nlmr NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service ~^:~: THOUGHTS ON THE SULJECT OF A HEALTH-ESTABLISHMENT FOR The City of Philadelphia. ■f\ V —— '*" A f^T a time when the best interests of our city lie prostrate, and the public mini is still smarting from the lash of past calamities, it is natural and becoming to indulge reflections respecting the future. In no other way can we profit by the salutary lessons of experience and observation ; in no other way can that wisdom acquired under the harsh but instructive discipline of misfortune, direct us to the means of preventing the recurrence of similar evils; and, I will be pardoned for adding, on no other ground can we support our pre ensions to the proud but milch abused name of rational beings. Per- haps few iccasions have occurred more apposite than the present, for reducing these general positions to practice. The strange scenes and transactions of the period of alarm and confusion which has just elapsed, are pregnant with choice instruction, and if we fail to make the proper use and application of it, the fault is in ourselves, and musfj be ascribed either to our neglect or want of discernment. It will be readily percieved, that I allude to certain proceedings relative to the late malignant fever, from the supposed dangers of which, popular rumour, co-operating vita the influence of an official memorial, drove our citizens to take refuge in the country. It is hot my intention to pass a censure on the character of the board delegated to watch over the health of Philadelphia. This would lead me io arraign the ?notives of the gentlemen who compose it, which I am persuaded are pure, honest and upright. But I am unable to review the catalogue of official measures which that body adopted during the late period of'our distress- es, without feeling and cherishing sentiments ot disapprobation. Notwithstanding the frightful reports of sickness, which with their gloomy train of concomitants, Spread with such rapidity through the city and country, there are thousands ready to concur with me in opinion, that we have had, during the present season, but very little if any ground for public alarm on this score, whib every one must acknowledge, that the alarm which issued from the office of the board of health about the beginning of August, was rash, preci- pitate, and out of all proportion to.the cause which then existed. It is worse than common error, it is an imposition fatal in its consequences to say, as some have done, that the rapid flight of our citizens, which succeeded this event, broke the chain of communication, and by that means prevented the spreading of disease. In the year 1798 the depopulation of the city by flight far exceeded any thing we have since witnessed, yet had it no effect in arrest- ing the course'of the dreadful epidemic of that season. It must be fresh in the remembrance of every one who was accurate in his observations, that on that occasion the disease overran neighbourhoods containing but few inhabitant no less rapidly than such as had many. It did not even attain to the height of its career till the month of September, at which time the population in every part of the city was much more diminished than it has been during the present year. On that melancholy occasion Philadelphia was desolated by a true epi- demic, whereas during the season just terminated, we have had nothing but sporadic cases of a disease, from which neither we nor any other large city in the United States, can expect to enjoy an entire exemption during the summer [ 2 ] - - f *• son and climate. But I repeat, that I am far from ascribing improper and unworthy mot -c , to the gentlemen who compose our board of health. I consider their memo- rial of alarm already mentioned, with the want of wisdom and consistency dis played in many of their subsequent measures, as nothing more than evidences Of their incompetency to discharge the duties of their appointment. Had it been possible for them to have gone even farther astray than i 1 s>. ne instances they did, I should still have held myself bound to regard tnem as deluded not as voluntary agents of mischief. Nor is it either criminal or disgraceful in men to be found defective in qualifications IV an office entirely new to them, and on I which they entered not of choice, but in obedience to the suffrages ol their fellow-citizens. All the public has a ri^ht to expect from such characters is, an honest, prompt, and faithful attention to what they conscientiously believe to be their duty, either on the credit of their own ceiiberations, or of aduct- recieved from others in whose judgement they have reason to confide. In me- ters of this kind, the only effectual security against error and mischief Hei Selecting to piaces of tru^t none but persons duly qualiiied by means of pre '•<.» is education and habits. At the close of the next session of the legislature of our Comm* iw alth, terminates by its own limitation the " Act for establishing an Health jfnxe for the city and port of Philadelphia." This is the instrument which gives exis- tence to our board of health, prescribes the principles and mo.ie of their nomi nation and appointment, and sketches the general outline of their official con- duct? As it is scarcely probable that we will be left altogether destitute of a legal establishment in relation to the health of our city, either the same act will be continued in its present form, or with such alterations and amendments as may appear adviseable, or else one entirely new will be substituted in its place. Which of these expedients may, in the issue of things, recieve a pre- ference, it- is not for me to hazard a prediction. But, be the matter as it may, considerations both of self-interest and public good render it incumbent on every Philadelphim, however humble and contracted his means, to con- tribute by the last exertion of his abilities, to shed light on a subject of such general importance, and so closely connected with his personal welfare. Impressed by these sentiments, but without either aspiring to the charac- ter of a legislator, or making pretension to a higher share of knowledge than, 1 the rest of my fellow-citizens, I shall offer a few remarks on what I concieve to be errors and deficiencies in our present health law, and at the same time endeavour to unfold certain principles which such an instrument ought to em- brace. But, previously to entering on the immediate discussion of these points, it is requisite to lay down a few preliminary observations, to render what may follow more easily understood. , An estsblishment intended to preserve the health of Philadelphia should, as far as practicable, extend to every source of malignant disease, that may, Under any usual combination of circumstances, become epidemic. Provided complaints prove general and mortal among our citizens, it is of little import whether they arise from putrid exhalation or animal contagion, whether they be of foreign or domestic origin. In either case their occurrence is equally j to be deprecated, and ought to be guarded against with equal vigilance. In I either case their prevention should be carefully provided for, in a system established for the preservation of health. If, in any instance, a doubt arise in I the public mind, whether an epidemic disease which threatens frequently to \ return, be the offspring of foreign or domestic causes, the only wise and en- * Every physician of observation must know, and every one of candour will acknowledge, that the Fall Fever of the city is as different from the Autumnal Re- mittent of the country, as the dress, manners, and habits of a full-bred citizen arc from those of a plain country farmer. Things attain to a state of refinement and sublimation m the city to which the country is wholly a stranger. C 3 ] lightened policy consists in erecting.suitable and efficient barriers against dane-er from either quarter. But this is more particularly the case should it appear probable that both sources unite, and produce the mischief by mutual co-oper- ation. Under such circumstances, safety can h^. ensured o.dy, by a system of caution and defence judiciously directed against the secret intrigues and open assaults of the enemies both within and without. This latter presumption (I mean that which embraces the agency of both internal and external causes) seem:; to harmonise most with public opinion respecting the origin and propagation of the malignant epidemics by which Philadelphia has been repeatedly visited within the last ten years. I forbear to express my own private opinion on this subject, convinced that the sentiments of an anonymous individual couiu have but little weight in either changing, modifying, or confirming those impressions which my fellow-citizens have long since recieved and cherished. As far as I have been able to inform my- self respecting a matter so extreme.lv precarious, the predominant belief among the inhabitants of Philadelphia now is, that our late epidemics have been ori- ginally introduced in vessels from foreign ports, and afterwards propagated among us through the medium, and instrumentality of a vitiated atmosphere. This vitiation is acknowledged to be peculiar to cities, and to arise from the filth with which their streets, docks,-sewers, and other places are suffered to be polluted. The testimony in favour of each branch of this hypothesis must be confessed to be specious and plausible. The leading articles of it may be summed up in the following manner. Our late epidemics have generally appeared first along our wharves, and in the neighbourhood of vessels among the crews of which similar diseases had previously prevailed. In some instances persons who had been either on board such vessels, or in their immediate vicinity have been numbered among#the earliest victims of disease. These circumstances seem to concur in support of a belief in the doctrine of importation. But, on the other hand, the malig- nant complaints in question, even after having gained a footing, are known to have raged with violence only in situations abounding in filth. They have ne- ver spread either in the pure air of the country, or in the high, cleanly, and well ventilated parts of large cities. They are further known never to prevail in the winter season, but to be arrested in their progress as soon as the process of putrefaction in the open air is checked, and the atmosphere depurated of septic effluvia by the occurence of frost. From these and other similar facts and considerations it is obvious, that to the prevalence of a malignant epidem- . ic,.a vitiated atmosphere is at least as necessary as imported poison. Let us, then, discard «.!1 narrow views, all party and impassioned pr< ju, dices, which have hitherto misled the public mind on this subject, and, for Hie sake of harmony, and effective measures of prevention, accede to what appears to be, if not the result of philosophical discussion, at least the dictates of com- j mon observation. Let us admit, that though evil may threaten us from with-. out, yet the foe has within our own walls, and even around our dwellings, a host of auxiliaries anxiously waiting his invasion to enroll themselves under his destructive banner. This view of things, provided we realize it in its full force, will induce us to extinguish the rage of party animosity, and unite in common , exertions, against the machinations of a common enemy. It will impress on us the necessity, not only of repelling open hostility from abroad, but aiso of crushing the secret and more dangerous intrigues of domestic corruption. In vain does an enemy attempt the conquest of a country where he finds no suc- cour in the defection of any of its inhabitants. Purity of principle and union in measures of defence have nothing to dread from the most powerful assailants. Inlike manner, it isliterally impossible that yellow fever should ever overrunour city unless it be aided by internal agents. For, whatever be the source from which . this disease springs, whether septic exhalation, or secreted contagion, it is known to be an evil that thrives only in a contaminated atmosphere. When • removed to the pure air of fthe country it languishes and dies without issue. Admitting yellow fever, then, to be really contagious and of foreign origin, ( the,first object of our health establishment should be, to erect, as far as practi- cable, sufficient barriers against its introduction. But, asjcjmtajn.oflJsjfc^MJT- C 4 ] tie and invisible agent, and may gain admission through channels unpercieved and even unsuspected, another object no less important is, to adopt such mea- sures, that, even when admitted among us it may prove innoxious. These measures consist in taking every practicable step to purge the atmosphere oi the city, and assimilate it in purity to the atmosphere of the count, y. '1 he accomplishment of this end, though plain and simple inks principles, is some- what arduous in point of execution. The air of particular places bears a close affinity to the nature of the places themselves. For our atmosphere, instead of consisting of air alone, is a heterogeneous compound, containing eilluvia from all surrounding objects, capable of being volatilized under the tempera- ture of our seasons. In order to assimilate the atmosphere of the city to that of the country, it is necessary to render the two places as nearly alike as pos- sible in their general scenery, and the nature of things they contain. The coun- try abounds in vegetation and streams of running water, and is polluted with but a small quantity of putrefying filth. But, with regard to the city, the* case is precisely reversed. It contains large quantities of putrefying- substan- ces, little vegetation, and no constant streams of pure water. From this sim- ple statement the inference must be obvious to the capacity of every one. Putrid substances are known * be active in contaminating, and stieams of water and vegetables in a living state, in d^pura'ing the atmosphere to some distance around them. Hence the principle sources of the difference between the purity of the air in the city and in the country. As the purifying and con- taminating sources in the two places bear an inverse proportion to each other, the atmospheres must be necessarily marked by a corresponding diversity.* I repeat again, that I do not mean to offer an opinion respecting the origin of yellow fever. My intention is, not to provoke and render more inveterate, but, if possible, to moderate and assuage the spirit of party on this subject, which has already risen to an inordinate height, and been productive of incalcu- lable mischief to our city. While the advocates of domestic origin will not object to an external quarantine under wise and proper regulations, those who believe in the importation of yellow fever can neither deny the influence of vitia- ted air in facilitating its propagation, nor oppose from laudable motives the establishment of an efficient system of internal cleanliness. If these opposite parties have not suffered their desire of victory to gain an ascendency o»er their attachrhent to the welfare of Philadelphia, they will not refuse, on tie summons of both reason and interest, to renounce their fruitless and distracting controversies, and unite in common efforts to guard against the ravages of a common enemy. Such appear to be the general spirit and views which ought to pervade a health law calculated to harmonize with public opinion, and to secure to our city an exemption from malignant disease. In my future numbers our pre- sent health establishment will undergo a brief examination, and be compared, as to its leading features, with the principles and sentiments here expressed. A PHILADELPHIAN. It was observed in my first number, that a health-establishment for the city of Philadelphia ought to embrace two principal and distinct branches. By means of an external and well regulated quarantine it should provide against the introduction of malignant disease from foreign places through the channels of commerce ; and, to obviate the propagation of such disease, in case of its being accidentally suffered to gain admission, as well as to prevent its genera- tion by the agency of internal causes, it should organize and enforce a strict and extensive system of domestic cleanliness. Competent provision being made * In order to destroy, as far as possible this diversity and obviate all its physi- cal consequences, let us introduce into our yards, gardens and streets as much vegetation as practicable, let us by means of our hydrants convert our gutters for a few hours every day, during the summer and autumn, into streams of pure water, end remove to a distance every putrid and offensive substance. C 5 ] and carried into effect on these heads, nothing would be left on the scofe of prevention to exercise wisdom or call forth exertion. l.et us briefly examine some of the leading features of our existing health law, and compare them with these simple and substantial tests. The first thing that attracts o ir attention in tjus instrument is, the nature, and mode of appolnti?;;?, tne board of health, which, wh<-n appointed, is invested with the po-vers both of a deliberative and an executive council. In the first section of the law. these points are laid down and provided for in the following wor^s. " The present bo^rd of managers of the marine and city hospitals shall nominate twenty four persons, fourteen of whom shall be resident in the city of i nladelphia, four within the Northern Liberties, four within the district of Soutawark and two within the township of Moyamensing; the Mayor or Recorder and Aldermen of the city of Philadelphia, or any four of them, tne Mayor or Recorder being one, and the Justices of the Peace of the county of Phil.dclpaia residing wic!1^ the No.taern Liberties, the district of Southwark, and townsl ,p of ^oyanieraiinp;, or any three of them shall meet on the last Monday in December in every year, and appoint7we£yf of the persons sonomi- nated by the boa d of managers of the marine and city hospitals" 8cc. Sec. Therevare two things essentially necessary to give a law effect and utility. The law itself must not only be wisely framed, but executed by officers suffi- ciently enlightened respecting the objects of it, to be ..ble to carry its injunc- tions and provisions to a proper extent, without rendering it unnecessarily op- pressive. If there be a deficiency in either of these points, the l.iw is in gener- al worse than a nullity. But of a palpable deficiency in the latter of them, we have a striking example in the instance before us. Our board of health now consists, and during the present establishment, will aKvays consist of men of common minds, common educations, and common acquirements. But the Lading objects of the law they are appointed to execute are exclusively of a scientific and professional nature. How then is it possible for such charac- ters to deliberate with wisdom, and act with effect, on subjects, the very elements of which are wholly unknown to them ? A few specimens of the ex- tensive and important discretionary powers vested in our board of health, will set this matter in so clear and forcible a point of view, that it must necessarily be understood and felt by every one. In the first section of the health law it is declared, that " The said board (of health) shall have full power to make general rules, order*, and regulations for the government and management of the Lazaretto, and the vessels, cargoes, and persons under quarantine, and the health office and public hospitals, and for prescribing the mode of visiting and examining' vessels, persons, and houses, &c." Again, Section 4th, the commander, second officer, or any person, on board a ship anchored near the Lazaretto, shall answer on oath or affirma- tion to the quarantine master or resident physician, " all such questions touching the health of the crew and passengers during the voyage, and the na- ture of the cargo, as the board of heal'h, by their rules, shall, from time to time di~. red to be asked." In the case of infection and sickness on board of a vessel," the board of health shall determine and direct what measures shall be pursued in order to purify the vessel and cargo, and restore the health of the diseased psrsong on board," Sec. All 'vessels arriving at the Lazaretto from tropical latitudes and certain. other places specified in the 5th section of the health law, from the fifteenth day of May till the first day of October, shall " there discharge the whole of their cargoes and ballast, which, together with the vessels, bedding, clothing, and every other article on board, which may be supposed (by the board of health) capable of retaining infection, shall be perfectly cleansed and purified, under the direc- tion of the resident physician and quarantine master, agreeably to such rules and regulations as the board of health shall, from time to time direct for that purpose," &c. Again, whenever the board of health may apprehend that the city would be endangered by a vessel, from the Levant or any other place where the plague frequently prevails, entering our port, " they shall have full power and autho- [ 6 ] rity to detain (at the Lazaretto) and unlade the said vessel, and cause ruch mea- .- (rvs to bf ;aken as will he conducive to the purification of such vessel, and of the persons and c^rgo on board thereof." "rL.c 15. yj-ci befurf.ir enacud, That when any vessel shall come up to the city of Philadelphia, or the shores of Squthvrark or the Northern Liberties, in the ri/er Delaware, (although the said vessel may have obtained a certificate ? cfKakh from the resident puvsician and quarantine master or consulting phy- sician,) if the said vessel shall' appear to the bjerd of health to be infected with cay contagious disorder, dangerous to ihe community, the said board are hereby authorised to order the said vessel to the Lazaretto, there to undergo the necessa- ry purine: tion, before she shall be permitted to return to the city or shores afore- ? said ; and the said board are aic-o hereby authorized and impowered to remove any vessel or vessels from such p< at of the city or shores aforesaid as shall be infected -with such disorders as aforesaid, to such convenient distance as they may deem ; proper, although such vessel may not be infected." Sec 23. And be it farther enacted, That it shall be the duty of the said boardofhealthtocar.se all offensive cr putrid substances and all nuisances which may have a tendency, in. their chir.ijn, to endanger the health of the citi- zens to be' removed from the streets, lanes, alleys, Sec. &c. and to cause such privies to be emptied or corrected v. ith lime, as the said board shall from time to time deem necessary for the health of the in.'->aLl:a;it:-."- Such are a few instances, selected from among many, of the high and im- portant discretionary powers delegated by law to the boasd of health. The objects of these powers, as already remarked, are decidedly of a philosophical and professional nature. They are, the laws, nature, and mode of eradicating, im- ported contagion, and a decision as to the hind of domestic nuisances,which threaten the production of malignant r/V-,r:ur. But men who have been pvofessir.r.ally bred, and who have devoted the bestportion of their lives to medical and philosophical » researches, acknowledge these to be among the most difficult points of investiga- W tion. How, then can common chacacleio, without the aid of either literature, profession, or study, and erig >ged for a subsistence in mechanic al or mercantile }\ pursuits, either judge with wisdom or act with consistency on such subjects? £ 1 do not mean to convey sentiments of direspect tow ards any character or occu- pation by these expies;>i ngr founde.i on experience. Abundant evidence of the truth of this asseriioa may be codected trom the begin ling of the fifth till the close of the ninth sc tion oi the health law. i.eM I mi ; it misrepresent the meairng of this part of t.te law by attempting a su.n- mary of it, I must beg the attention of the reader to the folloaang extracts. k> Stc. 5. And be it further enacted, Thai all ships and vesstk, as well vc, -els of-var as merchant vessels, arriving at the Lazaretto fom any port or pLce m the Ivleeiterranean, or the seas or waters connected witii '..he same, to the cast- ward of the straits of Gibraltar, or from the coast o; Africa wuhout tne straits of Gibralt a; and the territory of the same, and the ports of Africa otner than the Cape of Good Hope, in the Indian ocean, a;.d Loin the main land of north Or south America, or the West India Llar.ds, b-iween the latitude of the river St. Mary in Georgia, and the beginning of the 1 ..utuJe of tniity degrees soudi of the equator, and from Eatavii in the Island of jav:;, from the fifteenth day cf >i.ay to the first d.y of October, shall there Le detained at anchor, and dis- charge the whole of their cargoes ana ballast, which together v, itn the vessels, tracing, clothing, and every other article on board, which may be supposed capable of retaining infection, shall be perfectly cleansed and purified, under the direction of the resident physician and quarantine master, at the cost and charge of the owner or consignee, agreeably to such rules aud regula ions as the board of health shall, from time to time direct for that purpose ; a:iu when any oi the said vessels, cargoes, bedding, clothing, or otner articles shall be effectually cleansed and purified, tfae resident physician and quarantine master, upon recieving the full amount of the expense and charges for storing, keeping, cleansing, and purifying the same, shall make re-dclivery thereof to tHe captain, master, owner, or consignee of the ship or vessel, in wriich the same were imported, and deliver to the captain, or master of the said ship or vessel, the certiricate of facts to be presented at the health office as aforesaid, and discharge from quarantine such of the crew or passengers of the said ship or vessel, as may be in a healthy state, provided the said vessel shall have been at least fifteen d^ys under quarantine," Jkc. See. Were we to search the records of legislation in every country from the remotest period to the present time, we would "perhaps be unable to find a section of a law more defective in wisdom, and more lame in expedients for Xhe accomplishment of its purposes than the preceding. Nor could we p.o- -duce a more instructive instance of the folly of a deliberative assembly attempt ing to frame rules and regulations on a subject with the nature of which they are totally unacquainted. The feeble and blind policy displayed in this section makes no discrimina- tion between a healthy and a sickly, nor between a clean and a foul vessel. The port or even country from which she had sailed, or at which she had acci- dentally touched, is the only point that appears to have been considered as worthy of attention. Yet this, instead of being the first, ought certainly to havebeen j among the last considerations, to influence the decisions of a legislative body, en- gaged in delibrations on such a subject. What completes the folly and absur- dity of this section is, that some of the places mentioned in it as dangerous on account cf their contagious and pestilential diseases, are among the healthiest spots on the globe. The state and condition of a vessel, her cargo, and crew, are the only circumstances that should determine the policy of subjecting her to quarantine and purification. If a vessel be foul, if her cargo be damaged, or her crew affected by a malignant and a contagious disease, (no matter from what place or latitude she last sailed) she should by no means be admitted into the port of Philadelphia. *r ilth imported from Hamburg, from the Baltic, or even * Let the following narrative, the truth of which can be substantiated by evi- dence the most incontestible, serve as a memorable and impressive example, of the mischief that may result from a foul and unventilated vessel. Sometime in the au-\ tumn of the year 1801, the brig Esperanza arrived in the port of Philadelphia] with a healthy crew, anjd ivithout having previously had any sickness on board.] [ 9 ] from the latitude of St. Petersburgh, is as offensive in its qualities, and as noxious in its nature, as that introduced from Cape Francois or Batavia; and it is well known that warm climates are not the only places where'malignant and infec- tious diseases originate and prevail. When a vessel even from a sickly port in the West Indies arrives at our Lazaretto, provided she has had no disease among her crew or passengers, and provided also she be herself clean, and her cargo sound and free from any reasonable suspicion of infection, where is the necessity or even policy of subjecting her to a tedious and expensive quarantine ? ,1s it not worse than useless, is it not an act of cruelty, to adopt such a measure, when there is a strong probability that fifteen days confinement and idleness on board a vessel, subject to the chills of the night, the fogs of the morning, and the intense action of the midday sun, will generate disease among the most healthy and robust seamen '. Has a vessel under such circumstances ever introduced dis- ease from a foreign country either into this or any other port ? The most zealous and ingenious advocate for importation and indiscriminate quarantine will shrink from an attempt to support the affirmative, of this question. A vessel that has remained healthy both while in a foreign port, and during a subsequent voyage of three or four weeks through the pure and breezy air of the ocean, can no longer be regarded as an object of danger. Why, then, as soon as she has been duly examined by the proper officers,, and found to con- s',-: was laid up for the winter in a large dock adjoining Mr. West's wharf, a short distance to the northward of Vine street. In this situation she lay, without being either cleansed or ventilated, till within a few days of the appearance of the late malignant disease in that neighbourhood, which is known to have occurred early in the month of July of the present year (1802.). Two men who were employed in first opening her hatches were almost suffocated by an eruption of foul andfoetid air from her hold. A large quantity of putrid, dark, and most offensive bilge water was discharged from her by her pumps, John Edwards, a ship carpenter who worked •;; board of her was the first victim to the disease which soon afterwards spread through the part of the city where she lay. All the other persons, who were in the first instance attacked by that complaint, were near enough to the Esperanza to itiluile the pestilential vapour which issued so copiously from her bilge water and hold. Notwithstanding all the idle clamour which has existed, and the proofs which certain gentlemen have attempted to adduce to the contrary, there was no other ves- tel in that neighbourhood which could be reasonably suspected of giving rise to- disease. Between the tenth and fifteenth of July this vessel (the Esperanza) was remo- ved from the dock near Vine street, where she had so long lain, and brought to at a wharf near Chesnut street, where there had not previously been a single case of disease. In this place she continued about halfaday, and. was then, at the remon- strance of a physician, ordered away by the board of health. Within a very short time afterwards there occurred several deaths from malignant fever in the vicinity of the toharffrom which she had been last removed. This vessel now dropt down the river (J think) as low as Marcus Hook, where she lay about fifteen days. She then returned to the city, by permission from the board of health, and came to at Hamilton's wharf, a little above the Drawbridge, for the purpose of taking in freight. She had not lain in her new station many days, when malignant disease again made its appearance in some of the adjacent houses, carried off several per- sons very suddenly, and spread an alarm through the whole neighbourhood. Such is in brief the history of the Esperanza. Nor is it in the power of any one either to subvert or silence the facts which it exhibits. Perhaps no vessel that ever entered the port of Philadelphia furnished so strong a ground for being suer fiected of giving origin to disease. She touched at only three places in the city, \namely, near Vine street, Chesnut street, and the Drawbridge, and, faithful as [the shadow to the substance, malignant fever was her inseparable companion. But •he had not lately arrived from any of the places designated in the fifteenth section \of our health law. This is the true cause why such efforts have been made to transfer ill suspicion and odium from her to the St. Domingo Packet* 1 C 10 3 tain nothing of a suspicion's nature, is :■ fe not suffered I r> pvr)ce( 1 !rami oiately to her place of destination ? The interest and. r'g'it of the :i"*r« hant demand this, and the safe y of tr.e community does not Libid ;'. It is well k'ov,n that by acting on these enlightened. ..nd discnmimuiny. p-mcipk;. <■!* ijiianui- tine, our neighbouring states preserve the commerce ol ' eir ;■ >r:s unshackled, while tiuir cities remain at must as free from diser.se as our own. If a vessel be actually a repository of icbrjlr contagion, fift • n d,»y . ennsri- tute too short a period for the purification of herself and cievr. The truth b well as the reason of this mu-rt lie obvious to every ore acquainted ' >th he nature and phenomena of contagious diseases. We know that, at •. nm •, th? poison of such cor plaints lies dormant in the huuian system tioir. V. •• ra e' ■ to thirty day-:. Simoose, then, one or more of the cv ;W of ; quarantine a vessel of this description, merely because she has arrived ii n the "West Indies, Asia, or Africa, as it would be had she come Lorn the conti- nent of Europe. " Sec. 9. And be it further enacted, That it shall be the duty of the resident i.-hvrician, immediately on the arrival of any ship or vessel liable to be det -''.-ed a; the Lazaretto, in order to be cleansed and purified as aforesaid, to cause tj.o sick, if any on euard:, to be removed to che building which shall be appointed by the board of '.ealth for th; ir reception, and diligently and impartially, v.th his best skill, at'end upon and administer medical assistance to each and every s-ick person that shall be therein lodged, and generally superintend and rati ,e to be executed such orders a.:ul regulations as the said board shall, from .one to time, ordain for the government and rn.au genunt of L.e Lazaretto, and the vessels and cargoes and persons under quarantine." It is not sufficient simply to denominate the policy manifested in this \ section unwise aad inexpedient; it deserves to be branded as barbarous and a.hum .a:. It would incorporate well with statutes and ordinances pas;>ed in certain European countries during the ages of darkness and superstition, but is a stain on the legal code of Pennsylvania, so remarkable for its wisdom, mildness, and humanity. Provision is here made for the reiiei of the *ick that may be on board an infected vessel arriving at our Lazaretto, while the healthy part cf the crew are blindly or wantonly abandoned to their fate. The iormer are directed to be removed to pure and wholesome accommodations on shore, but the latter, instead of being indulged in similar privileges, are to be closely confined to a vessel supposed by the law to be replete with deadly con- tagion. This is but one degree better than the murderous edict formerly pas- sed in London during the rage of pestilence in that place, dooming both the fuel; and well of families to be shut up ia infected houses, and abandoned to promiscuous and almost inevitable death. Nor can there be a well founded season assigned-, why such rigorous measures should be adopted at our Laza-' retto. On the other hand both humanity and sound policy require, that during the quarantine of an infected vessel, the whole of the crew should be furnished with clean and airy accomodations on shore, and not be suffered to be on board a greater pioportion of their time than is absolutely necessary for the purpose of cleansing and puryfying her. As men are most liable to be affected by rualig jmnt and contagious fevers during the relaxed hours of sleep, the precaution*] here leeommended, would both afford the crew the best possible chance to] C 11 3 escr.pp contagion, and, at the same time, contribute in the most effectual maimer to the purification of the Vessel. For what can so certainly perpetuate con...gum in a ship- as the successive sickening of her crew on board ? 1 appral to ■ :ie profession^ knowledge of physicians, as well as to the good sense of my c'i.i^h ened fellow-citizens, whether or r.ct the strict confinement of fifteen or twenty persons, during as many scorching days and either chilly or sultry nights, on board a vessel subject to tie action cf marsh effluvia., be not a mea- sure much better calculated,to generate than to destroy infection and disease ? From every one of reflection and dLeernment I am authorized to expect an affirmative an.wcr. It would be impossible, v ithin the limits I have assigned to these essays, to pursue our heukh lu>v through ailits det.uls. iSor does such a step appear neces- sa; y, as the subordinate provisions of this instrument, though too numerous, comu'ex. and fo.m.J, cannot prove a source of any radical or extensive mis- chief- :..> entering on the present series of hints and remarks, my chief objects wi-vc, first to state a few q< jc-et'ons to certain leading principles and prominent features in our health es.ablistimeut, and secondly, to endeavour to show in what way the evils thence arising may be remedied. Having feebly and in part accomplished the former of these views, the latter will form the subject of u concluding number. A PHILADELPHIAN. Having finished my remarks on the insufficiency, and mischievous tendency of on" existing heakh law, it is now time to pass from the business of censur- ing to that of recommending. Conscious that it is much easier to detect and expose errors' and faults, than to substitute salutary alterations and amend- ments, I enter with diffidence on the present essay. But little conversant 'J with the theory, and an entire stranger to the practice, of legislation, seldom | accustomed to read and never on any occasion to draft a law, it is not my in- ter, tion to attempt a digested and complete form of an act for the establish- ment of a health system for the city and port of Philadelphia. Leaving legis- lative formalities and technicism to characters skilled in that kind of writing, I shall endeavour briefly to unfold some of the leading principles which such an instrument ought to embrace. {Agreeably to certain remarks, and propositions contained in my pre- ceeding numbers, there are four objects that ought in a particular manner tvt engage the attention of the legislature in framing a health law suitable to the exigencies of our city and port. These arc 1st. The establish- ment of a committee of health competent in point of talents and information, to the high trust reposed in them, and invested with a proper degree of legal authority. Zna'.'u, The organization of a rigid and extensive system of internal cleanliness. 3c/7;/, A well regulated quarantine of infected vessels, cargoes, and persons. And 4thly, A proper disposition and treatment of the healthy part of the crews of vessels during their detention at our Lazaretto. I shall proceed to the consideration of these four divisions of my subject in the order here stated. 1*^, As it is impossbile for a health law to make specific provisions for every object and exigency that may require attention, the committee of health must necessarily possess a great latitude of discretionary powers. In order to be able to exercise these powers with credit to themselves and with safety and advantage to the community, they should have a perfect knowledge of the nature of the business in which they are engaged. Ignorance is a neces- sary source of error and mischief in executive functions. But it has been already remarked that the leading objects of the health law "are exclusively of a scientific and professional nature, and it is easy to discover that the profession alluded to is that of medicine. I need hardly add, that, as divines are the ablest masters of theology, and judges most profoundly learned in law, so none but physicians have a perfect knowledge of medical subjects. It appears, | therefore, to be one of the plainest dictates of common sense, that our board of health should consist in part of medical characters. In no other way can it ^y^J^^meconiDetenttoth^^ [ 12 ] In no other way can its proceedings be rescued from the heavy charge* of inconsistency, error, and mischief. Physicians possessing a knowledge ol the causes and nature of malignant diseases, and being able to calculate rationally with regard to the probability of their spreading, are most competent to super-. intend the removal or prevention of the one, and to devise measures for arrest- ing the progress of the other ; or, in case of the latter issue being unattainable, to apprize their fellow-citizens of the proper time to secure themselves from danger by retiring into the country. Had there been a few physicians of res- pectability incorporated in our present board of health, the memor.il of general alarm published in the begining of last August, to the terror and incalculable j injury of our city, would never have been suffered to make its appearance. ; In New-York and Baltimore the health establishments are superintended '-- medical characters. ButI blush for Philadelphia on comparing the enligh m views and regular proceedings of those institutions with the inconsistence and want of knowledge which characterize the proceedings of our own. In those cities commerce is never interrupted except during the existence of real and imminent danger ; while with us, an idle rumour, a mere phantom of disease, is sufficient to destroy the business of a whole season. Of the truth of this the present year furnishes a melancholy and memorable example. But in reply to these observations it may probably be said, that the physi* cians of Philadelphia differ among themselves with regard to the origin of our malignant epidemics—that while some of them consider these diseases as the offspring of domestic causes, others believe them to be imported from abroad —and, that while some esteem them highly contagious, others deny that they are ever communicated in this way from one person to another. Whence, then, it may be continued, would be the advantage of committing the super- intendence of the health of our city to characters, whose jarring opinions and public controversies, have only tended to invellope the true source of our dis. eases in confusion and uncertainty ? It must be acknowledged, that, on a hasty and superficial view of things, this objection appears reasonable and weighty. But, when the subject is ma- turely considered, the very difference of opinion here stated to prevail among our medical characters, constitutes an additional reason why they should form a part of our board of health. It was remarked in a former number, and it is believed that the truth of the remark will be universally acknowledged, that even admitting yellow fever to be imported in the form of human contagion, it requires for its propagation a contaminated atmosphere. But this contamination is the result of the pu- trefaction of organized substances. Exclude foreign contagion by a strict quarantine, says one party of our physicians, and yellow fever can never again appear among us: let us, replies the other, purify our atmosphere by a strict and extensive system of internal cleanliness, and the disease, though introdu- ced, can never spread. Here, then, we find, at least in public opinion, if not in the nature of things, ample ground for bringing into action the principles both of the importers, and of those who advocate the doctrine of domestic origin. The principles of the former operate to the exclusion of a foreign enemy by means of walls and fortifications, those of the latter to place our forces in such a state of preparation as to be able to destroy him the moment he commits an unwarrantable encroachment, In such a state of things as this, the true policy with regard to the con* stitution of our board of health, must be obvious to every one. It consists in incorporating with the board an equal number of physicians of each sect • of those who believe in the domestic origin of yellow fever, as well as of those who consider this disease as a foreigner. Thus united under the same estab- lishment, these characters, instead of provoking mutual hostilities by pursu- ing their own principles exclusively and to the extreme, will, from motives of prudence and policy, immediately negotiate an amicable compromise. The believer in domestic origin will co-operate with the importer in the dueexecu- tion of an external quarantine, while, in return for this liberality, he will recieve aid and support in purging the city from internal filth. Another feature of this co-alition will be, a generous emulation in each party to render C 13 ] their respective principles and opinions conspicuous, which will lead to a more strict and able execution of the health law, than could be expected from men, not jealous of each other, and actuated by views precisely alike. There have been still further objections made to the present constitution of our board of health. It has been remarked that the members of that insti- tution are too numerous, that they are appointed for too short a time, and that there is something unjust and even oppressive in their being obliged to neglect there own private business, and devote their time to the public, without the smallest compensation for their services. To remedy all these evils at once, I beg leave to propose the following plan. Let the appointment of the members of the board of health be (if not per- manent) at least for a term not less than six years, and then let only a part of them go out of office at once, so that the board may never be left destitute of the aid of actual experience. In consideration of their trouble, services, and loss of time, let them recieve, like our other officers of police, an annual sa- lary out of the funds of the city, and let their number be reduced from twelve to seven ; that is, three from the city, two from Southwark, and two from the Northern Liberties. Of these seven let four be physicians, viz, two from the city, and one from each of the aforesaid districts, and let them be equally divi- ded in their opinions respecting the origin and nature of yellow fever. Let the two importing physicians have the principal superintendence of the business of quarantine, while those who believe in domestic origin should take a simi- lar lead in that of internal cleanliness. As this, however will fall under the private regulations of the board, it is not necessary that it should be provided for in a legislative act. In such a state of arrangement as is here recommended, places of trust would be consigned only to characters qualified to perform the duties attached to them. It is reasonable and right, that, that part of the, police of cities which relates to the preservation of public health should be under the direction of medical characters. No other description of men can be equally calculated to do justice to such a charge. A large and populous city situated in a warm climate is a valetudinary body, which, for the prevention of disease in the summer and autumnal seasons, stands constantly in need of medical attention and advice. Nor let it be supposed that a base and sordid principle oi self-in- terest would lead physicians to recommend such measures as would tend rather to invite than to prevent general and malignant sickness. Leaving the deep criminality of such conduct out of the question, it is a truth, that, even in a pecuniary point of view, the faculty of Philadelphia are among those who suffer most by the occurrence of yellow fever. Physicians feel, therefore, a common interest with the rest of their fellow-citizens, in endeavouring to avert the rava- ges of this disease. Idly. The next object in a health establishment for the city of Philadel- phia is, the organization of an efficient system of internal cleanliness. On this subject the health law cannot be expected to be express and specific, because it is impossible for the wisdom of any deliberative body to foresee and provide against all the sources of pollution that may occur in a large and populous city. Much, therefore, as formerly remarked, must be left to the discretion of the committee of health. Nor is there any cause to apprehend mischief from the abuse of such discretionary powers, provided this body be composed of charac- ters of principle and discernment. As all the noxious filth of our city is not exposed in streets, alleys, docks, sewers, and other public places, the commit- tee should be authorized to examine cellars, yards, privies, and all such pri- vate apartments as may be reasonably suspected of uncleanlihess. However obnoxious the delegation of such an extent of power may appear to some, it is absolutely necessary to the decency, comfort, and health of large cities. For, though the pride of our nature may create in us a wish to disbelieve the fact, it is notwithstanding true, that a considerable portion of every community must be compelled to be cleanly in their dwellings, no less than honest in their trans- actions, else will they be alike delinquent in both. • u nC*Cr **"s neac*lt 1S ProPer to observe, in particular, that during the hot and sickly months, no vessel from whatever port she may have arrived, and what- [ H ] ever may he the *o"ndne«s of her cargo, and the henhl. evi of her m* should be permitted to pump out her bilge water m any of o.nr whartoa. Such a practice may not o'dv prove injurious to health, but is extreme L unbec u- ing, and odensoe to the semes. * It is unecessary to .md, that the com' '"tee of health should be in.ee 1 with leg.d povers to enforce alt -ma measures of j cleanliness and purity, as maytbe esteemed conducive to Liic gem -rl good. 3 Iij. A well regulated quarantine of infecteu w-: ' cargoes, and persons, is, in the public estimation, an object of primary conscience towards prescr-.- ing the h.aLh of our city. But in the organizatioi eylhi-i branch of i hcahu establishment,, measures should be adopted essentially 'ifmrtmt i;om those n- dibcriminating and oppressive regulations, whu h aovy disgtu<<- the po t, and if continued will ultimately ruin the commerce m .'>.'. moioi.ia. It has bjen already seen, that, from the fifteenth r'l May ti'l the first r f October, all vessels, whatever be their state and condition, a riving at our Lazaretto from cert.dn specified places* are, together with their cargoes and crews, subject to a quarantine of at least fifteen day >. But niue out of ten, or even nineteen out of twenty, of such vessels are free from all .suspicion of contagion end otner sources of sickness, as \v ill be testified by the officers of quarantine themselves. How unjust, cruel, and oppressive then, to dete.i.i under a heavy expeiice nineteen cleanly and innocent vessels, becau >e the twentieth may chance to be foul and dangerous 1 ouch aa unreasonable and ui^necedented practice is worse than the evil it is intended, to obviate. Tue true policy on this subject is too obvious''to be mistaken by any o ic. It con- sists in permitting all vessels, after having undergone a due examination atj the Lazaretto, to pass immediately to flm cit\, except such as, either from their existing or previous state and condition, appear to threaten the healt-.i of the inhabitants. Such is the policy which, while it erects a sufficient barrier against the introduction of foreign disease, leaves the commerce of New-York and other neighbouring seaports unfettered. But, as many of our citizens, and even some of the faculty hold it n- tremely difficult if not impracticable, to ascertain, by a mere emmi n mm, whether a vessel be infected or not, I beg leave to propose another mode of quarantine, equally compatible with the health of the city, and much less inju- I rious to the interests of the merchant than that which now emm.s. This con- | sists in shutting o'ur port entirely against all vessels from the V, est Indies and other sickly places, from the middle of May till the first of (n'oom. .AU vessels, however, whose crews are not affected by malignant disease, a. d which have no articles of a suspicious nature on board, should, immediately after examination at our Lazaretto, be allowed to discharge the r c r<