AN
ENQUIRY
INTO, AND
OBSERVATIONS
UPON
THE CAUSES AND EFFECTS
OF THE
EPIDEMIC DISEASE,
WHICH RAGED IN
PHILADELPHIA
FROM THE MONTH OF AUGUST TILL TOWARDS
THE MIDDLE OF DECEMBER, 1793.
BY JEAN DEVEZE,
MASTER IN SURGERY, FROM CAPE FRANÇAIS, PHYSTCIAN OF THE
HOSPITAL AT BUSH-HILL, SURGEON-MAJOR AND PRINCIPAL PHY-
CIAN OF THE MILITARY HOSPITAL ESTABLISHED BY THE FRENCH
REPUBLIC AT PHILADELPHIA.
"Nature is the first Physician."
HYPPOCRATES, Pop. Mal. b. 6, s. 5.
PRINTED BY PARENT, PHILADELPHIA.
1794.

ADVERTISEMENT.
THE epidemic disease, of which so many of the
citizens of Philadelphia fell victims, and which
spread such a scene of terror around it by its ravages in
the month of August, interested the feelings of the
compassionate so forcibly, that at their own expence
the hospital at Bush-hill was opened.
At this juncture I arrived on this continent, and
was appointed to the medical direction of this hospital.
As the patients multiplied in abundance, Dr. Benjamin
Duffield, a member of the Coll

AVERTISSEMENT.
LES ravages qu'occasionnait en Août dernier, dans
la ville de Philadelphie, la maladie épidémique, dont
tant de citoyens ont été les victimes, et qui a répandu
tant de terreur, ont intéressé l'humanité de quelques
ames compatissantes qui ont fondé à leurs frais l'hôpital
qui subsiste encore sous le nom de Bush-hill.
J'arrivais cette époque dans ce continent; je sus
choisi pour avoir la direction de cet hôpital, en qualité
de médecin. Comme les malades y abondaient, le comité
m'associa le docteur Benjamin Duffield, membre du col.
lége médecine de cette ville. Mon premier soin fut
de lui communiquer la mani

[iv]
was, I confess, to me a motive of encouragement. Be-
sides, I had persuaded myself, that I had fallen upon
the true indications of cure; and therefore continued
my treatment according to my principles, excepting
only in those cases in which particular circumstances
required its modification.
The harmony  which perpetually subsisted between,
Dr. Duffield and myself, did not a little contribute
without doubt, to the success we experienced in the
management on a disease, one of the most destructive
that the human race can be afflicted with. This success
was another motive for me to be particular and exact
in the observations I have now the honour to present
to the public. They were originally destined to re-
main buried in my port-folio, for my own use, and to
have recourse to in case of necessity, if ever the same
disease should again appear with the same symptoms
and variations.
But I could not resist the solicitation of some particu-
lar friends; and I moreover imagined that they might
be useful to professional gentlemen who have not had
an opportunity of following the disease through all its
modifications, and to whom the danger of experiments.
and endeavours, always painful and afflicting to huma-
nity, has been dispensed with. I had another motive,
which was to incite those to whom the disease was
already known, to execute better than myself the;
desire I had of being useful.

[v] 
cations dont les circonstances déterminaient la nécessité.
La bonne intelligence qui n'a cessé de régner entre le
docteur Duffield et moi, n'a pas peu contribué, sans
doute, aux succè

[vi]
Added to this, some directors of the hospital, and
the committee to whom its administration was intrusted,
have informed me, that they should with pleasure see
my observations published. I therefore thought it a
duty to yield to their request, and to gratify my own
feelings in this testimony of my esteem for them. If my
endeavours have been useful, it is in part owing to the
encouragement they inspired me with, and to the
example they placed before my eyes, in performing
with the most religious pity, the most m

[vij] 
charité la plus meritoire. J'ose me flatter que ces motifs
auxquels j'ai cédé plutôt qu'à celui de faire un livre,
feront pardonner les négligences qui doivent se ren-
contrer dans cet écrit, et m'obtiendront l'indulgence du
Lecteur, qui n'y trouvera ni cette élégance, ni cette
correction de stile, si nécessaire dans des ouvrages de
pur agrément, et si superflues dans une simple narration
des faits.
Si mes recherches et mes observations sur les causes,
les qualités et le traitement de la maladie qui en fait
l'objet, rencontraient quelques contradiction ou quel-
ques perlonnes d'une opinion différente, je préviens que
je renonce d'avance à toute discussion polémique.

ERRATA.
Page 4, line 20, of barley, read barley.
-28,-8, complains, r. complained.
-30,-10, her, r. his.
-32,-26, and which, r. which.
-40,-27, an dlimbs, r. and limbs.
-58,-13, done, r. do no.
-58, -26, mendicament, r. medicament.
-60,-25, was renewed, r. renewed.
-108,-15, at, r. an.
-136,- 10, includes, r. include.
ERRATA.
Page premiè

RECHERCHES
ET
OBSERVATIONS,
Sur les Causes et les Effets de la Maladie
Épidémique qui a régné à Philadelphie,
depuis le mois d'Août jusques vers le milieu
du mois de Dècembre de l'annee 1793;
Par JEAN DEVEZE, Maitre en Chirurgie,
du Cap-Fran

AN
ENQUIRY
INTO, AND
OBSERVATIONS
UPON
THE CAUSES AND EFFECTS
OF THE
EPIDEMIC DISEASE,
Which raged in Philadelphia from the month
of August till towards the  middle of De-
cember, 1793.
A Few days after my arrival at Philadelphia the
seventh of August, 1793,it was reported many per-
sons had lost their lives in consequence

RECHERCHES
ET
OBSERVATIONS,
Sur les Causes et les Effets de la Maladie
Épidémique qui a régné à Philadelphie,
depuis le mois d'Août jusques vers le milieu
du mois de Décembre de l'année 1793.
PEU de jours apr

(6)
attacked with the same disease, and had the happiness
not to lose any, except a child that was placed under
my care at the last extremity.
Let it not be supposed, these observations are made
as an apology for bleeding. I acknowledge having 
cured many without that help; although it was gene-
rally requisite, have often observed symptoms which
forbid its use. I then substituted-glysters, gargles,
baths, lemonade, chicken water, skimmed milk, emul- 
sions, simples, and sedatives, and even sometives have
used them in conjunction with the lancet.
If in the beginning of this unfortunate malady re-
course had been had to a similar treatment, I am con-
vinced it would seldom have proved mortal.
But an ill-directed public often acted contrary to
what was efficacious. The diseased were carefully shut
up in close rooms, and covered with three or four
blankets; their beverage was infusions of camomile,
Madeira wine, and other inflammatory liquors, which
increasing the disease brought the patient to extremity,
having produced mortifications and over-charged the
brain. After death, the victim of this fatal practice
had a livid appearance, and the vessels of the head and
brain were in the same state as those who die with a 
fit of the apoplexy. 

(7)
la même maladie; j'ai eu le bonheur de n'en perdre
aucune, à l'exception d'un ensant qui n'a été entre
mes mains que sur la sin de sa maladie.
Que l'on ne pense pas que ce soit pour faire l'apo-
Jogie de la sargnée que je cite ces observations. Je dois
m

(8)
Some days after the sore throat appeared, the fever,
which spread devastation through the city, carried
mourning into families that were enjoying the purity
of their manners in the bosom of peace, and under the
protection of laws dictated by independence, wisdom,
and virtue.
Affectionate wives! unfortunate mothers and or-
phans! your fate overwhelms me with heart-felt dis-
tress-Would to heaven I could assuage your sorrows,
by accumulating them in my own breast, and thus re-
store you to the happiness inexorable death has de-
prived you of, in the objects of your dearest affection,
and make you forget your misfortunes. But alass! my
wishes are useless, and there remains to me only the
hope, that by fulfilling the duties my profession and
humanity require, I may soften your ills by diminishing
their number.
The misfortunes you have experienced are great,
but on looking back how dreadful must be the prospect 
to those who have to reflect, that in suffering their
minds to be affected by vain fears, which I will not say
extinguished, though it stifled the sacred sentiments
Nature has graven in every heart; when they call to
mind this terror was the cause of their forgetting the
first of duties, and abandoning to all the bitterness
of disease their nearest relations and dearest friend;
yet error justifies, nay more, I will say, prescribed the
conduct; the ideas suggested was the cause of your
abandoning the unfortunate victims of this fatal malady, 

(9) 
Quelques jours apr

(10)
neglected and left alone to expire in all the horror
of despair.
Children! mothers! husbands! think of the duty
which God has prescribed to you. Instinct will dictate,
give way to its impulse, and you will follow the road
to virtue; but if deaf to the voice of nature, those for
whom alone you ought to live are deprived of the
cares they expect from you-think what will be your
remorse when they are no more. But say you, the
fear of sharing the same fate, without the possibility of
saving another, was the only cause of your flight.
This mode of reasoning proceeded from those only
who gave way to prejudice, which prevented their
seeing, that by such an example they justified a similar
conduct in their children and servants.
But why should I endeavour to inspire you with sen-
timents that are already in our hearts. An hospitable
and generous people cannot be inhuman. If this vir-
tue, which does honour to your morality-if the exer-
cise of humanity ceased for a moment amongst you,
your hearts had no part in it-fear and error are an
excuse; they, for a time, suspended your courage,
yet you soon after was convinced your fears were ill-
founded.
In short, the public papers inspired you with terror
by pretending to declare the disease contagious. They
went farther-they advised marking those houses where
the epidemic had already sacrificed some victims. This
was, no doubt, one of the principal causes of the rapid
destruction, which spread devastation through this un-
fortunate city.
Honoured with your confidence, and that of your
representatives united in the committee, which ap- 

(11)
ont péri saute de foins, et expirées dans l'horreur du
désespoir.
Epoux, mè

(12)
pointed me to the care of the hospital at Bush-hill, the
refuge of the destitute, unfortunate persons attacked
with this epidemic; to you I owe the result of my
observations-may I acquit myself of the duty by the
production of useful ideas.
It will, perhaps, appear strange to many, that, con-
trary to the public opinion, I dare assert the malady
was not contagious. But the truth being unalterable,
could I refuse to believe circumstances proved to me
by continual observations? It is to the well-informed,
and those uninfluenced by party, I leave to pronounce
upon the proofs I will give, aud which seem to me to
establish my opinion in an incontestible manner.
The first public report inconsiderately spread abroad,
was that the disease had been imported in the brig
Mary, Captain Rush, from Cape Fran

(13)
l'hôpital de Bush-hill, refuge destiné à recueillir les
malheureux attaqués de l'épidémie, je vous dois le
fruit de mes observations; je m'empresse de vous en
faire l'hommage: puissé-je, en m'ac quittant de ce
devoir, vous développer des idées utiles.
Il paraîtra peut-

(14)
we were reduced to a most pitiable state, when we
were seen to disembark ill-cloathed, pale, and with the
most powerful expression of grief depicted on our
countenances, (occasioned as well by our past misfor-
tunes, as those that seemed to await us,) I am not sur-
prised the inhabitants of Philadelphia, tormented from
nearly that period with a malady, the origin of which
was unknown, or that men in ge

(15)
avons été réduits à l'état le plus pitoyable; et je ne
suis pas surpris qu'en nous voyant ainsi débarquer
mal v

(16)
The same uncertainty with respect to the cause of
this epidemic, gave rise, with no greater foundation,
to the report of its being brought in by the privateer
Sans Culotte. Unless we disbelieve the captain and
surgeon of this vessel, we must be convinced that nei-
ther the privateer, or the two prizes she brought into
port, had any sick on board. I should never end if I
was to relate all that had been advanced to prove the
disease was imported; shall, therefore, pass on to those
only which appear to me sufficient to demonstrate, that
the complaint took its rise in this country.
The first cause of this scourge is the same which pro-
duces almost all other diseases, the alterations of the
atmospheric air. This fluid, with which we are sur-
rounded, is well known to be one of the elements that
constitute the animal system; it is of all the most sus-
ceptible of modification; and which influences in the
most powerful manner the animal economy, either by
its weight or lightness, heat or cold, dryness or humi-
dity, or the different qualifies it is susceptible of, when
charged with miasmata, which arise from every part.
As a particular enquiry into all the modifications
of which air is susceptible would carry me too far, I
shall content myself with hastily examining the effects
it produces on the animal system, when too light or
hot, and also when charged with heterogenous or
putrid particles. 

(17)
à Bush-hill, d'une hydropisie, enfin deux demoiselles
qui sont aujourd'hui très-bien portantes, et dont la
maladie n'a jamais eu rien de semblable, ni aucun symp-
tome de celle qui a fait tant de ravage dans cette ville.
Les m

(18)
When the atmospheric air is too light, it does not
counterbalance the effort of the elementary air. People
then experience a degree of debility and lassitude,
which ignorant persons attribute to a cause opposite to 
the true one: the air or the weather, they say, is too
heavy; whereas the uneasiness they feel is the result
of a too great lightness of the fluids, which being rari-
fied, augments the volume of blood, distends the ves-
sels, forces them to give way by repletion, and prevents
a free circulation; the lungs on their part deprived of
the action afforded them by the outward air, are incapable
of exercising their functions.
A patient in this situation would feel a weight upon
the breast, with a quick and painful respiration, that
would soon be followed by a spitting of blood, and
death from suffocation. Such has been the effect some
travellers have experienced, whose zeal to make dis-
coveries in natural history has sometimes carried too
far, and who from the desire and glory of being use-
ful, have climbed elevated mountains, without consi-
dering their strength, and uncautious of the danger to
which they exposed themselves.
When the heat of the air is excessive, this element-
ary principle of life becomes equally pernicious; the
blood is inflamed by being deprived to excess of its
serous particles, which evaporate through the skin;
the stomach is relaxed, and incapable of performing
its functions; the gastrick juice no longer retains the
requisite qualities to promote digestion, or produce a 

(19)
léger, lorsqu'il pé

(20)
chyle proper to repair the extraordinary secretions of
the body; hence crudities arise, which weaken every
organ, and the machine becomes totally debilitated.
Such is the origin of the acrimony from which a great
number of diseases take their rise.
The air may become still more fatal when filled with
infected miasmata, which arise from every part. This
corrupted air, if I may so name it, carries with it, when
introduced into the body, the cause of many maladies,
with which individuals are more or less affected, as
their habit or constitution gives way or resists its mor-
bific quality, or even from their manner of living and
immediate physical or moral situations, which more or
less facilitate or oppose the action of the venom; nor
do I think individuals are equally affected, because it
may happen the putrid miasmata being unequally disse-
minated in the fluids, may accumulate more in one part
than in another; their being rejected, or retained,
may also proceed from situations, such as the borders
of rivers, the country, or forests.
It is thus that the air, more or less adulterated or
modified, produces different effects, relative to the situ-
ation of places and present state of individuals, inso-
much that those whose moral and physical temperament
easiest give way to the morbific cause, will fall sick the
first, while those in a situation totally opposite will
escape the danger; because nature by a perfect arrange-
ment of the different parts of animal organization, neu-
tralises and annihilates the principal causes of the dis-
ease, which act more strongly in the former, whose 

(21)
le suc gastrique n'a plus les qualités réquises pour que
le résultat de la digestion produise un chile propre à
réparer les pertes extraordinaires que fait le corps; il
s'établit un état de crudité qui assaiblit tous les organes,
et la machine se trouve dans un état de débilité totale.
Tel est l'origine de cette acrimonie qui devient la cause
d'un grand nombre de maladies.
L'air peut encore devenir plus meurtrier en se char-
geant de miasmes infectes qui s'élè

(22)
animal system is disordered. Often also we remark in
those patients who are not totally deranged, a certain
desire for some particular food in preference to another,
a desire which is often the effect of a natural instinct
that rarely deceives, and which a prudent physician,
accustomed to the study of nature, will never fail to-
profit by, with the wisdom that inspires him with the
knowledge of his art.
All this proves that the body, as I said before, gives
way or resists, more or less, the morbific cause. From
whence it results, that some though they resist long,
are attacked in their turn; others are affected lightly,
whilst it acts seriously upon a great number; which is
a natural effect of an epidemic, that, from the causes I
have indicated, shews itself successively in individuals,
and with different gradations.
It is for want of having paid sufficieut attention to the
variety of effects proceeding from the same cause, that
epidemic diseases have been looked upon as contagious;
nevertheless, I do not pretend to say there are no dis-
eases of that kind, but am of opinion they are not so
common as in g

(23)
fortement dans le premier, dont les ressorts de l'éco-
nomie animale sont dérangés. Souvent mê

(24)
is not so, which goes under the name of contagion by
immediate contact: such, among others, as the itch,
&c. &c.
It results from this definition, that maladies, conta-
gious at distance, are communicated to other bodies,
surrounding the infected persons, by breathing the
same air, which alternately passes into the lungs of those
who live in the same place, particularly in close apart-
ments; and then the malady may very well be charac-
terised under the title of contagions disease. But if
in an epidemic disorder those who continually touch
the sick, those who without any preservative listen only
to their courage and love of humanity, give themselves
up to the care of the diseased, live in the midst of them,
and breathe the same air; if these persons are not in-
fected, it is clear the disease is merely epidemic, and
not contagious. This was precisely the case in that
we are now speaking of. I am the more pleased in
relating my opinion, as it gives me an opportunity of
doing homage to a citizen, who must be ever dear to
his country for a zeal, courage, and virtue that has
hardly an equal; a fact from which I fear no contra-
diction, and that seems to me a certain proof that the
malady, whose consequences were so fatal, was not
contagious.
Mr. Stephen Girard, merchant of this city, and mem-
ber of the committee, a man blessed with an affluent
fortune, regardless of the injury he must sustain by
abandoning his house of commerce, gave way only to 

(25)
sonne affectée avec cellè

(26)
the generous dictates of humanity; not satisfied with
contributing by his wealth alone to the relief of his fel-
low-citizens, he attended them in person also; went
every morning to the hospital at Bush-hill, where his
first care was not only to direct, but to inspect into the
provisions and arrangement of the house; after which
he visited the apartments of the sick: the unfortunate
persons in the greatest danger were those who first
attracted his attention. He approached them with that
philanthropy that proceeds from the heart alone, and
which must give the greater lustre to his generous con-
duct: he encouraged, took them by the hand, and
himself administered the medicines I prescribed. I
even saw one of the diseased, who having nauseated
his medicine, discharged the contents of his sto-
mach upon his benefactor. What did Girard then
do?-entirely devoted to the public welfare, firm and
immoveable, and forgetting himself to think only of
the sufferings of his fellow-creatures, whom he wished
to succour; he wiped the patient's cloaths, comforted,
and by the force of persuasion and patience, induced
him to swallow the remedy. He did not stop here-
before he quitted him to shew the same attention to
another, he felt his feet and head, in order to judge of
the degree of heat, that he might take from or add to
his covering, according to the necessity of the case;
he arranged the bed, inspired him with courage, by
renewing in him the hope that he should recover.-
From him he went to another, that vomited offensive
matter which would have disheartened any other than
this wonderful man; then seeing one at a distance at 

(27)
aisance au soulagement de ses concitoyens, il voulut en-
core les servir lui-mê

(28)
the point of d

(29)
blantes et ensanglantées un pot de chambre qu'il ne
pouvait atteindre, Girard court à son secours, le met 
lui-mê

(30)
mention the surgeons that assisted me, who lodged and 
eat at the hospital, and dry and night visited the cham-
bers of the sick, to dress their blisters and superintend
the nurses: not any of them felt the least inconvenience.
I seize with pleasure this opportunity to return to those
fellow-citizens who seconded my cares and labours,
the justice due to their zeal, and the activity with which
they executed their duty. If the disease had been con-
tagious, certainly some of them would have been at-
tacked, but not one experienced the slightest indispo-
sition.
Mrs. Saville, principal nurse of the hospital at Bush-
hill, a valuable woman, and who deserves the gratitude
of the public for the manner in which she acquitted
herself in the charge assigned her, was the only one
of all the principal attendants that was seriously attacked
with the epidemic. She had been from her infancy
in Philadelphia, and it is very possible there acquired
the seeds of the disorder. It might equally happen,
and I am induced to believe, though slightly infected
from the first, her indisposition would have been trifling
had there not been added to the first cause, that of the
putrid miasmata spread throughout the hospital, where
me continually remained. This person was the last
patient seriously disordered I attended at Bush-hill,
and was so fortunate as to cure her: shall give the
history of this case as the subject of one of the observa-
tions at the end of this work.
Among the nurses for the sick, two only died: one
contributed to her death by her intemperance, being

(31)
Je citerai encore les chirurgiens qui me servaient
d'aides, qui logeaient et mangeaient à l'hôpital, et qui,
la nuit comme le jour, entraient dans les salles pour
faire les pansemens, visiter ses malades et surveiller les
infirmiers; aucun d'eux n'a éprouvé la plus légé

(32)
often disguised by liquor. They were both of this
country, and probably had the seeds of the disease pre-
vious to their going to the hospital; and those seeds
would equally have unfolded themselves had they staid
in town; which appears to me the more likely, that
many of the other nurses were not at all indisposed
although they eat and slept in the chambers of the
sick.
The importance of the subject shews me the neces-
sity of advancing every proof in my power; and con-
sidering the motive to be for the public interest, ima-
gine it will not be taken amiss if I cite myself an
example.
At the time that I was accepted as physician to the
hospital at Bush-hill, I had just experienced the most
serious misfortunes, having fallen from affluence into
the greatest misery; (and I should not forget to ob-
serve, that almost all the French who sought an asylum
h

(33)
intempérance à sa mort, tous deux étaient du pays:
ils avaient probablement le germe de la maladie avant
de venir à l'hôpital, et ce germe se serait peut-

(34)
the latter is deranged, the other is weakened in pro-
portion. It is what I experienced; the feelings of the
mind had so acted upon the body, that I have not re-
covered from the state of debility it had thrown me
into. This state must have favoured in a singular man-
ner the action of the miasmata, which I drew in with
my breath at the hospital, where I often went with a
most violent head-ach, and sometimes even with a slight
fever. I paid my morning visit fasting, that in the
afternoon immediately after dinner. I opened a great
number of bodies, and consequently was under the
necessity of dipping my hands in the black and cor-
rupted blood that proceeded from their mortified en-
trails, and breathed the infected vapours that exhaled
from them. I was, it must be acknowledged, one of
the most exposed to the disease; had it been contagious
without doubt it must have easily shewn itself in me,
for, independent of the danger, to which my duty ex-
posed me, I was in a state of indisposition that made
me likely to receive the action of the deleterious mias-
mata and to facilitate the operation: nevertheless I
was exempted.
To all these undeniable proofs against the opinion
of those who have advanced that the disease was con-
tagious, I will add another fact, which of itself must
be a perfect conviction of the truth of my assertions.
Many persons attacked with diseases totally different
to the epidemic, were taken care of at Bush-hill at
the same time and in the same apartments with those
infected with the reigning malady. They recovered, 

(35)
éprouve quelque dérangement, l'autre est affaibli en
proportion: c'est ce que j'ai éprouvé. Les peines mo-
rales avaient tellement agi sur mon physique, que je
me trouvais dans un état de débilité dont je ne suis pas
encore revenu. Cet état favorisait singuliè

(36)
though they saw on all sides persons die of the epide-
mic, whose beds were immediately re-occupied by
others having the same disease as those whose places
they supplied; and it is principally to be observed,
that the former were continually surrounded by those
who were dangerously attacked, as well as with the
atmosphere of miasmata, which the breath and perspi-
ration spread through the room, receiving into their
lungs the same air that had repeatedly passed and re-
passed through those of the other sick, which had not
only become more phlogisticated, but where it had
also been impregnated with emanations fit to have com-
municated the disease, if it had possessed the power.
What is very remarkable is, that I have not seen one
example of these patients having the epidemic, unless
previously attacked; and never, notwithstanding these
circumstances so favourable to contagion, did their dis-
ease change its character, fin

(37)
mê

(38)
that the symptoms in many were more serious, whilst
others had the disease in its full strength and malignity.
The constitution, age, se

(39)
dans celui-ci n'ont pas été bien graves, et qu'un autre
n'en a eu que de trè

(40)
There is another cause of corruption in the city-
the tan-yards, and starch manufactories, and also the
quays, where at low water the mud is nncovered,
from which a quantity of pernicious vapours arise; in
short, the ditches with which the city is surrounded,
from the earth being taken out to make bricks, where
the water from stagnating during the summer, sends
forth infectious exhalations, and also serves, as it passes
through the earth, to carry with it corruption into the
wells.
All these causes united must necessarily corrupt the
blood, and give to the bile such a degree of acrimony
as to become the principal cause of the epidemic.
All physicians and physiologists agree, that the bile
when degenerated produces an irritation of the solids,
and dissolution of the fluids, which I observed in this
disease, the symptoms of which were almost always
inflammatory in the beginning; this state was followed
by a dissolution of the humours, and with such rapidity,
that the physician had not time to deliberate upon the
choice he ought to make of the necessary remedies to
combat the dangerous symptoms attendant in each of
these states. Sometimes the patient felt a great lassi-
tude for some days previous to the manifestation of the
lever; in others it shewed itself without warning; in
ge

(41)
Il est une autre source de corruption qui se trouve
dans la ville, ce sont, d'une part, les tanneries et les
fabriques d'amidon, d'autre part, ce sont les quais qui,
à mer basse, laissent à découvert une étendue de fange
d'où

(42)
that heat was concentred in the inside, the patient
complained of an internal fire which consumed him;
the thirst was proportionable to the degree of heat;
many had this heat, particularly about the body and
breast; the extremities were only warm, and some-
times even quite cold.
The respiration was sometimes obstructed, painful,
strong, interrupted, and laborious. When I presented
the back of my hand to their breath, I found the heat
considerable; the dryness it produced in the throat,
tongue, lips, and nostrils occasioned an itching, and
made swallowing difficult; the tongue at first red, as
well as the lips when become dry, were soon covered
with a black crust, which also attached itself to the
teeth in a manner difficult to remove; a weight and
cousiderable pain about the epigastric region announced
and accompanied violent vomitings, which fatigued
the patient; the matter they threw up was of
different qualities, sometimes white and acid phlegm,
which set the patients' teeth on edge; sometimes green
or yellow bile, at others a matter black, and like the
dregs of an ink-bottle imperceptibly mixed with glair-
ous matter, from which was commonly exhaled an
odour like rotten eggs; it was so acrid it excoriated
the throat and lips; the stomach, irritated by its
action, rejected all kind of liquids, and the diseased,
though tormented by thirst refused to drink, in order
to avoid the pain of vomiting.
The patients were also often affected by diarrhœas
of different kinds, usually accompanied by pains in the 

(43)
d'autre fois cette chaleur était concentrée dans l'inté-
rieur, les malades se plaignaient d'un seu interne qui
les dévorait; alors la soif était proportionnée au degré
de chaleur; dans plusieurs cette chaleur était extrê

(44)
belly; sometimes the evacuations were frequent,
liquid, watery, and began with the disease; at others
it appeared some days after the fever; they were then
bilious, greasy, and frothy; they were often white
and glairous; in some green, yellow, inclining to red,
bloody; and sometimes only black blood. The dis-
charges from the patients were often unaccompanied
by pain; at others the gripings were excruciting;
sometimes the evacuations were without smell; at
others cadaverous and fœtid.
The patients experienced an inability to sleep; if
they slumbered by chance, their sleep was laborious,
they felt themselves as fatigued when they awoke as if
they had not slept at all; the urine assumed different
appearances during the course of the malady; in ge

(45)
pagnées en général par des douleurs aux lombes a
quelque fois ces déjections étaient fréqu mes, liquides
aqueuses, et commanç

(45)
blood was stopped. I observed this accident happened
only to those patients who were bled too late.
The tongue was covered with blood at first red,
then black, which issued from the pores of the tongue,
inside of the mouth and gums; to this hemorrage was
joined that from the nose, which sometimes preceded
and sometimes flowed at the same time.
If the remedy was inefficacious and did not produce
any change in the state of the humours, gangrene or
livid spots appeared in different parts, and gradually
extended in such a manner, that the whole body some-
times appeared mortified; the diseased, when in that
situation, before they died had a putrid smell; if the
back of the hand was then put to the mouth, a cold
sensation was felt, from the contact of the air which
proceeded from the lungs. Those who died in that
state had experienced weaknesses in the beginning of
their sickness; the morbific cause, from having long
acted, had perverted all the humours, and disposed
them to putrefaction.
It was very seldom medicine had sufficent power in
those cases to save the patient; when the disease was
at its height, the elements which compose the forma-
tion of the fluids and solids being no longer retained by
the glutinous particles which 

(47)
le sang. J'ai remarqué que ces accidens n'arrivaient
qu'aux malades qui avaient été saignés trop tard.
La langue se couvrait d'un sang d'abord rouge, puis
noir: il suintait de toute part de la langue, de l'inté-
rieur de la bouche et des gencives. A cette hémorra-
gie se joignait celle des narines qui, quelque fois,
précédait, et quelque fois coulait en mê

(48)
which is in the same class with the ardent fever, com-
plicated, and joined to another very fatal disease
which I had observed at St. Domingo, and known by
the name of the Siam Disease, or Siam Fever. It
seemed as if these two scourges had united their symp-
toms, and acted in concert, which may be judged of by
the description I have given, and which is only the
recital of my own observations.
The prognostics upon this malady were in ge

(49)
fiè

(50)
ought to act. He is an excellent physician who has ac-
quired that degree of knowledge - happy the mortal that
possesses him. Being in the habit of seeing the diseased,
and to observe nature, can alone guide the practitioner,
and render medicine a really useful science; but any
one who, seduced by the brilliancy of a system, will
force nature by the rules of the method he has adopted,
he, I say, is a scourge more fatal to the human kind
than the plague itself would be.
The public will find from, the account I have given,
it is impossible to lay down a mode of treatment appli-
cable in every case; nevertheless, though circumstances
obliged me to vary the means I made use of, I will set

(51)
ce moment précis, où

(52)
this incendiary practice perished by this fatal method.
If there were any of those unfortunate persons that
recovered, they owed their convalescence to the good-
ness of their constitution, and the little effect the ma-
lady had upon them; for mercurial preparations having
the property to dissolve the humours, acted in these
cases with the morbific cause, which itself produced
this disunion. Sodorifics also improperly taken hastened
the loss of the patient, and often rendered mortal a
disease that would have given way to proper treat-
ment. It is true nature will sometimes itself expel the
morbific cause by perspiration, but then these critical
evacuations terminate the malady. It is not in the
beginning of a disease that nature thus acts, and when
it does happen, these sweats become symptomatic. It
is the same with other evacuations, which only serve
to enervate the patient, without carrying off the cause
of the disease.
A skilful physician is not deceived by these evacu-
ations. He lessens or favours them according to the
time when they appear; but he can never take into
his method of cure, that of either exciting or in-
creasing them, when they are the symptoms of a serious
disease; if he acted otherwise he would favour the
malady to the destruction of the individual; then the
strength of the patient's constitution could alone sup-
port him against the force of the disease, and inexpe-
rience of the practitioner.
In order to give a clear idea of the g

(53)
péris de cette maladie, combien n'ont pas été victimes
de cette pratique incendiaire? S'il en est qui ont eu le
bonheur d'y résister, ils ne doivent l'existence qu'à
leur bonne constitution, et au peu d'effets qu'avaient
produit sur eux les causes de la maladie; car les prépa-
rations mercurielles ayant la propriété de dissoudre les
humeurs, agissent, dans cette circonstance, de concert
avec les causes morbifiques qui, elles-mê

(54)
crudity, that of the concoction, and that of its termina-
tion or crisis.
It is to be observed, these three periods followed
each other so quick, as to require the most scrupulous
attention to find out when they succeeded each other;
as they were often confounded. I was then obliged
to pay more attention to the prevailing symptoms than
to the time they made their appearance, in order to
apply the proper remedies. Without this precaution
I should have committed great errors, for I met with
some who had arrived to the end of the first period on
the fifth day, while others were at the expiration of
the disease on the third.
In the first period, wh

(55)
acion, ou si l'on veut de crudité; celui de la coction;
enfin celui de la terminaison ou de la crise.
Il est bon d'observer que ces trois périodes parcou-
raient leur durée avec tant de rapidité, qu'il fallait la
plus scrupuleuse attention pour saisir le moment où

(56)
it even the first. It must not be forgot I speak in ge

(57)
faire le premier jour; on ne doit point oublier que je
parle en général: il est des exceptions à cette r

(58) 
Hoffman's mineral liquor, and sedative salts; I also
gave to some, salt of tartar and lemon juice. If these
means did not answer my purpose, I was not obstinate
in continuing their use; I changed alternately from
one to the other, till I found which best moderated
and agreed with the immediate state of the solids.
Such was my plan of conduct in every circumstance.
It was an error to believe, what succeeded, well in
one case, would have the same success in all others,
though they appeared alike; because often an infinite
number of hidden circumstances produced a change in
the animal economy. I have seen a remedy that has
cured one, done good to a second, and hurt a third.
The diversity of effects proceeding from the same cause
will always prevent remedies being generally specific;
and proves the scientific part of physic will not be so
certain as the experimental.
When some of the liquids which I have mentioned
were successful, I had it continued, and accompanied
with camphire, in the form of bolusses, a manner least
digusting to the sick, and in which I could increase the
dose as I pleased, or according to the exigency of the

(59)
usage des potions tempérantes, sedatives, dans les-
quelles je faisais entrer l'éther vitriolique, la liqueur
minérale d'Hoffmann et le sel sédatif; je donnais 
quelque sois le sel de tartre avec le jus de citron. Si
ces moyens ne répondaient pas à mon attente, je ne
m'obstinais pas à en continuer l'usage, je passais alter-
nativement de l'un à l'autre jusqu'à ce que je rencon-
trasse ce qui couvenait au mode, à l'état présent ou
se trouvait le ton des solides. Tel a été mon plan de
conduite dans toutes les circonstances. C'est 

(60)
slices of sweet oranges, and during the first period
they rarely took any other food than creamed rice or
barley.
When the violence of the symptoms were abated,
and the patient arrived at the second period, which
happened sooner or later, I endeavoured to find out
the way nature seemed most to incline in endea-
vouring to expel the morbific cause; and sought for
what I judged most proper to second her.
I often made use of veal or chicken broth, creamed
rice, panada, Bourdeaux wine sweetened, and in short
more powerful cordials where the case required them;
and if nature seemed disposed to act of itself, I was
careful not to disturb in endeavouring to strengthen.
I only tried to second her when weak and trembling.
Sometimes the disease got the upper hand, and tri-
umphed over the efforts nature made to disengage her-
self, then the pulse became low, and sometimes convul-
sive, I had recourse to blisters, at which time I was
particular in the use of nitrous draughts, in order to
diminish the action of the cantharides upon the blister.
Sometimes I found myself obliged to give the most
powerful cordials to re-animate the action of the solids.
When the blisters answered the end I proposed, or
that alone, or with the help of cordials, the strength was
was renewed; when in short the humours flew towards
the part where they were placed, the malady usually ter-
minated without any other crisis than the suppuration, 

(61)
je leur donnais en boisson. Ce médicament, que je re-
garde comme un excellent sédatif et antiputride, est
celui dont l'usage, mê

(62)
which I took great care to encourage as far as appeared
necessary; for if the humours slew to the inside, I
observed the blister was covered with a dry and mor-
tified slough, the pulse became concentred and low,
the patient's extremities were sometimes cold, and
respiration difficult.
Authors have prescribed in similar circumstances to
put fresh cantharide

(63)
maladie se terminait assez ordinairement sans d'autres
crises que la suppuration que j'avais grand soin d'entre-
tenir autant qu'elle me paraissait nécessaire; car si
l'humeur venait à refluer dans l'intérieur, ainsi que
j'ai eu occasion de l'observer; dans ce cas les vésicatoires
se couvraient d'un escare gangréneux et sec; le pouls
devenait petit et concentré; le malade avait quelque fois
les extrêmités froides et la respiration labbrieuse. Les
auteurs ont prescrit dans de pareilles circonstances de
remettre de nouvelles cantharides sur les vésicatoires,
mais l'expérience m'a appris combien cette pratique
était sujette à produire des effets pernicieux, aussi ne
l'ai-je point suivie. En effet, dans un cas pareil l'action
des mouches crispe l'embouchure des vaisseaux sur les-
quels elles sont appliquées: ceux-ci étant déjà privés
de la liqueur qu'ils avaient sournie lors de la premi

(64)
the suppuration was great, it was also necessary to
assist it, as it often put a period to the disease. If the
immediate indications required cathartics, I gave them
in reiterated, but small doses; a strong purgative
would have retarded suppuration, by drawing the hu-
mours to the inside, and destroying the patient. If the
matter from the suppuration was not good, I continued
the use of the bark; sometimes the pus corroded the
parts, and formed ulcers that assumed different appear-
ances, which the more determined me to continue the
discharge, endeavour to correct the internal hnmours,
and assist nature in disengaging herself. In short, I
made use of cathartics, more or less, when the blister
healed of itself.
After what I have said, it must be understood the
blister produced an artificial crisis. I have met with
many cases where nature produced much better,
although very rarely in the epidemic we are speaking
of. I have sometimes observed the morbific matter
fall upon some particular part, and produce disorders
more or less considerable, as abscesses, mortifications,
&c. Sometimes even this mass of humours went off by
urine, an hemorrage, or diarrhœa. I never saw the
crisis act by perspiration in this epidemic, and those I
have already mentioned were almost always imperfect.
When the morbific matter settled on a part little
essential to life, I favoured the efforts nature made, by
augmenting or supporting her strength, and diminish-
ing the external resistance; for this purpose I made
use of emollients, either in fomentations or cataplasms. 

(65)
gangréneux, peu à peu elles se détachaient et finissaient
par tomber enti

(66)
This sort of crisis was also very rare; I saw only one
instance, which was in a suppuration of the parotides;
the patient recovered, but required great care and
precaution.
Sometimes the venom, by attacking a particular
part, destroyed the vital principle, and produced mor-
tification; then the patient could only be cured when
the affected part was large enough to contain the mass
of humours, and enable me by its extent and situation
to cut a way the mortified parts.
The urine, as I have already said, was one way
nature took to relieve herself, but I seldom found this
method sufficiently efficacious, notwithstanding I endea-
voured to forward it by diuretics.
I have seen some critical hemorrages. Women,
whose periodical evacuations happened at the time of
the crisis, usually recovered. A discharge of blood
from the nose has also had good effects; but it seldom
alone produced a perfect crisis. If this hemorrage was
symptomatic, and joined to that of the mouth, the
patient was in the greatest danger; they always ap-
eared to me to indicate a dissolution of the humours.
I then made use of antiputrescents, as camphire and
nitre; but found a much greater advantage from a
strong decoction of bark, acidulated with spirits of
vitriol. I gave this remedy in large doses; also made
use of broths, in which I had each time half a drachm 

(67)
forces, et en diminuant les résistances extérieures;
pour cette effet, je faisais usage des relachans, soit en
fomentation, soit en forme de cataplasme. Ces sortes
de crises ont été fort rares; je n'ai vu qu'une seule
sois une parotide en supuration: le malade en a guéri;
mais il a fallu y apporter beaucoup de soins et les plus
grandes précautions.
Quelque fois le venin, en se portant vers une partie,
y détruisait le principe vital, et y produisait la gan-
grè

(68)
of gum dragant, powdered; I ordered creamed rice,
and juice of sweet oranges; if the case required it, I
supported the patient with red wine, sweetened; some-
times by cordial draughts: but I never used these
means without the greatest circumspection. First,
I had to prevent the patient sinking into a state of de-
bility, from which I could not have recovered him;
then to take care not to raise him so high as to augment
the hemorrage, already too fatal of itself, and to
which I could only oppose internal remedies, fit to
give consistency to the humours that were dissolved by
the nature of the disease.
I have already said the diseased were wearied with
diarrhœs of different kinds; in g

(69)
dissoudre chaque fois un demi gros de gomme adragante,
en poudre. J'ordonnais des cr

(70)
Diarrhœas of every kind were preceded and accom-
panied by a weight and pain in the loins; when that
suddenly ceased, and pain of the head followed,
or increased after the suppression of that of the back,
this change shewed the morbific matter was quitting
the intestines, and attacking the brain; a truth I was
often convinced of by experience. In short, I have
seen this case always followed by delirium, the diar-
rhœa stopped, and coma followed, the pulse became
concentred, small, convulsive, and death did not fail to
put an end to this tragic scene. When a patient came
to the hospital with these symptoms my efforts were
always useless; but when brought in time, that is be-
fore the humour had fixed in the head, I had blisters
applied to the logs and thighs; the irritation drew
the humours to that part; if the discharge was in
quantity, it se

(71)
Les déjections de toute esp

(72)
be useful to be many others, who, I may venture to
say, perished for want of succour and assistance.
After what has been said, think I have reason to
to conclude, that the appearance or augmentation of pain
in the head, and diminution and cessation of it in ano-
ther part where the disease had fixed it, shewed the
patient was in imminent danger. This is also appli-
cable to pain in any of the vital parts.
Before I finish this part of my enquiry, I cannot
omit mentioning the use of one of the most powerful
remedies in the materia medica; and not to deviate
from my subject, will give as an example the effect it
produces on the head. The head-ach, as I have already
observed, increasing at the time in which the pain in
the loins disappeared, announced the transition of the
morbific matter to the brain; if in that case, to calm
the pain in the head, and watching, I had made use
of opium, I should have effectually calmed the pain,
and put the patient to sleep; but what would have
been the consequence? I should at the same time have
diminished the strength of the organs, particularly that
of the brain, and have favoured the overcharging of
the part where the morbific matter had a tendency to
settle; then there was no resource: the humour once
fixed, the patient dies. In order to render this reason-
ing more clear, I shall beg leave to make use of a com-
parison; and will suppose two men fighting; an
officious friend arrives, finds no other expedient to
separate them than tying the hands of one, whilst he
suffers the other to continue striking him. What must 

(73)
mités. J'ai été assez heureux, par ces moyens, d'en
sauver quelques uns qui auraient insailliblement péris
sans ces tentatives, et je dois avouer que ces succ

(74)
occur? the interference of the officious friend is inj

(75)
sensible, qu'il me soit permis de faire une comparaison.
Je suppose deux hommes en querelle et aux prises; un
ami officieux arrive, ne trouve d'autre expédient pour
les séparer, que de lier les bras de l'un pendant que
l'autre continue à lui porter des coups: qu'arrivera-t-
il? Que le service de l'ami est pernicieux à l'un des
deux, mis hors du combat. Et bien, le médecin qui
administre l'opium, dans le cas cité, est précisément
l'ami officieux qui, aulieu de détourner un mal, pour
le rendre moins pernicieux, le fixe dans une partie
dont il n'est presque plus possible de le faire sortir.
Quoique je reconnaisse toute l'efficacité de l'opium,
je pense qu'il est absolument contraire et nuisible dans
les fiè

(76)
his belly was hard and painful, the abdominal muscles
were in such a state of contraction as to flatten the
belly in a manner that it almost touched the back-
bone; the fæces were black, of an ill smell, and mixed
with blood; the urine in small quantity, also black and
fætid; in short, the pulse was concentred, and the
tendons convulsed. I had blisters applied, and hot bricks
to the extremities. I endeavoured to get some remedy
down his throat, but in vain; nature was so weakened
art could not re-animate him. He died in the night
of the 1st of October. The second I opened his body
and found:
The membranes of the brain in their natural state,
the sine

(77)
la respiration pénible, et les extrêmités froides. Il
vomissait avec effort tout ce qu'il prenait: son ventre
était douloureux et dur: les muscles de l'abdomen se
trouvaient dans un état de contraction qui rendait le
ventre applati et rapproché de la colonne vertébrale;
les matiè

(78)
brarnes appeared blacker in proportion as I approached
the larger intestines, the passages were lined with a
black, glairous, bloody matter of a fætid smell; the
liver, gall, bladder, pancreas, and kidneys in a natural
state. In opening the liver I found a small quantity
of black blood, the spleen black, withered, and of a.
consistence less firm than in its, natural state; the me-
sentery black towards the spine, its membranes having
opened formed a bag, that was filled with blood ex-
tremely black; that, contained in the largest abdominal
veins was of the same colour; in short, the bladder
was contracted, and contained but a small quantity of
black fætid urine, and the internal membrane was
spotted with a brown colour.
SECOND OBSERVATION.
The first of October, a man about thirty-three years
of age was admitted into the hospital. He was insen-
sible, cold, and almost without pulse; his mouth half
open, and full of black blood; his respiration low,
quick, and interrupted; his body deep yellow. Those
who accompanied him told me, in answer to my
questions, that he had been ill some days, but did not
say how many, and that he had taken many medical
powders similar to the preceding patient.
Every method I made use of to re-animate the vital
powers, were useless: the patient died during the
night. The second I opened him; the head shewed
nothing different from the preceding body.
The lungs even appeared in their natural state,
except some adhesions, but they were old and were
sound between the pleura and the right lobes. 

(79)
membrane interne, se colorant en noir à mesure que
j'approchais des gros intestins; le canal tapissé d'une
matiè

(80)
The pericardium contained a little serous matter
of a deep yellow; the heart withered, empty, and the
right auricle full of very black blood.
The stomach, which I should more than double its
natural thickness, contained also, as well as the in-
testinal canal, black blood, and bile also black, some-
times mixed together, and sometimes separate, the
internal membrane of these parts almost entirely de-
stroyed, the little that remained was mortified, detach-
ed, and floating in matter; the mesentery, towards
the intestines, was inflamed; the glands very much
swelled and black; it contained yellow pus between
its two membranes near the spine; the gall bladder
was empty, the liver, spleen, and veins in their
natural state; the pancreas, hard and inflamed, was
about twice as large as it ought to be; the urine was
black and fætid; the internal membrane of the bladder
mortified.
THIRD OBSERVATION.
A man, thirty-four years of age, of a sanguine and
robust habit, accustomed to drinking, fell sick the 11th
of October, after a debauch in which he had drank
brandy to excess. I saw him at the hospital the first
day of the disease; he had a burning heat, his skin
was hot and dry, his face the colour of crimson, his
eyes sparkling, he was extremely thirsty, his tongue
very dry and c

(81)
Le péricarde contenant un peu de férosité, d'un
jaune foncé; le cœur était flétri et vide; l'oreillette
droite pleine d'un sang trè

(82)
hard and tight, he complained of pains in the epigas-
trick region, and in the head.
I had him bled in the arm, and ordered clysters made
with a decoction of flax seed, a bath, and lemonade
with nitre. In the afternoon, finding the symptoms
not diminished, I had him bled again.
The day after, being the second, I had him twice
bled, and prescribed the same remedy, but he threw
up every liquid.
The third day he experienced lassitude, his pulse
became intermittent, his eyes and skin yellow, his stools
were glairous, mixed with blood, the abdomen was
neither extended nor painful, the little urine that came
from him was bloody; in short, he vomited green and
glairous matter, mixed with blood.
In this melancholy situation I gave him water acidu-
lated with dulcified spirits of nitre, and gave order at
the same time to change his drink according to his
fancy; they gave him that he wished, but he vomited
every thing immediately, and nothing could remain on
his stomach.
The fourth he experienced weakness, and the whole
body was of a deep yellow, th

(83)
pouls était dur et ferré; il se plaignait de douleurs à
la région épigastrique et à la tê

(84)
yellow; the rest of the head offered nothing remark-
able.
The lungs on the outward parts were covered with
black spots; in dividing them I found they were gorged
with a black frothy blood; the humour of the pericar-
dium was yellow, the heart absolutely empty, its right
auricle contained, black blood.
The stomach was extended by the air it contained,
it was almost double the thickness it ought to be, and
contained clots of black blood; the internal membrane
was inflamed but unequally, the red was in some
places brighter than others, that of the duodenum and
other intestines were in the same situation; clots of
black blood and glairous matter of the same c

(85)
trè

(86)
pure blood came from him, his pulse was strong and
frequent, he made some few drops of urine, with great
pain, and of a deep colour.
I ordered him lemonade with nitre, a simple emul-
sion, emollient clysters, cataplasms on the lower belly,
and had him bled three times in the course of the day.
The 16th I saw no other change than the weakness
he felt on going to stool; every thing he swallowed
instantly came up again with most violent and painful
efforts; his beverage returned from his stomach mixed
with blood. I tried many methods to stop the vomit-
ing, but in vain, he was in continual agitation till
death, wished to lie on the ground, and said he had a
fire burniug within him; these agitations terminated
in weakness, which carried him off the 18th, at the end
of the seventh day.
On opening his body I made the following observa-
tions: the corroidal plexus was not as high coloured
as in its natural state, the brain was firm, and the ven-
tricles without serosity, the sinuses of the duramater
contained very little blood, but of a brown red
colour; the right lobes of the lungs were much in-
flamed, the left in a natural state, no serosity in the
pericardium, the heart was empty, its right auricle
contained a clot of blood that did not stick to it; when
I took it put I saw another that followed, and came
from the vena cava inferior; it was three inches long,
and of two colours; the part that answered to the
exterior of the auricle was white, and resembled the
blood of those who have the pleurisy; the rest, as well
as what came out of the vena cava, was of a red brown; 

(87)                  
pressé; il rendait avec douleur quelques gouttes d'urine
d'un rouge foncé.
Je lui ordonnai de la limonade nitrée, une émulsion
simple, des lavemens émoliens, des cataplasmes sur le
ventre, et je le fis saigner trois sois dans la journée.
Le 16, je n'apper

(88)
the stomach contained blood as well as the intestin

(89)
L'estomac contenait du sang, ainsi que les intestins.
La membrane interne était tr

(90)
drink. The 16th I found her insensible, and she died
shortly after. The 17th I opened her body and found:
The sinuses of the duramater full of blood and in a
natural state, all the vessels of the brain in the same
state, the corroidal plexus gorged and very red, not
any serosity in the ventricle of the brain, the substances
of the viscera appeared in their natural state.
In raising the integuments of the breast, I found
blood spread under the large right pectoral muscle, it
came, from the internal mamillary artery, which had
been tore by the violence of the blood that had extra-
vasated behind the sternum, had opened the intercostal
muscles, between the third and fourth of the long ribs,
and spread as I have already said, without entering
into the breast, that is on the outside of the pleura;
the inside of the breast was filled with clotted blood,
the lungs were also swelled with it like spunges, there
were crevices through which blood had passed, which
filled the breast.
I found the liver a third larger than it ought to be,
an elevation in the middle part of the great lobe, indi-
cating to me an imposthume. I introduced my scalpel,
there came out a pint of bloody matter: the other
viscera were in their natural state.
SIXTH OBSERVATION.
A man about fifty years of age, of a bilious tempera-
ment, hair and beard grey, came into the hospital the
21st of October. He told me he had felt great weak-
ness for some time, and had been very ill about six 

(91)
pour prendre quelques boissons. Le 16 je la trouvai
sans connaissance, et elle mourut bientôt aprè

(92)
weeks previous. He was very weak, his pulse slow,
and almost in its natural state; said he had occasion for
food, and asked for something to eat. I gave him soup,
and for drink Bourdeaux wine, with water. He re-
mained in the same state three days, and except the
weakness seemed well, and said he felt no pain.
The 31st he was oppressed, his eyes became yellow,
and pulse weak. I prescribed him as a remedy, a linctus
of water, honey, and styllitic oymel; and for his com-
mon drink, water and honey. The 1st of November
the whole body became yellow, his nose bled, his
tongue was covered with blood, he spit a great deal in
the afternoon, respiration became painful, and the
extremities cold; his urine was black, as also the bile
he vomited, his pulse became intermittent, he had a pal-
pitation which very much incommoded him. I pre-
scribed a decoction of bark, acidulated with spirits of
vitriol, a camphorated cordial draught, and wine with
sugar was given in table spoonfuls. The second he
was worse; to the symptoms of the preceding day
were joined black and bloody fæces; he vomited often,
his strength insensibly decreased, and he died on the
morning of the third. In the afternoon I opened his
body, which was of a deep yellow, with mortified spots,
his mouth was full of black blood, and had a very ill
smell.
I did not find any blood in the sinuses of the dura-
mater, the vessels of the brain were discoloured, the
serosity of the ventricle yellow, and the brain firm.
The lungs entirely withered, and mortified next the
spine, dissolved between my fingers and spread an

(93)
que dans l'état naturel. Il dit qu'il avait besoin de
nourriture et désira d'avoir à manger: je lui fis donner
du bouillon, de la soupe, et pour tisanne, du vin de
Bordeaux, coupé avec de l'eau. Il est resté trois jours
dans le mê

(94)
infectious smell; the pericardium contained a little
yellow serosity, the heart of an 

(95)
doigts et répandaient une odeur infecte. Le péricarde
contenait un peu de sérosi é jaune; le cœur était d'un
volume extraordinaire et presque du double de celui de
l'homme le plus fort: il avait l'air d'avoir été lavé, et
ne contenait pas une goutte de sang: l'oreillette droite
était distendue: aprè

(96)
so well as to give me the hope of curing him, conse-
quently had him carried from the chambers of the
dying into another room. The second, he refused the
decoction of the bark which I had ordered, he took
creamed rice and diet drinks, he continued tolerably
well till the 5th, on which day his pulse became little
and concentred, the blisters dried up, the extremities
became cold and livid.
I again ordered the decoction of the bark, and a
draught, antiputrescent and cordial. I had the blisters
dressed with the unguent of storax, his extremities
were fomented, but all was useless-the progress of
the mortification increased every day, the slough fell
from the blisters; the 8th, suppuration was re-esta-
blished, the patient took all they gave him, every
function was perfect, and he said he felt no pain; he
preserved his senses till the 11th, on which day he
again became insensible, his pulse intermittent and
scarcely perceptible, he had an infectious smell, the
breath from his lungs was cold and stinking, he was at
length in such a state as to be unable to swallow, he
had convulsive motions in the tendons. He died the
12th in the morning; in the afternoon I opened him,
and found:
Black blood in the sinuses of the duramater, the rest
in its natural state, the lungs mortified, heart withered
of a flabby consistency, and containing black blood;
the stomach and viscera of the abdomen in its natural
state, the mortification of the lower extremities ex-
tended to the middle of the leg, that of the hands had
not passed the second joint of the fingers, but in both
it had penetrated to the bone. 

(97)
Le 2, il refusa de prendre la décoction de quina que je
lui avais prescrit; il prit la cr

(98)
EIGHTH OBSERVATION.
The 17th of November I saw a young man about
twenty-five years of age. He had been brought to the
hospital the evening before, and told me he had been
ill five days; he had a high fever, his skin was burning
about the body, though his extremeties had only their
usual heat; he complained of a seeming fire in the
inside; was thirsty, his tongue and lips black and dry,
his respiration laborious and frequent, the breath from
the lungs considerably hot, his eyes very yellow, his
person livid and very thin, instead of fæces glairous
yellow frothy matter came from him, his urine was
red, he threw up all he drank, became worse and died
the 19th, the seventh day of his disease. The 20th, I
opened his body: the lungs were spotted with red
and black, the pericardium contained a little yellow
serosity, in the heart was found blood of a pale red
colour.
The liver was of an olive green colour, in the inte-
rior as well as exterior parts; the gall bladder of
an extraordinary size, it floated in the abdomen, ex-
tended to the inferior part of the illiac region, and
was marbled with black; I took it out with care, and
weighed it with the bile it contained; I found it twelve
ounces three drachms; the bile when put in a vase

(99)
HUITIEME OBSERVATION.
Le 17 Novembre, je vis un jeune homme d'environ
vingt-cinq ans: il était à l'hôpital de la veille au soir.
Il me dit qu'il était malade depuis cinq jours. Il avait
une forte fiè

(100)
contain any thing, the internal membrane was slightly
inflamed, that of the duodenum in the same state; the 
intestines contained glairous yellow frothy matter, the
internal membrane had spots slightly inflamed; the
pancreas hard, red, and rather larger than in its natu-
ral state; the internal membrane of the bladder in-
flamed, the urine extremely red, the mesentery and
pyplon contained no fat.
NINTH OBSERVATION.
A woman, about twenty-eight years of age, robust,
and of a sanguine habit, entered the hospital the
30th of September. She was attacked with the fever
two days before; her respiration was short, quick, and
hot; pulse hard and tight, face red, eyes watery and
bright, skin hot and dry; she had pains in the head
and epigastrick region, her urine was in small quantity
and very red, she vomited white glairous matter of so
strong an acid as to set her teeth on edge, her tongue
dry and red, accompanied by excessive thirst.
I prescribed bathing, and bleeding in the arm,
which I had repeated in the afternoon, and gave her
as a beverage, water mixed with volatile concreted
alkali, in each bottle I put ten grains and two ounces
of simple syrup.
The next day, being the third, she was affected with
the same symptoms, and felt such extr

(101)
et par la couleur: l'estomac était reserré et ne conte-
nait rien: la membrane interne était lég

(102)
taken at the moment of effervescence, and repeated
twice a day, also every half hour a grain of camphire,
with three grains of nitre in form of a bolus.
In the afternoon she was less agitated; her pulse a
little dilated, the vomiting and pain in the epigastrick
region ceased about noon; her tongue was moist, and
a little white; she complained of pain in the reins.
The bolus and alkalised water were continued as
before.
The fourth day in the morning, her tongue was ash-
coloured, and mouth clammy; she had two evacuations.
of green, bilious, frothy, yellow matter. I prescribed
half an ounce of cream of tartar, and two grains of
emetic tartar, to be dissolved in a pint of water, and
taken in three doses, at the distance of an hour each,
observing not to repeat them, if either produced vomit-
ing two or three times. In the afternoon she was
without fever, with a moisture on the skin, had taken
the whole of the remedy, and vomited five times white
glair, mixed with green bile; she had also eight
motions.
I ordered strong broth, creamed rice, and for the
evening (as she had been deprived of sleep from the
time she fell sick) a jalap, composed of fifteen drops
of liquid laudanum, four ounces of common water, and
an ounce of simple syrup.
The fifth day passed without fever; she took creamed
rice, and the usual drink. The following day I gave
her a cathartic. The seventh passed without fever. 

(103)
avec du jus de citron, pour 

(104)
The eighth she again took an opening medicine, an

(105)
sans fiè

(106)
the head and epigastrick region had left him; the
abdomen was swelled but not painful.
The seventh day he was very uneasy, vomited green
and yellow bile, and almost all he drank; with the
abdomen painful, the head-ach returned, his breath
was short and quick, pulse weaker, shewing an approach-
ing state of debility.
In the afternoon he had an evacuation of white
and glairous matter, the head-ach and vomiting ceased,
repiration became easier, which determined me not to
apply blisters; but I ordered creamed rice, and wine
with sugar to support his strength.
On the eighth he was oppressed; I gave him wine
and water, creamed rice, and wine with sugar. The
ninth he was much agitated, with the abdomen swelled
and painful, he threw up all he drank, his respiration
was much confined; about two in the afternoon a
a bloody flux appeared; it was glairous and of a fœtid
smell, then the vomiting ceased, respiration became
free, and though he had several evacuations, was not
so weak as in the morning. The tenth the flux con-
tinued.
The eleventh it was more considerable, swelling
of the abdomen continued, the pulse was waving, and
the skin moist.
The twelvth and thirteenth passed tolerably well,
the flux being less; his tongue was covered with a fir
of a dirty white colour. 

(107)
Le sixiè

(108)
The fourteenth day passed without fever. I admini-
stered three drachms of rhubarb, and two ounces of
manna. This medicine had a good effect; the blood
totally disappeared after the two first evacuations, the
fever also gave way, and did not return.
On the sixteenth he took a similar dose; and on the
seventeenth was sent among the convalescent, from
whence he went out in perfect health.
ELEVENTH OBSERVATION.
The seventeenth of October a man was brought to
the hospital, about forty-five years of age. He was
insensible, with his mouth open, tongue and teeth
black, the body cold, and almost without pulse, respi-
ration was short and slow: he was placed on his arrival
in the chamber with the dying. I prescribed at antipu-
trescent, and cordial draught, ordered hot bricks to
is extremities, and wine with sugar to be given him.
He remained in the same state till the 19th, when I
found the pulse raised, his senses returned, and tongue
was moist. He complained of a pain in the genitals,
which were much enlarged; the testicles, spermatic
cords, and scrotum were mu

(109)
Le quatorziè

(110)
with fixed air; his food creamed rice. An emollient
cataplasm was put on the genitals.
The 20th I found him much better, but the mortifi-
cation had fixed on the penis. I made an incision as
deep as the part would admit, and had the poultices
composed with spirits of turpentine, and camphorated
spirits of wine; the internal remedies were the same.
The 21st I took away the skin that was loose from
the incision of the preceding evening; the part was
dressed with the unguent of storax, and cataplasms
applied as before upon the testicles. The 22d the
suppuration began; as it gradually augmented the
other parts decreased, and assumed their natural size.
This patient left the hospital perfectly re-established,
after having taken the decoction of bark, and water
acidulated with fixed air for a length of time; when
he ceased their use the suppuration became bad, and
fever returned. His cure was compleated by cathar-
tics, administered in proportion as the suppuration
dried up, and the cicatrice formed.
TWELVTH OBSERVATION. 
The third of November a young girl between
twelve and thirteen was brought to the hospital. She
told me she had been ill several days; her eyes and skin
were very yellow, the latter dry and of a burning heat;
she was thirsty, with a quick pulse, and interrupted
perspiration; she had an hemorrage from both mouth
and nostrils, the blood from the latter was very red,
the drops that fell on the sides of the bason appeared
composed of little globules which were not adhesive. 

(111)
ordinaire était de l'eau acidulée avec l'air fixe, et sa
nourriture, de la crê

(112)
I prescribed a camphorated draught, and for common
drink, water acidulated with fixed air. The following
day the heat of the skin diminished, but the other symp-
toms remained; to the remedies already given, I
added a decoction of bark, acidulated with spirits of
vitriol; and as the patient was very weak, she had 
during the day four cups of veal broth, in each of
which was infused half a drachm of gum dragant in
powder; she also took some spoonfuls of sweetened
red wine.
The 9th, she complained of a sore throat. I made
her a gargle with a mixture of water, styllitic oxymel,
and honey, acidulated with spirits of vitriol. The
hemorrage continued with the same force till the 13th,
on which day it was more considerable; the 14th it
entirely disappeared, as did the other symptoms; the
remedies were then laid aside, and she continued to
recover. I gave her a cathartic some days after, and
sent her to the convalescent, from whom she went out
perfectly recovered.
THIRTEENTH OBSERVATION.
The 27th of September a young woman, about
twenty-six years of age, was brought to the hospital.
She was of a phlegmatic constitution, and had a fit of
sickness a short time before. She was attacked with the
fever in the morning; her skin was dry, tongue and
lips in the same state; she felt a lassitude and pain in
the epigastrick region, she had a difficulty in breathing,
and was thirsty; her urine was excoriating and in
small quantity. 

(113)
Je lui fis prendre une potion camphrée, de l'eau
acidulée avec l'air fixe pour boisson ordinaire.
La chaleur de la peau diminua, mais les autres
symptômes se laissaient encore voir. J'ajoutai aux remè

(114)
I prescribed a cooling antiputrescent draught, and
water acidulated with dulcified spirit of nitre, sweetened
with simple syrup.
The second she became yellow, and vomited bile
of different colours. The third the yellow was deeper,
all the symptoms of the second day had increased with 
violence, the vomiting fatigued her very much; to
avoid the pain she refused to drink: at night her
tongue was covered with blood. The fourth a quan-
tity came from both mouth and nostrils; she was
excessively weak.
The fifth her pulse was low and intermittent, she
lost much blood, and was greatly oppressed; her ten-
dons were much convulsed. I ordered blisters to her
legs, and prescribed decoction of bark acidulated with
spirits of vitriol, wine with sugar, and broth with gum
dragant, as in the preceding case. In the evening she
was senseless, and almost without pulse; she mecha-
nically applied her fingers to her nose, which she
pinched, and covered her face with the black blood
that came from both mouth and nostrils; her face was
entirely yellow, mouth and eyes half open, which gave
her a most hideous appearance. I had hot bricks applied
to her extremities, which were cold, as also upon the
blisters; and ordered a cordial draught to be given in
spoonfuls, when she should be able to swallow.
The sixth I found her better, but her senses were
imperfect and ideas confused; she swallowed mecha-
nically all that was put in her mouth; the blisters rose

(115)
Je lui fis prendre une potion anti-putride et tempé-
rante, de l'eau acidulée avec l'esprit de nitre dulcifié
et édulcorée avec du sirop simple.
Le 2 elle devint jaune et vomit de la bile de diverses
couleurs. Le 3 la couleur jaune était plus foncée: tous
les symptômes des premier et second jours s'étaient
développés avec violence: le vomissement la fatiguait
beaucoup, et afin d'en éviter les douleurs, elle refusait
toutes sortes de boissons. Le foir sa langue se couvrit de
sang. Le 4 elle en rendit beaucoup par le nez et par la
bouche: elle était d'une faiblesse considérable.
Le 5 son pouls était petit, intermittent: elle per-
dait beaucoup de sang et se trouvait trè

(116)
well, and discharged thick pus. I supported her with
cordialised tincture of bark, wine, and broth.
The seventh she relapsed, and was as on the fifth;
the blisters were covered with a dry gangrenous slough,
and the hemorrage continued. I found her in a despe-
rate situation, and had her warmed with hot bricks as
before.
The eighth, ninth, and tenth she was the same, and
did not recover her senses till the eleventh; then the
mortified slough fell from the blisters, and suppuration
was great. She continued the acidulated bark till the
twentieth, when the hemorrage ceased; she also used
a detergent gargle, to brace and cleanse the inside of
the  mouth, which was excoriated and covered with
little ulcers, her lips were in the same state and swelled.
I made use of means to support her strength, gave her
cathartics when the blisters dried up, and sent her
among the convalesc

(117)
nèrent beaucoup de sérosité: je la fis soutenir avec une
décoction de quina cordialisée, du vin sucré et du
bouillon.
Le 7 elle tomba dans l'état du 5; les vésicatoires
étaient couverts d'escares gangréneuses et sèches:
l'hémoragie continuait: je la trouvai dans un état
désespérant: je la fis chauffer avec des briques comme
le 5.
Les 8, 9 et 10 elle ne fut pas mieux; ce ne fut que
le onziè

(118)
The third day she felt great uneasiness and g

(119)
Le troisiè

(120)
bed; she had a burning skin, and great thirst, took
whatever was offered her; her urine was red and in
small quantity; she had convulsive motions in the ten-
dons, and the solids were in a state of irritation.
I prescribed a draught of eight ounces of common
water, twenty grains of Homberg's sedative salts,
thirty-six drops of Hoffman's minerai liquor, and two
ounces of simple syrup, to be taken by the table spoon-
ful every half hour; the blisters were taken off about
four in the afternoon, there was a great deal of pus;
the pain in the loins and evacuation ceased, her face
was red, she had a violent head-ach and oppression, her
nose began to bleed about six in the evening, and her
pulse became concentred. I gave her wine with sugar.
At nine o'

(121)
os. L'oppression était si extr

(122)
spirits of nitre. She took two table spoonfuls of this
remedy every hour, and in the intervals red wine with
sugar, broth, and creamed rice, or barley.
Towards eleven o'clock her pulse raised, respiration
was easier; the hemorrage continued as before. At
four in the afternoon she became weak as in the morn-
ing, lost a great deal of blood, and breathed with diffi-
culty; her urine was thick and of the colour of strong
beer, it was put in glasses but did not settle; her pulse
was scarcely to be felt; her senses continued perfect,
though her weakness was so great. When the blisters
were drest, they were dry, and covered with gangre-
nous slough. I had unguent of storax applied. She con-
tinued the decoction of bark, wine broth and creamed
barley.
The morning of the ninth I found her better, the
oppression had ceased; but she fainted at four o'clock;
the hemorrage was considerable all night, but entirely
disappeared in the morning; she had two fœtid evacu-
ations in substance; her urine was abundant, and had
a cloud in it that did not settle; her skin was humid
and of an equal natural heat; she felt easy.
The regimen and remedy of the preceding day were

(123)
fis ajouter vingt gouttes d'esprit de nitre. La malade
prit toutes les heures deux cuillerées à bouche de ce
remè

(124)
only remaining; the urine was in quantity and thick,
as was a white sediment it deposited; the slough began
to detach itself from the blisters; the remedies were
continued the same. The elev

(125)                 
son pouls s'était développé; la fiè

(126)
seriorus reflections; and he immediately asked for some
drink. As my visits were as frequent in that room as in
the others, I perceived the change, and having some
hope from it, prescribed remedies suitable to the
case. He found himself very soon relieved, the action
of swallowing became free, and by degrees the disease
gave way. At the end of twenty-five days he was well
enough to sit upright, when he went into another apart-
ment. His cure was not retarded though he was con-
tinually with those that had the epidemic: he was per-
fectly re-established, and went out of the hospital the
19

(127)
coup de malades, victimes de l'épidémie, et aussitôt
remplacés par d'autres, il fit sans doute quelques ré-
flexions que lui suggéra ce spectacle effrayant; il se
détermina d

(128)
French hospital. This man was seventy-two days sur-
rounded by those attacked with the epidemic, many
of whom died by his side, whose places were imme-
diately re-occupied by others infected with the same
disease; and yet he never experienced any symptoms
that did not belong to his own complaint.
SEVENTEETH OBSERVATION.
A girl, about nineteen, was brought to the hospital
the 23d of September. She had a high fever, and
complained of pain in the head; her face was red,
eyes watery, and breath short; she was thirsty, and
felt a g

(129)
homme y resta. Pendant soixante dix-neuf jours qu'il
est resté entouré de malades épidémiques, dont plusieurs
sont morts à ses côtés et ont été remplacés par d'autres
attaqués la mê

(130)
height of the epidemic, but think those already given
sufficient to prove it not contagious.
I must do homage to truth, and undeceive the public
relative to a false report which increased the public
fear, and that some people seemed to delight in gain-
ing credit to; and he

(131)
ront pour prouver que l'épidémie n'était pas conta-
gieuse.
Je dois aussi, pour détromper le public sur un faux
bruit qui tend à perpétuer les craintes que quelques
personnes semblent prendre plaisir à accréditer; je dois,
dis-je, rendre hommage à la vérité, et avancer ici
qu'il est faux qu'il soit mort à l'hôpital Bush-hill des
personnes venues de St Domingue. Il y est mort une
femme venant du Cap, mais qui n'avait d'autre mala-
die que d'ê

(132)
After the cessation of the epidemic, when the patients
were convalescent and judged fit to return home, the

(133)
Lorsqu'aprè

(134)
say, these are no proofs of its not being contagious,
since these patients, as well as those persons who
escaped the epidemic, might not at that time be disposed
to receive it. This objection might be easily answered,
but I will content myself with observing, that among
so many sick of other complaints at the hospital, and
the great number of French who arrived he

(135)
que ce qui a servi à un épidémique peut, dans un
temps m

(136)
critical minds will perhaps exclaim against my observa-
tions, but flatter myself I shall be made amends by the
opinion of the philosophic and sensible, to whom there
is not any think extraordinary or superfluous when the
object is the good of mankind. I only propose general
means as preventatives, for if an epidemic again appears,
it will most probably assume a different form, and con-
sequently require another mode of treatment.
The methods requisite to be observed relate not only
to society in ge

(137)
pareil fléau. Des esprits, ou critiques ou puérils, s'étè-
veront, peut-ê

(138)
city. The vapours continually attracted from these
places of corruption by the sun, infect the air, whilst
the rain penetrating, washes in the graves the putrid
remains of the bodies, and carries with it into the wells
detached, infected particles, from which it could not be
disengaged by filtration, in the short space it has to
go.
After this remark, which I can only think of with
pain, may not an individual say before he drinks a
glass of water, "I am about to feed upon a being like
myself, to swallow particles from dead bodies, and per-
haps those once dear to me, and whom I still regret."
Independent of other inconveniencies from burial places
in the city, this reflexion alone is surely sufficient to
determine upon following the example of almost all
the cities of Europe; where, I repeat, experience has
nation to banish burial grounds from their cities. Many persons
near pretend, they could not at all affect the salubrity of the
city, and advanced as a proof, the disease not being so frequent
near those receptacles of the dead as in other places. If this asser-
tion was true, it could not confuse my opinion; however, I do not
pretend to say, the cause of the epidemic proceeded from the
burial grounds alone, but I declare and maintain, the putrid mias-
mata which continually exhale (however deep the graves might be)
being mixed with miasmata proceeding from other causes, must
render the city less healthy, and corrupt the air through which it
passes; this air thus charged with vapours, might be spread abroad
and affect persons at a distance, whilst those near the cimeteries
e

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que cette ville renserme dans son enceinte. Les vapeurs
que la pompe aspirante du soleil él

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induced them to banish such places, as they are capable
of injuring the healthiest constitution, and affecting
them with the most fatal diseases. I have not dis-
sembled, and am sensible how few will think with me.
I expert the sarcastic laugh of the half-learned critic,
and persons much attac

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qui m'ont appartenus et que je regrette journellement.
Outre ces inconvéniens, de la position des cimeti

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The particular means which regard individuals only,
consist in some precautions. The most necessary is to
fortify the mind, and resist as much as possible the fears
naturally inspired by epidemics. This emotion of the
soul disorders the mind, effaces reason, and occasions in
the whole machine such a commotion as to influence
the animal economy, and injure the health. It is there-
fore highly necessary to resist this childish fear, which
cannot cure, but may render the body more liable to
disease. Excess of every kind must also be avoided;
the air of houses and apartments continually changed
and every thing kept in the greatest estate of cleanliness.
This neatness consists in the frequent change of linen,
bathing often in summer, washing the mouth every.
morning and after each meal with water and vinegar.
I cannot finish these reflexions, and pass unnoticed
those little bags of camphire, and spunges filled with
vinegar, that were so generally made use of last
autumn; and do not pretend the means were not salu-
tary, but the manner they were used in was pernicious: 
the mouth and nose were so closely pressed, as totally
to interrupt respiration for a time, which must naturally
produce the most fatal symptoms. The air, that humid
and fluid substance, that serves for respiration, loses its
elasticity, and is easily corrupted by the acrid humours
drawn from the lungs; this humour mixed with it
produces a stimulating quality, which excites in the
bronchiæ, and other ærial vessels, a contraction that
prevents a free dilation of the lungs; and circulation 

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Quant aux moyens particuliers et qui ne regardent
que chaque individu, ils consistent uniquement dans
l'usage de quelques précautions à observer: le plus
essentiel serait, s'il était possible de résister à ce mouve-
ment involontaire, de se roidir contre la crainte et la
frayeur qu'inspirent au premier moment les maladies
épidémiques: cette émotion de l'ame trouble l'esprit
et offusque la raison de ceux qu'elle saifit, et elle occa-
sionne, dans toute la machine, une sorte de commotion
qui influe sur l'économie animale et altè

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of the blood, from whence the worst disorders may
proceed. Those who place confidence in this means,
should use it with moderation, to avoid finding a source
of disease in the real principle of life.
Such are the reflexions I think a duty to lay before
the public. From what I have seen, observed, and
studied, I have acted agreeable to my knowledge and
capacity. If my efforts and zeal have been crowned
with some success if the result of the observations I
now present to the public is useful, my end is attained,
and shall be happy in any opportunity I may have of
being useful to my fellow-creatures.
FINIS.
REGISTERED ACCORING TO ACT OF CONGRESS. 

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que l'effet le plus suneste. L'air, cette substance fluide
et humide, qui sert à la respiration, perd son élasticité
dè