A
TREATISE
ON THE
Autumnal Endemial Epidemick
OF
TROPICAL CLIMATES, 
VULGARLY CALLED THE
YELLOW FEVER,
&c.



A
TREATISE
ON THE
Autumnal Endemial Epidemick
OF
TROPICAL CLIMATES,
VULGARLY CALLED THE
YELLOW FEVER;
CONTAINING ITS
ORIGIN, HISTORY, NATURE and CURE;
TOGETHER WITH
A Few REFLECTIONS on the
PROXIMATE CAUSE OF DISEASES.
BY
JOHN B. DAVIDGE,
A. M. M. D.
ALTERAM PARTEM AUDI.
BALTIMORE :
Printed by W. PECHIN, No. 15, Baltimore-street
1798.



Introduction.
IT is not my intention in the following pages, to
unfurl the banners of personal opposition. Dr.
Rush professes truth to be the object of his inqui-
ries—truth is the end of my researches. The ex
panded mind of Dr. Rush, receives more sincere
and real pleasure in the perception of one truth,
than in all the fulsome incense that could ascend
from a thousand flatteries : His great mind, I
hope, is closed to the poisonous nutriment of boy-
ish vanity.
The object of my labours and studies, for seve-
ral years past, has been, in a great measure, an in-
quiry into the nature and etiology of diseases.
And although, not unfrequently, I could meet
with the opinion, that contagious diseases did often
originate in marsh exhalations, but as this opinion
was accompanied by feebleness, and want of con-
viction, I treated it more as the fondness for no-
velty and innovation, than as the candid result of
experience. Nor should I at present attempt to
arrest its growth, had it not found too able an
abettor in the learned and elegant Rush. Writers
of little note cannot give tone to opinions. Fal-
cons do not feed on flies. Great names alone can
introduce great errors.
Who among us would have imagined, that the
human mind was nothing but a flux of ideas, had

vi INTRODUCTION.
not David Hume given currency to this fancy ?
Or that thought was a peculiar configuration of
the combination of material atoms, had not Dr.
Priestly introduced it to our acquaintance ? But,
to come nearer home, who could suppose that the
water spout, that huge rising of the ocean, was ef-
fected by a power of suction resident in the clouds,
without the hint of Dr. Franklin.*
There has been of late, a great objection, to
nosologies, started. I see no injury that they can
operate : They unquestionably facilitate the acqui-
sition of every science, as well that of Nature, as of
Botany and Medicine. Nosology is a mirror re-
flecting, in pathognomonicks, the melancholy ca-
talogue of cruel diseases ; and a student will learn
more from a well arranged synoptical nosology, in
one year, than he will otherwise in five. The la-
bour of wading through, bulky folios, and turning
over musty aphorisms, is much more fatiguing and
unproductive, than the attentive study of those so
much aspersed multa in parvo. A tyro will much
sooner acquire the diagnosticks, when arranged by
the learned and experienced, than when he has to
cull them out from a cloud of similars.
It is true that we should prescribe for the nature
of symptoms ; and it is equally true that in pre-
scribing for a symptom, we should have an eye to
the nature of the epidemick that may prevail at
* The true, and real cause of the water-spout is ; a column
of electric fluid descends from the cloud, this electric column
rarefies the air to a given distance, the rarefaction of the air
causes an unequal pressure on the water : The equal pressure
being removed, the water immediately rise in bulk correspond-
ing to the space of the rarefied atmosphere. This column of
water ascends in proportion to the levity or thinness of the air,
sometime to amazing heighth ; and in its ascension acquires
a whirl occasioned by the circumambient air rushing to a focus
to fill up the partial vacuum and restore to itself its former
equilibrium.

INTRODUCTION. vii
the time. The inference is, that, in prescribing
for a nausea and puking in concussion and apoplexy,
we are not to look at the insulated symptoms, but
to inquire into the nature of the diseases ; in sick-
ness from concussion no physician will think of the
lancet, when he knows it to arise from a sudden
derangement of the nervous power ; but for the
same symptom in apoplexy he immediately lets
blood, from a knowledge that it proceeds from
compression of the brain.
We must always practice according to the na-
ture of symptoms, which nature is only known
from a knowledge of the, nature of the disease.
For a dark tongue in a typhus we order good wine,
for a dark tongue in the yellow fever we order
mercurial purges: The symptom is the same, but
experience informs us that the same remedies will
not answer. Then let physicians be cautious how
they prescribe blood-letting for every giddiness—
the giddiness in the jail fever is cured by wine, in
the yellow fever by active purges and the lancet.
Great names have a species of magick accompa-
nying them. Mr. John Hunter gave shape, for a
time in London, to the doctrine of digestion ; his
opinion, that it is the combined action of friction
and fermentation, has been successfully combated
by being put in competition with one better found-
ed. Spallanzani, by a series of well managed ex-
periments, has exhausted the subject of all doubt ;
according to this indefatigable man, it is nothing
more complex than a simple chymical process ;
such as takes place in the union of sugar and water,
where the attraction of combination overcomes the
affinity of aggregation : That which is proper nou-
rishment is taken up, by the locteals acting as ca-
pillary tubes, what remains is thrown off as excre-
mentitious refuse.
Nature has placed limits between diseases, as

viii INTRODUCTION.
well as between vegetables, and animals, nor must
we suffer the charms of simplicity to persuade us
to intrench on those outlines. The small-pox is
generically different from the varicella. By taking
away natural boundaries, we shall bring the sci-
ences, in confusion, about our ears, and precipi-
tate ourselves into a chaos of uncertainties. A dis-
respect to civil distinctions, brings about political
demise.
Animal electricity, in its hasty progress, promis-
ed us an acquaintance even with animal life and
human physiology ; and had we all been Italians,
we might, before this, have found the philosopher's
stone : The next thing would have been, the good
luck of Paracelsus, an introduction to an universal
panacea.
This comes forth, neither connected with name,
nor clothed with title ; I leave it to recommend
itself. If it prospers, well ; if not, it will only,
suffering the mishap which overtook one of David
Hume's best productions, fall dead-born from the
press.
Names frequently are more propitious to books
than their contents are. And many works, of
sterling value, too often instruct none but their
authors. †
† When the above was written I did not intend to have put
my name to this production, but for particular reasons I have
change my first intention, as the reader will perceive.

THE
CONTENTS.
CHAPTER I.
The Origin, History, &c.
CHAP. II.
Proximate Cause analyzed.
CHAP. III.
Diagnosis.
CHAP. IV.
Cure.



TREATISE, &c.
CHAPTER I.
THE yellow fever, synonymous with la maladie
de siam, or la fievre matelotte of the French, and
vomito prieto of the Spaniards, is the majority or
acmé, as the intermittent is the embryo, of the re-
mitten bilious fever ; It is to the common bilious, 
what the confluent is to the common mild small-
pox ; they are in kind the same, a specific differ-
ence only exists between them. It is conceived in 
the same matrix, and quickened by the same sun. *
It is indigenous to America and all other warm
climates. It is the great outlet, to Americans and
Britons, from life to the grave.
The rays of the sun diffused and scattered are
salutary and innocent, but collected and condensed
into a focus are dangerous and hurtful : thus the
concentrated effluvia of marshes is deadly and
venomous ; but scattered and diffused, circulate
among us innocently.
The generality of the French writers call it la ma-
ladie de Siam from a shapeless notion that it was
originally from Siam, a country in the east : this
contains as much truth as the opinion that it at-
tacks sailors only ; whence they call it la fievre
matelotte. It is, in all probability, the causus or
* ” Without the matrix of putrid vegetable matters, there
can no more be a bilious or yellow fever generated amongst us, 
than there can be vegetation without earth, water or air.” Rush
vol. 3. p. 168.

12 THE ORIGIN, &c.
febris ardens of Hippocrates, Aretœus and Galen.
Trallian and Lommius appear to have seen this
fever.
Ulloa makes mention of the vomito prieto pre
vailing, in a most horrible and destructive form,
in Carthagena in the year 1729 and 1730*. It
made its inroads in Barbadoes in the year 1696 †
a time long prior to the visit of Dr. Warren to
that island.
Marsh effluvia appears to be either the decomposition
of vegetables or water, whether inscrutably
combined with something else, or insulated, I leave
for farther investigation : in the decomposition of
either, hydrogene is produced in considerable
quantity. Water, in its liquid state, is a compound
of hydrogene and oxigene, with an addition of ca-
loric and a little common air : Its decomposition
is effected by the rays of heat inserting themselves
between the liquid particles until their separation
is such as to annihilate the attraction of combina-
tion between the hydrogene and oxigene. Whe-
ther then an union, betwixt the oxigene and light,
comes to pass, remains to be discovered ; this I
strongly suspect. The hydrogene being disengag-
ed and insulated, and very much accumulated, or
peculiarly combined, perhaps becomes the peccant
agent.
It is worthy of observation that the bilious or
yellow fever does not generally prevail during the
heat of the summer ; this may be owing to the
greatness of the heat dissipating and scattering the
hydrogene, or marsh effluvia, so as to enfeeble and
render it innocent.
That a combination between the oxigene and
light happens is likely, first from their natural af-
* Voyage to South America, B. 1, C. 5.
† History

THE ORIGIN, &c. 13
finity to each other, and secondly from a phœno-
menon observable during ignition ; the rays of
light falling immediately upon the ignited com-
bustibles, cause the flame to become faint and ul-
timately will extinguish every particle of the fire.
The probability is, that this phœnomenon is occa-
sioned by the rays of light attracting and combining
with the oxigene of the atmosphere, and thereby
interrupting the process which was going forward
between the oxygene and combustible bodies. To
this there is an accession of additional strength
from what takes place in vegetation.
A vegetable, kept in the shade, becomes white
and sickly ; when it is exposed to the light it re-
vives and becomes healthy : this I apprehend flows
from the light acting as a stimulus, and at the same
time attracting from it its oxigene, with which it
is necessarily charged in decompounding water for
its nutrition. Vegetables when analyzed yield
more or less of hydrogene. Hydrogene is that gas
which in its struggle to ascend, meets with the elec-
ric fluid of the atmosphere and forms what, in ver-
nacular vulgarism, is called jack-o-lanthorn—or
when it has gained the superior regions and formed
the upper strata of the air, comes into contact with
the electric fluid, and effects what enjoys the ap-
pellation of aurora borealis or northern lights. It
is also the principal agent in the motion of the
aerostatic machines.
The yellow fever made its first appearance in the
city of Baltimore in the last of August. The com-
mon bilious fever prevailed at the Point from June.
A lady from Philadelphia, bringing with her the
seeds of the disease, which were brought into ac-
tion by the fatigue of the journey, was severely
attacked with it in Charles-street, she had the ge-
nuine black vomiting, which resembled ink and
coffee- grounds mixed, for two nights and a day,

14 THE ORIGIN, &c.
miscarried on the sixth night of the disease—she
notwithstanding recovered ; no person in the fami-
ly, nor neighbourhood had it during the whole
season.
This, together with the number of cases of vio-
lent bilious fever at Fell’s Point, threw the city,
generally, into a combustion ; the committee of
health requested that the physicians would convene
in order to give a report of the city ; upon the
convention of the physicians, it appeared, from
their joint testimony, that the above-mentioned la-
dy was the only person, labouring under the fever
in the west end of the city, called the town in con-
tradistinction to the Point. [I shall in what fol-
lows make use of the distinction of town and Point]
The committee received a letter from doctor Coul-
ter, a physician of great respectability at the Point.
Doctor Allender, in person, waited on the com-
mittee, and gave information of that part of the
city. It was requested by the committee of health,
that some of the physicians of the the town would
visit the Point ; pursuantly to this request, doctors
Goodwin, Moores and Davidge politely went, and
waited on the sick individually ; they were piloted
by a gentleman who lives with doctor Allender,
together with a student of doctor Coulter's. Their
report was, " that there was nothing more than a
violent remittent bilious fever prevailing :" This
perfectly accorded with the sentiment which dropt
from one of those physicians during his report to
the mayor, “ his reason (he said) why he did not
report the case of the lady of Philadelphia, was a
full persuasion, that the yellow fever, being of the
same origin with a violent bilious fever, could not
be multiplied, by an intercourse of bodies, under
any circumstance whatever.”
The above report is a strong and prominent fea-
ture of their discernment, and indifference to popu-

THE ORIGIN, &c. 15
lar prejudices. A little after that period, the dis-
ease rising from the grade of a bilious to that of the
yellow fever, mounted its chariot of death, and
drove furiously through the streets, sowing dismay
and mourning wherever it approached : conveyed
by the north-east wind it scattered itself all along
Federal-hill, and west end of the bason ; which-
ever direction the miasmata (arising from the stag-
water and marshes about the Point and
wharves) controuled by the winds, took, the disease
tread closely in its footsteps. It evolved, in an
horrid and dismal shape, its venemous dispositions
in the south end of Hanover-street and its vicinity.
After a short interval this deadly effluvia penetrated
into the vitals of the city, and many who were not
near the Point nor wharves, those exuberant foun-
tains of mischief, took it, either in their houses, or
in the streets. Not an inconsiderable number of
those who were at the launching of the frigate re-
ceived the disease, several of whom died of it after-
wards up in the town ; but, fortunately for the
citizens, no person was infected from them. A
very considerable part of the inhabitants of the
Point fled into the country, and some from the
town removed ; a temporary desert was effectuated.
I scarcely need mention the daily deaths ; the
reports of the committee of health are inadmissible
of an accession of testimony to give weight to their
authenticity and accuracy.
The greatest number, in the the the town or
west end of the city, in any one day was seven or
eight ; the list of the deaths at the Point was, for
some time, considerable. This fever began to
faint about the first of October, and was nearly or
quite extinct on the first of November.
All endemical epidemicks, as they depend on a
peculiar constitution of the air, must of necessity

16 THE ORIGIN, &c.
cease whenever this condition is destroyed, whether
it be by frosts or rains.
The yellow fever, like all other epidemicks, de
lights in solitude. An epidemick, whether ende-
mical or contagious, depends on a general peculi-
arity of the air ; which general peculiarity will
have a general influence within its own dominion,
and communicate a general aptitude to all bodies,
within this jurisdiction, to receive its action. It
chases away all others of lesser strength, as is justly
observed, first by Diemerbrook, secendly by Sy
denham, thirdly by Pouppé Desportes, and after
them by Rush ; who is perfectly correct where he
says that no two epidemicks, of unequal force, can
prevail at the same time. How is it possible for
two general and opposite constitutions of the air to
exist at the same time ? with equal propriety we
would say that a cord can enjoy two distinct oscilla-
tions at the same instant ; or that two particles of
matter can occupy the same given space in the same
division of time. But this every tyro should know.
Some of the first traces of the yellow fever in
America are to be found about sixty or seventy
years back. A physician, in conversation, the
other day told me that he had met with the yellow
fever in Baltimore ever since he had lived in it,
which is fifteen or twenty years. It is violating all
obligations of decency and truth to say that it is of
recent date. The town of Baltimore, in propor-
tion to its inhabitats, is less subject to this autum
nal remittent or yellow fever, than the low situati-
ons about the Potowmac. A gentleman, who for
some considerable time was one of the principal
directors of the Potowmac business, informed me
that one season they lost a considerable number of
their workmen by the above fever. And that in
no instance did it spread by contagion.
Disease is simple, and indivisible ; it is the ab-

THE ORIGIN, &c. l7
sence of health. But, for the facility of the pen,
and ease of speech, we make disease an aggregate.
It is not, at all times, proper to act the philosopher
and metaphysician ; we must accommodate our-
selves to popular usage. Cold is the negation of
heat, and darkness the absence of light. Ice is the
natural state of water : yet custom, the standard
of all languages, persuades us, in familiar conver-
siation and common writing, to say it is cold, or it
is dark, &c.
Every country has diseases proper to its climate
and situation. Some diseases are common to eve-
ry country and climate : Accident and particular
circumstances will create sporadick diseases, in eve-
ry country, not peculiar to them respectively ; a
disease proper to one country can, by the medium
of intercourse, be carried into another and there
propagated.
Britain has its scrofula, and typhus ; the vicin-
age of the Alps has its goiter : the East has its
plague ; the West-Indies, America and other coun-
tries within or near the tropicks, have their remit-
tent bilious fevers, and hepatick affections. It is
not the import of this paragraph, that those diseases
are exclusively generated in these countries respec-
tively. The antogonist idea is incontrovertable.
But as those complaints, although they may ori-
ginate or be produced in every country and under
every climate, most commonly and generally ap-
pear in those countries in the manner above-men-
tioned, I have taken the liberty to stile them proper
to those individual climates. It is a concurrence
of circumstences, and not given latitudes, that is
requisite for the production of diseases.
The seeds of the remittent bilious yellow fever
are engendered in putrid vegetables and stagnant
water, and are vivified by heat and dryness. Those
C

18 THE ORIGIN, &c.
who live in their neighbourhood, in warm climates,
and during hot and dry autumns generally suffer
more or less. The more elevated situations, and
those distant from such sources in the West-Indies
and America, most generally escape this deathful
malady, except when the atmosphere becomes uni-
versally surcharged with the effluvia emanating
from those exuberant fountains of mischief and
poison ; under such occurrences they unavoidably
participate of the evil. This is echoed from the
united voices of writers and practitioners.
Males, by being more exposed to this effluvia
floating in the air, to the violent rays of the sun, to
night-dews, and to the various, sudden, and great
vicissitudes of the weather (these operate differently
according to their respective natures) are more sub-
ject to this, and all endemical epidemicks, than fe-
males, whose business is naturally within their
houses, where the poison is blunted and rendered
inert by the fires and smoke, and has itself dissipated
by striking against buildings.
The skirts of most cities are occupied by the
poorer class of inhabitants ; their houses are ex-
posed to the first and most violent assaults of all en-
demical epidemicks ; but as those epidemicks in-
trench more the vitals and heart of a city, they are
dissipated, enfeebled, and disarmed.
The remittent bilious yellow fever neither pities
helpless infancy, nor reverences the decrepitude
of age ; but its chief delight is to jostle, from the
stage of life, the young and vigorous The many
headed monster, armed with destruction and woe,
wantons in the citadel of life : and now, Anthro-
pophagi like, without warning or prelude implants
his merciless dagger ; and now under the garb of
innocence, gambols in the cheek of health. The
yellow fever is as fatal when with the investiture
of an intermittent, as when habited in its regular

THE ORIGIN, &c. 19
type. Having seen its birth an extract we make
an easy step to its nature.
Dr. Rush.
" The fevers generated by
putrid cabbage, mentioned by
Dr. Rogers, and by putrid flax
mentioned by Dr. Zimmerman,
were both contagious. Dr.
Lind ascribes the yellow fever
every where to marsh or vege-
table exhalations ; and this fe-
ver, we know spreads by con-
tagion. Dr. Lind jun. esta-
blishes the contagious nature of
the marsh fever which pre-
vailed in Bengal in the year
1762. I shall transcribe his
words upon this subject. “ Al-
though marsh miasmaia (says
he) first bring on the disease,
yet contagion presently spreads
it, and renders it more epide-
mic. Thus the Drake India-
man continued free from the
disorder for two weeks toge-
ther, when she had no commu-
nication with the other ships ;
whereas as soon as the disorder
was brought on board, many
were seized with it within a
few days in such a manner as
to leave no room to entertain
the least doubt concerning its
pestilential nature,"
Dr. Clark mentions a con-
tagious malignant fever from
marsh miasmata. which prevail-
ed at Prince's Island in the year
1771, and which afterwards
infected the Grenville India-
man. The contagious pesti-
lential fever in France, so ac-
curately described by Reveri-
us, was produced by an exha-
lation from putrid vegetables,
particularly hemp and flax.
Even intermittents, the most
The Author.
An endemick is a disease,
that afflicts several people toge-
ther in the same country where
it reigns, arising from local cir-
cumstances or a peculiar con-
dition of the air. It cannot be
carried from one country to
another, by the means of bo-
dies and cloths. It affects more
or less all within its own peri-
phery. It cannot be carried,
beyond its own atmosphere,
by bodies diseased with it.
No disease arising from marsh
effluvia can be communicated
beyond the atmosphere charged
with this effluvia. Every dis-
ease arising from marsh effluvia,
from the gentle intermittent to
the furious yellow fever inclu-
sive, then is endemick.
It does not appear, that any
of the cases, in the antagonizing
column, communicated them-
selves by means of the diseased
bodies beyond the circumfer-
ence of the atmosphere impreg-
nated by the vegetable exhala-
tions ; then if they did not,
which is pretty obvious, act be-
yond the limits of the inquinat-
ed atmosphere, the probability
is, that the vegetable or marsh
effluvia wasted through the air
did the mischief, and not the
intercourse of bodies.
That a ship's crew was free
from a disease this week, is no
just argument, if they be infect-
ed next, that it must be by
means of one diseased body
communicating it to another ;
the contaminated air may have
enlarged its limits—a particu-

20 THE ORIGIN, &c.
frequent and most numerous
offspring of the marsh exhala-
tion, are contagious. Of this
there are many proofs in prac-
tical authors. Bianchi de-
scribes an intermittent which
was highly contagious at Wol-
fenbuttle in the year 1666.
Dr. Clark mentions a number
of cases in which this mild spe-
cies of fever was propagated
by contagion.
Dr. Cleghorn has established
The contagious nature of inter-
mittens by many facts. Af-
ter mentioning numerous in-
stances of their having spread
in this way, he says “ These
tertians have as good a right to
be called contagious as the mea-
sles, small-pox, or any other
disease.” &c. Vol. 3, p. 160.
lar direction of the wind may
have conveyed the bad air to
the ship. Its happening poste-
riorly to a communication with
the diseased, is no argument,
except at the same time it be
proved that this crew was with
out the controul of the ill-con-
ditioned air. Marsh and vege-
table effluvia smite at the dis-
tance of miles, this no physici-
an doubts.
“ These diseases (speaking
of intermittents) make their
first appearance in February
and August particularly ; tho’
sometimes they appear sooner
or later, according as the air is
more or less disposed to pro-
duce them, which, of course
renders them more or less epi-
demic. “ P. 51, Dr. Sydenham.
A question of importance and magnitude here
emerges and invites our atrention ; it may serve
to awaken a little our judgments and elucidate the
present stage of the business. Why is it that the
intermittent fever has never clothed itself in its con-
tagious habiliment in America. It is rather pro-
blematical that it has ever done more mischief, or
been more common and violent in any other coun-
try than in America. Here is a mystery equally 
dark on all sides ; how are we to decipher the
enigma ? 
" Intermittentes.
Febres,miasmate paludum ortœ, paroxysmis plu-
ribus, apyrexia, saltem remissione evidente inter-
posita, cum exacerbatione notabili, et plerumque 
cum horrore redeuntibus, constantes : paroxysmo
quovis die unico tantum." Dr. Cullen, Tom. 2,
Synop.
Dr. Cullen, the luminary of the medical world, 
has been careful to inform us, that he has never

THE ORIGIN, &c. 21
met with contagious diseases arising from vegetable
putrefaction.
Sydenham, stiled by Dr. Rush, " the incompa-
rable physician," positively asserts that an inter-
mittent becomes epidemick from the air, and not
by contagion. Dr. Jackson says that the intermit-
tents and remittents become epidemick and spread
by the marsh miasma being diffused through the
atmosphere, and not by contagion (vide Jackson on
the diseases of America). Dr. Gilchrist mentions
in his tracts on sea voyages, that the marsh effluvia
being scattered through the air becomes the source
of popular diseases. That diseases, slowing from
marsh miasmata, are incapable of becoming conta-
gious has been considered, by the generality of phy-
sicians, as a fact almost self-evident. And I be-
lieve that few will long hesitate to determine be-
tween the authority of Sydenham and Cleghorn.
The unscientifick notion of intermittents and re-
mittent bilious fevers being contagious, is too ridi-
culous to find access even to the easy credulity of
the unread peasant : but yet it is embraced by phi-
losophick refinement. And what absurdity, though
ever so enormous, has net at one time or another
offended the dignified pride of delicate philosophy ?
organized absurdities, have long conspired against
the progress of science, and tyranized over the
tender germes of juster systems.
Endemick is the antithesis of contagious. En-
demick and contagious establish two opposite ca-
tegories.
Contagion is the emission, from body to body,
by which diseases are communicated. A contagi-
ous disease arises originally from human effluvia,
can be carried, by means of the infected bodies, or
cloths, from country to country, from city to city,
from town to town, in fine from any one place to
another ; The yellow fever has not its birth from

22 THE ORIGIN, &c.
human effluvia, cannot be spread, by means of dis-
eased bodies, or wearing apparel, or bed-cloaths,
from country to country, from city to city, from
town to town, nor from one place to another—the
yellow fever therefore is not contagious.
Either an endemick or contagious disease, be-
coming general, and affecting a whole country, or
great extent of territory, claims, in technical lan-
guage, the appellation of epidemick. It is not
whether a disease arises from vegetable or human
effluvia, but whether it has a general or universal
action, that constitutes an epidemick. It is the uni-
versality of its action, and not the nature of the
source whence it sprang, that stamps its character ;
whence two classes of epidemicks—the endemial
epidemick, and the contagious epidemick. The
yellow fever ranges under the former, the plague
under the latter.
Doctor Ruth.
“ It has been remarked that
this fever did not spread in the
country, when carried there by
persons who were infected, and
who afterwards died with it.
This I conceive was occasioned,
in part by the contagion being
deprived of the aid of miasma-
ta from the putrid matter which
first produced it in the city,
and in part by its being diluted,
and thereby being weakened
by the pure air of the country.
During four times in which it
prevailed in Charleston, in no
one instance, according to Dr.
Lining, was it propagated in
any other part of the state.”
Vol. 3, page 157.
The Author.
When the intercourse of bo-
dies, labouring under a fever,
cannot, without adventitious
auxiliary, support and multiply
the said fever, the fever is not
contagious ; the yellow fever
cannot simply and without the
addition of the effluvia arising
from vegetable putrefaction
support and multiply itself, the
yellow fever therefore is not
contagious.
A little attention to the nature and operation of
the small-pox, measles, or jail-fever, when con-
veyed into the purest atmosphere, will, in some
measure, obviate the difficulty which obscures the

THE ORIGIN, &c. 23
above fact in relation to the yellow fever. It is
found upon experiment, that, uniformly the small-
pox, measles, or jail-fever require nothing more
than their own presence and virulence to perpetu-
ate themselves. This is luculently apparent from
the many melancholy instances of whole families
being precipitated to their graves by the unfortu-
nate introduction of servants, purchased from on
board ships, infected with the typhus or jail-fever.
Out of fifty persons, who might visit a patient la-
bouring under the latter stage of the small-pox or
measles, forty-nine, in all probability will be in
fected. I have selected those diseases, as they are
common and known to every body.
In these diseases, which are essentially and abso-
lutely contagious, no heterogeneous aid is necessa-
ry ; in the yellow fever the addition of the marsh
miasmata seems to be the fine qua non, in mul-
tiplying and propagating the complaint, and the
efficient, occasional cause of its rise, independently
of any assistance from bodies : and without the
help of this miasmata, the bodies cannot generate
nor spread the disease ; hence it appears that the
miasma produces the disease whenever and where
ver it may occur, and not the bodies labouring un-
der the complaint.
It is not my expectation to turn, upon the axis
of a syllogism, the whole esculapian world—preju-
dice may for a time barr the understandings, but
time and accident will eventually unlock the judg-
ments of men.
Doctor Rush.
" Let it not be inferred from
the enumeration of the means
of preventing the contagion of
this fever, that I admit a con-
tagious nature to be one of its
characteristick marks. Far
from it. It is an accidental
circumstance produced chiefly
The Author.
A disease which is not es-
sentially, and in its own nature
contagious, is not, in strict pro-
priety, contagious at all—the
yellow fever is not essentially
and in its nature contagious—
the yellow fever is therefore
not contagious at all. A dis-

24 THE ORIGIN, &c.
by the concurrence of the wea-
ther." And on the same page.
" It is in no instance contagi-
ous in some cases." Vol. 4,
page 61.
ease which does not embrace
and infold, in its very nature,
radical, and inherent contagion
naturally repudiates the idea
of contagion. Fire, elementa-
rily, contains heat; and light 
is, intrinsically, luminous. 
If the vegetable effluvia does and can, of itself,
produce, perpetuate, and multiply the yellow fe-
ver : and if the human effluvia cannot and does not
in any instance, of itself, produce, perpetuate, and
multiply this fever, upon their fortuitous union ;
which is it that effects the mischief ? The utmost
precipitancy cannot endanger a decision.
The bodies diseased certainly produce an effluvia,
which, by disturbing directly or indirectly the
bowels, stomach, or sensorium commune, may de-
stroy the equipoise of the animal system, and thus
prove an exciting cause, in like manner with drunk-
enness or night-exposure ; hence the aptitude of
those who have to nurse, and wait on the sick, to
be diseased. This is not by receiving it by way of
contagion : but under those circumstances the
equilibrium of the body is destroyed, the œconomy
is disarranged, the vigour is unnerved, and an ad-
vantage is afforded the miasma to bring itself, with
all its lethiferous appendages, into existance.
The government of a country is called good or
bad, according to its nature ; the best government
becomes hateful and detestable from bad administration
; but the administration is not physically
consecutive of the government. In this instance
we are to depose our minister, not change our ci-
vil system. Thus if we remove the patient, in the
yellow fever, from the inquinated atmosphere, he
is no longer dangerous or hurtful to the attendants.
Christology, the substratum of hope and life, has
become hostile to the peace and safety of nations

THE ORIGIN, &c. 25
by its administration, not by its nature, its essence
is immortality and quiet.
Many things, in their nature, elude the most vi-
gorous effort of the human intellect, and tantalize
the grasp of genius itself. They present to us their
modes, qualities, and effects ; these, operated on
by the medium of the senses, advertise us of their
respective substrata. It is from the effects of hu-
man, and marsh effluvia, that we can have any clue
to the secret of their nature. Like causes will al-
ways produce like effects, provided they operate
upon the same order of patients. The human ef-
fluvia establishes one order of diseases, the marsh
effluvia another, these orders never embrace—they
have no intercourse. Of these identity forms the
curve, and those effluvia the asymptotes, they appa-
rently approximate, but they can never come into
contact. The human effluvia can never produce
the remittent bilious or yellow fever, nor can the
marsh effluvia ever give origin to the typhus or jail
fever.
Is it good logick, that a fever can arise from one
source to-day, and from another, diametrically and
physically opposite, to-morrow ? This is certainly
at variance with common ratiocination. Yet this
must come to pass, if the yellow fever, originally,
has its birth from vegetable putrefaction, and is af-
terwards perpetuated by contagion. Some have
asserted that heat and cold, though different, pro-
duce the same effects. Cold is a relative term—it
has no absolute existence—and that which has not
an absolute existence cannot possess a positive ac-
tion.
Sir Isaac Newton, who was a man of no humble
genius, is of the opinion, that it is incompatible
with the principle of philosophizing, in the expli-
D

26 THE ORIGIN, &c.
cation of any phenomenon, to adduce more causes
than are absolutely necessary for its solution.
After the above theoretical endeavour, we shall
direct our attention, a little, to the authority of ob-
servation, and minute inquiry, of some of the most
respectable writers and practitioners.
It is an unquestionable verity, a verity of the most
publick notoriety, that not one, of the very great
numbers who have left the cities and towns, some
of whom have died and some have recovered, has
communicated the yellow fever to those who have
attended. Not one solitary fact has ever reached
me ; and my scepticism is such as to lead me into
a persuasion, that there has not existed one unequi-
vocal, well analyzed fact of a patient, going to the
country, and there multiplying this fever.
" It affects the inhabitants of cities, and not of
the country, as in Charleston in the year 1732,
1739, 1745 and 1748. And in Philadelphia in
the year 1793.” That is, it could not be propa-
gated, by the diseased bodies, in the country. But
that it can affect inhabitants of the country and al-
so originate in the country is fully teneble. I know
that my opinions here, as in other parts of this es-
say, are the antipodes of those generally received.
But while I have facts, and those of the most stern
and inflexible nature, I shall not be over solicitous
about received whims whether popular or medical.
On the Potowmac Bottoms, and along the Mo-
nokocy, I have seen the most unequivocal cases.
It is also, from the very respectable authority of
Dr. Watkins, very common in different parts of
Kentucky. Dr. Watkins was in Baltimore during
the prevalence of the fever this autumn, and, with
me, waited on the sick. He, after being provided
of all necessary requisites to form an opinion, de-
clared it to be precisely similar to that of Kentucky.
He farther observed that the fever in that state fre-

THE ORIGIN, &c. 27 
quently was attended by the black vomiting &c.
He said that it was considered there as an ende-
mick arising from the marines, and in no instances
contagious. 
It is true that Dr. Rush mentions an instance of
this fever spreading in the country ; but we want
graver authority than inaugural theses afford. The-
ses, we all know, generally, are nothing but the
echo of the prelections of a preceptor.
In the flourishing and growing city of Baltimore,
we have had the most stubborn, and irrefragable
proofs, of the yellow fever being incapable of sup-
porting itself, in the cases which have occured about
the wharves and Fell's Point ; after those cases
were removed up into the city, they had their vi-
rulence to die with them, those who died ; and
from those, who recovered, all mischief and sup-
posed contagion evanesced into the empty air,
which bore it to the pages of medical writers, not
to the bodies of healthy attendants. This was the
result in 1794 and 1797.
The unfortunate case, of the very respectable
Dr. E. Johnson, with several cotemporary inci-
dents, afforded a short-lived triumph to those who
were wedded to the contagious system ; but when
their opinions, armed with all the address and sub-
tlety of the authors, came in coIlision, with those of
more erect and manly aspect, they felt their vacil-
lating uncertainty, and ceded in candid contest.
Which is most consonant with probability, for
gentlemen, going to an atmosphere, charged with
poison and death, an atmosphere immediately waft-
ed from the Point and concentrated under a hill,
where many had been forced, by its deathful influ-
ence, to pals the bourn of life, and others to per-
ceive death, with its black wings, to hover about
them, to take it from those exanimous and mori-
bund bodies or this death-bringing air ? Taking

28 THE ORIGIN, &c.
into view, at the same time, the fact, that none of
those gentlemen, several of whom died up in the ci-
ty, communicated, to any of their families or at
tendants, the disease.
Some even point out the luckless moment, in
which the relentless malady seized them—at a
particular juncture, I perceived something singular-
ly offensive—in three hours after that inauspicious
point of time, I became unwel : another was tak-
en ill a day or two posteriorly to some ill-omened
hour, in which the breath of the patient was breath-
ed directly into his face, it was then he inhaled,
with the pabulum of life, the fermenting leaven of
death. Who, after these and such like melancho-
ly tales, can hesitate to believe the yellow fever
contagious ?
I would no longer quarrel the sentiment of con-
tagion, had one of the above occurrences taken
place, in people, who were not. at the time of the
imagined infection, in an impure atmosphere, or
had not lately been exposed to air impregnated with
the destructive miasmata. The fact is, those per-
sons were all in this ill-conditioned air. I met with
two cases, in two young men who had been at the
Point at the same time, and were both attacked, on
the same day, with all the regular symptoms of
the fever, where the miasmata did not come into
action until the eighteenth day—they were not,
during the intermediate space, exposed to either
sick bodies, or vegetable effluvia, having been in
the country the whole time.
Whatever affects most our senses, we are prone
to attribute our evils to : This is excusable in men
unaccustomed to thought, but it is an incongruity
in the common order of reasoning, and is at total
variance with the notions of men of letters.
Logomachy is as inconsonant with my habits, as
any two opposites in nature are inconsistent with

THE ORIGIN, &c. 29
each other ; but I do not consider a war of sentiments
fraught with mischief or good, a colluctation of
principles, tending either to support or destroy the
commerce of a nation, as the idle jar of words.
It is no new act for men to force the most opposite
and contending principles into the most cruel and
unnatural union. Tradition, let it militate ever
so much with common sense ; and an association
of ideas, bearing no affinity nor cognation to each
other, press us, too frequently, into most absurd
beliefs and habits of thinking. I might here cause
to pass in review before the reader's mind the great
Lavater's philosophy of faces, that finished and po-
lished physiognomy of folly. And where is a phi-
losopher, bathing a few, who does not stuff his
works with the infinite divisibility of matter ? who
has dared to quarrel the corollary, of the great
Locke, that the human mind is, at first, as a blank
sheet of paper, passive to the characters of chance ?
and where are the friends of David Hume, who do
not, to this day, believe, that, if an ass were placed
between two cocks of hay, which impressed equally,
he would starve, being unable to make a choice ?
It is a good hint, that we should tread lightly on
the ashes of the dead ; I feel its influence, and may
David rest in peace, and his errors sleep in eternal
silence.
Now were I to plunge into the vacuum of meta-
Physicks, or enter the lists in the gipsy-jargon of
pneumatology ; I should believe, with the peerless
Reid of Glasgow, that the human mind possessed,
inherently, action, vigour and choice ; that it ope-
rated upon surrounding objects, and was not the
passive sport of incidental impression. Whence
comes genius, the innate perspicacity of the hu-
man intellect ; genius, that heavenly offspring, at
all times impatient of the trammels of control, and
indifferent to the habits of education ? not from

30 THE ORIGIN, &c.
the impressions of the beauties of Thompson, nor
the more sublime of Homer. It is in-born. Did
the mountains of Switzerland, give exertion to the
mind of a Haller, or the banks of the Potowmac,
infuse divinity into a Washington ? that encyclope-
dia of virtue and greatness, in whom may be found
every ornament of human excellence ; into him
who first boldly dared, to rend asunder the strong
ligaments of prejudice, to control the imperious tide
of ancient usage ; who magnanimously despised
the boisterous torrent of vulgar obloquy, and chal-
lenged the herald of recording time ? Collateral
arguments are, frequently, as relevant as those a-
rising immediately from the subject.
This apparent digression is to shew, that no name
is above truth, that our care and solicitude should
be the investigation and conservation of truth, not
the support and protection of names and traditions.
Doctor Rush.
" An aptitude or predispo-
sition from season, climate or
constitution must concur to ren-
der the contagion of this, as
well as other malignant fevers,
sufficiently active to produce
disease; as well might a travel-
ler attempt to describe the cli-
mate of a new country, from
the history of single season,
as a physician to fix the charac-
ter of an epidemic from its ap-
pearance in one season, or one
country." Vol. 4, page 62.
The Author.
" The one (the yellow fever)
is evidently caused by marsh
effluvia heat, violent exercise
in that heat, thick, hot, moist
atmosphere ; night air and
dews, and the abuse of spiritous
liquors. The other (the boul-
lam fever) on the contrary, is
caused by contagion alone.
This is certainly the most re
markable difference ; and con-
stitutes an obvious, clear, and
indisputable diagnosis." Chis-
holm, page 147.
" But I never could observe any one instance
where I could say that one person was infected by,
or received the fever from, another person who
had it." Hillary, page 145.
Dr. Jackson calls the yellow fever of Jamaica
an endemick, and no where mentions its being
contagious ; who also is of the opinion that most

THE ORIGIN, &c. 31
epidemicks spread by means of the marsh effluvia,
and not by contagion.
Dr. Mosely stiles it (the yellow fever) an ende-
mial causus, page 391. And ridicules the idea of
its being malignant, pestilential, and contagious,
as asserted by Dr. Warren, page 412. Dr. War-
ren, as Mosely justly observes, had scarce any idea
of this fever at all, except in its description.
Towne calls it febris ardens biliosa, but does not
add contagiosa, and asserts it to be an endemick of
the West-Indies.
That it appeared, at Barbadoes, anterior to the
time (1725) fixed by Dr. Warren is evident from
Dr. Gamble, who well remembered it to be very
fatal, in the island, in the year 1691. That War-
ren's account of the disease is altogether fabulous
is certain ; this man, wrapt in hypothetical chaos,
constantly erred.
Pouppé Desportes speaking of the la maladie de
Siam, says ; ” la régularité avec laquelle elle se re-
produit, semble devoir la faire regarder comme une
de ces maladies dont il faut chercher la cause dans
la constitution de l'air." Page 191, Tom. I.
Dr. Cullen supposed this disease to arise from
human effluvia and therefore, placing it under the
section of contagious diseases, called it typhus Icte-
rodes—but it is certain Dr. Cullen never saw the
disease, and equally certain that he borrowed his
idea from Dr. Warren—Dr. Cullen is consequent-
ly neuter on the present business.
As well might you say, that a skilful gardener
could make a tree flourish in a foil unnatural to its
growth, as physicians ingraft contagion on marsh
exhalations.
In the almost endless chain of cases, wherein the
clothes of those who have died, in the West-Indies,
from the yellow fever, were brought to America,
could contagion be explored but in one instance,

32 THE ORIGIN, &c.
even by the sagacious industry of the indefatigable
Rush. A gentleman's clothes being returned in
a trunk to his friends ; a young gentleman, upon
opening the trunk, became immediately unwel,
but no other person suffered in the least. Those
clothes, beyond a question, were damp, this damp-
ness was by heat converted into effluvia, corres-
ponding in every particular with marsh miasmata.
This effluvia, from the closeness of the trunk not
being able to escape, remained in its offensive and
concentrated state : And, upon the trunk being
opened, applied itself in its full force to the excit-
able system of the young man. In this manner,
from the water in the clothes being changed into
marsh effluvia, and not from the clothes acting as
the vehicle of the human effluvia, was this gentle
man diseased. Now if the supposed contagion was
so very vivacious as to perpetuate itself after so
long a lapse of time, how is it that the recent ema-
nations from his body treated with such great ten-
ederness the attending friends, as not to interfere in
the smallest degree with their healths ?
The idea of contagion is indirectly injurious to
commerce, and directly to society. Under the
influence of the persuasion, that there is one of the
most violent of contagious diseases prevailing in se-
veral of the sea-ports of America, can we suppose
that foreign ports will fuller our vessels to enter ?
A long and dangerous quarantine must be perform-
ed ; the damages, accruing from such remora, the
merchants too sensibly feel to be ignorant of. Even
when our papers do not echo the melancholy tid-
ings ; seeing that such disease has frequently visited
our cities, is it not probable that they will guaran-
tee, their own safety, by prohibiting the entrance
of our vessels ? will they not naturally say ? the
Americans have seen their error in rendering pub-
lick their diseases—their silence is a piece of policy

THE ORIGIN, &c. 33
—the diseases exist. Interest, the main spring of
human action, forbids their publicity.
From slender causes great events come to pass.
Few could have supposed that the interest France
took in the American struggle would have laid the
corner stone of her ruin and overthrow ?—The go-
vernment I speak of. Athens was ruined solely
by Pericles giving countenance and support to a
despicable tribe of stage-actors. Upon a slender
pivot play weighty matters.
Our extraneous interruptions are not the only
inconveniences we labour under, domestic com-
merce is subject to arrestation, a general calm and
stagnation in business enfeebles our ascent.
Has it ever been known that the yellow fever
has been propagated, through Baltimore, or any
other city, from a person bringing from Philadel-
phia this malady, even in instances where it has
proven fatal ? The archives of America will never
notice such a fact.
Do not our grave proclamations, and serious re-
solves of city-corporations challenge our astonish-
ment ? what are these proclamations and resolves
for ? to prevent, what, from the earliest dawn of
lapsing ages has never, and to the latest eve of ex-
piring time will never, come to pass. Our interest
and commerce fall a sacrifice, and are immolat-
ed at the shrine of our folly. As long as my re-
miniscence will afford me a knowledge of the pro
ceedings of the health-committee of the city of
Baltimore, I shall admire and esteem their judg-
ment and good sense. Has the yellow fever ever
been imported, from the West-Indies to America ?
report says it has, but where are proofs ? smothered
in murky obscurity ; they fly the face and converse
of investigation. Has this fever ever been carried
from the Weft-Indies to Britain ? No.
E

34 THE ORIGIN, &c.
The poor unfortunate subjects of disease, flying
from the cities, find the doors and windows of the
country barred against them. The children leave
their parents to die, and parents their children,
their minds being jostled by the found of contagi-
on, from their proper feats. The lonely hearse
solemnly conveys the dead to the dreary repository
of the silent multitude, where reigns
and death. Having considered the history and
nature of the yellow fever, we make a natural
transition to its symptoms, first premising a few
pages on the proximate cause.

CHAPTER II.
PROXIMATE CAUSE ANALYZED.
THE fabrick of the pathology of diseases, has for
more than two thousand years floated on the vary-
ing ocean of incertitude, the sport of winds and
tide. When the microscopick eye traverses the
hemisphere of medicine, it beholds theories hurled
on theories, fancies crushed by fancies, and lesser
errors smothered by those of greater bulk and ef-
frontery. From the auspicious days of Hippo-
crates, we gently glide down the silent tide of time,
collecting as we move the crazy wrecks of shatter-
ed systems, until we arrive at the fluctuating vari-
ety of modern hypotheses. Hippocrates, wrapt up
in the flattering pretensions of his humoral patho-
logy, and balancing between heat and bile, a long
time swayed the sceptre of the medical world.
From an attentive perusal of this author's works,
heat or bile, or plethora or obstruction (for in dif-
ferent passages he speaks of all these) seem to con-
stitute the proximate cause of fever. His success-
sors soon perceived the futility of this foundation,
and attempted to fabricate others more probable.
Diodes of Carystus, a physician who flourished
at an early period, and a man of considerable emi-
nence, asserted that fever was not so much a prima-
ry disease, as secondary and dependent on some
more hidden derangement. In order to avoid the
force of his doctrine, after physicians established
the diversity of symptomatick and idiopathick fe-
vers. Presently after Diocles, Erasistratus, a phy-
sician at the court of Antigonus, invited the atten-
tion of the world, his proximate cause resided in

36 PROXIMATE CAUSE ANALYZED.
an error loci. Next Asclepiades, the Bythinian,
stepped on the stage and rudely grasped the reins of
control ; he, adopting the doctrine of atoms, hand-
ed to the Greeks by Democritus of Abdera, at-
tempts to account for the difference of types by a
difference in the size of the corpuscles, which he
supposed to be formed by a combination of indivi-
sible atoms. Here emerges the doctrine of the ob-
struction of the permiable canals of the body, and
its consequence modern viscidity and lentor, so fa-
mous in the schools. Asclepiades was the father
and patron of the sect of the Methodicks.
Themison vibrated between strictun et laxum,
and on those two pillars reared his pathology of
diseases, here are the first traces of spasm, after-
wards laboured by Hoffman and matured by the
great Cullen : this hypothesis claimed the ascen-
dency, at Rome, for more than an hundred years.
At last Galen, the impassioned admirer of Hippo-
crates, exhumed and reanimated the humoral er-
rors.
Athenœus ventured to resuscitate the doctrine
of the putrescency of the blood (this is compre-
hended in the writings of earlier authors) and pu-
trescency has not made a very despicable figure in
the world. Avicenna expressly defines fevers to
arise from a preturnatural heat of the heart.
The Galenists prevailed until the beginning of
the sixteenth century ; about which time Aureolus
Phillippus Theophrastus, commonly known by the
name of Paracelsus, began to make a figure. This
man assailed the Galenical party with all the en-
gines of effrontery and sources of unimproved chy-
mistry. Here commences the period of medical
romance, so fraught with the struggles between the
mechanical and chymical modes of reasoning, these
eventually neutralized, and ushered in the chymi-
co-mechanical philosophy.

PROXIMATE CAUSE ANALYZED. 37
The furious archeus of Van Helmont, different-
ly modified, is the efforts of nature, so celebrated
by Campanella and Sydenham, and autocrateia
of Stahl. If we except Mundy, Borelli and Cole
are the only writers previous to the time of Hoff-
man, who considered the nervous system as direct-
ly affording a seat for the proximate cause of
fevers : Here in more positive terms originates
the spasmodick stricture. This idea of Hoffman,
Cullen has elaborated to its utmost perfection.
Who has taken the proximate cause from the heart,
and fixed it on the superficies of the body, in an
atony and spasm of the capillaries.
After the above recital the mind is restless, on
the poignant tenters of expectation, to embrace
a knowledge of the true nature and seat of the
proximate cause. I shall, leaving the anterior
whims to slumber with their authors, they being,
by one obliterating stroke of the pen of Dr. Rush,
sentenced to perpetual silence, take the liberty of
putting the opinion of the celebrated Philadelphia
Professor into the crucible of analitical inquiry.
The opinion of Doctor Rush is the latest that I
have met with in the writings of physicians. His
words are " having premised these general pro-
positions, I go on to remark, that a fever (when
not misplaced) consists in a morbid excitement
and irregular action in the blood-vessels, more es-
pecially in the arteries." " This irregular action
is in other words, a convulsion in the sanguiferous,
but more obviously, in the arterial system." Page
134. Vol. 4. " From the facts and analogies
which have been mentioned, I have been led to
believe that irregular action or a convulsion in the
blood-vessels, is the proximate cause of fever."
Pag. 139. Vol. 4.
There incontrovertably is a difference between
a fever and the proximate cause of a fever: a fever

38 PROXIMATE CAUSE ANALYZED.
cannot consist in, or be made up of (these are
synonimous) a convulsion in the blood-vessels, and
a convulsion in the blood-vessels be the proximate
cause of a fever. An effect and the cause of that
effect cannot be the same. If the fever consists
in, or is made up of, an irregular action or con-
vulsion of the blood-vessel, what is the proximate
cause ? and vice versa. It is illogical to identify
cause and effect.
The proximate cause, of which writers say qud
presens facit, sublata tollit, mutata mutat, after
being hunted from one part of the body to another,
and metamorphosed from one thing into another,
at last takes refuge in nullibiety ; having for its
associates Phlogiston* and the four elements ; †
and an honourable body they form, each having
enjoyed its apotheosis.
In a disease there are three essential causes. The
predisposing, or an aptitude of the body to be
acted on ; the occasional, which acts directly or
indirectly on the seat of life and action, and the
exciting, or that which destroys the equilibrium
of the nervous energy, and by this destruction of
the equipoise of the system gives the occasional
cause an opportunity of victory. The causation
or modus operandi which takes place between the
occasional cause and the living principle is not ac-
cessable even to the most vigorous efforts of the hu-
man mind.
An offending entity (the occasional cause) assails
the tranquility of the healthy body, a particular,
though inscrutable, infraction of the harmony of
* That accommodating nonentity of Stahl, which so much
and so long amused and eluded, one while under the form of
fixed fire, now in the shape of fixed light, and anon in the
investiture of the metallizing principle, the uncertain grasps of
infant philosophy.
† Those four perepatetick follies which for so many hundred
years disgraced the human understanding.

PROXIMATE CAUSE ANALYZED. 39
the animal œconomy is caused, evidencing itself by
a chain of symptoms more or less unequivocal ;
these constitute the symptomata of writers, that (the
primary derangement or infraction) the disease ;
here we observe a regular and simple concatenation
of cause and effect, and the evidences of such an
effect. We cannot apply the name of disease to
an arrangement of symptoms, no more than we
can the appellation of matter to an assemblage of
qualities, or the epithet of spirit to a combination
of modes, but to that particularly morbid state of
the body giving origin to such an arrangement of
symptoms.
Chills, fever, pain, prostration of strength, dis-
colouration of the tongue, &c. are symptomatick
of a hidden and essential derangement (a disease)
of the nervous power. Figure, divisibility, exten-
sion, and solidity are indicative of an inscrutable
material substratum. Passion, memory, and judg-
ment are proofs of an immaterial essence (asking
Dr. Priestley's pardon) the nature of which the
labour of the human mind cannot develop.
The cherishing beams of philosophy have begun
to dawn, and I hope soon will enable us to proceed
with more certain step in the healing art. It is
time that we should divorce from our minds the pi-
titio principii, and, like Pyrrho, disrobe ourselves
of credulous facility. This epoch demands self-
evident premises or proven data for the ground-
work of our inductions. Jurare in verba magistri
is the motto of unthinking hebetude, but a master's
nod ought not to block up the avenues of research.

CHAPTER III.
DIAGNOSIS.
THAT assemblage of symptoms, which general-
ly are the appendages of any disease, and establish
a barrier of division between it and all others, con-
statute its pathognomonicks or diagnosticks. The
general characteristics, which disjoin the yellow fe-
ver from all others, are the following,
Its precursers are, in some instances, a prostration
of spirits and an inaptitude to motion, a sense of
uneasiness and great fatigue ; pain and uneasiness
through the limbs, as if from riding. It some
times, without any premonition, impugns the
guardians of life. It will in one instance assume
the dress of the tertian, and in others clothe itself
in all the characters of a cold. But let what will
be its harbingers, it soon hangs out its own colours,
and demands a tribute. The eyes become more
or less affected by inflammation, accompanied with
an acrimonious or burning epiphora; the head
feels itself molested by pain and giddiness, and a
sense of congestion ; the tongue is indifferently
white, yellow, blue, red, brown or black ; in the
first days of the disease it has an oily feel. A py-
rexia attends ; the skin is one while hot and dry,
at other times preturnaturally cold and clammy.
The præcordia is much oppressed, attended by a
great inclination to vomit. Vomiting not unfrequently,
or a cholera morbus or a diarrhœa gives
notice of the approaching calamity. The stomach
in the latter stages of the disease labours under a
sensation of having in it something which it cannot

DIAGNOSIS. 41
digest ; this sensation they attribute to whatever
they have swallowed : A flatulency and hiccough
help to fill up the train of evils. There is pretty
uniformly a paucity of urine, and what is voided
is very high coloured. A black vomiting or purg-
ing, hemorrhages from every part of the body,
especially the stomach, uterus, bowels, nostrils,
and the incisions made by the lancet in bleeding ;
carbuncles and numerous little boils, more or less,
act their part in this tragical scene ; the black
matter and hemorrhages seldom appear until after
the fourth or fifth day ; yet they sometimes occur
earlier. The countenance has a peculiarly feroci-
ous look. The eyes are with the redness, tinged
with a croceous colour ; this yellowness frequently
diffuses itself through the whole superficies of the
body.
There is in some cases, about the fifth or sixth
day, a cessation of the fever, and all the violent
symptoms, every thing becomes apparently favour-
able, and the physician will augur auspiciously ;
but this is a mournful circumstance ; it is the
powers of life ceding, and not a relaxation of
the disease ; especially if yellowness and hemorr-
hages co-exist. There is frequently a metastasis
to the testicles.
In puking the patient some times throws up
nothing but what is taken into the stomach render-
ed a little ropy, at other times a black liquid re-
sembling a mixture of foot and water is ejected.
The blood when abstracted is seldom covered
with a buffy coat, but generally is what we call,
a dense, red blood ; it rarely is dissolved. An
obmutescence, and deafness are among the last
marks of an approching dissolution, they are truly
prophetic of death. The sensibility of the sur-
face of the body is exceedingly morbid ; and on
F

42 DIAGNOSIS.
the least touch communicates uneasiness ; this
preturnatural excitability I have met with in a sur-
prising degree.
Not unusually a considerable degree of delirium
accompanies this most prominent in the black
catalogue of human ills. Perhaps there is no
complaint, from the effect of which patients are
so long convalescing. Small purple spots very
often variegate the arms, breast, and neck ; they
are ominous of peril.
By the dissection of defunct bodies, we get a
view of the dreadful ravages of this relentless
malady : We behold the stomach disfigured with
sphacelated spots, and characters of inflammation.
The liver swollen, and exhibiting every mark of
phlegmasia : The spleen preturnaturally flaccid :
The gall-bladder turgid with black and acrid bill ;
the whole of the primæ viæ, when a natural diarr-
hœa co-operates, is manifestly affected with erysi-
pelatous inflammation, which by the way is the
species of inflammation that attacks the stomach,
and this, probably, is reason why the blood,
when abstracted, is not sizy ; were it of the
phlegmonoid species the size on the blood would
uniformly appear ; in some cases this species of
inflammation does attend, and in those the pleuri-
tic coat, cæteris paribus, proclaims its presence.
The erysipelatous species is generally too rapid in
its progress to mortification to communicate the
buff to the general mass of blood. That the
buffy coat is an inseparable and infallible sign of
inflammation, when accompanied by fever, and
vice versa : See the experience of the most en-
lightened and assiduous practicioners ; also the
professors of Edinburgh ; under whose wings,
were folly and ignorance to deluge creation, learn
ing and science would find shelter.
The lungs not unfrequently show marks of

DIAGNOSIS. 43
inflammation. The encephalon is pretty uniform-
ly implicated in the testimony of the general des-
truction occasioned by the yellow fever operating
on the animal frame : Its meninges are found
inflamed, the cortical and medullary substance itself
is unusually red.*
This disease attacks sometimes with such violence
and ferocity, as, either from its force or the feeble-
ness of the patients, to supersede, by death, most
of the above-mentioned appearances.
The black vomiting, hemorrhages, cerebral
affections, yellowness of the eyes and skin, pur-
ple spots, and pyrexia being the most conspicuous
and inseparable diagnosticks of the complaint,
merit more seriously our particular discussion.
The bile, in its natural and healthy state, is as
bland and mild as any secretion in the human
body, but when the liver is affected by any specifick
action, its secretory function, like similar physiolo-
gical processes, is subject to vitiation ; and that
this black matter, discharged indifferently upwards
or downwards, is vitiated bile, depending on a
morbid action in the secretory organ, is obvious.
1. From the great quantity which is found upon
dissection, in the gall-bladder. 2. From its great
acridity. * 3. From its analogy to other disorder-
ed secretions : For instance that of the kidney in
diabetes, of the stomach in dispepsy, of a sore
when it becomes, as we generally phrase it, vitiat-
ed. Laudable pus is a secretion, so is the acrimo-
ny escaping from a vitiated, a cancerous, or a
scrofulous ulcer. The atrabilis of the ancients
perfectly accords with the black vomiting of the
moderns. Some physicians have persuaded them-
selves that this black matter is owing to an admix-
ture of blood, and that there is an absolute want
of secretion in the yellow fever ; this opinion, I
* Vide Pouppé Desportes, Hillary, Mosely, Rush, &c. &c.

44 DIAGNOSIS.
must believe, has a more intimate affinity with
prejudice, than with reflection.
Hemorrhages seldom overtake the patient in
the early stage of the disease, except under the
form of epistaxis, which is not commonly consi-
derable. When they do occur, they are the
indubitable evidence of an atony or paralysis of
the blood-vessels and this atony in its turn depends
on a destroyed vigour of the nervous power ; this
destruction of the nervous influence is effectuated
by the peccant agency operating directly and im-
mediately on the sensorium commune. It is the
result of a violent action on the immediate seat of
life, and not of the vascular, or arterial system ;
the blood-vessels can only be acted on secondarily.
If we could timously diminish the quantity of the
hostile entity, we should infallibly prevent those
sanguineous fluxes. Moderate blood-letting, by
lessening the volume of the blood, will also con-
tribute considerably to that end ; but too profuse
bleedings, by robbing the system of its sources of
recovery from so violent a shock, precipitate the
unhappy sufferer to his grave. That a violent
action on, and not a smothered or incontrolable
exertion of the system, lays the foundation of
those hemorrhages, is patent. 1. As they do
not accompany phrenitis or pneumonia where the
vascular exertion is much more fierce, coercive,
and oppressed. 2. Blood-letting after the second
or third time, except in particular habits, when it
is pretty copious, so far from relieving the imagi-
nably oppressed pulse, rather renders it more feeble
and yielding. 3. In the most violent attacks,
where there exists the greatest degree of indirect
debility, the propriety and safety of immoderate
phlebotomy are in the inverse ratio of this indirect
debility. I speak from my own experience, and
that of Hillary, and Pouppé Desportes who carried

DIAGNOSIS. 45
the lancet to its greatest extremes ; and possessed
the most ample opportunities of seeing its advan-
tages and disadvantages ; not for one season only
but for fifteen or twenty years, during which time
he practiced in the West-Indies ; as also of several
of the most respectable physicians in the city of
Baltimore. Lastly hemorrhages are more apt to
occur in those who have been copiously, than in
those who have been moderately bled ; provided
untimely death, superinduced by those large eva-
cuations, does not obviate them. So is mortifica-
tion about the orifices made by the lancet. Pouppé
Desportes, speaking of those hemorrhages, and
mortification, remarks ; " Dans plusieurs les
saignées se rouvient, et le sang, malgré le nombre
des compresses, pénetre, cette hémorragie est
souvent accompanée d'une gangrene charbonnée,
qui se forme autour de la saignée, et dont on ne
peut, arrêter le progrès." And a little below.—
" Cet accident arrive ordinairement à ceux qui
ont été trop saignés."* I shall speak more diffusely
on this when I arrive at the therapeutick division
of this publication.
The Encephalon, although subject to inflamma-
tion and partial infarction, cannot labour under
general congestion ; that is, the brain-case cannot
contain more at one time than another ; except
before the bones and sutures become firm and
ossified, and in cases where the sutures are after-
wards destroyed by diseases. The medullary sub-
stance of the brain is incompressible,†  and the case
itself is unyielding: When a congestion of the
right side of the head happens, there is a simul-
taneous, and equivalent diminution of the ariæ of
the vessels of the left. In case of hydrocephalus
there is a general invasion of the ariæ of the cere-
* Vide Tom. 1. p. 200.
† Vide professor Monro’s incontrovertable experiments.

46 DIAGNOSIS.
bral vessels. In some instances the cortical sub-
stance is worn away by attrition. If a general
congestion of the brain could take place, a partial
vacuum would of consequence be possible ; and if a
partial vacuum took place, the plates which are be-
hind the eye-bales would unavoidably be forced in,
and instant death be the result by the weight of the
external air : The columns of which, in weight
amounts to about forty-two pounds on each eye,
allowing fourteen pounds to each square inch.*
The posterior plate that supports the eye is fre-
quently so thin as to be quite diaphanous. The
inference is that either an inflammatory or partial-
ly congested state of the brain must give support
to that delirium, vigilance &c. we observe in the
yellow fever and many other complaints.
This receives accession of certitude from the
circumstances attending the decapitation of an
animal ; when the head of an animal is severed
from its body, all the blood discharged is from the
external parts of the head, not one drop escapes
from the internal. This is substantiated by the
following experiments. Dissect the Vessels to their
exit from the skull, then secure them firmly by a
ligature, this being done, divide the case and you
will find every vessel regularly filled and replete
with its contents having suffered no evacuation.
Again, take a glass-globe with two opposite
orifices, fill it with water, then put your finger
upon one, and turn the other downwards ; no
water will escape until you remove your finger
from the superior orifice. Nor can the contents of
the skull be either decreased or augmented, ex-
cept the case previously be exposed to violence.
The yellow or brown colour of the eyes and
skin is owing to absorption of the bile or brown
matter after it is secreted. There is sometimes a
*Vide Hale’s experiments.

DIAGNOSIS. 47
tempory yellowness of the skin, this may be pro-
duced by a peculiar action of the blood-vessels.*
The purple spots constitute a pathognomonick,
they are neither the production of an over action
of the system, nor a dissolved state of the blood.
They are to the yellow fever what the red spots
are to the cynanche maligna, or the eruptions of
the skin to the measles ; they are symptomatick,
and no regular consequence of the general state
of the fluids or condition of the solids.
Pyrexia or fever, as asserted by Dr. Clark,† and
afterwards by professor Rush, is simple, and has
no generick difference ; there is but one fever :
A fever is the mode of a disease, and not idiopa-
thically the desease. ‡ It, with other concomitant
qualities, evidences an infraction of the harmony
of the animal œconomy. Extension and figure
are the qualities of matter ; thought and remini-
scence the modes of spirit. 
Small pox propagate small pox, and measles the
measles : The small pox and measles are generi-
cally different ; a fever accompanies both : If the
fever were idiopathick in either, a fever would
possess generick difference, A fever is simple or
an unit, the corollary is then, a fever is the mode
or quality of a disease.
Fever is a convulsive action of the arterial sys-
tem, as mentioned by Dr. Rush, accompanied
by more or less of a peculiar and indescribable
heat and dryness of the skin : The dryness and
heat though are not always present ; as in the
febris typhodes. This convulsion of the arterial
system is the result of a more inscrutable and hid-
den morbidity of the source and seat of life and
action, the nervous power. The muscular fibre
* Vide Rush.
† Vide medical commentaries by Dr. Duncan.
‡ Vide Diocles.

48 DIAGNOSIS.
possesses no vis insita, its sensibility and contractility
are feudatory of the vis nervia.*
The source of life and action must be originally
and primarily concerned in all the operations,
whether morbid or healthy, of the animal body.
The nerves are the " seat and throne" of all
diseases.
Whether a fever be the result of a mere me-
chanical action, or the provident effort of the
vis medicatrix naturæ, that power in the body to
heal its own maladies, I leave to the more learned
to determine. But there is a something about a
fever which is easier recognized than developed.
A peccant entity, acting either mediately as in
the form of fracture or wound, produces fever
indirectly ; or immediately as in the shape of
human or marsh effluvia &c. produces fever direct
ly. In both cases the fever is the same, and
symptomatick : In neither is it idiopathick. It
is nothing but a symptom of a more primary and
essential derangement of the nervous energy.—
This primary and essential derangement is uniform-
ly the disease ; whatever succeeds is only indicative
of this first disturbance of the quiet of the animal
system.
* Vide Monro's nervous system.

CHAPTER IV.
CURE.
WE now arrive at the division of this essay
which is the most interesting and merits the most
serious and unbiased investigation. And leaving
the slippery declivity of hypothetical change, we
introduce our readers to the more unequivocal and
inflexible data of practical experience : where fee-
ble theory is supplanted by more certain practice,
where the sick bed triumphs over the reveries of
the closet.
Dr. Rush, in manfully and successfully labour-
ing to stem the torrent of error and preposterous
madness which had diffused themselves throughout,
and woven the tissue of general practice ; and call-
ing the medical mind back to the almost antiquat-
ed system of depletion so fortunately pursued by
Sydenham, Cullen, Monro, Gregory, Botallus,
Pouppé Desportes &c. has attached immortal ho-
nour to himself, and, using a gallicism, deserved
well of mankind. The doctor's exalted dignity
elevated him above the mean wiles of plagiarism.
He, with the candour proper to great minds, frank-
ly acknowledges his obligations- to preceding wri-
ters. I am though considerably persuaded that in
his strenuous exertion to crush the growing folly
of medical prejudice, which took root in the exe-
crable writings of Brown of Edinburgh, and Kirk-
land of England, he has suffered himself to be hur-
ried within the embraces of the opposite extreme.
It is beyond contradiction that the experience of
F

50 CURE.
some of the most scientific and best informed phy-
sicians, will not warrant the extremes of depletion
inculcated in his learned works.
In the management of the autumnal remittent
or yellow fever there are four therapeutic inten-
tions.
1. To diminish the violent action of the general
system and remove as far as possible the inflamma-
tory disposition of the liver, stomach, &c.
2. To take off the stricture of the superficies of
the body.
3. To discharge the acrid bile as quickly as it is
excreted.
4. To restore the vigour of the frame as soon as
possible after the fever has subsided.
The first intention is best accomplished by a ju-
dicious and proper use of the lancet, together with
a speedy introduction of mercury, either in the form
of calomel or ointment, into the system. It will
too often happen from an over excitability of the
stomach that the calomel cannot be used. When
this occurs the mercurial ointment must be freely
applied to the insides of the thighs, legs, and arms ;
those parts being the most abundantly, of all the
external parts of the body, supplied with the lym-
phatics.
Calomel is the most efficacious and powerful of
all medicines in the resolution of inflammations of
whatever kind they may be. But in those of the
liver its salutary effects are peculiarly deserving our
notice. For this valuable information we are prin-
cipally indebted to Dr. Gilchrist of Scotland and
the practitioners of the East-Indies.
When we enter the room of a patient in this fe-
ver our first attention should be to the state of the
eyes, the degree of pain in the head, oppression a-
bout'the præcordia , and fullness of the pulse.  This
is seldom or never hard ; indeed the stroke of the

CURE. 51
artery is more deceitful in this fever, than in any
other disease I have ever met with. If the eyes be
much inflamed, or labour under a sense of protru-
sion from the sockets, or an unweldiness in their mo-
tion : an acid epiphora frequently distils from the
eyes ; together with the above if the head com-
plains much, the pulse appear full to the applica-
tion of the fingers, and be frequent ; we must in-
stantly have recourse to the lancet. Even should
the tongue at the same time be blue or brown.
The colour of the tongue is not to be in general
confided in. It is sometimes blue or brown from
the first days of attack. Whilst ever the pain of
the head, or back continues, with a very frequent
or full pulse the lancet must be resorted to. This
though will rarely be the case after two or three
good bleedings, except in particular habits. Some
habits will bear the lancet to the fifth or sixth re-
petition, especially where the indirect debility of the
system is not great ; where there is great heat of
the surface of the body, and the tongue white.
A timous use of the lancet more effectually than
any other remedy, tends to prevent the rapid pro-
gress of the inflammation of the different viscera.
When it has taken place blood-letting promises
more liberally than all other remedies. But when
bleeding is carried to too great extremes, it exhausts
the general system and prostrates the powers of
life in so great a degree, that the animal frame can
never renew its functions ; it hastens, by robbing
the blood-vessels of internal support and nourish-
ment, that atony, and palsy of the vascular system
which lays the ground-work of those melancholy
hemorrhages.
When blood-letting is had recourse to, it should
be practiced with in the first three or four days. It
may, under particular circumstances, be performed
at later periods, but not with such propitious conse-

52 CURE.
quences. I have practiced it, as late as the tenth
and fifteenth day of the disease, in instances where
the patient's strength had not been sapped by eva-
cuations.
Experience together with the writings of most
of the respectable practitioners of the West-Indies
establish the following,
Those who were not bled suffered from the ne-
glect of the lancet.
Those who were bled largely died from the abuse
of the lancet.
Those who were bled according to the pain of
the head, fullness of the pulse, and oppression about
the præcordia, or in other words moderately, in a
much greater proportion recovered. Bleeding is
by no means new in the yellow fever.
There were two young gentlemen, who in a
visit to the Point contracted the disease : They
were both taken ill a few day after their return to
the Town. One of them was blooded six or seven
times, and died. The other was bled once only
and recovered. The violence of the attacks was
apparently equal.
A little after, there were two others who took
the disease by going to the contaminated atmos-
phere ; one of whom was bled six or seven times
within about forty-eight hours, was put into the
cold bath, had injections of cold water ; he died,
amidst the hands of the operators, during the
third injection of cold water. The other who
was delirious almost from the first onset of the
complaint, was not bled at all, yet after a severe
and dangerous illness recovered.
There were two other cases, one of whom lost
about as much as would be taken away at four
common bleedings, and recovered. Though no
patient could be worse than she was to recover.—
The other was bled twelve or thirteen times, his

CURE. 53
arm mortified and he departed from among the
living. Out of six who took the disease at or
near Bowley's wharf, five, some of whom were
so much evacuated that their friends threatened to
interfere, died. The one, Mr. Waters, who
escaped was bled but twice and that moderately.
There were a few instances of recovery after those
profuse evacuations, but they were relatively few.
Where one, after such immense losses of blood
escaped, there were ten who were either not bled
at all, or but once or twice, that recovered. Out
of all the blacks, for negroes by no means escaped
this complaint, whom I attended from the first at-
tack of the disease, and they were not few in num-
ber I lost none. I bled but one, and him only
to the amount of six ounces. I do not recollect
that I met with a single instance of hemorrhage
in a black person.
Calomel not only is the most effectual medicine
that can be used in the first stage, but is also the
only one in which we can have confidence to re-
move the stricture of the surface of the body ;
especially when assisted by the warm bath, either
generally or partially applied. I have seen the
ephidrosis produced to that extent by a liberal use
of calomel, as to require three or four changes
of linen in twenty four hours.
Calomel not only cures by acting as a diaphore-
tic and antiphlogistic, but also by establishing in
the system an opposite action to that of the fever.
No two general actions can exist at the same time :
So that when the mercurial action takes place the
morbid one must, of necessity, cease. The esta-
blishment of this mercurial action is confirmed to
the practitioner by a free ptyalism. Whenever a
free salivation takes place the patient is safe. Per-
haps no person ever died after the full establishment
of this discharge from the gums. Not that the

54 CURE.
salivation, strictly speaking, isof any service in
itself. It is in the yellow fever, as in the lues
venerea, the unavoidable consequence of the gene-
ral mercurial action of the system, and of no far-
ther service than informing the physician of this
general action.
That the local pain is of no advantage is evident
from the following : Let the gums become ever
so much inflamed, pained, and swollen, if a very
free spitting should not succeed, the sick reaps no
advantage, but on the contrary this state of the
gurus is ominous of approaching death.
To invite the mercury to the surface of the
body, the tepid bath should be used, or in its
place the pediluvium, and local applications of
flannel, wrung out of hot water, to the regions
of the liver, stomach, &c. Those should be fre-
quently repeated, and continued, at least, half
an hour each time.
The cold bath has been very strenuously recom-
mend by Jackson. But it does not appear from
his writings that he ever used it with success with-
out its being preceded by the warm bath : This
together with its ill effects whenever it has been
introduced into practice in America,* render it
probable that Jackson attributed to the cold, what
belonged to the warm bath. If it has ever been
of the slightest utility in cases in America, these
cases have not as yet found their way to the pub-
lic. I say from the cold bath, in the practice of
Dr. Jackson, being uniformly preceded by the
warm, and its general failure in America when used
alone, I am fully persuaded that it not only is a
useless, but a dangerous application in the yellow
fever.
Emetics even of the gentlest kind are inadmis-
* Vide Rush.

CURE. 55
sible in every stage of the fever.* No preparation
of antimony, from the tendency in those articles
to excite vomiting, can be used with safety. The
justly celebrated James' powder is here of too
precarious operation. All neutral salts are too
inert and uncertain.
Whether, upon being called to the patient, we
bleed, or not; we must instantly order a mercu-
rial purge, which should be repeated every day or
every second day, so as to produce four or five
stools daily, this number he at least ought to have.
To assist the operation of the cathartics; the lower
part of the intestines must be opened by means of
glysters. A glyster-syringe will with great pro-
priety and utility be kept constantly in the patients
room, that by the use of this the purges when
they are too slow may be quickened and invited
downwards. For as above mentioned the sick
should never have less than four or five passages a
day during the strength of the fever. Cathartics
are of all remedies the best and most useful. They
are not be omitted even in cases where the pulse is
feeble, and intermitting : If purges cannot re-
lieve the patient, his chance is truly melancholy.
In support of the great necessity of constant
purging consult Moseley, Hillary, Pouppé Des-
ports, and the learned Rush. I had my patients
to call for the close-chair from three to ten and
fifteen times a day. And those who purged most,
when not accompanied by puking, recovered soon-
est. In one case which I was called to, four grains
of calomel produced thirty-five stools : after which
evacuation the patient began to mend and recover-
ed. A patient, to whom I was called, took a
little broth which rendered him much worse than
he had been the preceding day. I ordered him
* Some practitioners; have given emetics in the instant of at-
tack with supported advantage.

56 CURE.
thirty grains of jallap and ten of calomel (my
usual dose) which operated twelve times ; and from
that instant he began to recover. It was to the re-
peated use of cathartics, and mercurial diaphoretics
that I trusted the blacks to whom I was called.
Of all cathartics, I prefer gamboge and calo-
mel, or jallap and calomel. By the timous use
of the former of these I prevented the regular
course of this fever, in at least thirty patients,
who upon the first appearance of the disease called
on me.
The fourth and last intention is employed prin-
cipally in selecting those articles which will the
most readily restore the exhausted strength of the
patient. From habit and prejudice in this stage
of the disease, physicians generally fly to the well
known powers of bark and wine, opium and
æther, colombo, and quassia, &c. But although
these medicines are in appearance our hope and
reliance ; a just pathology and experience will
quickly evince the impropriety and hurtful ten-
dency of all tonic and stimulant remedies. The
snake-root itself is too great a bitter, and must not,
except under particular circumstances, be exhibited.
Our sole trust and dernier resource is in a well re-
gulated dietetic plan, with now and then a purge to
keep the bowels open. Nor must the inexperi-
enced suffer the weakness of the patient to frighten
them from the free use of purgatives.
The habits and desires of the stomach are chiefly
to be consulted after the fever has subsided. But
during the heighth of the fever, neither flesh nor any
thing made of flesh can be allowed. Vegetables
are the only articles of food that the patient can
be indulged in while the fever possesses any consi-
derable strength.
The patient must never take any beverage strong-
er than barley-water, lemon-ade, cold water, water

CURE. 57
with a toast in it, and such like mild potables.
Some physicians are too cautious in giving cold
water, and lemonade during the use of mercury.
But I am satisfied from daily practice that no drink
is more innocent and beneficial in a fever, especi-
ally the yellow fever, than lemonade, and cold
water : nor are we to discontinue the citric acid
even during the use of calomel. Chymical affini-
ties might induce us to believe that upon an union
of the acid and calomel, the latter would, by de-
compounding the former, and attaching to itself
part of its oxigen, convert itself into the oxiginated
muriate of mercury, or what is vulgarly called cor-
rosive sublimate. This though in fact does not
happen. If any acid possessing a greater affinity,
to the base of calomel, than the muriatic, be used,
the muriatic acid will be precipitated, and a new
neutral, formed by this more powerful acid, and
the base of the calomel viz. mercury, will be the
consequence.
Blisters are sometimes useful ; particularly when
applied to the epigastric region. They quiet the
disturbance and excitability of the stomach. They
are not unusually applied to the extremities and
other parts of the body, but perhaps more from
custom and fashion than conviction of their real
use.
Opium may, in the last stages when there is no
fever present, be given in very small quantities,
thereby to take off for a few hours the great irri-
tability of the stomach. But all opiates must be
followed, within six hours after they are given, by
cathartics; otherwise their stimulant qualities will
far more than counterbalance any advantages the
patient may at first receive from them.
During the moribund state of a patient, I have
made use of æther and musk, but my views con-
H

53 CURE.
templated the removal of particular symptoms,
such as hiccough,twitches of the tendons &c. which
very much distressed what few friends there were
who had courage enough to come near the depart-
ing sufferer ; and by no means the cure of the
complaint. They serve under such circumstances
to smooth the passage to the grave, they cannot de-
liver from the pounce of the fell malady.
When hemorrhages do overtake the unhappy
sufferer, general experience has painfully convinced
us of the impossibility of managing them by astrin-
gents whether internal or external, except in those
of the uterus where applications of cold vinegar
for the most part answer. We are here still to pur-
sue our general plan.
All applications to the carbuncles which oft ac-
comany this fever, are useless. They may do mis-
chief but we can expect but little benefit from them.
Nor does opening of them seem to answer any
good end. It is best to leave them to nature.

Appendix.
DURING the time that the foregoing Tractate was at the
press, I accidentally met with the answer of the Physicians of
Philadelphia, to the request of the governor, the hon. Thomas
Mifflin—in relation to the yellow fever. A perfect and har-
monious coincidence unites our sentiments, so far as they respect
the origin and cure. For the satisfaction and benefit of the
public, I will insert the letter.
SIR,
" IN compliance with your request, the subscri-
bers have devoted themselves to the investigation of the origin,
progress. and nature of the fever which lately prevailed in our
city ; and we have now the honour of communicating to you the
result of our enquiries and observations.
We conceive the fever which has lately prevailed in our city,
commonly called the yellow fever, to be the bilious remitting
fever of warm climates, excited to a higher degree of malignity
by circumstances, to be mentioned hereafter.
Our reasons for this opinion are as follows :
1st. The sameness of their origin, both being the offspring of putre-
faction. Of this there are many proofs in the in histories of the
yellow fever in the West-Indies. Where there are no putre-
faction the West-India islands enjoy a perfect exemption from
that disease in common with nothern climates.
2d. The yellow fever makes its appearance in these months
chiefly in which the bilious fever prevails in our country and is
uniformly checked and destroyed by the same causes ; viz. heavy
rains and frosts.
3d. The symptoms of the "bilious fever are the same in their
nature. They differ only in their degree. It is no objection
to this assertion that there is sometimes a deficiency or absence of
bile in the yellow fever. This symptom is the effect only of a
torpid state of the liver, produced by the greater force of the
disease acting upon that part of the body. By means of deplet-
ing remedies this torpor is removed and the disease thereby made
to assume its original and simple bilious character.
4th. The common bilious and yellow fever often run into
each other. By depleting remedies the most malignant yellow

60 APPENDIX.
fever may be changed into a common bilious fever and by tonic
remedies, improperly applied, the common bilious fever may be
made to assume the symptoms of the malignant yellow fever.
*5th. The common bilious and yellow fevers are alike con-
tagious, under certain circumstances of the weather and of pre-
disposition in the body. That the common bilious fever is con-
tagious we assert from the observations of some of us, and from
the authority of many Physicians who have long commanded
the highest respect in medicine.
6th. The yellow and mild bilious fevers mutually propagate
each other. We concieve a belief in the unity of these two
states of fever to be deeply interesting to humanity, inasmuch as
it may lead patients to an early application for medical aid, and
physicians to the use of the same remedies for each of them, va-
rying those remedies only according to the force of the disorder.
It is no objection to this opinion that, that state of bilious fever
called the yellow fever, is a modern appearance in our country.
From certain revolutions in the atmosphere as yet observed only
but not accounted for by Physicians, diseases have in all ages
and countries alternately risen and fallen in their force and dan-
ger. At present a constitution of the atmosphere prevails in the
United States which disposes to fever of a highly inflammatory
character. It began in the year 1793. Its duration in other
countries has been from one to fifty years. It is not peculiar to
the common bilious fever to have put on more inflammatory
* This argument, the spirit of which states this and the bilious fever
to be contagious, appears to be the offspring of conjecture and a biased
education. Whatever the exertions and perspicacity of some indivi-
duals of Philadelphia may have explored I cannot determine. But, in
my candid opinion, the observations, which deceived them into the
persuasion that the bilious fever is infection, are, like Dr. Priestley's
chymical experiments, somewhat defective. Many physicians of emi-
nence have asserted, in their writings, the above fever to be contagious ;
but they have neglected to accompany above conjectures with tributary
facts to support and give life to them.
There is not, so far as my reading extends, one solitary case of a con-
tagious bilious fever in the records of medicine : I say not one case
wherein contagion has been, or can be proved. And here, reader,
my opinion is propugned and countenanced by Cullen, Sydenham and
many more of the most learned and experienced of physicians. Bilious
fevers spread by what those learned gentlemen in the latter part of the
following paragraph call " a constitution of the atmosphere which pre-
vails in the United States and disposes to a fever (the bilious or yellow
fever) of a highly inflammatory character. It is this constitution, ef-
fectuated by the marsh effluvia or vegetable putrefaction being diffus-
ed through the air, which in the first place gives rise to, and afterwards
renders epidemick or general the bilious or yellow fever, as those gen-
tlemen in what follows of their reply wisely allow. Those who wish
to be satisfied that this fever is not contagious, will do well to pay par-
ticular attention to the cases instanced in the above letter.

APPENDIX. 61
symptoms than in former years. There is scarcely a disease
which has not been affected in a similar way by the late change in
our atmosphere and that does not call for a greater force of de-
pleting remedies than were required to cure them before the
year 1793.
7th. And lastly. The yellow fever affects the system more
than once, in common with the bilious fever. Of this there
were many instances during the prevalence of our late epide-
mic.
The fever which lately prevailed in our city appears from the
documents which accompany this letter to have been derived
from the following sources.
1st. Putrid exhalations from the gutters, streets, ponds and
marshy grounds in the neighbourhood of the city. From some
one of these sources we derive a case attended by Dr. Caldwell
on the 9th of June—one attended by Dr. Pascalis on the 22d of
July, and by two cases attended by Dr. Rush and Dr. Physic
on the 5th and 15th of the same month; and also most of those
cases of yellow fever, which appeared in the northern parts of
the city, and near Kensington bridge, in the months of August,
September and October. We are the more satisfied of the truth
of this source of the fever from the numerous accounts we have
received of the prevalence of the same fever and from the same
causes, during the late autumn in New-York and in various parts
of New-Jersey, Pennsylvania, Maryland, Virginia and South
Carolina, not only in sea ports but inland towns. The peculiar
disposition of these exhalations to produce disease and death was
evinced early in the season by the mortality which prevailed a-
mong the cats and during every part of the season by the mortali-
ty which prevailed in many parts of our country among horses.
The disease which proved so fatal to the latter animals is known
among the farmers by the name of the yellow water. We con-
ceive it to be a modification of the yellow fever.
2ndly. A second source of our late fever appears to have been
derived from the noxious air emitted from the hold of the snow
Navigation, capt. Linstroom, which arrived with a healthy crew,
from Marseilles on the 25th of July, and discharged her cargo
at Latimer's wharf, after a passage of eighty days. We are led
to ascribe the principal part of the disease which prevailed in the
south end of the city to this noxious air, and that for the follow-
ing reasons.
1st. The fever appeared first on board this vessel and in its
neighbourhood, affecting a great number of persons nearly at the
same time, and so remote from each other that it could not be
propagated by contagion.
2dly. There was in the hold of this vessel a quantity of vege-
table matters, such as prunes, almonds, olives, capets, and seve-
ral other articles, some of which were in a state of putrefaction.

62 APPENDIX.
3dly. A most offensive smell was emitted from this vessel after
she had discharged her cargo, which was perceived by persons
several hundred feet from the wharf where she was moored.
4thly. A similar fever has been produced from similar causes,
in a variety of instances : we shall briefly mention a few of them.
At Tortola a fever was produced in the month of June, in
the year 1787, on board the ship Britannia, capt. James Welch,
from the noxious air generated from a few bushels of potatoes,
which destroyed the captain, mate, and most of the crew, in a
few days.
Two sailors were affected with a malignant fever, on board the
-, capt. Thomas Egger, in the month of March, 1797,
from the noxious air produced by wine that had putrified in the
hold of the ship, one of whom died soon after her arrival in Phi-
ladelphia.
In the month of June, 1793 the yellow fever was generated
by the noxious air of some rotten bags of pepper on board a
French Indiaman, which was carried into the port of Bridgetown,
by the British letter of marque Pilgrim. All the white men and
most of the negroes employed in removing this pepper, perished
with the yellow fever, and the foul atmosphere affected the town,
where it proved fatal to many of the inhabitants.
On board the Busbridge Indiaman a yellow fever was pro-
duced in the month of May, 1792, on her passage from England
to Madras, which affected above two hundred of the crew. It
was supposed to be derived from infection, but many circumstanc-
es concur to make it probable that it was derived from noxious
air. The absence of smell in the air does not militate against
this opinion, for there are many proofs of the most malignant fe-
vers being brought on by airs which produced no impression on
the sense of smelling. This is more frequently the case when
the impure air has passed a considerable distance from its source
and becomes diluted with the purer air of the atmosphere.
Several cases are related by Dr. Lind, in his treatise upon fe-
ver and infection of the yellow fever, originating at sea under
circumstances which forbade the suspicion of infection, and
which can only be ascribed to the impure air generated from pu-
trid vegetables.
So well known, and so generally admitted is this source of
yellow fever in warm climates, that Dr. Shannon, a late writer
upon the means of preventing the diseases of warm climates, in
enumerating its various causes, expressly mentions " the putrid
effluvia of a ship's hold."
We wish due attention to be paid to these facts, not only be-
cause they lead to the certain means of preventing one of the
sources of this fever, but because they explain the reason why
sailors are so often its first victims, and why from this circum-
stance the origin of the disease has been so hastily, but erroneous-
ly ascribed solely to importation.

APPENDIX. 63
The fever which prevailed along the shore of the Delaware,
in Kensington, and which proved fatal to Mr. Joseph Bowers
and two of his family, we believe originated from the noxious
air emitted from the hold of the ship Huldah, capt. Wm. War-
ner. This air was generated by the putrefaction of coffee which
had remained there during her voyage from Philadelphia to Ham-
burgh, and back again.
* In the course of our enquiries we were led to suspect one
source of our late fever to be of foreign origin. The sails of the
armed ship Hinde, on board of which several persons had died
of the yellow fever, on her passage from Port-au-Prince, and
which arrived on the 4th of August, were sent to the said store
of Mr. Moyse. Four persons belonging to the loft were soon
afterwards affected with symptoms of a bilious yellow fever.
We shall not decide positively upon the origin of the fever in
these cases ; but the following facts render it probable that it
was not derived from the persons who had died of it on board the
suspected vessel. 1st, The fails emitted an offensive smell ; 2d,
three of the cases of the persons affected in the fail lost were of a
mild grade of the fever ; 3d, the fever was not propagated by
contagion from any one of them ; 4th, the fail lost was within
the influence of the noxious air which was emitted from the hold
of the snow Navigation, being not more than fifty yards, and
was in the direction of the wind which blew at that time over her.
The extent of this air has not been accurately ascertained, but
many analogies give us reason to believe that it may be convey-
ed by the wind, in its deleterious state, from half a mile to a mile.
In support of the opinion we have delivered of the origin of
our late fever, we must add further, that in that part of the city
which lies between Walnut and Vine-streets, and which appear-
ed to be free from the effects of exhalation and the noxious air of
the ships, there were but fews cases of the fever which appeared
* Relatively to the persons affected after receiving the sails of the
armed ship Hinde, there is not the smallest probability that they were
infected by the fails acting as fomites. The explanation given by those
gentlemen is perfectly satisfactory. And had not the snow Navigation
been in the vicinity, we should not have been at a loss to account for
their indisposition without admitting the idea of contagion. The sails
emitting an offensive smell is an irrefragable proof that they were damp;
and what must be the state of the water and deleterious gas which were
enveloped in their folds ? this putrid state of water is the very postulate
to render it destructive.
It is impossible that Philadelphia amidst the numerous sources of were
getable exhalations could have one street or lane free of this miasma.
And the sparse cases which happened between Walnut and Pine-streets
were produced by a lesser quantity of this vegetable effluvia.
There is not in this nor any other writings of the physicians of Phi-
ladelphia a single case accompanied by even the probability of conta-
gion. And there is no axiom more evident than that the bilious or
yellow fever is not contagious.

64 APPENDIX.
to spread by contagion, even under the most favourable circum-
stances for that purpose.
Having pointed out the nature and origin of our late fever,
we hope we shall be excused in mentioning the means of pre-
venting it in future.- These are,
* First. A continuance of the present laws for preventing the
importation of the disease from the West-Indies, and other parts
of the world where it usually prevails.
Secondly. Removing all those matters from our streets, gut-
ters, cellars, gardens, yards, stores, vaults, ponds, &c. which
by putrefaction in warm weather afford the most frequent remote
cause of the disease, in all countries. For this purpose we re-
commend the appointment of a certain number of physicians
whose business it shall be to inspectall such places in the city, the
northern liberties and Southwark, as contain any matters capa-
ble by putrefaction of producing the disease and to have them
removed.
Thirdly. We earnestly recommend the frequent washing of
all impure parts of the city in warm and dry weather, by means
of the pumps, until the water of the Scuylkill can be made to wash
all the streets of the city ; a measure which we conceive promises
to our citizens the most durable exemption from bilious fevers of
all kinds, of domestic origin.
Fourthly. To guard against frequent source of yellow fe-
ver from the noxious air of the holds of ships, we recommend
the unlading all ships with cargoes liable to putrefaction at a
distance from the city, during the months of June, July, August,
September and October. To prevent the generation of noxious
air in the ships, we conceive every vessel should be obliged by
law to carry and use a ventilator, and we recommend in a par-
ticular manner the one lately contrived by Mr. Benjamin
Wynkoop.—We believe this invention to be one of the most
important and useful that has been made in modern times, and
that it is calculated to prevent not only the decay of ships and
cargoes, but a very frequent source of pestilential diseases of all
kinds in commercial cities.
* This disease can only be imported from the West-Indies or any
place by vessels arriving from those plates with putrid water or vege-
tables in their holds, &c. As this fever uniformly arises from the un-
sound vegetables or putrid water, and never from clothes as the vehicles
of contagion, or bodies which may be diseased on-board such vessels;
our chief attention, instead of being confined to the persons, should be
directed to the state of the cargoes; which by the bye ought always,
during the sickly months, to be examined before they are suffered to
come so near a city as that the noxious air can injure the inhabitants.
I have not annexed this appendix, solely. for the purpose of adjusting
The ettiquette of science, but in order to preserve the excellent preven-
tive observations contained in the reply to the request of the governor
of Pennsylvania,

APPENDIX. 65
In thus deciding upon the nature and origin of our late fever,
we expect to administer consolation to our fellow citizens upon
the cause of our late calamity, for in pointing out its origin to the
senses, we are enabled immediately and certainly to prevent it.
But while the only source of it is believed to be from abroad and
while its entrance into our city is believed to be in ways so nu-
merous and insidious as to elude the utmost possible vigilance of
health officers, we are led in despair to consider the disease as
removed beyond the prevention of human power or wisdom. It
has been by adopting measures similar to those we have delivered
for preventing pestilential diseases, that most of the cities of Eu-
rope, which are situated in warm latitudes, have become healthy
in warm seasons and amidst the closest commercial intercourse
with nations and islands constantly afflicted with those diseases.
The extraordinary cleanliness of the Hollanders was originally
imposed upon them by the frequency of pestilential fevers in their
cities. This habit of cleanliness has continued to characterize
those people after the causes which produced it have probably
ceased to be known.
In thus urging a regard to the domestic sources of the yellow
fever, we are actuated by motives of magnitude far beyond those
which determine ordinary questions in science. Though we
feel the strongest conviction that the value of property, the in-
crease of commerce and the general prosperity of our city, will
be eminently forwarded by the adoption of the foregoing propo-
sitions, yet these are but little objects in our view when compar-
ed with the prevention of the immense mass of distress which ne-
ver fails to accompany a mortal epidemic. We consider our-
selves moreover as deciding upon a question which is to affect the
lives and happiness not only of the present inhabitants of Phila-
delphia, but of millions yet unborn in every part of the globe.
We are with the greatest respect,
Sir,
Your very humble servants,
Benjamin Rush,
Charles Caldwell,
William Dewees,
John Redman Coxe,
Phillip Syng Physick,
James Reynolds,
Francis Bowes Sayre,
John C. Otto,
William Boys,
Samuel Cooper,
James Stuart,
Felix Pascalis,
Joseph Strong.
His Excellency  
THOMAS MIFFLIN.

ERRATA.
IN page 7, line 35, for locteals read lacteals.
Page 15, line 11, for tread read trod. Line 30, for the the
the Town, read the Town.
Page 16, line 11, for secendley read secondly.
Page 17, line 26, for antogonist read antagonist-line 33, for
Circumstences read circumstances.
Page 22, line 15, for whence read hence.
Page 26, line 23, for tenable read tenable.
Page 36, line 13, for strictun read strictum.
Page 38, line 10, for qud read quæ.
Page 42, line 17, for bill read bile-line 22, for is reason read
is the reason, and for practicioners read practitioners.
Page 43, line 14, for rouvient read rouvrent.
Page 45, line 3, for ariæ read areæ.
Page 46, line 6, for eye-bales read eye-balls.
Page 51, line 4, for unweldiness read unweildiness-in line 5,
for acid read acrid.
Page 52, line 20, for day read days.
Page 64, line 47, for etiquette read etiquette.
Aliis, si qua sint, ignoscat benevolus lector.