the city and district.
  These oysters and shells lay in that situation from the last
of June till within a few days of the close of July. By com-
putation, they were never less in quantity than one hundred
and sometimes, amounted to at least three hundred bushels.
The Board  of Health or  some  of the members of it were
repeatedly desired by the neighbours to have them removed,
but obstinately declined  complying  with their  request, till a
very short time  previously to the  appearance  of the  fever.
One of the  members, when somewhat urged on the subject,
peevishly replied, " that he knew of no law for the  removal
of oyster-shells." Had the wave-washed timbers or the tem-
pest-beaten sails or spars of a ship from Cape Francois, been
deposited in the  same place, this  same gentleman and his
colleagues would have passed toilsome  days and even sleep-
less nights to effect their removal.  Had no law existed, they
would, in the plenitude of their power and self-sufficiency,
have immediately made  one  for the purpose, or,  as they did
in several other instances, would have acted without a law.
But, to have removed offensive oyster-shells, would have
been a  tacit acknowledgement that such  substances might
produce sickness, a doctrine  which their creed-founders had
denounced as heretical.  At length, however the  clamours of
the neighbourhood became general and loud, and the Board,
though  with much reluctance, were obliged to  remove the
nuisance.
  These oysters  and shells were exposed for, at least, four
weeks, to a  series  of the hottest weather that  had been ex-
perienced in Philadelphia for many years.  The consequences
of such an  exposure need scarcely be mentioned. The mass
ran into the  highest state of putrefaction, and soon emitted
a stench that was quite intolerable. The putrid effluvia exten-
ded to a great distance, and were so  offensive,  that manv
persons sitting at their doors in the evenings were made sick 
61
by the smell.  It will be  recollected  that no rain fell during
this period to wash away or even dilute the corruption. In the
meantime, the members of the Board of  Health frequently
passed by and regarded  the scene with as little  concern, or
apprehension of danger, as if this Avernian mass of putre-
faction, had been nothing but a bed  of Cyprian roses.
  The human race were not the first victims to the pestilen-
tial gas, with which these oyster-shells adulterated the atmos-
phere. Early in July, the cats of the neighbourhood began to
droop, and in the course of the month  died in considerable
numbers. The seat of their disease  appeared  to  be in the
alimentary canal, for they were generally affected  with both
vomiting and purging. No means, I believe, were resorted to
for their relief.  Nor did some of the other domestic animals
of the neighbourhood escape unhurt. Two dogs, one the pro-
perty of captain Day, and the  other belonging to Mr. Jacob
Winnemore, were remarked for being very familiar with the
bank of putrid oyster-shells. They were said to frequent the
place for the purpose of eating stale oysters that were  occa-
sionally thrown out of the boats lying at  the  wharf. These
dogs were both taken sick towards the close of July: the for-
mer died and the latter recovered with much difficulty.  Like
that of the cats, their disease appeared to be abdominal, for
they were affected with  profuse and distressing evacuations
both  upwards and  downwards.  Two or three other neigh-
bouring dogs  were also indisposed, but in  a slighter degree.
These circumstances  gave rise  to  a  report, that  the dogs
in that part of the district were poisoned by a gang of house-
breakers, which  then  infested the city, in order that  these
felons might carry on their nightly depredations without any
danger of detection from those faithful domestics. But as
the dogs in all other parts of the city escaped, this story was
discovered to be without foundation.  The dogs were indeed
poisoned, but it was by the pestilential effluvia, which they
inhaled in its most concentrated state, during their repeated
visits to the oyster-bed.  At  lengdi,  in the words of the poet,

           "----The vengeful arrows fix'd in man."

   It has been already  mentioned, that the  first sufferer from
the disease was  John Davis. This  man, from  being a dea- 
62
 Ier in oysters,  was constantly about Catharine street wharf,
 throughout the day, and was  therefore, greatly exposed to
 the septic exhalations arising from the bank of shells.  In ad-
 dition to this, he had, for some nights previously to his illness,
 slept on the deck of an oyster-boat which lay at the wharf,
 with  no other covering but one of the  sails. Thus, did he
 suffer, perhaps, the greatest possible exposure both to the
 predisposing and exciting causes of pestilence.  For it is well
 known, that nothing acts with greater certainty in awakening
 the seeds of such a fever into life, than  the influence of the
 night air on the system, particularly during the languid hours
 of sleep.  Accordingly  on the twenty-fifth of July, these
 causes took effect, though not  with  such violence as some-
 times marks the commencement of a pestilential disease.  The
 patient was removed, from the boat where he  had lain, to
 the house of John North, from whence, on the  thirtieth, he
 was  conveyed  to the alms-house, where, in a few days, his
 case terminated fatally with the malignant symptoms already
 mentioned.
  The  persons  next affected  were Peter Young, Joseph
 George,  and Tobias Smith.  They  all lived in the house of
 Samuel Chrissman, at the corner of Water and  Catharine
 streets, about thirty paces from the bed of putrid oyster-shells.
 They were,  by  trade, house-carpenters,  and two of them
 were  somewhat  intemperate and irregular in their habits.
 After being greatly heated by  exercise  and exposure to the
 rays  of  the sun  during  the day, it  was their  custom in the
 evening frequently to recline on benches that were arranged
 along the side or end,of the house, and in that situation, with-
 out any covering or shelter over them, to sleep till bed-time.
 During  this  time  the stench of the oyster-shells was at its
height.  For, in the summer season, putrid bodies are most
 offensive in the  evening, while  the  noisome exhalations are
 undergoing a degree of  condensation, but have not yet been
 entirely precipitated by the cooler air of the night. The ex-
posure of these persons, whether to predisposing or exciting
 causes, was perhaps but little inferior to that of Davis him-
 self.  They accordingly  sickened about  two days after his
 attack. The circumstances subsequent to the commencement
 of their disease have been already  stated. It is  proper to
 mention, that the house  of Mr.  Chrissman was,  next to that 
63
of Mr. North, most immediately exposed to the  exhalations
from the oyster-shells. Judging, therefore, from  first princi-
ples alone, we would be led to consider the inhabitants of it
liable to  be next injured  by these exhalations. Mr. Chriss-
man's family had suffered great inconvenience from the stench
of the shells.
   Two of the next sufferers in order (at least of those who
attracted  any public notice)  were a young  gentleman and a
lady of the neighbourhood, who had contracted a mutual at-
tachment to each other, and frequently passed their evenings
together. The  gentleman played delightfully  on the  flute.
On a fine moonlight evening, about four or five  days  previ-
ously to  his attack, he went, accompanied only by the  young
lady, on board of a boat, which he moored at a short distance
from Catharine street wharf, and there, in music  and conver-
sation, passed the time till about eleven o'clock.  In addition
to this,  he exposed himself considerably  by patrolling the
streets at night, to assist in apprehending the gang of house-
breakers already mentioned. Such causes as these succeeded
in producing an attack of fever, which  proved  fatal  in a few
days. The young  lady did not sicken  till  after  her lover's
death. The exciting cause  of her disease  appears  to have
been the sight of his coffin, at the distance of  at least sixty
or eighty paces, as it was borne from his father's house  to-
wards the grave. The shock convulsed her frame to such a
degree, that she was near sinking to the ground. Symptoms
of malignant fever soon afterwards supervened, and terminat-
ed her existence on the fifth day of her illness.
   Some  of the members of the Board of Health have asser-
ted, that this unfortunate girl visited the object of her affec-
tions  during his sickness, and in  that way contracted the
disease which destroyed her. This report has no foundation
in truth.  She never saw him after the commencement of his
illness, as his constant attendants during his confinement are
ready to  assert on oath. It is evident that they both derived
their predisposition to disease from  the same original  cause.
And as to the exciting causes, some of them have also been
mentioned.  We will not attempt to follow the footsteps of
this  fever any further. We conceive that  enough has been
already said to establish the fact of its  domestic  origin; and
shall only add, that all the observing men of the neighbour- 
64
hood concurred in attributing it to the same source of cor-
ruption.  It continued from this time  to  spread irregularly
among those  persons who had been most  immediately expo-
sed to the  deleterious gas  emitted by the oyster-shells, till
its particular course was at length swallowed up and lost in
its epidemic  prevalence.
  But this is not the only instance where masses of putrid
oyster-shells  have  produced a pestilential  fever in our coun-
try.  Occurrences of the same kind took place in  Philadelphia
in the year 1803.  It will be recollected that  during that sea-
son, the pestilential fever broke out in two places in the city,
or rather in  one in the city, and in one in the district of
Southwark.
  It appeared first in the neighbourhood  of  the  wharf next
below Market  street, and  about a week  or  ten da}7s after-
wards, at Almond street wharf. A  great proportion of the
intermediate  space between these two situations was  yet
healthy.  During that season large  quantities of  oyster-shells
-mixed with many damaged oysters, had been thrown on these
wharves  for  the purpose of filling th«m up and rendering
them firm and dry. For some weeks previously to the fever,
these animal  substances, having taken on the putrefactive pro-
cess in  consequence of the heat of the weather, emitted a
very offensive  smell. The stench  was  much complained of
bv the neighbours in both places, and, when the fever appear-
ed, the putrefying substances were pronounced by  many of
them to have been the cause of it. These facts were first dis-
closed to me at the time by persons  living adjacent to the
wharves, who had listened only to the evidence  of their own
senses, and who had no preconceived hypothesis to establish.
After an attentive investigation of every circumstance, and
the most mature consideration of the  whole subject, I was
 convinced that these plain  and unprejudiced  observers of
nature were  right in their opinion, and that the  first cases of
fever, in both places, were to be attributed to the septic gas
emitted  by the oyster-shells. The events of the year 1805
have contributed  still further  to  the  establishment  of this
 belief.
   But instances of a similar nature have occurred in other
 places as well as in Philadelphia. It appears  from a neat and
 correct statement  on the subject by Dr.  Dick,  published in 
65
the Medical Repository of New-York, that the pestilential fe-
ver which prevailed in Alexandria in the year 1803, origina-
ted from the septic exhalations thrown into the atmosphere by
a large bed of putrid oyster-shells. I do not know that any
attempt was made  to trace that disease to a foreign source.
I believe the matter was so clear as to force conviction on
the mind of every observer.
   In Dieppe, a city of the province of Normandy in France,
a pestilential disease was produced in the year 1776, by putrid
oysters in the shell. These oysters had lain in a frozen state
throughout the winter.   On the return of  warm weather
they  were  thawed, and soon hurried  into a state of deep
putrefaction. The  stench  arising from them became insup-
portable. The  consequence was, a pestilential disease, accom-
panied with great violence and mortality.  Some of its cha-
racteristic symptoms were, a sense of burning in the stomach,
a soreness in the epigastric region,- and black vomit. (See ob-
servations on the epidemic diseases and constitutions of France.)
   To men of extensive  medical research, these facts will not
appear either new or extraordinary. Hosts  of  similiar ones
are to be met with in the writings of both ancient and modern
physicians.  Indeed there is scarcely any thing more common
in medical history than narratives of  pestilential diseases
originating, in warm climates and seasons, from the putrefac-
tions of large masses of animal matter. What appears most
extraordinary is, that, in the very face of such a blaze of tes-
timony on  the  subject, the competency of these  causes to
produce  those  diseases should be called in question. But, in
a case where prejudice and passion  have usurped the seat of
reason and common sense, the greatest absurdities and devia-
tions from truth cease to exrite surprise.
   Let no one cavil at the  statement here given, by alleging
that oyster-shells are incapable of putrefaction.  It is, indeed,
true, that the pure calcaneus portion of them is incapable oi
this  process: but it is equally true, that this is not the case
with  respect to the quantity of animal mucus and  the nume-
rous worms which they  contain, nor with  regard to the por-
tion of the oyster itself which always adheres to  them.  These
are substances as  susceptible of, and as offensive  under, the
putrefactive process, as any belonging to the animal kingdom.
Besides, the masses of shells mentioned on the  present occa-
                              i 
                           66

$ion were mixed with hundreds of damaged oysters, which
had been thrown on the wharves, as unfit for use. But all spe-
culative reasoning ©n the subject is a mere waste of words.
Facts alone are worthy of our attention. And it is a well known
fact, that in each of the beds of oyster-shells, which have been
here represented as sources of disease, putrefaction arose to
an uncommon height.
  The distance around, to which a large mass  of putrefying
matter may contaminate the air, is altogether undetermined.
It must doubtless depend on a variety of atmospherical cir-
cumstances, which have hitherto eluded our research. When
we  recollect, however, the extent of country which is often-
times rendered sickly by the putrefaction of timber and small-
er vegetables in consequence of the erection of a  mill-dam,
we  are compelled  to allow a very considerable latitude  to
the  action of such  repositories of corruption.  The  stench  of
the  oyster-shells on Catharine street wharf, in the summer of
1805, extended in great force to  Front street. But we have
no  reason to believe that this stench was  a  necessary con-
comitant' of the pestilential gas  that issued from  the  same
source.  This latter aeriform substance was,  no doubt, dif-
fused through a much  wider extent of atmosphere than  the
former.

                    SECTION III.

      OF THE CONTAGIOUS NATURE OT THE DISEASE.

  Under this head of  my subject I must necessarily be con-
cise, particularly as I do  not  know that I have any new facts
to offer.  Should I succeed in giving a new and  more impres-
sive aspect  to facts already known, though the measure of
my ambition may not be filled up, yet the extent of my present
views and expectations will be accomplished.  Even in that
case, I shall experience the satisfaction of having performed
an  important duty to my country, by contributing  somewhat
to the elucidation and  establishment of a truth, in  which her
interest and welfare are deeply concerned.
   A  knowledge of the contagious or non-contagious nature
of a disease, is the result of experience and observation alone.
 NTo physician, however sagacious he may be, can tell from the 
67
mere aspect or appearance of a fever, whether it is commu-
nicable by contagion or not.  There is nothing in the pulse,
the countenance, the tongue, the decubitus, the colour of the
skin, or the smell of  the  perspirable matter of the patient,
that can possibly lead  him to such a discovery. Nor can he
see  and identify  the  matter of contagion, as  it  gradually
issues  from the bodies  of the sick.  He must wait, till the
question be determined by an intercourse, under proper cir-
cumstances, between the sick and the well.  If, at every sea-
son of the year, and in an atmosphere free from any common
cause of fever, the attendants and visitants of the sick be at-
tacked by a disease similar in all respects to that under which
the sick labour; if this attack occur within  a given time after
exposure; and  if none  but  persons thus exposed  suffer an
attack; under such circumstances, there is strong ground to
consider the disease as actuaMy contagious. But if, on the other
hand, In some one particular season of the year and in that
season only, this  disease  attack, without discrimination, al-
most every one living in certain situations, whether any pre-
vious  exposure  to the sick have been incurred or not; and, if
cases  of  it when  removed  from such  situations  run  there
course without being  in any instance communicated to visi-
tants or attendants; in this state of things, the disease cannot
be considered as arising from contagion, but from an atmos-
phere vitiated by other  causes.
   We will assume, as examples, the small-pox and intermit-
ting fever, for  the further illustration of these several  posi-
tions.  Notwithstanding the singular and striking appearance
of the former of  these diseases, yet no physician  could dis-
cover it  to be  contagious, without  having first  acquired  a
knowledge of the fact, either by experience, or through  some
other  channel.  I mean, by this, that small-pox exhibits no
sign or characteristic naturally and necessarily expressive of
contagion, any more than pleurisy, dyspepsia or rheumatism.
How, then, do we arrive at a knowledge  of this terrible
attribute of that disease?  I answer, in the following manner.
   If small-pox occur in a family where  it has never appeared
before, whether this  family  breathe the adulterated atmos-
phere of a citv, or the pure air of  the country, and whether
the season of the year be spring, summer, autumn, or winter,
all the individuals of this  family will be successively attacked
% 
68
by a disease precisely, similar.  Nor does the mischief termin-
ate here.  The  very same disease attacks  also such of their
neighbours as  kindly visit them in their distress, as well  as
those who are employed as nurses. But persons in the neigh-
bourhood who keep at a distance, and carefully shun all inter-
course, whether direct or indirect, with the sick, retain their
health. The immediate atmosphere of the sick, or the atmos-
phere of some  article that has been in contact with them,  is
the only place in which there is danger.  This is, at least, the
general course of small-pox.
   Under such circumstances it is clear, even to demonsta-
tion,  that the  disease is communicated by contagion from
the sick to the well. That is,  it is evident that by  the disor-
der prevailing in the systems of the former, a peculiar poison
is formed, which, when suffered to act on the systems of the
latter, produces a disorder of the same kind. Our only know-
ledge  of the contagion of small-pox, then, is derived from
the principles and manner of the spreading of that  disease.
Were its  manner of spreading different, our opinion respec-
ting the cause of its spreading would be also different.
   We will now turn to intermitting fever and mark the con-
trast. This disease appears only at particular seasons of the
year, and then  principally in low humid situations.  It attacks
numbers at the same time, or  in succession, and that  without
their having previously had any intercourse with each other.
It oftentimes  affects only one or two in a familv, while  all
the other individuals of that family remain well. If a case  of
this  disease be removed from  the flat  and damp situation
where it originated, to  one which is  high, dry, and healthy,
it terminates without injuring the health of visitants or atten-
dants.  The sick subject may be approached by those  who are
well without the slightest risque. The atmosphere immediately
surrounding his person and clothing may be breathed  with
as much safety, as the atmosphere of a person affected  only
by a common catarrh. Those persons who keep up the most
familiar intercourse with him, retain their  health no less per-
fectly than those who cautiously shun him.
   With such  facts as these operating on  the  mind, no one
can  admit this disease to be contagious.  As it is not com-
municated from the  sick to the  well, when removed  to a
high and  healthy situation, the universal conclusion is, that 
69
it does not, in the place where it originated, spread by con-
tagion, but by means of a contamination of the atmosphere
from some common cause. Did it spread by contagion in one
place, it would not, without an essential change in its nature,
lose this  property when removed to another.  But,  no such
change takes place, inasmuch, as all its symptoms  continue
the same.
   Let us now compare with the foregoing examples, the man-
ner and  circumstances of the spreading of our late  pestilen-
tial fever, and see to which  of the two it is most assimilated,
small-pox'or intermitting fever.
   The pestilential fever prevailed during a particular season
only, breaking out in July and disappearing  in October.  It
prevailed also in a particular  situation, being chiefly confined
to the lowest parts of Southwark and of the city.  On  its oc-
currence at Catharine street wharf, its earliest victims were
characters who had had  no previous intercourse with each
other. Nor did those who  had the most  immediate connex-
ion with these sick persons suffer  sooner or with more cer-
tainty than many others who never approached them.  Even
the reverse of this  was true. For it is a  fact, that most, if
not all, the attendants and visitants of some of the  first sub-
jects  of the disease  escaped.  Throughout the whole season,
there were, comparatively, but few families, in which  all  or
even a majority of the individuals sickened. In most families
not more than one, two, or  at furthest three persons  were at-
tacked. Nor did these fall sick in  such succession as to furnish
any ground to suspect contagion as the cause. They sickened,
for the most part, within a few days of the same  time. Had
the disease  spread by an active contagion, it is  difficult  to
conceive  how it could have occurred in most families  in
Southwark and disappeared again, without attacking the great-
er part or all of the individuals composing them.
   In the year 1805, as on former occasions," many cases of
the pestilential fever were carried into the surrounding coun-
try, were they terminated,  without, in a single instance, com-
municating disease  to the  nurses  or attendants of the sick.
There was no more danger in approaching these  cases, than
if they had  been nothing but pleurisy or rheumatism. The
immediate atmosphere of the sick was as free from  any dele- 
70
terious or febrile poison, as any other portion of the general
almosphere.
   But this was not all.  Many cases of the disease were also
conveyed from Southwark into  the very heart of  the city.
These events were, at first, productive of considerable alarm.
But this alarm began to  subside, when it was found, that
such'  cases uniformly terminated without,  in any  instance,
proving hurtful to those who had even the  most familiar in-
tercourse  with  the  sick. Those whose duty confined them
constantly to the sick chambers as nurses, and who were fre-
quently in contact with the persons of the diseased, and even
repeatedly received their  breath warm from their lungs, re-
mained ih as perfect health, as  those, whose apprehensions
impelled them to remain at a distance. Fortunately for truth
and, I hope, for the cause of humanity, these occurrences
were  not lost on  the  minds of the citizens. Many persons
who had, previously, entertained doubts respecting the con-
tagious nature  of malignant fever,  decided now  against its
contagion; and not a few, who had formerly been strenuous
advocates for its contagion, became, at least, very lukewarm
and sceptical on the subject. Indeed, how  could the matter
be otherwise? It was evident to every one, that cases of this
disease when carried from the place where  the disease pre-
vailed, into neighbourhoods which were healthy, terminated,
like cases of intermitting fever, without being communicated
to a second person, and  did  not, like small-pox,  impart  a
similar disease to all who ventured within the atmosphere
of the sick. On the other hand, it was obvious to  every one
who had an opportunity of making correct observations on
the subject, that in the place where  the disease did prevail,
many became the subjects of it, who had had no intercourse
with any sick person previously to their own attack. At least
two-thirds of all those who suffered from the disease in South-
wark, sickened without any such previous  exposure. These
circumstances render it evident, that the disease under con-
sideration  spread, not, like the small-pox, by means  of  a
morbid poison  formed by disordered action in the  systems
of the sick; but,  like the  intermitting fever,  in consequence
of a vitiated state of the atmosphere produced by a cause of
greater extent. 
71
  But further. At the  city hospital, which was a receptacle
of the most malignant cases of fever, and to which upwards
of three hundred patients were  conveyed during the  season,
no marks of contagion were discovered. This fact, supported
also by the experience  of former years, is alone  sufficient to
determine  the question. Such a number of patients crouded   ,
together into a few  wards, could not fail to communicate
their  disease to physicians and attendants, if indeed that dis-
ease were  communicable.
  In  the place where pestilential fever prevails, it spreads by
far too rapidly to depend on the gradual  and slow operation
of  contagion.  It  spreads, for example, much more rapidly
than  the natural small-pox in the common way.  But-,  when
carried  into a pure  and salubrious atmosphere, it does not
spread at  all.  I am utterly at a loss to know how these  cir-
cumstances are to be reconciled on the principle of contagion.
In  one situation, according to the creed of our contagionists,
the secreted poison of pestilential fever is more  active than
the poison of small-pox,  whereas in another situation,  and
that  at a very short distance, it is perfectly inert. " There
is  something  more  than  natural in this, if our philosophy
could find it out."
   Lastly,  on the  occurrence of cold weather, the malignant
fever, precisely like intermitting fever, was first checked and
 soon afterwards  eradicated.  But what effect could the  first
 cold  weather  of autumn  have in arresting the course  and
 destroying the existence  of febrile contagion?  From  every
 view and  consideration of the subject,  we  are justified in
 asserting,  that it could have  no such effect. Cold  weather
exerts  an  immediate influence on the external  atmosphere,
but not on the atmosphere of the chambers of the sick. It is
still less capable of producing such a change in the diseased
action of  the'system, as to take from  that action  the power
 of  forming a  morbid  poison, provided such a  power were
before possessed by it.  Upon the whole, it may, I conceive,
be  laid down  as an axiom in  medicine, that when a disease
occurs frequently in  any place about the beginning of autumn
 and  uniformly  terminates  on the commencement  of cold
 weather, that  disease, whether it be denominated plague or
 yellow fever, is a true  endemic of the place where it prevails, 
72'
and does not depend on contagion  either for its original in-
troduction  or subsequent propagation.
   But it may be asked, if the pestilential fever of the year
1805  was not contagious; if it was  produced by septic exha-
lations issuing from a bed of ovster-shells; why did it con-
tinue  for  nearly  three  months, instead of disappearing as
soon as the source of these exhalations was removed?
   At first  view this subject seems to be  involved in some
degree  of obscurity.  But,  when  properly considered,  this
obscurity vanishes. It is not alleged that the identical exha-
lations proceeding immediately from the oyster-shells, kept
the fever in existence during  the whole season. They only
served at first to kindle and for a certain time to support the
flame, which was afterwards fed by similar exhalations from
various  other sources.  But such sources  were numerous and
copious throughout the whole district of Southwark, as well as
in many parts of the city. They existed in all places where
putrid animal or vegetable  substances were suffered to re-
main. The constitution of  the atmosphere was already, in
and of itself, so nearly pestilential, that it was rendered actu-
ally so by the  admixture of even a moderate share of these
putrid effluvia.
   Quere.  Do the noxious effluvia issuing from  a large mass
of putrid substances act as a septic  ferment on other masses
with which they come in contact, and thus accelerate in them
the generation  and  emission  of  similar effluvia?  However
fanciful this idea  may appear, facts  are not  wanting to render
it probable. Thus we  are  confidently  told,  that  in places
where pestilence  prevails, meat and all  alimentary substan-
ces are  found to putrefy sooner, than in other  neighbouring
places, even during the same season, where that disease does
not prevail.


                     SECTION IV.

      OF THE MEANS OF PREVENTING THE DISEASE.

   The means of preventing pestilential fever may be divided
into general and personal. The first  relate to the podce, or
municipal  regulations of the places where the  disease pre- 
                            73
vails j and the second to the customs and modes of living of
the inhabitants.
   On this occasion I must necessarily speak in general terms,
as a descent to particulars would swell the present section to
an improper length: nor does the end I have in view call for
a detailed discussion of the subject.
   From the first  subdivision of this section, namely,  that
which is to treat of the general means of prevention,  I exclude
entirely all measures and systems of quarantine.  I am  con-
vinced that neither  Philadelphia  nor  any other  city in the
United States, has ever derived the least advantage, on the
score of health, from these burthensome and oppressive mea-
sures.  They are  the offspring of error and superstition, and
can never be rendered subservient to the welfare of mankind.
It is not against the purification, but the unnecessary deten-
tion  of vessels that I here  object.  No  vessel  ought  to be
suffered to enter the port of Philadelphia without being first
thoroughly cleansed both of foul  air and foul water; for  both
or either of these substances may prove injurious  to health.
But  this may be accomplished  in forty hours as well as in
forty days.*  Should her cargo or any part of it be damaged,
that ought also to be discharged  for purification, and not be
permitted to be brought into the  city in  a putrid state.   But
the vessel herself, when cleansed of her foul air and offensive
bilge-water, together with her crew and the undamaged  part
of her  cargo, may be admitted into port with perfect safety,
and cannot, therefore, be detained at quarantine without great
injustice to the persons concerned in  her.  I challenge those
who may be inclined to oppose me in this sentiment, to point
out a single instance in  which the health of Philadelphia has
been injured by the admission of vessels under these restric-
tions.  I know, indeed,  that much  has been said about the
introduction and propagation of  malignant fever among us
by infected clothing and  crews.  But  these   stories, when
strictly  examined, have been  discovered to  have had no
foundation  in truth. They originated in  ignorance, and have
been kept in circulation and credit, by prejudice, party spirit,
  * The term " quarantine" is derived from the French word " quarante,,?
which signifies forty. In its original acceptation, therefore, it means a
lustration or purificatory process which must continue forty days,  from .'.
superstitious veneration which the founders of quarantine establishments
had for that term of time.
                             k 
74
and the pride of opinion.  Many physicians and other charac-
ters of note, adopted and  openly advocated  them  at  first,
for want of better information, and  were afterwards either
ashamed or afraid to acknowledge .their error.
  The whole of the general means* of prevention that are
within the power of man, may be comprehended  under the
single term of cleanliness.   Filth in  sufficient quantity,  and
weather sufficiently hot and dry, when acting in concert, are.
adequate to the production of malignant fever. Without the
agency of such causes, neither sickly crews, nor vessels  from
the West-Indies on board of which persons had died, would
be at all dangerous to the people of the United States. Hence
such vessels arrive at Philadelphia in the winter season, with-
out doing any mischief, because  then  the  weather  is  cold;
and hence such crews are accommodated in the summer sea-
son without danger in the  country,  because there filth  does
not exist in sufficient  abundance  to  vitiate  the atmosphere.
But neither of these causes acting separately, that is, neither
filth nor hot and  dry  weather, is alone capable of producing
this effect. As, therefore,  we cannot direct the course of the
winds, call down friendly showers from the clouds, nor con-
troul, in any measure, the temperature of the season, our
only alternative is the preservation of cleanliness.
  We do not contract pestilential diseases immediately  from
the ground on which we tread, nor from the water which we
drink; but from the air which we breathe.  The state of the
atmosphere is, therefore, the best test of the purity of any
situation, so far as that purity is  connected with  the health
of the inhabitants of the place.  An  atmosphere impregnated
with a putrid and offensive smell, can never be otherwise than
injurious to the health of those who  are compelled to breathe
it. It is loaded with a poison inimical to life. The preserva-
tion of cleanliness consists in removing or destroying all s^ch
sources of filth, as contribute to  produce  this dangerous im-
pregnation.
   The preservation of cleanliness and  purity in a large and
populous city, like  Philadelphia,  requires great vigilance, in-
dustry and firmness in those persons to whom  the business is
entrusted.  Such are the nature and circumstances of the city,
that there is a daily regeneration of filth in all parts  of it.
To prevent, therefore, undue and dangerous  accumulations 
75
of this nuisance, daily removals of it are absolutely necessary
during the summer season. The mode of effecting these re-
movals must be accommodated in all cases to the nature of
the noxious materials.  No substances capable of putrefaction
should be suffered to lie exposed  even  a single  hour in the
streets, on the  wharves, or in any part of the  city, in hot
weather. But double attention should be paid to the cleanli-
hess of Water street, and the space of  ground that  extends
from it to the river.  This constitutes literally the low ground
of the Delaware, where  all filth has a tendency to accumu-
late, and where  yellow fever has always made its  -first appear-
ance in an epidemic  form.  In all parts of the United States
the low grounds of large rivers are infested in the autumnal
season with bilious  fevers, sometimes of a highly malignant
character. These  fevers uniformly commence on  the flats im-
mediately adjacent  to, and nearly on a  level with, the  beds
of the rivers, and extend in their progress to the higher and
more distant grounds. They are always most malignant in
the  lower situations.  The draining and  cultivation (which
amounts in fact to a purification) of these flats, never fails to
make them more healthy. Though these  measures may not
prevent the disease entirely,  they render it much  less gene-
ral and much less malignant.
  In like manner, our pestilential fever appears to be nothing
else  than the autumnal endemic of the low ground of the river
Delaware, heightened by the circumstances connected with a
large and populous city.  By removing, therefore, particularly
from Water street, and the adjacent wharves and docks, all pu-
trid  and offensive substances, this disease, though it might not
be entirely prevented, would be rendered much less frequent
and  general.  This  cleansing process would resemble, in its
nature and effect, the draining and cultivation of low marshy
ground in the country.  But the higher parts  of the city ought
not to be neglected.  For, though the fever  originates, in its
epidemic form,  from the septic exhalations that issue from
the immediate vicinity of the river, yet similiar exhalations
arisingTrom  other and higher situations, serve afterwards to
spread and nourish the destructive flame.
  Pure water seems to be nature's handmaid, in the great
work  of purification throughout  the globe.  Without  this
cleansing element, many places, even of great extent, would 
76
   be soon converted into scenes of pestilential  corruption. I
   need not add, therefore, that streams of water passing con-
   stantly along the gutters, and through the sinks and sewers
   of the city, would contribute greatly to cleanliness and health.
   Pestilential fetfer  can neither originate nor  spread in  the
   country, because,  there, the  atmosphere  is uncontaminated
   by septic effluvia.  When the police, therefore, is such  as to
   remove from  a city,  as far as possible, whatever may tend
   to render its  atmosphere less ptire than  the  atmosphere of
   the country, every tiling practicable is  done, on the score of
   general regulations, for the prevention  of pestilence. A con-
   fined atmosphere  vitiated  by putrid  substances  is  the true
,   fomes of this disease.  Water thrown, during  warm weather,
   into the air by engines, and made to fall in the form of rain
   on the houses and streets, tends to cool the atmosphere, and
   may somewhat retard the progress and prevent the baleful
   effects of putrefaction.
      Perhaps the greatet individual nuisance, of constant stand-
   ing, in the city of Philadelphia, is, the docks,  in their present
   foul and neglected state.  The remedy for this evil is plain
   and practicable. Let  these repositories of filth be kept con-
   stantly cleansed to such a  depth, that their bottoms may be
   at least twelve inches beneath low water  mark.  Being thus
   uniformly covered with a body of fresh water, they will cease
   to vitiate the  atmosphere by their pestiferous exhalations.
      Another nuisance, highly injurious indeed to  ourselves,
   but which threatens to be still much more so  to posterity, is,
   our public burying-grounds. The continuance of  these im-
   mense laboratories of corruption in the  very heart of  our
   city, excites the surprise of  all enlightened strangers.  And
   well it may; for it is a circumstance disavowed alike by  rea-
   son and humanity.  Notwithstanding the feeble  defence set
   up for it by some, on the score of sentiment, and regard for
   the relicts of our  friends, yet the very best  feelings of  our
   nature are arrayed  against it.  What can be more painful
   and shocking to us, than to  reflect, that after death, our fes-
   tering bodies may send forth a poison to destroy those whom,
   in life, we held most dear, and that even at  the time when
   they are affectionately bedewing our memory with their tears?
   Yet such may be  the fatal posthumous effects of our bodies
    on our best friends,  if buried in the vicinity of their dwell- 
                             77

  ings.  If the contemplative Hamlet could, without consider-
  ing the  matter  " too curiously," trace  the  noble  dust of
  Alexander till he found it " stopping a beer-barrel;" or that
  of Caesar till he  detected it, " patching a hole to expel the
  winter's flaw;" by a much shorter and more natural process
  may we discover the relicts of the dead in Philadelphia, turned
  into a pestilential poison for the annoyance of the living.
     My  second  subdivision of the means of preventing pesti-
  lential  fever, relates to customs and modes of living.  This
  disease, as already  remarked, is a native  of the  warmer re-
  gions of the globe.  In  such  regions,  general temperance is
  emphatically a virtue. Excess in eating and drinking is pecu-
  liarly, injurious,  by  predisposing to pestilential and other in-
,  flammatory diseases.  Animal food and strong liquors should
  be either wholly avoided, or  taken  with  great  sparingness,
  during the summer and autumnal heats.  During the winter
  and spring, their use  is accompanied  with less  danger:  yet
  immoderate indulgence in them,- even then, unfits the consti-
  tution  for bearing with impunity the heats of the  approaching
  season.
     Perhaps there is no people in the world, whose modes of
  living  are so ill  adapted to the  nature of their  climate,  as
  those of the inhabitants of the United States.  We have de-
  rived not .only our  birth, but also our modes  of  living, as a
  people, from Great-Britain and other countries  situated  in
  high European latitudes.  Certain kinds  of food and drink
  which are proper and salutary in those  temperate climates,
  are highly improper  and injurious, particularly  during  the
  summer and autumn, in the fervid regions of our own coun-
  try. I am convinced  that a much more moderate indulgence
  in the  use of animal food and-stimulating drinks, would prove
  beneficial to the inhabitants of Philadelphia, on  the score of
  preventing pestilential fever.   We are told that by means  of
  temperance alone,  Socrates walked  in security amid the de-
  vastation of the  plague of Athens.
     There is one  custom, in particular, very general among the
  inhabitants of Philadelphia in the summer and autumn, which
  I cannot forbear to mention with disapprobation, because it
  is peculiarly injurious to health. It is that of  sitting at  their
  doors in the evening, exposed to the coolness and humidity
  of the  atmosphere, without any other clothing than what they 
78
 had worn during the heat of the day.  In many places such
 a custom is safe and allowable; but in Philadelphia it cer-
 tainly is not, in consequence of the great difference between
 the mid-day and the evening temperatures of the air.  Perspi-
 ration is frequendy checked, the whole cutaneous system dis-
 ordered, and severe fevers produced by  such imprudent
 exposure to this change of temperature.  Were the  citizens
 only to walk in the evening air, or could they be persuaded
 to dress themselves, while sitting,  in  warmer clothing, the
 custom, which is certainly a pleasant one, would probably be
 attended with no bad effects.  But when,  to this exposure to
 external coolness, is added, as  is frequently the case, the in-
 ternal use of ice-creams, and certain refrigerating drinks, the
 evil is carried to a very hazardous  extreme.  Yet such are
 the dangerous customs and luxuries in which many of our
 citizens are in the habit of indulging themselves. In pestilen-
 tial periods, I have known them frequently to act as the ex-
 citing causes of the disease.
   Promote, by every practicable measure,  personal and gene-
 ral cleanliness;  cultivate  strict temperance,  in  all things,
 particularly during the summer and autumn;  and avoid all
 unnecessary exciting causes.  Such,  in  brief,  would  be my
 advice to the citizens of Philadelphia, as to the best mode of
 preventing pestilence.


                     SECTION V.

            OF THE HISTORY OF THE  DISEASE.

   This disease spared neither age, sex, nor colour. Very old
 persons, however, were not so  liable to it as those who were
 younger, and it was less malignant in children  than in adults.
 Women did not suffer so generally nor so much from  it as
 men, in consequence, probably, of being exposed to fewer and
 less violent exciting causes. Persons of African descent, con-
 sidering their numbers in the places where it  prevailed, suf-
 fered nearly as much from it as the descendants of Europeans.
 Other circumstances being alike, it was most fatal to persons
 in the bloom of life, that is, between the ages of fourteen and
twenty-five or thirty years.  Habitual drunkards, when attack- 
73
ed by it, were its most certain victims. I do not recollect  to
have either seen or heard of, a single recovery in a patient of
this description. Persons who had had the disease in former
years, were not so liable to be affected  by it  again;  and if
they even did experience it a second time, their attack was
generally very light.  I knew of but one death from  a second
attack.  This occurred in the  case of a young man  who had
suffered from the disease in 1797, but had since revolutionized
his constitution by the excessive use  of  ardent spirits.  He
was to  be included in the class of habitual drunkards.  I wit-
nessed  but two instances in which a second attack was expe-
rienced during the same season. In each case  the last  attack
was very mild. In both  of these instances about three  weeks
intervened between  the first and second attacks.  Relapses
flever took place, except as the consequences of great impru-
dence.  They were, therefore, extremely rare;  for the appre-
hensions and actual weakness of convalescents rendered them
very cautious.  In addition to this,  the  susceptibility of the
system to  the predisposing stimuli was greatly exhausted by
the action of the febrile poison. Owing to these several causes,
only one relapse fell under my notice, during the whole season.
   As in former years, Creoles and persons long resident  in,
and perfectly seasoned to, tropical climates, escaped the dis-
ease. The pestilential constitution of the atmosphere did not
acquire sufficient strength, to produce any morbid  effect  on
systems that had been long accustomed to the  impressions of
a similar constitution in other quarters of the globe. For the
liability of strangers to pestilential fever, in some parts  of the
West-Indies, during every season of the year, evinces the
constant prevalence of a pestilential constitution of the atmos-
phere in those  places.
   In compliment to the  good sense of the inhabitants of Phi-
ladelphia,  it deserves to be mentioned (and the present is not
an improper place to do it)  that preventive amulets were  al-
most entirely abandoned during the prevalence of the  fever.
Vials of the vinegar of the four thieves, bags of camphor sus-
pended from the neck, bundles of tarry  rope,  and  such like
trumpery, formed no longer the superstitious badges of those
whose  business called them into sickly neighbourhoods. The
citizens in general were convinced that the use  of these odori-
ferous  substances could be of no avail in guarding them from 
                           80

the action of a poison, which was afloat in the atmosphere,
and which they were, therefore, inhaling at every breath. A
few physicians, however,  belonging to the  school  of Dr.
Meade, the great apostle of contagion, though I believe they
did not actually carry  preventive amulets  about them, still
continued to  observe in sick rooms what they very wisely de-
nominated the necessary precautions.  These precautions con-
sisted in the following strange and indecorous behaviour: viz.
Always to take their position on the windward side of the bed;
to spit on the floor, into the fire-place, or elsewhere, every
minute during their stay in the room; to blow the  nose  re-
peatedly in the pocket-handkerchief;  to stand at a  distance
from the patient and stare  at him, as  if afraid to approach
him;  or, if they ventured to examine the pulse, to do it with
the arm both of the physician and the patient extended to its
full length, the physician's  face being turned away in the op-
posite direction to avoid the patient's breath; to request a
sight  of the  tongue of the sick, at such a distance, as not to
be able to distinguish either its colour or state; to put, in a
hasty manner^ a few questions to the nurse, without,  perhaps,
attending with calmness to her answers; and,  lastly, to run
out of the room,  should the patient make an effort to vomit,
particularly if he should discharge from his stomach, a fluid
of a dark colour.  On some ocsasions these necessary pre-
cautions have been carried still further. The  wary disciple
of contagion has either made  his  inquiries  and given  his
directions through a window from  the street, from the foot
of the stairs, or has just ventured  to take a  peep  into  the
sick room, though not  " behind the  curtain"  and in that
situation has made a mockery of  ministering to  the  re-
lief of his  patient.  This is  no exaggerated  picture,  but
a true representation  of scenes that  have occurred  in  the
city of  Philadelphia, to the great terror, not to say, the ine-
vitable destruction of many sick persons.  I could name the
places where, and the  physicians by  whom, these " pranks,
enough to make high Heaven  weep," were  actually played.
But to return from this digression.
   The disease was generally, but not always, ushered in by
an impaired appetite, a languor,  a heaviness, and certain un-
usual feelings, of one or more  days continuance. At the end
of this time a chilliness came  on, accompanied  occasionally 
81
by some degree of tremor.  In most cases, however, no tre-
mor was experienced, and the chilliness was often compared
to a stream of cold water running down the back, and branch-
ing out in various directions round  the body and along the
limbs. During this time, a general  paleness of the surface  of
the body, a shrunken countenance,  and cutis anserina, mani-
fested the existence of a spasm of the skin.  For, though  I do
not agree with the disciples  of Hoffman,  in considering  a
spasm on the surface of the body as the  cause of fever,  it is
unquestionably one of its earliest symptoms.  The respiration
was less free than in health, and the pulse, though preterna-
turally frequent and quick, was  small and  contracted.   This
state of things frequently continued for a whole day, the pa-
tient considering himself too slightly indisposed o be confined
to bed, yet too ill to venture out.
   To these symptoms succeeded a burning fever, accompa-
nied by a severe pain in the  head and  back, extending  in
many cases to the lower extremities, and sometimes affecting
the hands and arms. The pain in the head ran across the
forehead, a little above the frontal  sinuses.  The pain in the
back,  but more particularly in the limbs, approached at times
the severity of rheumatism.  The  pulse was now  frequent,
full, and tense, and was still marked by a quickness in  its
stroke. The stomach became disordered,  sometimes with a
burning sensation, and  a puking of a  fluid tinged with bile
oftentimes ensued. In some cases there was a great soreness
of the scrobiculus cordis.  This symptom, however, which
was a very unfavourable one, seldom came on till a more ad-
vanced period of the disease, and was generally accompanied
with frequent sighing.
   The skin, though hot, was now  soft and moist, evidencing
in the system  a disposition to perspiration.  This  symptom
furnished,  as  will appear hereafter, an excellent indication
relative to the treatment of the disease.  In this respect  the
 pestilential fever of 1805 differed  somewhat from those  of
 preceding years, except that of the year 1803.  Patients sel-
 dom suffered much from thirst.
   Though costiveness  was a common symptom, it  was not
 so obstinate as in former years, particularly in the years pre-
 ceding  1803.  Mild purgatives were sufficient for its  re-
 moval. 
82
   The urinary discharge was not much affected as to quan-
 tity, and its appearance was so various as to forbid descrip-
 tion.  Nor, as far as  my experience  went,  could  any  useful
 practical inference be drawn from an attention to the state of
 this fluid.  An entire suppression or rather deficiency of urine,
 arising as I conceive from  a paralysis of the kidneys, and
 which fortunately occurred but very seldom, was always a
 fatal symptom. I do not recollect to have  ever  witnessed a
 recovery in any case of yellow  fever, where this symptom
 appeared.  I think the same remark, has been made by other
 writers.
   The appearance of the tongue was very various.  In some
 cases it was nearly natural. In others it was natural from the
 top to the distance of about two inches downwards, and from
 thence to the  root covered with a thick crust of a  buff co-
 lour.   In other instances  a  streak, of the same  colour ran
 along on each side  of the tongue, nearly to the  tip of it,
 while its centre was either entirely clean and of  the natural
 colour, or marked with a browish streak.  But the most com-
 mon appearance was a crust,  of  a buff colour,  spread uni-
 formly over the tongue, lighter towards the point, and deeper
 as it approached the base. I think I generally observed the
 affection of the stomach, and the general severity of the dis-
 ease, to be somewhat in proportion to the  thickness  of this
 crust.  I have frequently anticipated danger from a very thick
 covering of the tongue alone, when other symptoms were not
 unpromising.  Subsequent events  generally proved, that my
 appi-ehensions were not unfounded.  The tongue was for the
 most part moist. A dry and dark coloured tongue, such as we
 meet with in typhus fever, was a very rare occurrence. When
 it did take place, I am inclined to believe that it was always the
 result of neglect or injudicious treatment, which had suffered
 the disease to assume something of a typhous form. In a few
 cases of extreme  malignity, I have seen the tongue of a livid
 cast,  as  if actually  verging towards mortification.  I  need
 scarcely add that  the termination of such  cases  was always
fatal.   In  many instances the tongue  was  affected with a
tremor, when the patient put it out for the inspection of the
physician.  This also was an unfavourable symptom.
  The crust which covers the tongue is a morbid secretion,
evidencing a state of excessive and disordered action in the 
83
vessels of the part. It resembles the inflammatory membrane
formed in the trachea in cases of croup.  It is always of the
same colour with the size or coagulating lymph of the blood.
If the size  of the blood be  buff coloured, the crust is buff
coloured, and if white, the  crust is white.  Hence we are
justified in  believing, that  the  crust is derived from the
coagulating lymph, by the  disordered action of the secret-
ing vessels of the tongue.  Is the internal coat of the oeso-
phagus and  stomach ever lined with a similar crust ?  I have
not heard of any dissections having been made with a view
to determine this question;  but, were I  to judge from first
principles alone, I should think the affirmative most likely to
be true. The subject is well worth  investigation,  both as a
matter of science, and a point of practical utility.
   There was something (not easily described) in the aspect
and general appearance of the patient,  which, to an  expe-
rienced practitioner, served to discriminate  this disease at
first sight, as well as to indicate  the degree  of danger that
accompanied  it.  A physician who had seen and attentively
examined five cases, must have been dull indeed, if he could
not have discriminated the sixth and all subsequent ones, at
a single glance.
   The countenance was flushed, sometimes of a slightly livid,
and at other times of a light mahogany  colour.  The eyes
were red, watery, and heavy, or of a muddy cast, their colour
consisting of an  intimate mixture of red and a'dull white.
There was  frequently a frown on the brow, indicating a want
of ease and serenity  within. Indeed the  whole expression of
the countenance was  that of a kind of hebetude and distress,
accompanied with some degree of moroseness.
   The patient was oftentimes uneasy, tossing from one side
of the bed to  the other, without being able to  assign any
cause for his restlessness.  This was an  unfavourable  s>mp- ^
torn.  At other times he lay quiet,  complaining  of nothing,
but answering,  when interrogated, that he was well enough,
except that he  was weak.   This also was a terrible  symp-
tom, as it indicated an almost entire extinction, or at least a
very depraved state,  of feeling.   Most persons were affected
with a giddiness, or, as they termed it, a lightness of the head,
 when they  attempted to sit up  or  stand erect.  With some
 patients this  was  almost the only complaint. In  an  early 
84
 stage  of the  fever, delirium, though an occasional, was by
 no means a common symptom. This disease was seldom ac-
 companied with a cough. On the other hand, I have known
 it to suspend, for  a time, an habitual cough in old persons,
 and even the  hooping-cough in children.  For

           " ■'  '■    where the greater malady is fix'd
           " The lesser is scarce felt.----—"

   The reader will understand, that the foregoing description
 is applicable only to those cases, in which the character of
 the fever was  completely formed.  In cases of a lower grade,
 which occurred in considerable numbers, the state and aspect
 of things were materially different.
   Such were the course and appearance  of the disease, till
 about the third or fourth  day, when a sudden and  very re-
 markable change occurred.  All the febrile symptoms disap-
 peared, and nothing but their effects remained behind.  The
 temperature of the skin sunk below its natural state, and the
 pulse below its natural force.  In point of frequency the pulse
 did not now deviate much from its healthy state.  The  eyes
 became yellow:  a yellowness also appeared  first about the
 angle of the lower jaw, and on the neck, and spread gradually
 over the face,  and the  whole body.  Ail acute pain  was  now
 at an end, and the patient oftentimes fancied himself nearly
 well.  But this flattering delusion was of transitory duration.
 It arose from  a morbid and fallacious state of sensation, or,
 perhaps, I might say,  from  a want of sensation, in conse-
 quence of the  disorganization of  certain parts of the system.
 It certainly discovered the utmost derangement in the nerves.
 A more melancholy train  of symptoms was soon to succeed.
 It was now that the mind became the sport and wreck of an
 unconquerable  delirium.  Sound sleep was exchanged for
 perpetual watchfulness, or  for broken slumbers  even more
 distressing than watchfulness itself.  The patients became so
restless and ungovernable that they could not without difficulty
and even force be confined in bed.  In  many  instances  they
walked about their rooms  till within a few minutes of their
dissolution.  There is, perhaps, no disease in which the patient
lives so long after his skin has become cold, and  the artery
at his wrist has ceased  to puisate, as in this. I have  known a 
85
person to survive nearly three days, when entirely pulseless,
and with his extremities as cold as marble. During this state
of things, the temperature of the surface of the  thorax re-
tains its warmth, and the  action of the heart is  strong and
convulsive.
  But this  secondary stage of the  disease was  oftentimes
marked by more disorder  of the stomach, than of the intel-
lect.   In these  cases, soon  after the febile symptoms had
subsided, the patient was attacked by an obstinate vomiting.
At first, nothing was discharged but the drinks that had been
taken  in, mixed with a quantity of mucus.  This mucus be-
came  by degrees more abundant, and assumed somewhat of
a flaky and brownish appearance.  This brownish colour grew
deeper and  deeper, till it  terminated  finally in black vomit,
a symptom  from which I never witnessed a recovery.  The
evacuations by stool, were at the same time equally black, and
of a tarry consistence.
   The preceding symptoms of  the  secondary stage,  were
oftentimes attended in their  course by others, no less distres-
 sing and dangerous. These were  haemorrhages from the nose,
mouth, anus, and other parts of  the body.  Blisters  and old
sores  were  not unfrequently marked by obstinate oozings of
 blood. The puncture made by the lancet in blood-letting, has
been  known to become troublesome  from the  same cause.
The  blood  discharged through  these channels was  never
capable of firm coagulation, an evidence that its  vitality was
nearly extinguished, and that the  system was fast approaching
to dissolution.
   Death, when  it occurred, generally took place sometime
in the course of the second day,  from the commencement of
the second stage of the disease, and on the fifth or sixth day,
from  the time of attack. Some  patients  died  in apparent
ease and composure, while others, in their last hours, ap-
peared to suffer great agony.  I have witnessed some  cases,
towards the close of which  every act  of respiration was ac-
companied with a kind of  short groan. I ought to have  men-
tioned previously to this, that the disease is marked by fre-
quent and deep sighing, particularly after the commencement
of its secondary stage, when the action in the extremities of
 the system has become very feeble. 
86
   The pestilential fever might be briefly characterized in the
following manner, viz. a disease of warm weather, arising
from septic exhalations, and marked by high febrile symptoms
for the first three or four days. These symptoms then disap-
pear, and are succeeded by great debility, preternatural cool-
ness of the surface of  the body, preternatural weakness of the
pulse, a yellowness of the eyes and skin, obstinate vomiting,
sometimes of a black matter, delirium, and haemorrhages from
various parts of the body. Though death is not a necessary
concomitant, it  too often brings up the rear of these  symp-
toms. The crisis* happens most  frequently on the fifth or
sixth day.
   Such is  the  general course of the disease; but, like all
other general rules, it is  subject to many exceptions. Ano-
malous cases not unfrequently occur, different from any thing
here laid down.  The disease sometimes  attacks suddenly,
and with such violence as to prostrate the  vital  energies of
the system, and completely  paralyse the powers of reaction.
In  such  cases, no  febrile commotion occurs.   The  pulse,
skin, and tongue are  nearly natural, and  the patient com-
plains of nothing but weakness, giddiness, and sometimes a
dulness of  vision.  All the mental powers, but particularly the
memory, are greatly  impaired. The patient can scarcely re-
collect your question long enough to  return a pertinent an-
swer. He speaks incoherently, and either remains still in bed,
or saunters about his  room,  while able to  walk,  in  an un-
meaning manner.  These  cases generally terminate fatally on
the third, or at the farthest the fourth day, with haemorrhages,
petechias and  sometimes  black  vomit.   They are attended
throughout with an alienation of mind.
   Other cases are still more violent and rapid  in their course.
I knew of one person dying in nine, one in twenty-four, one
in twenty-seven, and another in about thirty-six, hours illness.
In these instances, the subjects of disease had been addicted
to  frequent intoxications. They  were  delirious from the
commencement of their several attacks, till  the hour of their
dissolution.
   In other instances,  the  disease has lingered on in a slow
and very insidious manner,  for the space of two weeks, and
then terminated fatally. I was called to visit a patient on the
fourteenth  day of his disease.  He had walked  out daily, 
87
from the commencement of it, and even when I first saw him
was walking in his room.  I found him  actually in a dying
state.  His skin was yellow, his eyes muddy, marked with a
mixture of red and yellow;  his extremities were cold, he was
without a pulse, and  complained of great soreness in  the
epigastric region, particularly when pressure  was made on
the part. In a few hours  black vomit  came on, and in the
evening  my  patient  expired.  Had  this  case  of disease
been properly  treated  at first, it might  have been cured
with  as  much  certainty  as a case  of  common  catarrh.
I say,  with as much certainty, though perhaps not  in so short
a space of time; for I  attended  several  cases of a similar
description, from the second or third  day after their com-
mencement.  In these, though they were not dangerous, I had,
great obstinacy to encounter. They required more blood-
letting than any other  form of the disease, notwithstanding
the pulse was never very  high.  One of these cases was not
brought to a favourable crisis till the fourteenth day.
   It appears from the particulars  of the foregoing history,
that the epidemic of  1805, consisted of at least three varie-
ties or forms of disease,  differing from each  other  in  their
degrees of violence.
   The first had its crises on the  third or  fourth day,  and
was mostly fatal in its termination. This form approached or
perhaps  equalled in malignity  the Asiatic plague.  It  was
the result of strong exciting causes, or of a strong predispo-
sition of the system, or of both. It occurred most frequently
among the intemperate, and  the poor who dwelt in confined
situations, and lived on a scanty and unwholesome diet.
   The second had its crisis on the fifth, or from that to the
seventh day, and when attended to in time was a manageable
disease.  This was the most common form of the  epidemic.
It occurred among persons in better circumstances, and was
produced  by  causes  of less violence.  It included  perhaps
seven-eighths of all the cases of the disease.
   The third had its crisis  from the ninth to the fifteenth day,
and was never fatal except from neglect or very gross  mis-
management.  I- approached  the character of a common re-
mittent, although it had no regular exacerbations.  It appear-
ed most frequently in  persons under twelve years of age.  I
do not recollect to have met with it in more than two or three 
88
 adults during the whole season. I believe it always occurred
 at a distance from  the river. It was evidently the result of
 the weakest exciting and predisposing causes, that were capa-
 ble of producing the disease.


                     SECTION VI.

        OF THE CAUSES OF PARTICULAR SYMPTOMS.

   Under this head of my subject there are four symptoms,
 in particular, that  deserve  to  be mentioned.   These  are,
 1st.  A suppression  or entire defect of urine. 2d.  The  yel-
lowness of the eyes and skin.  3d. Haemorrhages  from differ-
ent parts  of the body.  And 4th. The black  vomit.  These
shall be briefly  considered  in the order in which they are
here enumerated.
   1st.  A suppression or entire defect of urine.  It  is fortunate
that this  symptom but rarely  occurs, for it  is,  as already
mentioned, of the most fatal import. It must arise from a
paralysis of the kidneys,  for there appears to be  no urine
secreted in those cases where it occurs.  With  the immediate
cause of this paralysis we  are unacquainted. In most cases of
the fever there is a  pain in the lumbar region, which mani-
fests a determination of the disease, either primarily or by
sympathy, to the kidneys or adjacent parts. As inflammation
in the kidneys disorders the stomach, may not an inflammation
of the stomach produce a  similar effect on the  kidneys?  But,
whether the affection of the  kidneys  be primary or sympathe-
tic, the same cause or impression which  produces pain in
them may, by being  increased in force  and  violence, com-
pletely paralyse them, both as to sensation and motion. It is
thus that  a moderate shock  of electricity  produces  pain,
whereas a very violent one destroys the power of feeling by
giving rise to a temporary paralysis of the  part.  I  do not
know that any vestiges of actual inflammation of the kidneys
have ever been observed in the  dissection  of pestilential
subjects.
   2d. The yellowness of the eyes and skin.  This  symptom is
erroneously attributed by  many to the absorption of bile and
 its subsequent diffusion through the system. It occurs as fre-
quently in cases where the bowels are open, and the bile freely 
89
and  copiously  discharged,  as  in  those  where no such dis-
charges take place.  Nor is  the yellowness of the  pestilential
fever of the same cast with  that of jaundice. Though the dif-
ference between these shades  cannot be easily described, it
can be very readily  distinguished by the eye of an experien-
ced observer. Besides, the  yellowness in jaundice comes on
gradually and slowly, whereas that of pestilential fever fre-
quently takes place  in a much shorter space of time.
  This symptom appears to arise entirely from a morbid state
of the blood. In what precise  kind of alteration or derange-
ment in the crasis of the blood this morbid state consists, we
cannot determine. It is produced, however, by diseased vascu-
lar action, and has no connexion with absorption of bile from
the liver. Duringthis yellowness of the skin, the blood is always
in what physicians  call a dissolved state:  that is, it is in  a
state of greatly diminished vitality. For a dissolution  of the
blood is nothing else, than a want of a  sufficient  quantity or
degree of life in that fluid, to enable it to coagulate or con-
tract, when drawn from a  vein and  exposed to the stimulus
of the atmosphere and of the vessel into which it  is received.
In the  disease arising from the bites or stings of venomous
serpents,  or insects,  a similar yellowness takes place from the
same cause; or, perhaps, from the immediate  action  of the
poison of the serpent or insect, on the blood itself. Certainly,
however  the vellowness in such cases can have no connexion
with any preternatural absorption from the hepatic system.
There are other instances where  an alteration in the crasis of
the  blood gives  a yellow  colour to the skin. Thus, when a
severe contusion is  received, the  blood effused into the cellu-
lar membrane of the part becomes first blackish; but previously
to its being taken up by the absorbents, it undergoes such a
further change as to communicate to the skin a greenish, and
then a yellowish cast. The vitality of the blood  is here lost.
   3d. Hemorrhages from  different  parts of the body. This
symptom is  attributed by  many to a dissolved state  of the
blood.  That fluid, say they, becomes so thin and subtle that in
the  course of circulation it percolates  or oozes through the
fine mouths of the  capillary vessels. Nothing,  however, can
be more  truly erroneous and unmeaning than such an expla-
nation. While  circulating  in  the arteries and veins,  what is
 called dissolved blood is no thinner than blood in the highest
                             m 
90
state of health.  It appears thinner when drawn out of the
vtins, only because it is incapable of contracting, or coagula-
ting as it is termed,  while healthy blood soon takes on that
process,  and  becomes  a solid mass.  Were  there  no dis-
ease in the1 solids of the body, the blood could not make its
way through them by percolation,  if it were even as thin as
water.
  It is in the condition of the blood-vessels themselves, that
we must look  for the cause of the haemorrhages  under  consi-
deration.  A dead animal fibre is  known to be  much  more
easily lacerated than a living one.  It is one jof the properties
of the vital principle, whatever that principle may be,  to act
as a strong bond  of  union between the constituent parts of
the  body which it animates.  A muscle,  when dead, cannot
support,  without laceration, one fourth part of  the weight
which, while living,  it is capable of raising, without the least
injury, by simple contraction.  An athletic man can, by the
action of certain muscles' of the arm, raise  a body weighing
several hundred pounds. But  these same muscles, when  dis-
sected after death from the arm of the strongest man, are in-
capable of supporting a body weighing fifty pounds.
  But if such is  the weakening influence of actual death on
animal fibres, an approach towards death must produce, to a
certain  degree,  a corresponding effect.  In other  words, a
weakened state of the  vital principle  must be accompanied
by a weakened state of cohesion between the particles of ani-
mal fibre. In an advanced stage of yellow fever every thing
bespeaks a great exhaustion and debility of that  principle. In
consequence of  this, the component parts  of the several  or-
gans of the system  are held  together by  a very feeble tie.
In such a state  of things, the minute and tender vessels of
the gums, schneiderian  membrane, and of the internal coat of
the rectum, give way, on the  smallest violence being offered
to them, and allow the blood to escape through  their lacera-
ted extremities. Nor is there left any ground  of hope  that
this haemorrhagy will be readily checked.
  When a rupture of one or more blood vessels occurs dur-
ing a healthy state of the system, a haemorrhagy more  or less
copious always ensues.  But there are two principles, or  rather
two  modifications  of  the same,  principle, en  which  this
haemorrhagy at  length  ceases. The  biuod coagulates  in the 
9i
mouths of the ruptured vessels, closing them up like so manv
plugs, and the mouths of  the vessels themselves  contract,
rendering their diameters considerably smaller than natural.
Both these phenomena take place in consequence of the acti-
vity or vigour of the vital principle, and the blood necessarily
ceases to flow. But no such salutary efforts of the system oc-
cur to check the spontaneous haemorrhagies in the advanced
stage of pestilential fever. The blood neither coagulates in the
mouths of the ruptured vessels, nor  do the mouths of the
vessels themselves  contract.   The vital principle  is in  too
feeble a state to effect such purposes.  The consequence is,
that the extremities of the ruptured vessels continue patulous
and the blood remaining fluid, continues to flow without in-
terruption. The true indication for checking these haemorr-
hagies is, to add vigour to  the  vital principle, a measure
which we  are too seldom able to accomplish. The haemorr-
hages in question, then, depend on an enfeebled state of the
animal fibre, and  a want  of the power of contraction  or
coagulation in the blood.
   4th. The black vomit.  The matter of black vomit has been
considered as the result of disordered hepatic  action.  As lav
as my inquiries have extended, this was the general opinion,
till as late as the  year 1798.  In  the  month of May of that
year, Dr. Stuart, of Philadelphia, published an  Inaugural Dis-
sertion, in which he  gives a different  view of the subject.
He derives the matter of black vomit, to use his own words,
from " an altered secretion from the arteries of the stomach,
which, in a healthy state, are wont to secrete mucus and the
gastric fluid." This ingenious Thesis is contained  in the se-
cond volume of " Medical Theses" published by Thomas
and William Bradford.
   Some time after this, Dr. Physick published  in the Medical
Repository, vol. 5, page 129, a very valuable and interesting
paper on the same subject.  In this communication  the doctor
delivers it as his opinion, that the matter of black vomit  is
" a secretion from the inflamed vessels of the stomach  and
intestines."  This opinion he  appears to have derived from
numerous dissections made  at the city hospital, during the
time in which he acted as  physician  to that institution.  If I
comprehend correctly the doctor's meaning, he considers the
secretion of the matter of black vomit as a sign of approach- 
92
»ng death in the stomach, but not of actual gangrene. For he.
observes, " This colour (the colour manifested by the internal
surface of the stomach) differs very much from the dark pur-
ple of a part in a state of gangrene."
   To the opinion of these gentlemen I have nothing to add,
having never myself made the origin of black vomit an object
of particular research.  Independently of the evidence of actual
dissections  in their favour, there is nothing at all,improbable
in their opinion.  On the other hand,  it has numerous analo-
gies  to support  it.  We  find .the  lungs, kidneys,  and other
glands, capable, when diseased, of secreting a matter of a black
colour. Why, then, may  not a matter of the same colour be
discharged from the secretory vessels of the stomach?  Even
the matter  of perspiration secreted from the skin, has  been
observed on some occasions to be of a dark colour.
                    SECTION VII.

                   OF THE PROGNOSIS.

   As the unfavourable import of several symptoms of malig-
nant fever has been already mentioned, the present section
will consist, in part, of a repetition, in a more condensed form,
of what may be found scattered through some of the preced-
ing ones.  It  may not be improper  for me to  state, that  all
the prognostics, which I shall here  attempt to  lay down, will
be drawn from what has fallen  under  my own  observation.
It is possible, perhaps I  might say, probable, that the experi-
ence of other practitioners may have been different.
   I know of but two  symptoms of malignant fever which I
have had reason to consider as  necessarily fatal.  These are
   1st. A total defect of urine, arising, as already mentioned,
from a paralysis of the secretory vessel of the kidneys. And,
   2d. The genuine black vomit.  From  neither of these two
symptoms have I  ever witnessed a recovery.  Yet, in many
cases, where one or the other of them existed, I  think I have
teen all the resources of the healing art  exhausted for the
purpose of saving life. In some instances, indeed, a suppres-
sion of the urinary discharge will exist for some  time in con-
sequence of the action of blisters, and yet  the case terminate
favourably.  But that suppression is  intirely different from the 
95
defect of which  I here  speak.  The former affection is com-
mon to all diseases in which blisters  are  applied; whereas I
have met with the latter only  in malignant fever.  I do not,
however, positively say, that  it never occurs in any  other
form of disease.
  Tnere is also a discharge of a dark coloured  matter from
the stomach, in pestilential fever, from which recoveries are
by no means unfrequent. But this discharge generally  occurs
early in the  disease, and appears to  consist of vitiated bile.
Some practitioners even welcome it as a favourable omen. It
is essentially different both in appearance  and in import, from
the true flaky, coffee-ground black vomit, which takes place
in a more advanced stage of the disease.
   A yellowness of the  eyes and skin, is considered by some
practitioners as a  favourable  symptom,  provided it  occur
early in the  disease. In the epidemic of 1805, this was not
the case. At whatever period of the disease that symptom
occurred, it denoted great danger, though not certain  death.
Indeed how could the case be otherwise, since this yellowness
plainly  bespeaks a  dissolved state of the blood?  Throughout
the whole epidemic, I learnt, from painful experience, to trem-
ble for  the fate of my patient, as soon as a yellowness of the
surface appeared.
   Hemorrhages from different parts of the body.  From the
explanation given of this symptom, in the preceding section.
it evidently foretels great danger, but is not necessarily fa-
tal.  I have had the pleasure of witnessing numerous recove-
ries from it.  I  think I have observed these hemorrhages to
be accompanied with least danger when  they  proceed from
the nostrils, and from the vagina.  Like a yellowness  of the
surface, they also denote a dissolved state of the blood.
   Dissolved blood.  When the blood drawn in venesection is
incapable of coagulating, or contracting  into a  firm  mass;
when it throws up a thick but very tender covering of yellow
size,  while the cruor  beneath  remains perfectly fluid, this
symptom furnishes ground for  an  unfavourable prognosis.
Yet recoveries do occur in cases where  the  blood exhibits
this appearance.  The number of these, however,  is propor-
tionally small.  I think a dissolved state of the blood is less
dangerous in an early, than when it occurs in an advanced,
stage of the disease.  In the former  case,  I  have seen the' 
                           94

blood, by repeated venesections,  restored from its dissolu-
tion and rendered capable  of vigorous contraction;  but,  in
the latter, I  have very seldom been witness to such  a re-
sult.  I  have at this moment (January 4th, 1806) two  cases
of disease under my care, which,  in September last, would
have been called decided cases of yellow  fever.  In one  of
these cases, I have employed  venesection twice, and in the
other three times.  In each of them, the  blood  first drawn
w;.s in a high state of dissolution,  but exhibited much less of
this appearance on the subsequent repetitions of the opera-
tion.  I have now the pleasing prospect of a favourable ter-
mination to both of these cases.  Dissolved blood  bespeaiks,
as formerly mentioned, great exhaustion of the  vital princi-
ple, and cannot, therefore, do  otherwise than denote danger.
   The tongue being generally and  deeply covered with a
very yellow crust, whatever may be the state  of the  other
symptoms, is always a sign of some degree of danger.  I
have found it necessary to watch very closely  every patient
whose tongue exhibited this appearance.
   So much  for the import of single symptoms.  But it is also
necessary to speak of certain combinations of symptoms which
occur in the progress of pestilential fever.
   In the commencement of common cases of  this disease,
it  is difficult for the practitioner to form a prognosis, in any
measure satisfactory even to himself. So much depends on a
variety of incidental circumstances, over  which he can have
no controul, that the issue  is  necessarily  involved  in  great
uncertainty.  But  as the disease  advances, this uncertainty
becomes less and less, till, at length, a tolerably correct esti-
mate can be formed respecting its termination.  To the eye
of an experienced practitioner, the third,  or at farthest the
fourth day, seldom fails to  disclose the certain  issue of the
disease.
   A red or muddy eye, a countenance expressive of morose-
ness, or silent anguish, with sighing and  great jactatio,  are
bad symptoms, at whatever period of the disease  they may
occur. But if they exist on the commencement of the  se-
condary stage, and be accompanied with delirium and a sore-
ness of the epigastric region, the case may be  considered as
almost hopeless.  Under such circumstances the approach of
black vomit is greatly to be  apprehended.   A burning sensa- 
95
tion in the stomach, and a flatulency, either with or without
vomiting,  are  unfavourable  symptoms,  inasmuch  as  they
denote the actual existence of, or a strong disposition to, in-
flammation.  Hiccough is dangerous for the same reason. By
proper treatment, however,  these affections may be often-
times removed. To speak in general terms, any irritation of
the stomach, in  an advanced  stage of the disease, under
whatever form such irritation may appear, is to be regarded
with  apprehension,  whereas a tranquil and settled state of
that organ is always favourable.
   What are called walking cases of the disease,  where the
patient is sometimes in bed, and sometimes sauntering about
his room, complaining of nothing but debility, and exhibiting
a dull and listless countenance, a watery eye,  and a  com-
plexion almost of a mahogany colour;  in such cases the ter-
mination is for the  most part fatal.  The patient  not  unfre-
 quently  walks about, and exhibits, at intervals, marks of con-
 siderable muscular strength, even after the radial artery has
 ceased to pulsate.
   When a coma or partial apoplexy ushers in  the disease,
 the" utmost danger is to  be apprehended.   This symptom de-
 notes great derangement in the brain or stomach, or both. In
 such cases, as well  as in those marked by high delirium, the
 brain is  only secondarily affected.   The original seat  of the
 disease is in the stomach, or some part of the alimentary ca-
 nal.  The brain suffers by sympathy with the organs first at-
 tacked.   I  conceive it impossible for the poison  of yellow
 fever to make its first impression either on the  brain or the
 arterial  system.  It acts first on the stomach,  in the  same
 manner as arsenic, or an over dose of corrosive sublimate.
   A weak, depressed, and  shattered pulse,  with but little
 preternatural frequency, in  the  beginning of an attack, ac-
 companied by a moderate temperature of the skin, a frequent
 sighing, and a tongue of a pale buff colour, or of an appear-
 ance nearly natural, are symptoms which  mark  a disease of
 great danger and malignity. They bespeak a prostration or
 an exhaustion of the  system, which leaves the  practitioner
 but little to act on.
   We will now turn to  the more pleasing side of our subject,
 and  enumerate a few  of those symptoms  and circumstances
 which promise a recovery. 
96
   In the lighter attacks of the disease, such as I would rank
under the third variety, the prognosis is always favourable.
Such cases never terminate  fatally, except through neglect or
extreme mismanagement.
   In common cases, or those of the second grade of malig-
nity, a full, free, open and active pulse is a desirable symp-
tom. It denotes a vigorous state of vital energy, which gives
the practitioner room to work.   If  it  be  accompanied by  a
tranquil state of the stomach, and a condition of the  bowels
capable of being readily moved  by medicines, the  patient
mav be pronounced in but  very  little  danger. In the  epi-
demic of the year  1805, a disposition to  a free perspiration
was always favourable.
   On the  commencement of the second stage of the disease,
if, with a  remission of the febrile symptoms, the stomach re-
mained  tranquil and the mind free from delirium,  and if to
these symptoms were added a gentle  perspiration, a pulse
somewhat expanded, and an equable state of heat over  the
whole system,  the patient  might  be  considered  as  out of
danger.
   A change of the countenance from  a clouded and  frown-
ing, to a pleasant and serene, and of the eye from a  red or
muddy  to a  clear  and  bright appearance, were  favourable
symptoms.  I might speak in more general terms, and  say
the same thing of  a return  of the  patient's  natural counte-
nance, aspect, and  habits. This  latter, however, is true with
respect to all diseases. A patient is never free from danger,
who is rendered, to use a common expression, " unlike him-
self," either in  countenance, speech, or behaviour, by an at-
tack of fever.  A loss of this " unlikeness," and a return of
his natural appearance, natural tone of voice, and natural ha-
bits, is alw ;ys a symptom of favourable promise.
   A plentiful discharge from blisters was a flattering symp-
tom.  It bespoke a centrifugal tendency in the disease, which
had the happy effect of saving the  vital  organs.  The same
thing might be  said of a return of this discharge after it had
for some time ceased, and also of severe pains in  the limbs
and a general soreness of the flesh. These  also  denoted  a
centrifugal state of action in the system, and were therefore
favourable signs. In  one or two instances I  saw  a salutary
crisis produced, or at least accompanied,  by  an eruption on 
97
the skin.  In a few cases, the first mark I discovered clearly
expressive of amendment  was, the tongue  becoming free
from crust about the tip and edges.  I always regarded  this
symptom as an earnest of a happy issue.
   A return of reason after delirium, of a clear and  active
after a dull and palsied state of intellect,  and of tranquillity
after great restlessness, were propitious omens.  The same
thing was true with respect to the occurrence of a copious
flow of urine, after a scanty secretion of that fluid, and a re-
turn of natural warmth after a preternatural  coolness of the
skin. A protraction  of the disease, under almost any circum-
stances, beyond the  ninth  day, opened a door of hope. Mor-
tal cases were seldom lingering ones.  The seventh day  was
mostly  their utmost boundary.
   An incipient disappearance  of the yellowness of the  skin
and eyes, and a general cessation of haemorrhages, were to be
regarded as signs of an  approaching  favourable  crisis.   So
was a return  of appetite for any article of diet, of which the
patient had been particularly fond during health.
   Such are a few of the favourable and unfavourable appear-
ances in yellow fever; I mean, particularly, as it prevailed in
Philadelphia  in the  year  1805.   When taken together, they
must be acknowledged to form but an imperfect outline: for
a  complete prognosis of this disease is a subject which words
are  not made to  communicate.  After all that can be said re-
specting it, there is  a certain indescribable something  in the
tout ensemble of  the patient, which the practitioner can learn
only from experience and observation.  This^e  ne sais quoi,
this something which language  cannot  impart, is communi-
cated to  the  experienced practitioner by the eyes and other
features  of  his  patient,  by  the general expression  of his
countenance, his mode of speaking and breathing,  his decu-
bitus,  and by  almost every  circumstance  connected with
sensation and life.  It  is  from this general  state of things,
that the most safe and satisfactory prognosis  is to be derived.
                             n 
98
                   SECTION  VIII.

OF THE MORBID APPEARANCE DISCOVERED ON DISSECTION.

  Those parts of the system which claim more particularly
the attention of the anatomist, in his dissections of bodies
that have died of malignant fever, are the  brain, the lungs,
and the abdominal viscera. Indeed as the cranium, the thorax,
and the abdomen, contain all the  organs that are essential to
life, one or more of these cavities must constitute the prin-
cipal seat of most diseases that prove mortal.
  There are but few, if any cases of pestilential fever, which
terminate fatally, without being marked, particularly towards
their close, with some degree of delirium. Judging from this
circumstance, we would be  naturally led to conclude, that the
brain must necessarily exhibit, on examination, something of
the ravages or effects of inflammation.  Experience, how-
ever, in this instance, as in  many others, exposes the fallacy
of our reasoning, and teaches, us  that the case is otherwise.
I know of no dissection performed, during our late epide-
mic, in  which the brain exhibited any unequivocal marks of
inflammation.  The  appearance of that organ was found to be
natural,  or  very nearly  so, in every case  of which I have
been able to procure satisfactory information.  Such, I believe,
was the uniform experience of Dr. Physick, on similar occa-
sions, in former years. In no instance, I think,  was he able
to discover marks  of inflammation in  the  brains,  of those
who had died of malignant fever, notwithstanding the degree
in which their  minds  had been  previously  shattered  by
delirium. Hence it  is obvious, that this most distressing symp-
tom can be nothing but 'a. sympathetic affection.
   Nor is this circumstance by any means peculiar to yellow-
fever.  In many other cases delirium is to be regarded as a
sympathetic or secondary affection, proceeding from a  pri-
mary affection of the stomach. The following very remarka-
ble instance of the  kind, fell under my own  notice, in the
summer of the year 1802.
   A  labourer had fatigued and over-heated himself,  by-
working on board  of a vessel, during a very hot day.  A 
99
bucket of fresh pump water was handed to him, of which he
hastily swallowed upwards of  a quart.  In less than five
minutes he was perfectly delirious, and in less than twenty a
corpse.  In this case the delirium must have been sympathe-
tic, for it came on too suddenly to admit of  an explanation in
any other way.  A vein was opened in the patient's arm, and
the blood which was drawn, was completely dissolved; in
other words, it was perfectly  dead. This appears to be the
case in all instances of sudden death, occasioned by blows or
other violent impressions on the stomach. The  fact demon-
strates,  in a very striking point of view, not only the close
connexion that exists between the brain and the  stomach, but
also the immediate and powerful influence which this latter
organ exercises over the  life of the whole system.
   The lungs.  This viscus suffers but little, except by sym-
pathy, in  pestilential fever. Dissections generally exhibit it
in a sound state,  at least, in a state of freedom from any un-
equivocal marks of inflammation. When such marks appear,
they are to  be attributed  to a  pre-existing  affection,  or to
some irregularity in  the  course  or character of  the disease.
The lungs, therefore, are not  to be regarded as the seat of
yellow fever.
   The abdominal viscera.  Some of these  viscera, particu-
larly the stomach and small intestines, were always found in
a state of high disease.  The coats of the stomach were some-
times thickened, and that organ itself diminished by contrac-
tion to less than half its  natural  size. On its internal surface
were  marks  of inflammation, and in its cavity more or legs
of the matter of black vomit.  This, however, was not always
the case.  In  a few instances, even where this matter had been
discharged during  the  life of the patient,  none of it was
found in the  stomach after death. The same dark coloured
fluid was  detected occasionally in the intestinal tube, though
in smaller quantities.
  The  small intestines  exhibijed, in  general, the strongest
marks of  inflammation.  Their blood vessels were enlarged,
their coats were thickened, and they were sometimes border-
ing on  a state of gangrene.  The gangrenous disposition
was most evident on their  internal surface.  This  inflamma-
tion was communicated from the intestines to the mesentery 
100
and the omentum, and extended in some cases along a por-
tion of the peritoneum.
  The  appearance of the  gall-bladder was various.  It was
sometimes filled with black, sometimes with green, and some-
times with natural coloured bile.  At other times it was found
almost empty.  The biliary duct  was but  rarely obstructed.
Hence there was no ground to consider the yellowness of the
skin as resulting from morbid hepatic absorption.
  The appearance of the liver was, for  the most part, na-
tural, unless when altered by a pre-existing chronic affection.
It was  observed,  that the livers of drunkards exhibited, in
general, marks of  disease. This was, no doubt, owing to the
previous action of ardent spirits, and other stimulating drinks
on that organ.  It  does  not appear to be true, therefore, as
has been alleged by some,  that the liver is a principal suf-
ferer in yellow fever. Nor is it by any means true, as asserted
by others, that a deficiency of bile is even a common, much
less a necessary symptom of that disease. On the other hand,
the complaint is generally accompanied  by very profuse dis-
charges  of that fluid.  Perhaps the copiousness with which
the bile is secreted and discharged, constitutes the principal
cause  why the  liver so rarely  suffers  from inflammation.
Such  a discharge performs on that viscus the office of  local
depletion.
  The existence of intro-susceptio intestinalis was the only
actual discovery made by the knife of the  anatomist, during
the epidemic of 1805.  This affection was confined to the
small intestines, and was found to exist in several cases  of
the disease.  I believe the  discovery was first made by Dr.
Stuart,  in private  practice, and  afterwards  by Dr. Parish,
at the city hospital.  I do not know that these gentlemen had
had any intercourse or communication  with each other  on
the subject, previously to the phenomenon having been ob-
served by both of  them. Dr. Stuart has published an account
of one of his dissections,  accompanied with a plate, in the
Medical Museum, vol. 2, page 299.
  The course of the introsusception was always from above
downwards, the upper portion of the intestine being  the re-
ceiver, and the lower portion the received.  The following re-
marks are offered  in explanation of the manner in which this
affection appears to take place. 
101
  A tonic spasm or permanent contraction occurs in a por-
tion of the intestine, greatly diminishing its  cavity  and  cir-f
cumference, a: d suspending  entirely its peristaltic  motion.
The portion of  intestine immediately above this is free from
spasm, and retains  its peristaltic motion.  Perhaps this motion
is even increased by the action of some purgative  medicine.
When such a  state  of things continues for any length of time,
the event likely to  result from it is sufficiently  obvious.  The
upper  portion of intestine,  forming  by its natural  action a
fold at the place where the permanent contraction commences,
passes down over  the lower portion,  and  receives  it com-
pletely into its embrace. But as the natural  direction of the
peristaltic motion  is from above downwards, so long as the
contraction  of  the intestine remains  permanent, its  lower
portion will necessarily continue to be invested by its  upper
one.
  The modus  operandi in  the  process of  introsusception
may be illustrated  by  the manner in which some people take
off their  stockings. These  persons turn down the head of  the
stocking, and by pulling this, invert the whole stocking, and
thus draw it off the leg. In this case, the lower portion of the
stocking, like the contracted or  lower portion of the intes-
tine, remains  stationary, while the upper portion  is forced
over it, so as  to receive it completely within itself.
   I am aware that objections have been made to the  expla-
nation which  I  have here attempted.  Some physicians con-
tend that during the formation of introsusception, the intes-
tines are  under the influence of  a compound  movement, or
rather of two  movements  running in  opposite directions.
These characters allege, that the upper or receiving portion
of  the intestine, moves downwards by its natural  peristaltic
motion, while the lower or received portion, moves  upwards
by  an  inverted or preternatural motion. But this explanation,
besides being more complex than that which I have offered,
is liable to other insurmountable objections, which will readily
present themselves to the mind of the reader.
   Although the discovery  of the existence of introsusceptio
intestinalis, is  interesting  in itself, yet I am sorry to add,
that it has shed no new light on the treatment of the disease.
We are even  unable to enumerate any particular set of  symp-
toms,  which,  during the life of the patient, give satisfactory 
102
 evidence of the presence of this affection. It belongs, as yet,
fto  the knife of the anatomist, and to that alone, to discover
 its  existence after death. Could  the existence of introsuscep-
 tio  be clearly  ascertained during life, perhaps bleeding the
 patient ad deliquium animi, would be the most  likely  way to
 remove the inflammation and spasm, which constitute it.
   From what has been laid down in this section, it appears,
 that the primary and deepest ravages of malignant fever, are
 confined entirely  to the abdominal viscera. This is the strong
 hold  of the  disease,  where it  carefully  concentres all its
 powers. Though the other parts of the system suffer greatly,
 they appear to suffer only through the medium  of sympathy.
 They tremble from the shock impressed on these organs so
 essential  to  life.  It  is  thus that the  branches of a  tree
 wither, when a deadly canker invades its roots.


                    SECTION IX.

           OF THE TREATMENT  OF THE DISEASE.

  The epidemic  of the year 1805, though highly malignant
 in many instances, and productive of great mortality,  was
 not in itself an unmanageable disease.  There were but  few
 cases in which it was necessarily fatal.  It was rendered so
 by  neglect, terror, indigence, or bad  treatment; sometimes
 by  all these causes combined.  When early application  was
 made for  medical aid,  and when that aid was skilfully  and
 attentively administered under  favourable circumstances as
 to nursing and accommodations, it was less obstinate,  and, in
 most cases,  I  think,  less dangerous,  than peripneumony.
 During the course of the epidemic  I  attended about  two
 hundred and fifty patients. Of this number I lost but five to
 whom I was  called on the first day of the disease. Of these,
 two were children, who had been previously much debilitated "
 by  hooping-cough:  two of the  remainder  were drunkards,
 and the filth had the misfortune to be without a good nurse.
 Under the most favourable circumstances, however, this last
 case would have  probably terminated fatally, for it was  one
 of the most malignant  I ever witnessed. The system of the
 subject  of it appeared as unsusceptible of the action of medi-
 cine as a block of marble. The  impression made by the  dis- 
103
ease was  so strong,  as to preclude or  swallow up every
other.
  But when no medical aid was called in,  as  was  too  fre-
quently the case, till the third or fourth day after the' com-
mencement of the attack, the prospect of a favourable issue
was very  faint.  In this state of things, the disease  had al-
ready run, perhaps, two-thirds  of its course, and produced
such derangement in  some vital organ  as nothing could -re-
move.  The physician had then too often to undertake the
painful task, of engaging in a combat, where victory had al-
ready declared for his adversary. For it is during the course
of the first three or four days, while the febrile action  runs
high and  is determined  to some of the abdominal  viscera,
that the disease generally  aims its fatal  blow.  Unless the
physician has an opportunity of warding  off this blow, or
breaking  its force,  it is too apt to reach the life of his patient.
In  other words, inflammation of the stomach or some other
organ essential to life, has advanced so far, that nothing can
arrest its  progress, or prevent it from proceeding to a  fatal
issue.
  When  called in on the first or second day of the  disease,
my chief reliance was placed on bleeding, purging, sweating,
and blistering.  These  were  my  four cardinal remedies.
When  skilfully managed, they very seldom failed  to bring
the disease to a favourable termination.   We will treat of
them in the order in  which they are here enumerated.
   1st. Of blood-letting.  It is scarcely necessary to  observe,
that this remedy was  admissible only in the earlier stages of
the disease, while the vascular  action was yet excessive.  It
was not requisite in every case, nor did I  find  it expedient
to repeat it more than three, or, at most, four times, in any
case. When the pain in the head and back were violent, par-
ticularly if they were  accompanied by much sickness at sto-
mach, this remedy was indispensable.  From  forty-eight  to
sixty ounces of blood, constituted the full amount of what I
drew from any one patient. In general, one or two moderate
blood-lettings, on the  first and second days of the  disease,
were sufficient. I  seldom prescribed  this remedy  after the
fourth, and never,  I think, after the seventh day. The repe-
titions  of it, however, as well as the quantity of blood drawn, 
104
 were to be regulated entirely by the circumstances of the dis-
 ease.  No general rule could be laid  down, as  applicable  to
 all cases.  The judgment of the physician must be the arbiter
 of his practice with .respect to this  important  remedy.  It
 will  be perceived from what is here stated, that the epidemic
 of 1805 called for less blood-letting than that of some former
 years.
   The appearances  of the blood  drawn  in pestilential  fever
 deserve some notice. This fluid is seldom covered with that
 firm buff-coloured size, which  so generally occurs  in  other
 inflammatory diseases. When it is, the symptom is a favour-
 able  one,  as it denotes the existence of nothing  but  common
 inflammation. I never lost a patient in yellow fever, whose
 blood exhibited this appearance.
   In general, the blood is almost as florid as if it came  from
 an artery. It coagulates, indeed,  but not firmly. The coa-
 gulum remains soft  and friable,  with but  very  little serum
 around it. The cause  of this appearance is  obvious.  The
 vitality of the coagulating lymph  (the only vital  portion of
 the blood) is so much  weakened  by the febrile action, that it
 is  rendered incapable of contracting sufficiently to press the
 serum out of the general mass.   For, in the  coagulation of
 blood, the serum is forced out from among the  coagulating
 lymph and the red globules, on the same principle,  that the
 whey may be squeezed out of curds by the pressure of the
 hand.  This loose  coagulation of the blood, then, is the first
 step  towards  a dissolution of it.
  But there is another appearance or state which is still worse.
It is that, in which the blood throws  up a very thick but ten-
der covering of coagulating lymph, of a yellow colour,  leav-
 ing the cruor beneath in a state of dissolution, that  is,  with-
out any of the coagulating lymph among it.  This appearance
 occurs very  frequently in the cases of persons addicted  to in-
 temperance.  It bespeaks a second step towards a complete
 dissolution of the blood, and has been already ranked among
 the unfavourable symptoms.
   The third  appearance is that where the  blood is so per-
 fectly dissolved, as to  remain in the state of a dark cruor,
 with a stratum of  coagulating lymph floating  on its surface,
 and  possessing the consistence of soft jelly. This denotes the 
105
  death of the blood, and the approaching death of the  whole
  system.  If recoveries from this symptom ever occur, they
  are extremely rare.
     Blood-letting, though indispensable, was not of itself a real
  curative, but only a palliative, remedy.  It moderated  exces-
  sive action, weakened the force of morbid determinations,
  and thus prevented the destruction of organs essential  to life,
  till these irregular and morbid determinations could be done
  away, and the general action of  the  system  equalized  by
  the influence of other remedies. In addition to this, it greatly
  promoted the operation  of these remedies, by  rendering it
  much easier for them to arrest or turn aside the curreiits of
  wrong action, by which the abdominal .viscera, the brain, and
  other important organs were  threatened or oppressed. For
  a stream or current can be much more readily  turned aside
  or obstructed, if it move with an impetus equal only to one,
  than it can if it move with an impetus equal to two.  So can
  a wrong determination in the system, when urged but weakly
  onward, be more readily checked than when  it is  urged  on
  with greater force.  Blood-letting, therefore, was  to  be  re-
  garded rather as a preparative, or predisposing, than as a cu-
  rative remedy; as preventing death, rather than as restoring
,  health.  In cases where a strong determination to the head
  was evidenced by violent head-ach, a throbbing in the tem-
  poral arteries, or an  obstinate delirium, the application of
  leeches and cups to the temples was oftentimes attendees with
  very happy effects. So was  a similar application to th^.;-epi-  ,*■
  gastric region, when  the scrobiculus cordis  was soreijfto the  ^
  touch, or the patient was affected with an obstinate v^uting,-**'
  or complained of a burning sensation in the stomach/'    -."v*1
     2d. Of purging. It may  be laid down,  I believe,  as ah
  axiom in the practice of medicine, that purging is an  indis-
  pensable remedy in all diseases, where  there exists an irfl un-
  mation of, or an  undue determination to, the abdominal vis-
  cera.  It acts on  these organs in a manner somewhat similar
  to the action of topical blood-letting on externa! parts, when
  labouring under inflammation or congestion.  It not only re-
  moves the morbid stimulus of the faeces, but also that of a
  part of the fluids with which the diseased viscera are over-
                              O 
106
loaded. It may be compared to a plentiful suppuration and
discharge in removing the inflammatory state of an abscess*
  In the epidemics of some former years the bowels were in
such a torpid state, that they could not be moved except  by
the most powerful and drastic  purgatives. Hence  calomel
and jalap,  gamboge and scammony,  were in common use.
In the epidemic of 1805 the case was  different.  Here  the
milder purgatives, such as  castor oil, an infusion of  senna
and manna, Glauber's salts, cream of tartar, and, in some
cases, even magnesia, were found to be sufficient.  In the ad-
ministration of these, I was  governed more by  effects than
by quantities.   I was never satisfied,  particularly during the
first days of the disease, unless my patient had at least five
or six plentiful evacuations, within each space of twenty-four
hours. I directed, therefore, some one of the foregoing pur-
gatives to be exhibited at certain intervals, till  the  desired
effect was fully produced. Purging might almost have been
denominated the Alpha and Omega  of my practice;  for it
was frequently my first and  my  last remedy.  Towards  the
close of the disease, hpwever, it was necessary to  exhibit
purgative remedies with a more sparing  hand.  At this  pe-
riod, the strength of the system could not bear, nor did  the
state of the disease require,  such copious evacuations.
   In a few instances, the torpor of the bowels was such, that
calomel was used in considerable quantities, in aid of other
medicines, before the  wished for effect was produced.   In
two or three cases, a slight mercurial affection of the mouth
was the consequence of this practice.  No sooner did that af-
fection appear, than every symptom of danger was at an end.
In this particular the epidemic of 1805  corresponded with
that of preceding years.
   In  the  early stages of the  disease,  bilious evacuations,
whether dark or green, were considered  as favourable, inas-
much as they denoted  a freedom both from hepatic obstruc-
tions, and hepatic paralysis. For, in some cases, there was a
defect of bile from a paralysis of the liver, no  less  than a
defect of  urine from  a  paralysis of the  kidneys.   I need
scarcely add, that an entire  torpor or paralytic state  of any
large  and  important viscus, is at all times  a symptom of
great danger. 
107
  A free and open state of the bowels had a tendency to re-
lieve that irritation of the stomach and  obstinate  vomiting,
which  constituted, at times, a very troublesome and danger-
ous symptom. That distressing symptom was also, in some
instances, removed by mint tea, or a  mixture of magnesia in
sweetened water.  I think this latter remedy was more  gene-
rally efficacious than any other I employed, in relieving that
burning  sensation  in the  stomach, and  that  sickness and
vomiting, which so frequently occur,  and produce  such dis-
tress, in  pestilential fever.
  As long as the stools continued of  a dark colour, the  use
of purgative  medicines  could not be omitted with safety,  al-
though the disease might be in a very advanced stage, and
the patient already reduced to a state of great debility.
  Worms were frequently discharged from the intestines by
persons labouring under the yellow fever. This circumstance
might be explained on  a twofold ground.  First, the morbid
and inflammatory action which oftentimes existed in the  in-
testines,  rendered them a very uncomfortable abode for  the
worms.  In consequence of this, these animals were induced
to attempt an escape from their labyrinth, which they  some-
times  effected in a living state.  Secondly, the copious use of
purgative medicines by sweeping off the  mucus of  the intes-
tines, in  which they lay embedded, and increasing  the force
of the  peristaltic motion, rendered it impossible for the worms
to keep their ground. They were, therefore, evacuated along
with the general mass of faecal matter.  To these two causes
perhaps  a third might be added.  Many  patients  took little
or no nourishment for several days.  This circumstance de-
prived the worms of their accustomed food, and  compelled
them to  emigrate  in search of a region of greater plenty.
  In a few instances, I administered a mixture consisting Oj.
a solution of tartarized antimony and Glauber's salts. The
effect of this was a copious vomiting and purging, or an arti-
ficial cholera morbus.  Besides effectually cleansing the  sto-
mach  and bowels, it had the additional effect of determining
to the  skin and contributing, not a little, to the perspiratory
process.   This mixture,  when  exhibited at the very com-
mencement of the attack, arrested on one occasion the pro-
gress of the disease, and was, in  every instance, in which I 
208
employed it, a useful remedy.  Frequent injections were used
in aid c'i purgative  with great advantage.
  I cannot close this article without observing, that purging
does not appear to me to  be duly appreciated as a general
remedy in the treatment of diseases. There are many com-
plaints, and those of  a very serious  and alarming  nature,
which  may be greatly  relieved, if not entirely cured, by this'
remedy alone, when carried to a proper extent; and there
are lew, if any, in which it is not highly useful.  Diseases of
the head are particularly under its influence. Hence, among
the ancients, it was principally relied on for  the cure of in-
sanity.  In dropsy, hysteria, and indeed in the whole tribe of
what are railed nervous diseases,  it is highly beneficial. As
these complaints are aim .-; always attended with costiveness,
purging may be  considered as the  most natural remedy tor
them.  To have its du^ effect, however, it must be oftentimes
carried so far as 10 deserve the name of an artificial diarrhoea.
   3d.  Of sweating. B  oodletting- and purging were excellent
preparatives for this  remedy.  They weakened or removed
ihe spasmodic affection which frequently exsited on the sur-
face of the bodv,  and  thereby contributed to the process of
cutieuiar secretion. I seldom, therefore', attempted to thrgw
my patient into a perspiration, till after  his bowels had been
plentifully evacuated.
   The stomach being generally tender and irritable, it was of
great importance to produce a sweat by the mildest and least
irritating means.  Accordingly, mv only internal  remedies,
for this purpose, consisted of warm drinks, gently stimulating,
such is vinegar whey, lemonade, or teas made of sage, balm,
chamomile, or mint.  These were  taken in  such quantities,
and at such intervals, as  the stomach could bear, and were
assisted in their operation by the application of the steams of
v-megar to the surface of the body.  This application, which
was of great  efficacy in relaxing the skin, was made in the
following manner, the simplicity of  which  was one of its
higiicst recommendations, as  it rendered it universally prac-
ticable. Four or five bricks were heated in the fire, to  as high
 a degree as the hand could bear: these were wrapt up in pieces
 of flannel, which was then plentifully moistened with vinegar.
 The bricks thus prepared, were placed under the bedclothes,, 
109
close to the feet", legs, and hips of the patient, and renewed
as often as circumstances required.
  By this external and internal application of heat and gently
stimulating moisture, a copious sweat was generally produced,
and that in a very short time.  But it was necessary that this
evacuation should be continued for many hours.  I have had
it kept up from ten  or  twelve to eighteen or twenty hours,
with the happiest effects.  Instead of being debilitated, my
patient was even  invigorated by it, inasmuch as  it removed
entirely  his febrile  symptoms and reduced  his  pulse to a
natural  state.  When properly  conducted, it was certainly of
all remedies the most  perfecly equalizing in its  operation.
The state of action  which it produced was altogether centri-
fugal, and, salutary to the viscera  in general.  It was particu-
larly successful in stoping  the vomiting which so frequently
occurred, and in relieving the stomach from all irritation.
  If, as  was sometimes the case, the process of sweating did
not appear sufficient to  reduce the pulse to the standard of
health,  I never  hesitated  to  draw blood, even  during- the
continuance of it. It is an error to allege, that blood letting
has  a tendency to check the  cutaneous secretion.  On the
contrary, it is Certainly  calculated  to promote  it.  The sweat
seldom failed to flow more  freely after blood letting than it
had  done before it, and, in no instance, did it flow less .freely.
The duration of the process must be determined  entirely by
the judgment of the-practitioner.  I seldom had it continued
less  than ten, or more  than twenty hours. I need  scarcely
observe, that it was  necessary, the perspiration should go off
very gradually, and the  patient's bed and body linen be chang-
ed after  its  termination. Such change became necessary,  at
times, even during its continuance, and was not attended with
any bad effects.  In  many instane.es, the  perspiration tinged
the linen of a  yellow colour.  This, however, was  to be re-
garded as a bad  symptom of bad and  generally protracted
cases.
  By what modus  operandi is sweating  produced, by the
foregoing warm  drinks  used for  that purpose? Does it de-
pend on their entering  the  lacteals, passing*into the general
circulation, arriving at  the  secretory vessels  of the organ of
perspiration, and, by their actual and formal presence excitr 
no
rag them into action? We presume it does not. It seems to
arise from  their immediate operation on the stomach, affect-
ing the skin through the medium of sympathy. The effect is
oftentimes too instantaneous to be explained in any other way.
When the  body is heated, a draught of cold water will ex ite
a copious perspiration in less than two minutes.  But surely no
one will contend, that this fluid could have  travelled the
whole round of the circulation in so short a space of time. In
like manner, a draught of vinegar whey or sage tea will pro-
duce a perspiration in a  much shorter time, than would be
requisite for it to pass through such a circuitous and tedious
route. Sweating must be, therefore, regarded as a sympathe-
tic process.
  4th. Of blistering.  The proper period for blistering was,
a short time  previously to the commencement of the second
stage of the disease, that is, a little before the  febrile action
had entirely subsided. I have frequently prescribed this re-
medy, and  that with great advantage, even before the sweating
process had been brought to a close. The object in blistering
was, to produce excitement on the skin, in order to  keep up
as much  as possible,  a centrifugal  state of action, and thus
preserve the stomach and other viscera essential to life.
  The places  on which blisters were most frequently applied
Wm re, che  wrists and ankles, the insides of the thighs, and
the epigastric region. Blistering  on the latter  situation was
frequently  of singular service, in removing the disordered
action of the stomach. As the  intention of this remedy was,
to k-.ep up external excitement, the blisters were ordered to
be dressed occasionally, if necessary,  with epispastic oint-
ment. By this practice, the action in, and the discharge  from,
them, could be readily continued  for any requisite length of
time.  Blisters were, in some  cases, applied on  the head, and
in others on the back of the neck. The effect of these, howe-
ver, was,  with  me, very doubtful.  I certainly derived  but
little if any advantage from them  in my own practice.  In
consequence  of this, I relinguished them entirely,  long be-
fore the epidemic had disappeared.
  Much has been said  of the  extreme  caution with  which
blisters ought to be applied in yellow fever, lest the irritated
parts should become gangrenous. But such apprehensions are 
Ill
visionary and unfounded.  During the course of the epidemic,
I probably prescribed blisters for two hundred  patients.  In
only one case did a disposition to gangrene occur in the irri-
tated parts, and in that it was fortunately checked by the use
of wine, bark,  and  cordial -diet.  Notwithstanding what is
here said, I have, in some cases, thought it adviseable to al-
low the first blisters to heal  up,  and then, apply  others at  a
little  distance from  them, rather than to have irritation con-
tinued for too great a length of  time on the same spot.
   In many instances blood oozed from the blisters  in consi-
derable quantities. This,  though an  unfavourable, was  by no
means a fatal symptom.  I witnessed probably  not  less than
twenty recoveries from it.  I was affected with it  myself, in a
violent attack  of yellow  fever, in the year 1797.  A  much
worse symptom than this was, a  sensibility or soreness of the
blisters, so exquisite,  as  to  compel  the  patient to cry out as
often as they were touched. In many cases that terminated
fatally, this extreme, and as I my call it,  preternatural sore-
ness, particularly of the  blisters on  the  wrists, constituted a
very striking symptom.  I ought to have mentioned it when
treating of the prognosis of the disease. Recoveries from  it
in my practice were very rare.
   The serum  discharged from  blisters was in all cases very
yellow.  This evinced a strong disposition to a dissolution of
the blood, even where it did not actually take place. Indeed
it is  evident to me, that  such a  disposition is  a never-failing
characteristic of pestilential fever.  Whence does this dispo-
sition arise?  from  the  mixture of the febrile  poison with
the blood, or from its immediate action on the stomach ?  I
am  of opinion that it arises from  the  latter  source.  The
blood of persons who die suddenly, from  a blow  on the
region of the  stomach,  or in consequence of  drinking cold
water, when greatly heated, is always dissolved.  Yet in such
cases, there is  neither any thing mixed with, nor  any morbid
impression made immediately  on,  the general mass of the
blood.
   I have thus  given a very brief outline of the common, and
successive  use of the four cardinal remedies in pestilential
fever. It must not, however, be supposed that they were all
necessary or even  admissible in every case of  the disease. 
112
 In many instances moderate purging and sweating, with a low"
 dkt, and confinement to bed for a few days, were alone suf-
 ficient for its cure.
   When the physician  was not called in till a late period  of
 the disease, bloodletting was in general inadmissible. His prin-
 cipal reliance then was on purging, sweating, and blistering.
 These he employed, at discretion, according to the strength
 of his patient, and the indications of  cure.  One or the other
 of them was suited to every period of the disease,  though
 blood letting was in general useful only in its early stage.
   There were other remedies  of inferior note,  calculated
 more especiallv for the relief of particular symptoms, which
 were occasionally  employed  with much advantage.   A fewr
 of these deserve to be mentioned.                .
   Intense pain in the head was, as already mentioned, some-
times greatly relieved  by cups or leeches, applied to the
 temples. The same end was attained by wetting the forehead
with cold vinegar  and water, or iced  water, or by surround-
 ing the whole head with bladders  filled with ice.  These ap-
plications, by absorbing heat, contributed to diminish exces-
sive action in the vessels of the brain. Washing the extremi-
ties with cold vinegar and water, was grateful to the patients,
raid, when  it did not improperly interfere with the process  of
 sweating, was a useful remedy.
   The burning in the stomach and inclination to vomit,  so
distressing to many of the sick, were greatly relieved by the
use of magnesia.   That medicine, aided by  mint tea, and
sometimes   by new milk, constituted a  principal  remedy
against these painful and  alarming symptoms.  Other practi-
tioners derived much advantage, in cases of obstinate vomit-
ing, from the use of spirits of turpentine, a remedy first pro-
posed by Dr. Physick.  The doctor appears to have taken the
hint, in this instance,  from the  efficacy  of that article  in
preventing gangrene from severe burns.   His object  was  to
prevent black vOmit, and the death of the  stomach from
excessive inflammation.  I  am sorry to add, that in my hands,
that remedy was not productive o< those happy effects which
are said to have attended  its use  in  the  practice of other
physicians.  This burning and sickness at stomach were,  in
Sf#me instances, relieved by injections of cold water,  as  weli 
113
as by the application of leeches and  cups to the epigastric
region.  This latter remedy I employed several  times,  with
evident advantage.  As  I  do not know of its  having been
used by any one but myself, I cannot venture to recommend
it without diffidence. I hope  its effects will be further tested
by the experience of others.
   Injections calculated and intended to irritate  the  rectum,
and  even to  produce a  degree of inflammation in it, ap-
peared to be on some  occasions  successful in diverting in-
flammation and death from the stomach.  This remedy  acted
by revulsion, in the same manner as a blister applied to the
epigastric region.  It was  founded on the  general doctrine of
sympathy, which  teaches us,  that morbid irritation in one
part of the system, oftentimes relieves morbid  irritation in
another.  It  was  admissible only after the febrile symptoms
had subsided.  These injections consisted  of brandy either
 alone or rendered more highly stimulating by a slight ad-
 mixture  of pulverized pepper or mustard,, spirits  of wine,
 spirits of turpentine,  or  a weak solution  of corrosive sub-
 limate.  As the remedy  was both active and severe, it was
 necessary to use it with great caution, and that only in cases
 where the usual remedies had been employed without effect.
   One or two cases of obstinate hiccough were relieved by
 assaieetida, both  given  in  pills,  and  administered,  in an
 aqueous solution, in the form of injection.
   Repeated friction of the  part with sweet oil contributed
 somewhat to the relief of a soreness of the abdomen.  I tried
 the  same remedy, but not  with the same success, in that
 soreness or rather pain of the lumbar region, which occurs
 in the beginning of the disease.
   In protracted  cases of the epidemic, which had assumed
 something  of a typhous form,  wine, particularly claret and
 other light wines, constituted an excellent remedy.  These
 were administered either alone, with water, or mixed with
 panado, gruel, sago, or other articles of diet. I saw but few-
 cases of the disease, in which the bark could be borne, and
 in none of them did  it  appear  to be  productive of any
 benefit.
   In the fever of 1805, I did not salivate more than  two  or
 three patients intentionally, although inthe epidemics of former
                             P 
114
years,  that remedy constituted  the  sheet  anchor of safety
and hope.
   In a few protracted cases of the disease, where the debility
was extreme, accompanied by a  coldness oJ the skin, and  a
general defect of action throughout the system, great advan-
tage was derived from the use of warm brandy, gin,  or spi-
rits and water, sweetened, and given at short intervals in such
quantities as the stomach was capable of bearing.  I attended
one case, in particular, in which  the recovery  (certainly  a
more extraordinary one than I had ever before  witnessed)
was, I  think, to be ascribed principally to the use of this re-
medy.   It occurred in the month of October, not long before
the disappearance of the epidemic.  The subject of it was  a
young  man, about twenty-seven years of  age, of  a robust
constitution, and what  is generally denominated a  sanguine
temperament.  From the fifth till the eleventh day of his -dis-
ease, he was insensible to every  thing around  him,  ?nd  did
not articulate a single word.  His skin was cold, and his puise
barely  perceptible;  at times, I fancied it not  perceptible at
all.  He had haemorrhages from  his mouth, nose, and anus.
That from the latter part  was so profuse as to pass through
the bed on which he lay;  for he was for a  time incapable of
being moved.  His breath  was more offensive than the smell
of a carious tooth.  Notwithstanding his  chamber being kept
as clean and pure as possible, I was unable to remain in it a
greater length of time  than  was  barely necessary for me to
feel his pulse, examine his countenance, put a few questions
to the  nurse, and give her a few directions.  Nor could I even
have done so much, had not the fetor been corrected by im-
pregnating the air with the  steams of hot vinegar.  The only
circumstance which furnished a ray  of hope was, that my
patient was still capable of swallowing liquids  in small quan-
tities,  and what he  did swallow was not thrown up again. In
this desperate state  of things, I prescribed brandy and gin
diluted with water and sweetened, in such quantities, and  at
such intervals as they could be received and  retained.  The
nUrse  was faithful and persevering.  The result was the per-
fect recovery of my patient, who now enjoys his usual health.
   From this case and some others which  I attendwd, and  of
which I have received information,  I  am of opinion,  that 
115
during the epidemic of 1805 there  was a greater number of
recoveries from states of the disease apparently hopeless, than
occurred in former years. # Whether this was owing to some-
thing peculiar in the character of the fever, or to the employ-
ment of a more skilful mode of treating it, I cannot venture
to determine. It was at least highly gratifying to the friends
of humanity, and tended  to alleviate the distresses of the
time.
   It is common for practical writers to give a catalogue  of
tonics, or chronic stimulants, calculated to restore the strength
of convalescents.  In convalescency from the malignant le-
ver, I employed in general no medicine  of  this description.
The usual and best tonic  in my practice was, aliment and
drink, gentiv stimulating, grateful to the stomach, and easy
of digestion.  In the commencement of this regimen, porter
and water, oysters and weak chicken broth, constituted com-
mon and very  useful articles.  The patient  returned by.de-
grees  to  the use  of wine, and other kinds of animal food.
Nor did  I ever experience the least inconvenience from thi«
neglect of the fashionable tonics of the shops.  It is in a state
of convalescency from chronic or protracted forms  of fever,
that such tonics are more particularly useful.  In yellow  fe-
ver, I am convinced they are seldom or never necessary, pro-
vided  the complaint in its early stages be treated  in such a
manner, by proper evacuants, as to remove  all inflammation
and congestion from the internal  viscera, and to restore  an
equilibrium or equal diffusion of excitement throughout the
system.  The same thing is true with respect to most other
acute forms of disease.  Provided the early treatment of them
be such as to prevent them from running into a chronic state,
medicinal tonics,  or chronic stimulants  are  seldom requisite
during a state of convalescence from them.  In such diseases,
these  remedies are rendered necessary only by the neglect or
mismanagement of patients, or by a want of skill on the part
 of practitioners.  Suppose a physician were  called to the  re-
lief of a person reduced to  extreme debility by a long absti-
 nence from  food, what would be his prescription?  Would he
 administer peruvian bark, chalybeates,  elixir of vitrioi, or
 preparations of any of the bitter tonics?  I conceive he would
 not. At least I am sure such treatment would be improper. 
116
The only thing necessary or admissible  in  the  case would
be, such  mild alimentary articles as might be suited to the
state of the stomach and system in general. But a patient
in a state  of convalescence from a  well  treated  case  of
yellow fever or other acute  disease, is in a  state analagous
to that of a person greatly debilitated by  a long  want  of
food.  All  congestion  and  preternatural  action  in  par-
ticular organs are removed,  and the excitement  throughout
the system is equable and free.  Nothing, therefore, is requi-
site, buf proper aliment and  drink, and a prudent us'- of the
non-naturals, to restore the  convalescent to his usual health
and vigour.
THE END 
Caldwell, Charles
  ... An essay on the pestilential or yellow-
fever • • •

  This book is the appendix to Alibert, J, L,
A treatise on malignant intermittents,  Philadel-
phia, 1807,  The complete book is -»■■» Wn^i^gf^p J
aiid io not in the HMD collection. 
 
C|f7es
1^07 
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