ife'77; ft,:.. 3 i—iv/- niC 1 ' 1 MEDICAL FACTS AND INQUIRIES, RESPECTING THE CAUSES, NATURE, PREVENTION AND CURE OF FEVER: MORE EXPRESSLY IN RELATION TO THE ENDEMIC PETERS OP SUM- MER AND AUTUMN IN THE SOUTHERN STATES. TOGETHER WITH A HISTORY OP THE BILIOUS REMITTING FEVER OF ALABAMA, AS IT APPEARED IN CAHAWBA AND ITS VICINITlT SUMMERS AND AUTUMN& —-. OP I- f f} . fj Of Blood-letting,.......~*° Of Emetics, .......*}" Of Cathartics,.......* Z*~ Of Calomel,........i™ Of the Cold Bath, - - - - - ■ ' %** Of Cold Applications and Sponging the Body, - ^ Of the Warm Bath,.......^* Of Febrifuge and Sudorific Medicines, - - - ^ Of Blistering,......' " ' ol* Of Peruvian Bark,.......J*o Of Wine, -.---- 344 Of the Sulphate of Quinine, ----- 347 Of Stimulating Drinks,......347 Of Mineral and Vegetable Acids, - - * - 348 OfOpium,........361 Directions concerning Convalescents, - - - 364 \n account of the Bilious Remitting or Endemic Fever of Alabama, as it appeared in Cahawba and its vicinity in the summer and au- tumn of 1821, .........5ri An account of the Endemic Fever of 1822, . . . - .418 • PREFACE. JT EVER is a disease of such common occurrence, that accord- ing to Gorier one third, and according to Sydenham two thirds, of all the disorders to which mankind are liable, are of this de- scription ; and it has been a received opinion among physicians, that more than one half of the human race are destroyed by fe- ▼er alone.* What an idea must we not have of the malignancy and fatality of the yellow or bilious fever of the West Indies, when we are informed by Dr. Home, that three out of four of his patients in Jamaica were destroyed by the disease ? This, however, is by no means equal to the mortality caused by the bilious fever in Natchez, in the summer of 1823 ; in which, out of four hundred persons that were taken sirk between the loth of August and the 20th of September, only twenty survived. The inhabitants of Europe, and of large manufacturing estab- lishments in our own country, are subject to a description of fe- vers called typhus, from the low nervous symptoms which attend them ; these, as being of a local and more limited extent, are not the subject of the present inquiry. Those who wish to become acquainted with the typhus fever of England, may consult with advantage the ingenious work of Dr. Armstrong. Nor is it my design to enter minutely into the discussion of the various forms and characters of febrile affections ; but my object is more es- pecially the consideration of those fevers which are obriously connected with and originate from heat of climate and noxious exhalations: or in other words, the endemic bilious and remit- tent fevers incidental to the wide extent of the United States, but especially to its southern section. As a knowledge of these fe- vers, from the malignancy which they frequently assume, is of the greatest importance to the physician, so every attempt insti- tuted to investigate the laws by which they are governed, their nature, prevention and cure, must thence derive an importance, proportionate to the ability with which it is conducted. The * Burserius' Practice of Physic, p. 104. iv PKEFACE. merits of this performance I leave for others to determine.'— Having, from careful and mature consideration of facte, drawn the most obvious and practical conclusions, 1 have at least satis- fied myself with respect to many particulars on the subject of fe- ver which have been hitherto neglected, or but slightly and im- perfectly remarked and understood. The outlines of these observations were drawn up during my residence in the southern portion of the United Slates. Upon my return to the north, I consulted every writer within my reach who had treated on fever, and the relative branches con- nected with the subject. In thus presenting myself as an author before the public, I have maturely weighed the responsibility and importance of the step which I have taken. It is now nearly ten years since I first turned my attention to this inquiry, during which time I have carefully examined and considered the subject matter of investigation, so that it cannot be viewed in the light of a hasty, indigested essay, without maturity or experience, but as the re- sult of labor, study and observation. Such as it is, I now offer it to the public. In several instances I have found it necessary to prune, correct and enlarge the crude performance of my more juvenile years ; and although I have not the vanity to think that the present work is entirely free from errors and defects, yet I flatter myself that in every point of view these observations will be found of practical utility. No disease has been the theme of so much discussion as fever, and there is probably none upon which so much has been ad- vanced to so little purpose : but as every subject of scientific investigation must be progressive in its course to perfection, so by improving upon the experience and researches of our prede- cessors we may hope ultimately to arrive at the summit of hu- man perfection. I might here take up an investigation of the va- rious hypotheses that have prevailed in the medical world on the subject of fev^r, from the time of Hippocrates to that of Dr. Rush. But a labor of this description would prove as unprofitable in its result as it would be painful and tedious in its performance. The reader will perceive that I have taken a new view of fe- ver, at least one quite different from any that has lately appeared. I have, indeed, endeavored to trace this disease through all its intricacies and meanderings of its causes and operations to its complete and final developement. And as the feveis which form the subject of the present work are known to be connected with, and to depend upon morbid changes and vitiations existing in the atmosphere, I have, as a leading inquiry, directed my attention to the chemical composition of this element, and have further attempted to show what it is that destroys the salubrity of the atmosphere in certain seasons and situations, and to point out the manner in which this stale of the air may be guarded against and prevented. PREFACE. On the subject of contagion and importation, I have also dwelt at considerable length, and as I conceive hf.ve given it a fair and candid investigation. The practical purposes to which this branch of the inquiry more expressly applies, are the police of cities, the enforcement of quarantine regulations, and the inter- course of physicians, nurses and friends, with those laboring un- der disease The establishment of just principles, therefore, in relation to this subject, is of the first importance ; not only in a medical, but also in a civil and national point of view. In conducting this inquiry, facts were necessary to establish principles. Of these, therefore. I have availed myself to as great an extent a? my time and opportunity would permit, or as the subject might seem to require. I may, perhaps, in the opinion of some, have adduced more examples in proof of the pernicious effects of putrid exhalations, than the general admission of the fact might seem to demand : yet in an investigation of this na- ture, it is highly necessary and proper that every individual should knou the foundation and reason of his opinion and be- lief; and as the chief object in the prevention of diseases is the knowledge of their causes, it is evident that these cannot be too cleariy defined and asceitained. The present is but a part of a more extended performance, the publication of which is for the present postponed : and I find that in my delay in appearing before the public, I have lost much of the credit that I might otherwise have acquired. Thus the theory of ricke's advanced by Mr. Bonhomme, of France, and which has been successfully applied to practice, was entertained and advocated by the author of this work long before the publi- cation of the performance of Mr. Bonhomme. But in the pre- sent inquiry I believe 1 have not been anticipated. Some, perhaps, will dispute my claims to originality, both as it respects the theory of scurvy and fever. This, however, I must do myself the justice to say, that at the time this work was undertaken my mind was perfectly unshackled by prejudice or preconceived opinion ; and that the ideas that suggested them- selves were for the most part original and unborrowed ; and it was not till I had embarked in a general course of medical read- ing, with the view of qualifying myself as an author, that I dis- covered several coincidences of opinion between myself and some former physicians. But these coincidences which I occasionally observed on the part of others, were like random steps taken in total darkness ; where one by chance and possibility may be right, and where a hundred in probability will be wrong. They were detached and disconnected, in scattered fragments without order or design ; and clouded and beset with so many absurdi- ties, that it appeared clearly the writer had no distinct and defi- nite ideas upon the subject. One kind of scurvy, or fever, for instance, depended on an acid, another on an alkali, another on phlegm, another oa salt or an unknown acrimony, and finally on vi PREFACE. all the elements, either singly or combined, earth, air, fire and water. These, by fermenting and working, and mixing and strain- ing, and heating and cooling, and boiling and foaming, produced all the various form? and phenomena of fever. " Fevers," says Hippocrates, " are caused by the bile and phlegm growing hot ; these mixing with the blood at first con- dense and cool it, and occasion the coldness and rigor; after- wards they heat the blood and produce the hot stage."* No better founded are the opinions of many of his successors, who have attempted to account for the nature of diseases upon the supposition of certain qualities and mixtures of the different flu- ids of the body ; for as the properties of these were unknown, of course all reasoning upon their mixtures, changes and chemi- cal action, could have been nothing more than the erroneous vagaries of mere speculation. " Experiments," says Dr. For- dyce, "can only determine the condition of the fluids of the body. Every thing, therefore, that is said with regard to the fluids before the time their properties were investigated by ex- periments, excepting some of the external appeaiances of some ot the secreted fluids, is to be entirely passed over as not at all relevant to the explanation of the causes of this disease, {fever,) or the history of it in any manner. The first part of the blood which was distinctly marked was the serum. Some person about a century and a half ago discovered the red particles. Even Boerhaave was unacquainted with the coagulable lymph ; and the properties and varieties which take place in these three es- sential parts of the blood, are even not well known to the ma- jority of practitioners in Europe. It would appear, therefore, that there is very little ground for resting the cause of disease. whether it be fever or any other, on what has been affirmed of the properties of the fluids by many, even practical authors, for they knew them not, and did not examine them."| " From Willis to Fothergiil," says Dr. Beddoes, " and from Foihergill downwards, scarce any real observation occurs upon the state of the blood. One tells us that it is polluted, another that it is contaminated, a third that it is acrid, a fourth that it is putres- cent, without recollecting that to employ terms expressive of phenomena, such as the senses may recognize, and to reason upon such phenomena alone, are indispensable conditions in philosophizing."! In taking the view of the subject here presented to the pub- lic, practical conclusions are established, founded on the latest discoveries and improvements in medical philosophy. As in the time of Dr. Cullen, an investigation of the nature of dis- eases on the principles of the humoral pathology would have * Hippoc. De Mcrb. Lib. 1. t Geo. Fordyce on Fever, &c. p. 158. | Beddoes' Observations on Sea Scurvy, ic. p. 122; PREFACE. vii been in a great degree unsuccessful and abortive from the im- perfect knowledge of animal chemistry at the time, in like man- ner the nature and phenomena of many diseases remained unex. plained. Many of these difficulties no longer exist, and in the present work I have called to my aid the latest improvements in medical science. In my attempt to contribute to the cause of my profession, I have aimed at some fundamental pathological conclusions, and have endeavored to establish a practical theory, founded upon the sure basis of facts and demonstration. It is the custom of many to decry theory in physic as vain and unprofitable specu- lation, and to insist upon the superior advantages of experience, as the only and essential qualification for successful practice.__ But it was well observed by Dr. Beddoes, and the same idea ie expressed by Dr. Moore, that there are few diseases in which we have any fixed rules of practice, and our specifics are so few, and so easily applied, that this part of medicine may be acquired without difficulty or loss of time. In some instances a theoreti- cal deliberation of 9ome sort must precede prescription, and here the discrimination of persons habituated to speculation will have the superiority of skill over chance, and their facility of resources will appear to peculiar advantage. For, as observed by Dr. Moore,* some diseases appear in such a questionable shape, that the most knowing are puzzled to decide to what class they belong, and the combined powers of experience and saga- city have sufficient employment in treating them. " He who draws medical knowledge from books alone," says Dr. Moore, 14 and whose exalted notions have not been moderated by expe- rience, will practise medicine as the philosopher who declaim- ed on the art of war to Hannibal would have commanded an ar- my ; but he who has seen much practice without reasoning, as one of Hannibal's pioneers, and he who to extensive experi- ence joins the greatest natural acuteness and all the powers of reasoning, as Hannibal himself." And it is well observed by Dr. Rush, that 4' a single principle in our science will lead to more truth in one year, than whole volumes of uncombiued facts will do io a century." As this work consists more in demonstration than in theoreti- cal speculation, the facts and illustrations, to whatever purpose they may be applied by others or myself, must be considered of essential practical importance. My original design was, at first, merely to embrace an histori- cal account and medical illustration of the epidemics of the years 1821 and 1822 ; but with the view of rendering the work the more generally useful and interesting to the medical reader and to the public at large, I have thought proper to embrace a gene- ral history of the causes and treatment of endemic fevers as thef * Medieal Sketches. VI PREPACK. all the elements, either singly or combined, earth, air, fire am* water. These, by fermenting and working, and mixing and strain- ing, and heating and cooling, and boiling and foaming, produced all the various form? and phenomena of fever. " Fevers,*' says Hippocrates, " are caused by the bile and phlegm growing hot ; these mixing with the blood at first con- dense and cool it, and occasion the coldness and rigor; after- wards they heat the blood and produce the hot stage."* No better founded are the opinions of many of his successors, who have attempted to account for the nature of diseases upon the supposition of certain qualities and mixtures of the different flu- ids of the body ; for as the properties of these were unknown, of course all reasoning upon their mixtures, changes and chemi- cal action, could have been nothing more than the erroneous vagaries of mere speculation. " Experiments," says Dr. For- dyce, 4,can only determine the condition of the fluids of the body. Every thing, therefore, that is said with regard to the fluids before the time their properties were investigated by ex- periments, excepting some of the external appeaiances of some of the secreted fluids, is to be entirely passed over as not at all relevant to the explanation of the causes of this disease, {fever,) or the history of it in any manner. The first part of the blood which was distinctly marked was the serum. Some person about a century and a half ago discovered the red particles. Even Boerhaave was unacquainted with the coagulable lymph ; and the properties and varieties which take place in these three es- sential parts of the blood, are even not well known to the ma- jority of practitioners in Europe. It would appear, therefore, that there is very little ground for resting the cause of disease, whether it be fever or any other, on what has been affirmed of the properties of the fluids by many, even practical authors, for they knew them not, and did not examine them."| '4 From Willis to Fothergill," says Dr. Beddoes, " and from Fothergill downvvards, scarce any real observation occurs upon the state of the blood. One tells us that it is polluted, another that it is contaminated, a third that it is acrid, a fourth that it is putres- cent, without recollecting that to employ terms expres.sive of phenomena, such as the senses may recognize, and to reason upon such phenomena alone, are indispensable conditions in philosophizing."^: In taking the view of the subject here presented to the pub- lic, practical conclusions are established, founded on the latest discoveries and improvements in medical philosophy. As in the time of Dr. Cullen, an investigation of the nature of dis- eases on the principles of the humoral pathology would have * Hippoc. De Mcrb. Lib. 1. t Geo. Fordyce on Fever, &c. p. 158. \ Beddoes' Observations on Sea Scurvy, 4-c. p. 122." I PREFACE. vii been in a great degree unsuccessful and abortive from the im- perfect knowledge of animal chemistry at the time, in like man- ner the nature and phenomena of many diseases remained unex- plained. Many of these difficulties no longer exist, and in the present work I have called to my aid the latest improvements in medical science. In my attempt to contribute to the cause of my profession, I have aimed at some fundamental pathological conclusions, and have endeavored to establish a practical theory, founded upon the sure basis of facts and demonstration. It is the custom of many to decry theory in physic as vain and unprofitable specu- lation, and to insist upon the superior advantages of experience, as the only and essential qualification for successful practice.— But it was well observed by Dr. Beddoes, and the same idea ie expressed by Dr. Moore, that there are few diseases in which we have any fixed rules of practice, and our specifics are so few, and so easily applied, that this part of medicine may be acquired without difficulty or loss of time. In some instances a theoreti- cal deliberation of some sort must precede prescription, and here the discrimination of persons habituated to speculation will have the superiority of skill over chance, and their facility of resources will appear to peculiar advantage. For, as observed by Dr. Moore,* some diseases appear in such a questionable shape, that the most knowing are puzzled to decide to what class they belong, and the combined powers of experience and saga* city have sufficient employment in treating them. " He who draws medical knowledge from books alone," says Dr. Moore, 44 and whose exalted notions have not been moderated by expe- rience, will practise medicine as the philosopher who declaim- ed on the art of war to Hannibal would have commanded an ar- my ; but he who has seen much practice without reasoning, as one of Hannibal's pioneers ; and he who to extensive experi- ence joins the greatest natural acuteness and all the powers of reasoning, as Hannibal himself." And it is well observed by Dr. Rush, that 44 a single principle in our science will lead to more truth in one year, than whole volumes of uncombiued facts will do in a century." As this work consists more in demonstration than in theoreti- cal speculation, the facts and illustrations, to whatever purpose they may be applied by others or myself, must be considered of essential practical importance. My original design was, at first, merely to embrace an histori- cal account and medical illustration of the epidemics of the years 1821 and 1822 ; but with the view of rendering the work the more generally useful and interesting to the medical reader and to the public at large, I have thought proper to embrace a gene- ral history of the causes and treatment of endemic fevers as they * Medieal Sketches. Vlil PREFACE. occur in various places and seasons in the United States ; adapt- ing the practice more especially to the fevers of the southern section of our country. And with the design of rendering this treatise the more profitable, I have enlarged upon the practi- cal part considerably more than if I had intended it exclusively for the experienced physician. In this, however, the inexperi- enced will find an advantage ; for it often happens thai the young practitioner, who has beeu more familiar with theory than the bed-side ofthe sick, finds himself materially at a loss on approach- ing his patient*, at the diversified character of diseases : and upon consulting his best authorities, he is still left in doubt and uncertainty. The general treatment of diseases is described, but so many particulars are omitted, that he finds himself, in a great measure, thrown upon the resources of his own judgment and discretion. To obviate these inconveniences, and to render the work useful to the general community, I have extended the subject of the prevention and cure of fever considerably beyond tny original design. As it respects the treatment of fever of 1821 and 1822, 1 have spoken almost entirely from my own ex- perience ; and what has been omitted under these heads may be found discussed at large under the general treatment of fever in the previous part ofthe treatise. Accounts of the fever of 1821 and 1822, will be found in the latter part ofthe present work. In the execution of this performance some inaccuracies have, perhaps, escaped me, as the authorities referred to were prin- cipally taken in manuscript during my residence in New-York, in the years 1815, '16, and '17 ; and the impossibility of again consulting them on the present occasion, must be my apology for the few orthographical errors that may be detected. As the sense in which the words epidemic and endemic should be received, has not hitherto been accurately defined by medical writers, it may be thought necessary for me to explain the ac- ceptation in which 1 employ them. An endemic may be defined, a disease incidental to a country or tract of country, and such as from local peculiarity of climate and situation, or similarity of constitution, frequently occurs : thus the bilious remitting or yellow fever is an endemic of the East and West Indies, and of various parts ofthe United States. As in each place it has some symptoms which are not observable elsewhere, each district and section of country may be said to be liable to an endemic pe- culiar to itself. The itch is an endemic in Scotland, and the plica Polonica in Poland. Now as the season and situation may be more or less unhealthy, the endemic may be epidemic or spo- radic ; epidemic, when it attacks a large proportion of the peo- ple ; sporadic, when it affects only a few scattering individuals. This is the construction which I give the words epidemic and endemic ; making endemic the class, and epidemic and sporadic the orders. But there may exist an epidemic w ithout an endem- ic disease ; as is the case with most contagious disorders, as the PREFACE. IX small pox, meazles, chicken pox, &c. as likewise influenza and the spotted fever. As these are incidental to every country, and confined to no one in particular, they cannot, with propriety, be called endemics. By designating the summer and autumnal bilious fevers ofthe United States, whether appearing in large cities and sea-ports, or in inland situations, the endemic fever of the country, I have endeavored to simplify the subject, and to disrobe it of that mys- tery and terror with which some physicians have endeavored to invest it. A fever originating from offensive docks and filthy streets has received the frightful appellation of the yellow fe- ver ; but to designate by that name a disease arising under simi- lar circumstances of heat and putrefaction in the interior ofthe country, would by the advocates of imported contagion be con* demned as heterodox in the extreme. In the view which I have taken, I have considered all the modifications of summer and autumnal fevers as the same disease, diversified, however, in different seasons and situations, in form, violence and degree ; but in every instance originating from similar causes. 8 OF THE CAUSES, NATURE, PREVEN- TION AND CURE OF FEVER. CHAPTER I. Ofthe causes of Summer and Autumnal Fevers in hot and trop- ical climates—Chemical and philosophical investigation of the preliminary circumstances of Endemic Fevers—rChemi- cal analysis of the process of putrefaction and decomposition* SECTION 1. Introductory Remarks. FROM a consideration of the circumstances which are generally connected with the origin of fever, there can be little doubt that the most frequent cause of it consists in that vitiated condition of the atmosphere occasioned by animal and vegetable decomposition; so that whatever favors and promotes this process must equally favor the production of fever. It must be obvious to every person, of even the most lim- ited observation, that the salubrity, or unhealthiness of cli- mates is essentially modified by the temperature and condi- tion of the atmosphere, and by the physical processes which are constantly taking place on the surface ofthe earth. Thus we find that a high degree and long continuance of heat du- ring the summer and autumnal months, give rise, in various situations, to bilious diseases. We as regularly observe, on the other hand, that the cold of approaching winter puts a stop to the prevalence of these diseases; hence we infer with as much certainty, as from the alternate vicissitudes of light and darkness, which take place upon the rising and setting ofthe sun, that this luminary is the source of light; with the same certainty we infer that the prevalence and declension of bilious diseases are owing to the successive 12 Remote Causes offerer. vicissitudes of heat and cold, in connexion with other physi- cal circumstances, which is the object of this history to point out and ascertain. One of the most striking effects of a high temperature is the decomposition or destruction which it occasions in dead animal and vegetable substances. The immediate conse- quence of this decomposition is the escape of elastic gases, and the corruption or vitiation of the surrounding atmos- phere. The effect of this contamination of the atmosphere, as determined by extensive observation, is the production of endemic and epidemic diseases. Thus we find that the same sun which warms and cher- ishes the seasons, affording life, support, activity, and beau- ty to the animal and vegetable world, is also, to the human race, the prolific parent of diseases and death. Previously to entering into an investigation of the more immediate causes of fever, I shall, therefore, premise a short account of some preliminary circumstances; as the process of putrefaction and decomposition: a chemical considera- tion of the atmosphere; the vitiations and changes to which it is liable; together with the theory of vegetation. SECTION 2. Of the processes of putrefaction and decomposition. The circumstances required for the putrefaction of dead animal and vegetable substances, are heat, moisture, and ex- posure to the atmospheric air. The temperature most fa- vorable to the process, seems to range between 75 and 95 degrees of Fahrenheit. A higher degree of heat, by dissi- pating humidity, impedes or suspends the process. The degree of heat necessary to putrefaction, is much inferior to what is required for spirituous and acetous fermentations, for putrefaction take place at the temperature of 45°; but a higher temperature is still more favorable, at least if the heat be not so violent as to volatilize and dissipate all the moisture of the putrescent substance, and render it en- tirely dry. Access of air is another circumstance especial- ly favorable and necessary for putrefaction, for it is found that vegetable substances are preserved in vacuo. A certain degree of moisture is indispensably necessary for decomposition. When animal bodies are suddenly de- prived of their humidity and aqueous juices, they become hard, dense, and incorruptible, like petrifactions. This is exemplified in the arid and sandy deserts of Egypt and Ara- Remote Causes of Fever. IS bia, and also in some parts of South America ; where, not- withstanding the heat of climate, the dryness of the atmos- phere and soil prevents putrefaction by the rapid exsiccation of the animal juices which it occasions. By an increase of caloric, the quantity of water which the atmosphere is ca- pable of holding in solution, is also increased. Now the air in passing over these parched and sandy deserts, where there are no trees, herbage, nor aqueous exhalations to re- fresh it, becomes intensely heated by the scorching sun. so that its capacity for water is greatly augmented ; from which circumstance it happens that every thing is robbed of its humidity which is capable of affording it, and animal bodies are converted into mummies. We are informed by the learned Dr. Shaw, in his travels from Egypt to the Holy Land, that he saw in the deserts, the bodies of some dead camels, which had belonged to a former caravan, and re- maining in a state of preservation, entirely free from putre- faction.* *The destruction of caravans and travellers in the deserts of Asia and Africa, is frequently caused by the fatal breeze called Samiel wind, a blast of which, in those parched deserts, proves instantly fatal to the unfortunate traveller or beast, that may be exposed to it These winds seem to pro- duce death by suffocation, in consequence of their depriving the lungs of the ability to perform their function, and not by any pestilential poison in the air itself It appears from the experiments of Dr. Priestley, that oxygen gas will not act upon the blood through diy membrane, and that a moist state is necessary for this purpose. This dry and parched air of these sandy deserts iostantly absorbs the moisture from the delicate membrane forming the air cells of the lung--, and thereby prevents the oxygen of the atmos- pheric from performing its purifying operation upon the blood. Theeffecti of this air upon the surface of the body, are similar to those upon the lungs; it shuts up the pores of the skin, and puts an entire stop to perspiration. These reflections were made previous to my seeing those of Mr. Volney upon the same subject; who says, in his description of the Kamsyn, (which may be considered the same as the Samiel) that the lungs are irritated by the presence of this air, are contracted and rendered crisp. "This wind," continues he, " crisps the skin, evaporates animal moisture, closes the pores, and produces febrile heat which always accompanies suppression of the perspira'ion." The effect of this hot suffocating blast or vapour, (the Sa- miel) says Dr. Lind, on the human body, even when mitigated by passing through a moist atmosphere, is the same as that of intense cold ; it shuts up every pore of the skin, and entirely stops the perspiration of such as are exposed to it. They come on only in the day time, and always from the des- erts. Water is the only known atitidote or corrector of this vapour. {Lind* on Hot Climates, p. 144.) It apppars from the experiments of Saussure, that a cubic foot of atmospheric air will hold eleven grains of water in solution ; from five to ten grains, however, is the usual quantity contained in every cubic foot. A certain degree of humidity is necessary to preserve substan- ces upon the surface of the earth in a proper state of moisture and pliability. During a season ofthe year the wind called the Harmatan prevails in the interior of Afrif a, which is so extremely dry, from passing over the sandy tfesert?, that furniture of houses is destroyed by it, the floors and joints of / 14 Remote Causes of l\ ver. It is owing to a want of access of air to favor decomposi- tion, that the accumulation of soil constituting peat and morass is ?o inert and unproductive. 'Vhe cultivators of cotton about Baton Rouge, and the lower parts ofthe Mis- sissippi, as the} find the top of the soil which is alluvial, im- poverished by repeated crop?, remedy the evil by ploughing deep with a strong team of cattle, thereby exposii g the mould, which has been hitherto excluded from the air, and again rendering the earth fertile and productive. buildings are laid open, and the scarfskin on the human body is rendered crisp a»d peels off. We are informed by Wafer, an English surgeon, that he and some others landed at Virmejo, in South America, in 16S7, and marched about four milr? up a sandy bay. " All which," he says, ''we found covered with the bodies of men, women and children ; which lay so thick, that a man miijht, if he would, have walked half a mile, and never trod a step off a human body. These bodies to appearanc a seemed as if they had not been above a week dead ; but if you handled them, they proved as dry and light as a sponge, or a piece of cork. Alter we had been soaie time ashore, we es- pied a smoke, and making up to it, found an old man, a Spanish Indian, who ^as ranging along the sea-side, to find some dry sea-weeds, to dress some fish, which his company had caught; for he belonged to a Spanish boat hard by. We asked him many questions in Spanish about the place, and how the dead b.,dies came there. To which he returned for answer, that in his father's time, the soil there, which now yielded nothing, was green, well cultivated, and fruitful. That the city of Wormia had been well inhabited by Indians, that they were so numerous, that they could have handed a fish from hand to hand twenty leagues from the sea, until it had come to Inca's hands ; and that the reason of these dead bodies was, that when the Span- iards blocked up and laid siege to the city, 1he Indians, rather than be at the Spaniards' mercy, dug holes in the sand and buried themselves»alive.— The men as they now lie, have with them their broken bows, and the wo- men their spinning wheels and distaffs with cotton yarn upon them." Voy- age and Description if the Lthmas of America. Fuzier, a French voyager, who was also in Peru in 1712, confirms the same account. lie says, " The vale, of Hilb, in which there are not at present more than three or four families, maintained an Indian town, the remains of which are still to be seen, two leagues from the sea ; a dismal effect of the ravages the Spaniards have made among the Indians. There are still more moving marks of the misfortunes of that poor nation, near .A lie a, above the church of llilo, and all along the shore as far as the point of Coins, being ?u infinite number of tombs, that when they dig up at this very time, they find bodies almost entire, with their clothes, and very often gold and silver vessels. Those 1 have seen are dug up in the sand, the depth of a man, enclosed with a wall of dry stone ; \hey are covered with .wattels and canes, on which there is a layer of earth, ai.d sand laid over, that the place where they were might not be observed They were so ter- rified that they thought they must die. when they were inferme 1 that the Spaniards had not spared their beloved AtaF.halpa, who among them was looked upon as the offspring ofthe sun, which they worshipped. Therefore to escape out of their hands, they fled as far as thev could eastward, to im- plore the mercy of the sun; but being stopped by the sea, they buried themselves alive on the edge of it." Relation du Voyages de la Mer du Sud. The preservation of these bodies appears to have been the effect of drvnes* a-ad exclusion from atmospheric air. Remote Causes of Fever. 15' The influence of heat and moisture in favoring decompo- sition seems to consist in expanding and attenuating the corruptible substances, thereby enabling the elementary matters to come more intimately within the sphere of each other's attraction. Animal substances are more prone to decomposition than vegetable matter, on account of the laxity of the former, and their consisting of a greater num- ber of elements, which begin to exert their respective affi- nities as soon as the vital principle is extinguished. These vegetable substances, which consist of but one or two ele- ments, as wax, resin, gum, oil, under ordinary circumstances, are scarcely susceptible of decomposition. Atmospheric air is necessary to this process, by affording the principles with which the decomposing matter may combine. This is illustrated in the preservation of vegetable substances in vacuo. Accession of air, however, is a less essential re- quisite than heat and moisture, since the phenomena of pu- trefaction sometimes take place without exposure to it, es- pecially in animal substances** * The following account of the singular discovery of the carcass of a mammoth, given by professor Cuvier, as taken from a report in the supple- ment to the Journal du Nord, No. 80, by M. Adams, adjunct member of the Academy of St. Petersburg, is interesting, as affording an illustration of the preservative power of cold upon dead animal bodies, and ofthe neces- sity of heat for their putrefaction. As no account of this animal is preserv- ed in natural history, and as the only knowledge we possess of its former existence is from the remains which have been discovered, it is probable that this carcass might have been preserved in this block of ice more than two hundred years previous to its discovery. By what accident, convul- sion, revolution, or phenomenon of nature, it became placed in this situa- tion, is not the object of the present inquiry to investigate. "In the year 1799, a Tungusian fisherman observed a strange shapeless mass projecting from an ice bank, near the mouth of a river in the north of Siberia, the nature of which he did not understand, and which was so high in the bank as to be beyond his rear h. He went next year, observed the same object, which was then rather more disengaged from among the ice, but was still unable to conceive what it was. Towards the cud of the fol- lowing summer, l"0l,he could distinctly see that it was the frozen carcass. of an enormous animal, the entire flank of which, and one of its tusk=, had become disengaged from the ice. In consequence of the ice beginning to melt earlier and to a greater degree than usual in lf;03, the fifth year of this discovery, the eiormous carcass became entirely disengaged, and fell down from the ice-crag on a sand-bank, forming part of the coast of the Arctic Ocean. In the month of March, of that year, the Tungusian carried away the two tuf ks, which he sold for the value of fifty rubles; and at this time a drawing was made of the animal, of which 1 possess a copy. " Two year3 afterwards, or in 1806, Mr. Adams went to examine this ani- m; 1, which still remained on the sand-bank where it had fallen from the ice, but its body was then greatly mutilated. The Jukuls of the neighborhood had taken away considerable quantities of its flesh to feed their dogs ; and the wild animals, particularly the white bear, had also feasted on the car- cass; yet the skeleton remained quite entire, except that ono of the fore- 16 Remote Causes of Fever. In the chemical composition of animal suostances, arc discovered, hydrogen, which is the principal base, combined with a large portion of nitrogen, charcoal, oxygen, phospho- rus, and not unfrequently sulphur. All the fluids, and what are called the soft solids of the animal body, undergo de- composition with greater or less rapidity when exposed to a temperature of 65° or more. When exposed to the air under such a temperature, the muscular fibre becomes pale, soft, and relaxed, exuding a coloured serocity ; with the destruction of its organization, its smell becomes insipid and disagreeable; the altered substance, by degrees, de- creases in bulk, and its smell becomes ammoniacal. After this, if it be preserved in a close vessel, the putrefaction proceeds more slowly, and nothing but an alkaline pungent smell is perceived from it; the matter effervesces with acids, and turns syrup of violet green. But when air is admitted, this urinous exhalation goes off, and a peculiar, suffocating, putrid smell is rapidly evolved. This smell, says Fourcroy, continues for a long time, penetrates every where, and seems to effect the bodies of animals, like a fermenting sub- stance, capable of altering their fluids. This smell is cor- rected, and in some measure confined by ammonia : the lat- ter substance, formed by the union of the nitrogen and hy- drogen of the animal matter, is one of the principal gaseous results of putrefaction. It is evidently this, says Accum, that fills the cavities of the celular texture, so as to inflate and puff up the body. After the volatilization of the am- legs was gone. The entire spine, the pelvis, one shoulder-blade, and three legs, were still held together by their ligaments, and by some remains of the skin ; and the other shoulder-blade was found at a short distance. The head remained, covered by the dry skin, and the pupil of the eyes was still distinguishable The brain also remained within the skull, but a good deal shrunk and dried up ; and one of the ears was in excellent preservation, still retaining a tuft of strong bristly hair. The upper-lip was a good deal eaten away, and the under-lip was entirely go;ie, so that the teeth were distinctly seen. The animal vas a male, and had a long mane on its neck. "The skin was extremely thick and heavy, and as much of it remained as require! the exertions of ten men to carry away, which thev did with considerable difficulty. More than thirty pounds weight of the hair and bristles of th;3 animal were gathered from the wet sand bank, h^vin^-been trampled into the mud by white bears, while devouring the carcass. Some ofthe hair was presented to our Museum of Natural History, by .VI. Tar^e censor in the Lyceum ot Charlemagne. It consists of three distinct kinds. One of these is stiff black bristles, a foot or more in length ; another is thinner bristles, or coarse flexible hair, of a reddish-brown colour; and the third is a coarse reddish-brown wool, which grew among the roots of the hair. These afford an undeniable proof, that this animal had belono-ed to a race of elephants inhabiting a cold region, with which we are now'unac- quainted, and by no means fitted to dwell in the torrid zone. It is abo evi- dent that this enormous animal must have been frozen up by the ice at the moment of its death.'" Remote Causes of Fever. 17 monia, the putrefaction proceeds with new energy: phos- phuretted and sulplmretteti hydrogen gases are disengaged, lastly carburetted, or oxy-carburetted hydrogen gases are evolved ; it now shrinks again, its colour i3 altered, and the fibrous texturj ofthe flesh is now scarcely distinguishable ; it is converted into a soft pulpy matter, of a brown or greenish colour; its stnell is insipid and nauseous, but acts wi*h great energy on animal bodies. This odorous principle, at length, loses its strength, the fluid part of the flesh becomes, in some measure, consistent: its colour becomes deeper; and it is at last reduced to a friable matter, half dry, yet deliques- cent, which by friction with the fingers, breaks into a coarse ponder, like earth. A much lower temperature is required for the putrid fer- mentation of vegetable substances, than for the vinous or acetous: decomposition takes place in a medium of 45°; but a higher degree of heat is much more favorable to the process, provided it is not >o great as to entirely dissipate moisture. When vegetable substances putrefy, they be- come turbid, lose their colour, and deposit various sedi- ments ; if immersed in wafer, bubbles ascend to the surface, ?nd a green mould gathers on the surface at the beginning ofthe alteration. Soft vegetable matters, exhibit the same appearance on being wet or exposed to damp. The com- motion produced, is not so considerable as that which ap- pears in the cases of spirituous and acetous fermentations : the decomposing vegetable substances do not increase in size, nor is their temperature augmented : a change of smell is remarkable with a urinous odour, and towards the end of the process, ammonia is evolved. The latter, however, is disengaged in greatest abundance from the vegetable sub- stances that contain nitrogen in their composition, and thereby more nearly approach to the chemical properties of animal matter; such as cabbages, potatoes, onions, the flour of wheat, the tetridinamious class of plants, mush- rooms, gelatinous vegetables, &c: this approximation to the chemical composition of animal substances increases the tendency of these vegetable matters to spontaneous decom- position. In the decomposition of vegetable substances, there is not, in general, as in the putrefaction of animal mat- ter, any disengagement of the putrid combinations of sul- phuretted and phosphuretted hydrogen gases. Of all the elastic aeriform emanations, carburetted hydrogen gas is that which seems to be evolved in the most considerable quan- tity from decomposing vegetable matter. It is this which ;s constantly exhaling from swamps and morasses. Dr. o 18 Remote Causes of Fever. Seybert, of Philadelphia, found (he quantity of this gas, dis- engaged from a mixture of mud and water, so gr< at as to occasion a violent explosion ofthe bo'tle in whieh the mix- ture was made. As this yascous compound is the most abun- dant product of spontaneous decomposition in the moulder- ing mass of extinct vegetation, so does it seem to be the mostessenlial requisite and principal ingredient in the econ- omy of vegetable growth. All vegetable substances ulti- mately undergo decomposition. The greater or less facili- ty, however, and the rapidity with which this process takes place, depend upon the different states of-laxity or density in their texture, and their being more or less so'uble in wa- ter. Those which are the most soluble are the soonest to undergo decomposition. From the evolution of ammonia, putrefaction has been callr 1 alkaline fermentation, and ammonia considered as its product. Towards the close of the decomposition of veget- able substances, the pungency which is exhaled in the ln-iglit ofthe process has become dissipated, and is sec-eeded by a degree of nauseous insipidity. The decomposition having attained its height, the putrid vegetable mass, becoming very soft, sinks down into a gelatinous consistence, and the odorous principle exhaling from it undera e- many succes- sive modifications; at length, losing its disagreeable smell, it becomes dry; and a blackish, carbonaceous residuum re- mains, known by the name of humus vegetabile, consisting of saline and earthy substances. SECTION 3. Composition ofthe atmosphere—Eudiometry no test of its purity. The atmosphere may be considered as a great chemical laboratory and receiver, in which ail the attenuated and vo- latilized productions of terrestrial bodies are received, min- gled, agitated, combined, and separated,* and altfiough the two essential constituents of the atmosphere are nitrogen and oxygen, in the proportions of twenty-one parts of the latter to seventy-five of the former,? yet from the various * Park's Chem. Catechism. t The precise proportions of these elements, together with aqueous vapour and carbonic acid gas, which are alwajs present, according to Mr. Henry are as follows: Nitrogen gas, 75.5 by measure, 75.55 by weight. Oxygen gas, 21 23.:32 Aqueous vapour, 1.42 1.03 Carbonic acid gas, .8 .10 Remote Causes of Fever. Id chemical combinations and decompositions which are al- most, constantly taking place upon the surface ofthe earth, the air which we breathe is liable to be vitiated by the va- rious admixture of heterogeneous substances, deleterious in their properties to animal life, and foreign to the composition of the atmosphere itself. The nitrogen and oxygen which form the atmosphere, are merely in a state ot mixture, not of chemical combination : and it has been proved by Mr. Da'ton, that whenever two or more of the permanently elas- tic fluids come in contact, they penetrate each other, and form an equable mixture : and that, therefore, a lighter gas cannot for any considerable time float upon the surface of a heavier, but the mixture of the two elements becomes inti- mately diffused and blended ; in the same way that distilled spirt's, which is a lighter substance than water, becomes in- timately blended with it, when poured into and agitated in the same vessel. As already observed, the atmosphere is liable to become contaminate*.* by various admixtures foreign to its nature, resulting in a great degree from the decomposition of animal and vegetable substances. The degree of this vitiation, however, is not to be determined by chemical tests; the most certain, and indeed the only cnterions by which it can be ascertained, are the appearance of physical causes, and the morbid effects produced upon the human constitution. Philosophy may blush for the imperfection of her boasted wisdom and sagacious powers of investigation, when it is considered that the constitution of man is the only infallible eudiometer.* by which the purity or impurity ofthe atmos- phere can be satisfactorily known. The experiments of Dr. Priestley, and the researches of De Marti, have ascertained that the air of places the most offensive and unwholesome, affords as much oxygen as that of others of an opposite de- scription ; the air, for example, of crowded cities, on the summits ofthe loftiest mountains, and in the bottoms ofthe deepest vallies, has not been found to vary in the propor- tion of its two constituent elements; the noxious qualities of the atmosphere depending, not on the deficiency of oxy- gen, but on the admixture of deleterious substances, beyond the power of eudiometry to detect. It is a lamentable fact, that such is the imperfection of science, and the grossness of chemical experiments, that eudiometry can discover no dif- ference between the air of an infected prison, the atmos- * An eudiometer is an instrument or apparatus employed for measuring, the purity ofthe atmosphere. 20 Rtmote Can;,? of Fever. phere of a swamp loaded with sickly vapors, and the delete- rious products of animal and vegetable decomposition, and that of the most salubrious situations. It even appears from the experiments of Dr. Davidson, of Martinique,* that the atmosphere of the tropics contains :• greater proportion of oxvgen than that of northern climates. These experiments are confirmed by those of Dr. Chisholm. M. Scguine has, also, analyzed the air of hospital wards, which had born con- stantly shut up for the space of twelve hours, and, for nil that he could discover, it appeared to he almost as pure as the open atmospheric air, although if had an insupporlahly of- fensive smell. Bertbolet, likewise, in his analysis of the atmosphere, found that the air of Eg} pt did not differ in its physical and chemical properties from that of the most salu- brious climates of Europe : and this was demonstrated even when the plague prevailed in that countiy. To these curi- ous facts may be added the experiment contained in the me- moir of Gattini. This experiment wis made August 15th, 1779, on the stagnant air of (he offensive marshes of Fort Fuentis, at the mouth ofthe river Vattelipe, where bilious fevers constantly prevail in the summer season. And such is the unhealthiness of this place, that, according to Gattini, whoever ventures to sleep in that situation during the sum- mer season, is sure to be attacked by an intermittent: the air of that place was compaied with the air on the summit of Mount Legnone, which, always covered with snow, forms a chain with the lofty mountains ofthe Grisons, and is ele- vated above the level of the sea about 8,640 feet. On com- paring these two portions of air in the eudiometer, with the utmost exactness, the air of the marshes was f.nmd to be two degrees purer than that from the summit of Legnone. Though this experiment was repeated as often as fifteen times, varying all the circumstances of time, season, &c. the result was still the same. That the air of the infected places where these experi- ments were performed was contaminated, there can be no question; that this vititiation was not discoverable by the tests employed, proves the imperfection of these experi- ments themselves, and leaves the field open for the discove- ry of more improved and accurate researches. * See an account of these experiments, contained in a letter to Dr Mitchell, dated Port Royal, April 7, 1798. Medical Repository, vol. 2. Remote Causes of Fever. 21 SECTION 4. Economy of Vegetation, and its relation to the Causes and Origin of Endemic Fever. It appears from numerous and extensive observaf ions that the principles of vegetation and the causes of fever are inti- mately connected, and so closely and inseparately allied as to render probability almost certain, that the sources and nature ofthe causes of both are analogous. We know that where the principles and requisites of a luxuriant vegeta- tion exist in the greatest abundance, there also fever, as an endemic, is apt to prevail. Heat and moisture are essen- tial to putrefaction, and the consequent production of veget- able growth. These circumstances are (he most conspicu- ous in the low and marshy situations of hot and tropical cli- mates, along the margins of rivers and creeks, and near ponds of stagnating water; in such places, also, endemic fever is a common occurrence ; whilst, even in the same climate, where the country-is high and dry, and in hilly situations above the reach of inundation and the miasmata of the low grounds, swamps and water courses, fever as an endemic is scarcely known : much less in cold and northerly climates similarly situated with respect to elevation and dryness.— We may remark, however, that there are some low and marshy situations, which, abounding with an excess of the necessary ingredients, are, notwithstanding, covered with a stinted crop of vegetation : here the superabundant stimu- lus of nutrition, as in the animal kingdom, proves unfavora- ble to a healthy and vigorous growth; whilst at the same time the light and spongy mould of which these marshes consist does not afford a foundation of sufficient firmness and solidity to admit ofthe support of large and luxuriant veget- ation. As in such instances the principles of vegetation which are evolved from this mass of corrupting materials are unappropriated to (he growth of plants, they will float in the atmosphere, and show their deleterious effects upon such persons as live within the extent of their diffusion. Since the corrupting materials of the physical world af- ford food, nourishment and growth to living plants, it fol- lows, that provided vegetation is sufficient for the consump- tion of the products of animal and vegetable decomposition, the atmosphere will preserve its purity. Although places abounding with the requisites of a luxuriant vegetation are, 22 Remote Causes of Fever. on that account, the least healthy, still the position general- ly holds true, that the more copious and luxuriant vegeta- tion is in any situation, the more healthy will that place be rendered : for the consumption ofthe gaseous results of an- imal and vegetable decomposition, upon which processes the insalubrity ofthe atmosphere depends, will purify the air in proportion to the quantity of these morbific materials ap- propriated to the growth of vegetable matter. We have a striking and convincing proof of the pernicious influence of miasmatic emanations from corrupting substances, in the first settlement of towns and districts in a hitherto wild and uncultivated country, where the land is suddenly cleared of a flourishing and exuberant vegetation by which it was for- merly shaded; and in the progress of cultivation an unusual quantity of vegetable mould is ploughed up and exposed to the action of the air and sun ; whilst at the same time, from the destruction of the trees, the country is deprived ofthe natural agents by which the accumulation of noxious exha- lations in the atmosphere was prevented. From this view ofthe subject, we may explain a fact of frequent observa- tion, that swamps and new lands are prevented from exert- ing any pernicious influence when planted with vegetables of rapid growth, as the sugar-cane, Indian corn, and other plants of quick and great luxuriance, which consume, and appropriate to their nourishment and increase, a large quan- tity ofthe putrefactive products. We are informed by Dr. Rush, in his account ofthe climate of Pennsylvania, of its being a well known fact, that inter- mittent and bilious fevers had increased in proportion as the country had been cleared of its wood in various parts ofthe state. And on the contrary, of its being equally certain, that these fevers diminished or disappeared in proportion as the country became cultivated.* In illustration of the circumstance, that vegetation con- duces to health, we are informed by Dr. Williamson, in his history on North Carolina, that families who live in the Dis- mal Swamps, without a perch of clear or dry ground, en- joy more health than people who live on their new planta- tions, near the rivers and swamps. He observes, that the bad effects of recent cultivation, by which decaying vegeta- bles are exposed to the sun, are severely felt in flat countries and warm climates. Carolina was less sickly before the country was opened. The second colony of adventurers remained twelve months in the country, and they lost only * Med. Inq. and Obs. vol. 1, p. 44T Remote Causes of Fever. 23 five men out of one hundred and seven, though they were badly sheltered and suffered much from the scarcity of pro- visions. A gentleman in Craven county had lived on his farm about forty years without suffering by intermittent fe- vers, though his family consisted of fifty cr sixty persons. There were about one hundred and fifty acres of cleared ground in front of his house that had been cultivated many years, but a thick wood extended in the rear of his dwelling. In the beginning of the year 1785. he caused all the timber and shnbYthai were behind his house, within four or five hundred yards, to be cut down : his object was pasture, and a free circulation of air. One third of his family, the next summer, were taken down by intermittent fever; though such ectopia!!!** were not more pr( valent than usual during that summer, in other parts ofthe flat country. This fact is al-u illustrated by Dr. Scctt, in his account of the fever of Gennessee county, in the state of New-York. We are informed that (hough the land, previously to its being cleared, was very moist, yet the first settlers were healthy; but as the trees were removed, the inhabitants became subject to severe attacks of a very malignant fever, until the whole country became a scene of mortality, and many died vomiting black matter in the greatest extreme of anxiety and pain; while others would walk about, saying they were quite well, until within a few hours of their dis- solution. But after vegetation was established and had be- come general, the country was again rendered more heal- th)-* This subject will be further illustrated when we come to speak ofthe fevers of Alabama. That judicious and accurate observer, Dr. Robert Jack- son,! has remarked, that the rise and progress of endemic fever are evidently connected with the different periods of the season. In spring, the principle of vegetation is extri- cated in great quantity, while the capacities of plants are still small; an excess is consequently generated, and this excess extends its influence to a certain distance around. In summer, the extrication of the principle still increases, but the capacities of plants having extended in a greater proportion, the means are more adequate, and the excess is actually less. In autumn, the growth of plants being com- pleted, while the causes still continue to produce a great extrication ofthe principle of vegetation, the excels abounds and escapes in a wider circle. '* Med. Repository, Vol. X. f History and Cure of Fever, chap, iif. 24 Remote Causes of Feter. It nppears tbat the leaves of plants perform a function in their economy analogous to that which lakes place in the hum, of animals and the gills of fishes; in other words, that the leaves are to vegetables, what the lungs are to the ani- mal creation ; and that the leaves may therefore be called the lungs of plants. During the spring of the year, previous to the developement of the/leaves, and in the early part of the cay, whilst the sensibility of the plant is greatest, the sap rises by the stimulus of heat, through the alburnum or sap of the wood, and falls by the same vessels when the heat is withdrawn, or considerably diminished ; hence it happens, that if a tree be pierced at this period, the sap ex- ude? through the wound, because there is no other outlet. By the process of vegetation, however, a new channel of communication is opened, and the sap is now protruded onwards and circulates through the leaves, from which a copious transpiration takes place; and as the sap now de- scends through the liber, or inner bark, the tree no longer bleeds. The alburnum, or what is called the sap ofthe wood, pass- ing from the branch is expanded through the parenchyma of the leaves, in the form of ribs and smaller vessels, through which the sap circulates. The leaf itself is covered with a cuticle or scarfskin, both on its upper and lower surface; the latter is supposed to absorb, and the former to transpire. As in the animal body, so the vessels of plants appear to have at least two terminations, one in transpiring, the other in returning vessels ;* by the former, the redundant and wa- tery part ofthe sap is exhaled in copious quantity, whilst the remainder, having undergone the necessary change, returns through the appropriate vessels ofthe leaves and hark, and is finally deposited in a pulpy state on the exterior surface ofthe alburnum, where, after being sufficiently inspissated and hardened, it forms a portion ofthe growing plant.! Various earthy and metallic substances are found to enter into the composition of plants; and it is a matter of some doubt, whether these are formed denovo by the plant itself, * Besides this vascular structure of the leaf which has been noticed, its bulk and colour are chiefly formed by a series of cells, supplied, probably, by a third and distinct termination ofthe vessels which perform the circu- lation ofthe crude sap. t These annual depositions of ligneous matter are very conspicuous in the chesnut arid other trees of rapid growth and porous structure. By counting those concentric circles in the stump or body of a tree, its a^e may be asccrtaine.l. Remote Causes of Fever. 25' ur are absorbed in an attenuated and liquid form from the air and sol!.* It was at one time supposed that growing plants gave out oxygen and absorbed carbonic acid, but as the latter is always necessary fur the production of the former, and as the quantity ofthe oxygen gas produced is exactly equal to the quantity of carbonic acid gas that disappears, it seems that the oxygen gas is merely the result of the decomposi- tion of carbonic acid. The experiments of Sir Humphrey Davy, however, seem to prove, that when plants are con- fined in an excess of carbonic acid gas, they possess the power of absorbing it to an unusual degree, rendering the air thus confined more pure than that ofthe external atmos- phere. From the experiments of Sir Humphrey Davy and Mr. Ellis, it appears that growing plants universally and un- der all circumstances consume .oxygen and produce carbo- nic acid gas; and that the bulk of the acid gas produced is exactly equal to that ofthe oxygen consumed. This seems to contradict the plausible theory entertained by modern philosophers, that the carbonic acid gas evolved by combus- tion and animal respiration, is consumed by the growing plants; and that the process of vegetation thus counteracts the adulterating effects upon the atmosphere of respiration and combustion. It was observed by Sir Humphrey Davy, that in the dark no oxygen gi5 is produced by plants, whatever be the elas- tic medium to which they are exposed, and no carbonic acid * From the following interesting account by M. Henri Bracconnot, {An- na!:s de Chemie, Fee. it Mars, /K08,) we should be inclined to the pre- sumption that plants possess the power of forming denovo the various earths and metals found in their composition. Seeds of various plants were sown in pure river sand, in litharge, in flow- ers of sulphur, and even among metal, or common leaden shot; and in ev- ery instance nothing employed for their nourishment but distilled water. The plants throve, and passed through all the usual gradations of growth t.> perfect maturity. The author then proceeded to gather the entire pro- duce, the roo^s, stems, leaves, pods, seeds, &c. These were accurately weighed, dried, and again weighed, then submitted to distillation, incinera- tion, lixivation, and the other ordinary means useful in a careful analysis. Thus he obtained from these vegetables all the materials peculiar to each* individual species, precisely -«s if it had been cultivated in a natural soil, viz. the various earths, the alkalies, acids, metals, carbon, sulphur, phos- phorus, nitrogen, Sec. tie concludes this very important paper nearly in, these extraordinary words: <' Oxygen and hydrogen, with the assistance of solar light, appear to be the ordy elementary substances employed in the constitution of the whole univer-c ; and Nature, in her simple progress works tho most infinitely diversified effects by the slightest modifications in the means she employs."' See " PuJicrches sur la force Assimilatrke dans Us Vcgtlauj; par -A. Henri Bracormot,'' as quoted by Parkes. Chem. Cat- echism, p.405. B 2G Remote Causes of Fever. gas is absorbed. In most ins'aric-s, on the contrary, oxygen g ts, if it be present, is absorbed, and carbonic acid gas i9 produced. " I once supposed." he adds, ki that all the car- bonic acid gas produced by plants in the night or shade, might be owing to the decay of some part ofthe leaf, or epi- dermis ; but the recent e1periments of Mr. Elli- are opposed to this idea; and 1 found that a perfectly healthy plant of celery, place;! in a given portion of air, f>r a few hours on- ly, occasioned a production of carbonic acid gas. and an ab- sorption of ox\gen." P,I:\ Davy thinks, however, that upon the whole, the balance is in favor of amelioration ofthe at- mosphere from the process of vegetation. We know (hat most of the metals, and m mv of the earths, have a strong tendency to combine with carbonic acid : whether the con- sumption in th;> way is equivalent to its production by res- piration and combustion, I do not fel myself authorized to determine, though the supposition appears probable. Be th< as it may, carbonic acid gas is probably never, in any degree, the cause of endemic fever. 'She inhabitants of many cities are daily in the habit of taking large quantities of it into the stomach, in the different preparations of aerated or soda wafers, without experiencing the least injurious ef- fv'<. It is also exhibited with advantage in fever itself; and it has been found (hat in warm climates pestilential fe- vers abate during the vintage; which circumstance has been ascribed to the fermentation and consequent evolution of carbonic acid. Though the decomposition of carbonic acid by growing plants, was the only or principal manner in which the pre- vention of an excessive accumulation of this gas could be accounted for, yet there may be some secret process, left for the discovery ,nf some future philosopher, by which this circumstance may he satisfactorily expl lined. It would seem, since water forms such an essential requi- site in the growth of plants, that they possess the power of decomposing it, and of appropriating the hvdrogen to their own nourishment and growth. This would appear more especially the case in aquatic plants, and the variety of sea weeds, which seem to draw their su-tcn mce almost exclu- sively from the water ale,,,-.-. Besides, we know (hat plants, bv (heir vegetation and decay, have the property of fertilizing the soil, and that plaster (gypsum) and oih r mineral sub- stances act merely by increasing the'power of absorption in th- growing plants. Hydrogen, one of the elementary prin- ciples of water, forms a very important pait of vegetable matter; it is by the combination and consolidation of this Remote Causes of Fever. 27 clement with the carbon ofthe atmosphere and a portion of the oxygen, that are formed the vegetable oils, wax, gums, resin, sugar, and finally the wood and solid fabric ofthe plant and tree; the residue of the unappropriated oxygen of the water is returned to the atmosphere to purify and enrich it. Plaets, likewise, iuve been made to grow in sand, and after having come to maturity, the sand, upon being dried and weighed, was not found to have sustained any diminution; so that the substance ofthe plant mu-d have been derived from the water »vith which it was nourished, and from the atmosphere.* Whatever- may be tie function of the leaves, there can be no doubt that the principal part of the nourishment of vegetables is taken in by the root. The elastic matters that escape from animal and vegetable manures, principally con- sist of carbonic acid, hydro-carbonate and ammonia; and as vegetable-substances are composed chiefly of hydrogen and carbon, the materials which furnish these elements are essen iaiiy conducive to fertility and vegetation. Nor >gen is aso favorable to the growth of plants which grow and flourish freely in this gas. Since these substances are ab- sorbed by growing plants from decomposing matter, whether these are taken in by the leaves or root, the effect in pre- venting the deleterious operation of noxious exhalations will be the same. One striking peculiarity of hot and tropical climates is, the vast luxuriance of the vegetable world, and the countless myriads of animated being*. All nature teems with life. Wherever the land is fertile, but especially on the rivera and water courses, the oak, the poplar, the ash, the gum, the lynn, the sycamore, the hickory, &c. uniting their hranche-, make a dense shade, impenetrable to the noon- day sun: in addition to which, the variety of vines, shrub- bery and undergrowth, form a matted thicket, in many places almost impassable to the wild beasts which they shelter and protect. The plants of the season wither and die with the col 1 of winter, but no sooner does spring recal the warm and genial breezes ofthe south, than nature starts into renovated bloom and verdure : mounting the loftiest trees, the vines, which lately appeared like the ropes and cordage of a navy, soon cover the woods with their luxuri- * In proof that fishes possess the same power of decomposing w?ter and of applying it to their own nourishment, we read of a fish that was kept three years in a vessel of water, which element was its only food; the fish at last became too large to live any longer ill the vessel. {Rondelet it Piscibus, lib. i. cap. 12.) 28 Remote (Jttuses of Fever. ant foliage ; the lawns and opening vistas of the forest are closed and obstructed to the searching eye. A deep and melancholy gloom gives art aspect of solemnity and awe to the groves and uncultivated wilds. Not a foot of ground is left unoccupied, the spaces afford.;! by the larger frees are filled up by those of smaller growth; and vines, bushes, briars, weeds, and shrubbery of different descrip- tions contend for the renminder: to all which, add the swarms and multitudes of flies, musquetoes, bugs and small- er insects which find a continent in every leaf, lizards, rep- tiles, beasts, birds and smaller animals which seek the shady covert of the woods, and some idea may be conceived of the prolific nature of a southern clime. It is to this luxuriance of vegetation, and this countless number of insects and animated beings, which annually perish and decay, infecting the air with their morbific ema- nations, (hat we may ascribe, in a considerable degree, the origin and prevalence of endemic fevers. The evening air, in this climate, in all damp and shady places, is generally impregnated with some palpable odour. The most disagreeable, is that of ponds and marshes, where the water has been recently dried up; the smell is old and musty, with a considerable degree of fcetor; the next in degree of strength, is the musky smell ofthe banks of small streams, reed brakes and wet. places ; the odour, though strong, is not unpleasant, except to those whose olfactories are very delicate; the scent approaches nearer to that of musk than any other. The next, and faintest in degree, is a peculiar aroma, as if composed of musk and spices ; it is mostly perceived in the vallies of a sandy soil, upon a cool and still evening succeeding a hot day. Besides these odours there are others less frequently observed, which are more or less disagreeable, but which do not admit of a description. One remark which I would make is, that (he unpleasant odours appear to be nearly allied to the agreeable in (heir proximate principles. Upon the subject of decomposition as applicable to ma- nures, Sir Humphrey Davy, in his lectures on agricultural chemistry, has some useful observations. " The doctrine of the proper application of manures from organized sub- stances," says Sir Humphrey, " offers an illustration of the economy of nature, and of the happy order in which it is arranged. The death and decay of animal substances tend to resolve organized forms into chemical constituents, and the pernicious effluvia discharged in the process, seem to point out the propriety of burying them in the soil, where they Remote Causes of Fever. 29 are fitted to become the food of vegetables. The fermen- tation and putrefaction of organized substances in the free atmosphere, are noxious processes; beneath the surface of the ground they are salutary operations. In this case, the food of the plant is prepared where it can be used ; and that which would offend the senses, and injure the health if cx- p > ed, is converted by gradual processes, into forms of beauty and usefulness: the foetid gas is rendered a constituent of the aroma of flowers; and what might be poison, becomes nourishment to animals and to man." It is thus that provision has been made for the regenera- tion of the fallen leaves, which lie scattered, 'And rot upon the ground, and which, to ordinary observation, would ap- pear to be lost for ever. It appears from the experiment of Bertholiet, whenever the soil becomes charged with the de- caying and corruptible materials of animal and vegetable growth, the oxygen of the atmosphere combines with the mouldering mass, and converts it into carbonic acid gas, the food and nourishment of growing plants. In this manner it is that, by the products of putrefaction, the animal and vegetable creations are renewed. Nothing is lost by death : it is but a change of condition, a transmu- tation of matter. From the mouldering ruins of departed life, a new growth arises into existence, with all the grace and beauty of renovated you(h ; and thus the metempsy- chosis of animal and vegetable beings, as likewise the ancient fable of the phenix emerging into life from her parental ashes, is chemically true. Thus when a monarch or a mushroom dies, Awhile extinct the organic matter lies ; But as a few short hours or years revolve, Ah hymic powers the changing mass dissolve; Emerging matter from the gtave ret urns, Feel--; new desires, with new sensation burns, With youth's first bloom a finer sense acquires, And Loves and Pleasures fan the rising fires. Darwin. Organic forms with chemic changes strive Live but to die, and die but to revive; Immortal matter braves the transient storm, Mounts from the wreck, unchanging but inform. 30 Remote Causes of Fever. SECTION 5. Of Heat and Moisture. Some physicians, overlooking the more immediate causes of diseases, have entertained (he idea (ha( the heat of sum- mer in hot and tropica! climates, was alone concerned in the production of endemic fever. Whereas the only influence which the heat of climate and season can have upon the constitution, in aiding the influence of miasmata, is to pro- duce debility, thereby renc!« ring the body more susceptible of disease: or, in other w(frds, acting as the predisposing cause of fc\ci-. "The heat of tropical climates," says Dr. Hunter, " though generally represented as the cause of their onhealthiness, will not alone produce fevers, as is strikingly exemplified in those living on board of ships, who remain free from fevers; and a!so, the inhabitants of dry sandy spots along the coast, in which the heat is unusually great, yet the situations are healthy, as Fort Augusta, Fort Royal, and others.'** In order to produce endemic fever, it is neces- sary that the heat should have corruptible matter to act up- on, and that this corruptible matter be in a state of humidi- ty. " It is commonly asserted," says Assa!ini,t "that the heat, in Egypt, puts a stop to the plague, whilst it makes it break ou* in Constantinople. How is this fact," continues he, "to be accounted for? The explanation, in my opinion, is very simple. At Constantinople, the exhalations from various bodies, in a state of putrefaction, are very copious during summer; the cold of winter prevents their formation, and the disease ceases. In Egypt, on the contrary, the action ofthe sun is very powerful, even during winter, and gives rise to noxious exhalations. When the low grounds have become dry, which happens in the month of Nisidor, (in June, at the festival of St. John) then the coast of Lower Egypt becomes as healthy as the rest of that fine country." It is remarked by the natives on the coast of Coromandel, and the observation is confirmed by the experience of many Europeans, that the longer the hot land winds continue to blow, the healthier are the succeeding months; agreeably to their opinion, these winds purify the air. The inquiry is made by Dr. Lind, whether these winds are not the cause why the air on the coast of Coromandel, except during their * Diseases of Jamaica, p. \G. t Assalini on the Plague, American Edition, p. 72. Remote Causes of Fever. 31 continuance, is more healthy than in other parts of India, where these winds do not blow; and whether this does not suggest a very probable reason why the plague in Egypt generally ceases in the beginning of June : the periodh al hot winds that come from the deserts of Nubia and Ethio- pia, having then rendered the air in Egypt pure and whole- some.* This effect of the hot wind seems to be owing to the sudden and rapid exsiccation which it occasions, depriv- ing the decaying remains of animal and vegetable matter of their moisture, and thereby suspending the process of pu- trefaction : another, and perhaps considerable effect, seems to be its power of rarifyjng, by the degree of heat which accompanies it, the noxious miasmata themselves,! The fact ofthe hot winds, as they are properly called, put- ting a stop to the plague in Egypt, is confirmed by the gener- ality of travellers, who have made observations upon the subject.I After the 24th of June, the plague, however great may have been its ravages, ceases in Egypt. After that day, there i- seldom an instance of any person being attacked by that disorder. Some have attributed this to the overflowing ofthe Nile, others to the prevalence ofthe north wind ; but it is pretty clearly ascertained, that (he plague generally ceases before any increase of the Nile is perceptible, and before the commencement of the north wind. And Mr. Antes has shown from authentic facts, that any extraordinary degree of heat, even at an earlier sea- son, produces a similar effect. Different from this, however, is a hot, close, stagnating air, not agitated or refreshed by breezes and gusts of wind ; and which, by debilitating and relaxing the system, must act as a predisposing cause, and by favoring (he accumulation of infectious miasmata, must contribute to increase the vitiated state of the atmosphere : for where the putrefaction is of a local nature, a strong breeze, by displacing and re- moving the infected atmosphere, for a time renders it healthy, until again corrupted by the original source of de- composition. Hippocrates, in describing a pestilential fever, says the year in which it prevailed, was without a breeze. A similar state of the atmosphere exited during the prevalence of the plague in London in 1665. We are informed that du- * Lindon the Diseases of Hot Climates, p. 47. \ t The injurious and sickening effect of this wind, during its continuance, is to be attributed to the circumstances already mentioned, its constricting fhe skin, and checking perspiration. f; Antes' Observations, p. 45. Brown's Travels, p. 369. 32 Remote Causes of Fever. ring a plague at Vienna, the wind did not blow lor three months : at the end of this time, a breeze arose, by which the distemper was evidently alleviated.* We are told by Dr. Clark, that sailors become sickly after long calms in East India voyages. Sir John Pringle observes, that -when the heats come on soon, and continue throughout autumn, not moderated by winds or rains, the season proves sickly, d:itempers appear early, and are dangerous. This hot, stagnating and oppressive state of the atmosphere, is also taken notice of by Dr. Rush, as attending the mortality of the yellow fever in Philadelphia in 1793. Gusts of wind and showers of rain have considerable in- fluence in purifying the atmosphere, by precipitating and dispersing the noxious miasmata, and thereby givingacheck to the rise and prevalence of disease. This was particu- larly remarkable in different parts of Alabama, in the sum- mer of 1823. There were but very few days successively, in which there were not one or two copious showers of rain, accompanied with loud peals of thunder, and heavy gusts of wind. The extinct relics of animal and vegetable growth had scarcely time to commence decomposition be- fore they were swept away by a flood of rain, and the nox- ious m asmata attaching themselves to the drops and parti- cles of water, were carried off in the common deluge. Sometimes, for three or four days successively, the face of the sun would be scarcely visible for a moment. The Ala- bama river was almost constantly swollen, and had a depth of water sufficient for the largest steam-boats ; a thing unusual at that season of the year. The consequence was, that the summer and autumn proved remarkably healthy. Dr. Rush, on the subject of the yellow fever of 1795, observes, that "On the 30th and 31st of August, there was a fall of rain, which suddenly checked the fever of the season, inso- much, that the succeeding autumnal months were uncom- monly healthy."t The same thing took place in the fever of 1796, in consequence of the rain which fell about the mid- die of July, so that August, September and October, were nearly exempt from disease.]: It appears from the register of interments in the Friends" burying ground, that the yellow fever which raged in Phila- delphia in 161)9, and which is taken notice: of in the Journal of Thomas Story, ceased about the latter end of October, * Van Swieten's Comment. t Inquiries and Observations, Vol. Ill, p. 440, % Ibid. Remote Causes of Fever: 33 or the beginning of November. The same disease wai checked by wet and cold weather in the year 1741. As to the degree of temperature necessary (o the origin and prevalence of the bilious endemic or yellow fever, the folHwiug facts are adduced in illustration. Dr. Le Blond, in his observations on the yellow fever, as it fell undo- his nofice in America, between the i 5° of north, and the 15° of south latitude, represents the temperature of the hot or low country, situated near the sea coast, as be- ing in the day marked from 82, to 100, of Fahrenheit, and in the night from 73 to 68. Dr. George Davidson, in his observations on the yellow- fever of Fort Rnyal, Martinique, informs us, that towards the latter end of June, the thermometer, in the shade, stood for several days at 90° of Fahrenheit, at 2, P. M.; which proved a prelude to the appearance of (he disease. " I have no doubt," says he, " when the mercury stands at 86°, or above that for several days, the weather being at the same time calm, that exhalations from swamps, and miasmata from putrid vegetable and animal matter, chiefly, are capable of producing the disease."* Dr. Richard Bailey, on the subject of the yellow fever of New York, in the years 1796, '97, and '98, gives the fol- lowing thermometrica! statement ofthe weather.t On the 8th of August, 1798, the mercury in Fahrenheit thermometer, at an elevation of forty feet above the ground and in the shade, at 2, P. M. stood at 91°. On the 9th, 96°, On the 12th, 86°, 10th, 90, 13th, 83. 11th, 89, The highest to which the mercury rose in July, 1795, was 83°, July, 1797, was 90°, August, 95, August, 82, July, 1796, 88, July, 1798, 94, August, 89, August, 96 After the immense fall of rain on the 14th of August, 1798, which filled many cellars in the lower parts of the city, and occasioned a quantity of standing water, the (hermometer, which had fallen on that day to 78, rose on (he 15th, to 82, 17th, to 90, 16th, 85, 18th, 90. * Letter from Dr. Geo Davidson, dated Fort Royal, Martinique, Sept. 20, 1796, to James Mease, M D. resident physician ofthe port of Philadel- phia. Med. Repos. Vol. I. p. 157. f See Med. Repos Vol. II. p. 285. E 34 Remote Causes of Fever. This sudden and great increase of heat, our author informs us, immediately after,the violent rain, appeared to have, a proportionate influence in producing fever: and lhat irom this period, the disease became more general. The great- er fatality ofthe fever in 1798, Dr. Bailey ascribes to the greater degree of heat, moisture, and corruptible materials; and the fever was particularly severe in Cliff sSreet, Cathe- rine slip, Water street, Burling and Beekman slips, where, in addition to the offensive accumulations of offals, garbage, the refuse of vessels, kitchens, and other impurities deposi- ted in the slips and gutters, there was an enormcus quantity of spoiled beef, fish, and other articles of a perishable na- ture, the stench from which was extremely offensive. Du- ring the prevalence of an easterly wind, and utter its con- tinuance for forty-eight hours, (here was scarcely a house in Pearl street, near where (he spoiled provisions were sto- red, in (he lower end of John street, and in Cliff street, which was not visited by the fever. The bilious or yellow fever prevailed in Boston, from the 18th of June, 1798, lo the 29th of October* The disease prevailed principally in the neighborhood of filthy and offen- sive docks, sewers, and confined narrow, iVirty lanes, and in the vicinity of a mill pond, the receptacle and deposit of all manner of filth, as dead dogs, cats, putrid meat, fish, and rot- ten vegetables. The thermometer in June ranged for twenty days from 70 to 83, and nine days from 69 to 70. The diseases this month were fevers, pleurisy, bilious and inflammatory fe- vers, opthalmia.and a few cases of cynanche parotidea. During the month of July, the range of the thermometer was from 72 to 96, excepting three days, when it descended to 67. The diseases this month were (he typhus gravior, and in some instances the yellow fever. In the month of August, the mercury fluctuated between 72 and 94, except on the 20th and 23d, when it fell to 69 and 67. During the month of September, the thermometer va- ried from 56 to 77. On the 29th, (here was a frost; and the fever abated towards the latter end ofthe month. In the month of October, the thermometer ranged from 36 to 56. 1- or thirteen days, the wind was from the N. W. • for the remainder of the month, it was variable from N. e! to S. E. On the 7th, there was a great storm, with much M^RepirVoTTl.^ ** ^^ prevalent in Boston> h? *^ R*nd. Remote Causes of Fever. S5 rain. A severe frost happened on the 29th, when the fur- ther progress of the fever was arrested. The remitting, bilious, or yellow fever, which prevailed at Wilmington, (Del.) in the summer and autumn of 1800, was preceded by cynanche maligna, parotidca, and by diar- rhoeas, choleras, and dysenteries. There was a great ten- dency to inflammatory affections, especially in cases of local injuries which were liable to run into gangrene. During the month of July, the thermometer ranged from 85 to 91°, with occasional thunder gusts throughout the month. During the month of August, the thermometer ranged from 73 to 85, and on the first of the month the mercury stood at 91°.* We are informed by Drs. Selden and Whitfield, that du- ring the prevalence of the yellow or bilious fever in Nor- folk, (Va.) in 1800, after the 25n Artnasfo wrote an eloquent and interesting pamphlet on the plague ur bilious fever of Cadiz in 1800. With this pamphlet 1 have merely obtained a slight acquaintance, through the medium ofthe Medical Repository. In the re: view, one ofthe most material parts ofthe work, the meteo- rological observations are omitted. We are (old, however, that the weather was unusually hot during this sickly period, and that the thermometer rose to 95°, a degree of heat un- usual in those latitudes, equal to that of Senegal, and greater than that of the equatorial continent of America. In the rays of the sun. and in damp places, the mercury often rose to 112°. The winter rains having been protracted one month later during the spring, the moisture was as excessive as it ever has been observed in countries subject to pestilence. In fine, forty days of the most distressing easterly wind, highly predisposed every living body to disease.t Dr. Joseph Johnson, in his account of the diseases of Charleston in 1793, makes the following observations upon the weather which ushered in and attended the bilious re- mitting or yellow fever of that season, after remaiking that the approach of summer was as rapid as the spring hadbeen backward, he observes, " The 11th of June was one of the hottest days to which our climate is subject; (he thermom- eter standing at 92°, in a very cool situation, and at 94° gen- erally through the city. The average heat of July was 86° ; a range considerably higher than had been observed since 1796, and somewhat exceeded the great heat of (hat year. From (he 26th of July to the 18fh of "August, there had'becn but one shower; the "heat being steady and considerable, the * ^ed. Repos Vol. If. p. 12. t Ibid, Vol. XI. p. 137. Remote Causes of Fever. 37 tndemial cavsus commenced about the latter date, and was aggravated by the extremely hot weather, from the first to the fifth of September, when the thermometer, at noon, in tin: coolest situation, varied from 90 to 92|. September was. from sickness and death, the blackest month ever re- corded in Charleston, there having been 328 interments, of which 114 were from endemial causus; and at least one fourth of the inhabitants were affected with the influenza about the last of the month.'' The remainder of the season was remarkable for lite severity of the drought, so that many cattle died for want of wa(er, and (ravellers could not obtain a sufficiency near the roads, either for themselves or their hc.:-.es.* Dr. Caldwell, in his essay on the yellow fever of Phila- delphia in 1805. by a reference to a journal of (he weather, kept for several years in that city, proves the coincidence b'-lween hot summers and (he prevalence of the yellow fever. Dr. Frost, in his account of the death of Dr. Valli, of yellow fever, at Havana,! in September, 1816, observes, that the thermometer ranged in the day from 81 to 85 of Fahrenheit, and never beluw 81, even at nighf. A maligna.it bilious fever appeared in July, in Winches- ter. Virginia.j in 1804. We have no regular register of the weather, but are told, that from the 15lh of May nearly to July, there was more or less rain every day, with wind mostly from the S. E.; the mercury in Fahrenheit's ther- nometer ranging from 66 to 84 and 86. From the begin- ning of July to the 1 3th, the weather was very warm, wilh occasional heavy showers; bu( from (he 15th (o the 22d, the weather was fair, and extremely hot, the mercury rising to 94 and 96. hi the island of Jamaica, the heat at Kingston throughout the year varies from 70 (o 80° of Fahrenheit. In ascend- ing towards the mountains, the temperature quickly alters * Med. Repo=. Vol. XI. p. 402. From 1700 to 1748, the yellow fever Fas;ed at five different period* in Charleston. For forty-four years after tlvJ period, there was no epidemic prevalence of the disease, though it appeared in different summer* in a few sporadic cases. A new era of this fevsi- commenced in the year 179^2. It raged in Charleston in that year, and in 17-14, '95, '9U, '97, '99, 1300, '1, '2, '4 and 7. The number of victims in the mostfan.l sears, were, in 1799, 239; in 1800, 184; in 1802, 96; in 1804, 118; in 1807, 162; in 1793, 98. It prevails from July toNo- vemher, but is most epidemic in August and September. t Ibid, Vol. VIII. p. 252. Winchester is situated in 39° N. Lat. % Ibid, Vol. XVIII. p. 369. 38 Remote Causes of Fever. with the elevation; eight miles from Kingston the maximum is only 70; at the distance of four miles from this town, where the elevation is 4200 feet, the average range of the thermometer is from 47 at sun-rise, to 58 at noon ; and the minimum in winter is 42.* In the ishn 1 of Java, from (he month of July to Novem- ber, the thermometer on the coast generally ranges between SO and 90 during the hottest time' of the day ; and during the coolest part of the morning, is seldom lower than 88. In ascending towards the high grounds, the warmth of the atmosphere gradually diminishes from 85°, the ordinary heat in the plain, to 50°, the temperature experienced on the summit of the mountains, which are even occasionally cover- ed with snow. In the highest parts that are cultivated, the heat during the day is from 60 to 65°, and at niuht as low as 54°. The climate on the coast, and especially at Bantam, is more pernicious to the health of Europeans than that of any other country where settlements have been formed.— Of persons newly arrived, the usual calculation is, that three in five will die (he first year, and of the survivors from nine to twelve in (he hundred, annually; exclusive of (he troops and teamen, amon^ whom, in consequence of their irregu- larities, the mortality is truly deplorable.! hi India, the temperature of the coast of Coromandel is generally much higher lean that of the provinces on the coast of Malabar; and the Carnatic and the north west ex- tremity of the northern Circars are deemed the hottest, not only on the Coromandel coast, but in all India. In the lat- ter di.-tri'(, the French, in the year 1757, lost seven Euro- pean soldiers in the course of a single day by coup de soliel. Along the sandy and almost dry bed of the Krishnah. (he temperature is most oppressive; the thermometer being sometimes raised, near the mouth of that river, to 110° for several days, even in the house, and seldom falling under 105. In the low country of the Arcot district of Carnatic, dnnng the hot season, the thermometer, under the corner of a tent, rises to 100°, and, when exposed to the «un, to 120°. Taking (he average of the whole year, the heat of Ai.tdri- is less than that of Calcutta. In January, the ther- mometer is about 70°; (his is the lowest temperature: the highest is in July, when the thermometer is about 9i°4 * IC4;i.b. Encyclop. Art. Jamaica. t Ibid, Art. Java. ^ Ibid, Art. India. Remote Causes of Fever. 39 The following state ofthe thermometer was observed in 1801, in Demarara. by Dr.'Chit-holm,* where the yellow fe- ver generally prevails. In January, it ranged from 82 to 84°. In February, from 76 to 83. In March, from 80 to 86. hi July, from 80 to 87. In August, from 78 to 80. In September and October, from 86 to 88. In South Carolina, from 1791 to 1808, the difference be- tween the coolest and (he warmest summers, was from 88 to 93°, and the difference between the mildest and the cold- est winters, on a few particular days, from 50 to 17°. In Charles(on and (he low country, the heat is more moderate than in the interior parts of the slate. At Columbia, in the summer of 1808, the mercury in (he thermometer frequent- ly rose to 96, 97, and sometimes to 98, whilst at Charleston it did not exceed 91°. The medium temperature of well water in Charleston is 65°, twelve degrees above that of well wafer in Philadelphia. It is* remarked by Dr. Blain, that in order to produce yel- low fever, there must be. for a length of time, a heat sel- dom falling below 75° of Fahrenheit's thermometer.! From the result of observations upon the degrees of heat in Philadelphia in June and July, between the years 1793 and 1809, collected and published by Mr. Evans, in the True American1, of the 2d of August of 1809, it appears, that the yellow fever has never been epidemic in Philadel- phia, when the medium heat of June and July was below 79°, except in 1802, when it was 78, and in which year not more than two hundred persons were supposed to have di >.d of it. Though fevers of inferior grades prevailed at a low- er temperature.J From all that has been advanced in relation to this sub- ject, I think it will appear (hat a range of (emperature from 70 to 86 of Fahrenheit is necessary to the production of (he bilious endemic, or yellow fever; that the temperature should not fall much, if any, short of 70 at night, nor of 36 in the heat ofthe day. .But it may be remarked, that the higher the natural temperature of the atmosphere, provided it is not sufficient to dissipate, moisture, the greater (he pu- trefaction, and the more sickly the season ; always bearing in mind, however, that a greater degree of heat will com- pensate for a deficiency of corruptible materials, and an ex- * See Edinb. Encyclop. Art. Cotton. t Diseases of Seamen, p. 425. J See Rush's Inq. and Obs. Vol. IV. p. 16S. 40 Remote Causes of Fever. cess and abundance of the latter will be equivalent to a greater degree of the former. As to moisture, its only effect upon the body, when ex- ternally applied, seems to* be that of aiding the operation of cold in stopping the pores of the skin, (hereby checking perspiration, and suspending the excretion of offensive mat- ters from the m tss of blood. It would be trifling and absurd to attribute to it any directly deleterious property ; since moisture, in the form of water, is one ofthe most essential requisites of life, as well in the animal as in (he vegetable kingdom. We daily consume, without the least apprehen- sion, a large quantity of this article; and so far from produ- cing disease, it is one of the most necessary preservatives of health, without winch, man soon sickens, languishes and dies. ''Simple moisture alone," says Dr. Hunter, '; is harmless, at least as far as relates to the production of fe- vers, of which Fort Augusta and Port Royal may be given as examples, for they are nearly surrounded with water on all sides."* That it is the miasmata, and not the moisture of particular situations, as some have contended, which occasion fever, we have shown from the observations of Dr. Lind, confirm- ed by those of other physicians, that ships lying at anchor at a considerable distance from a sandy shore though envelo- ped in fog, escape intermittcnts; whilst others lying near are subject to them. Dv. Franklin, in a letter to Dr. Percival, makes the fol- lowing sensible observations: " The gentry of England," says the Doctor, "are remarkably afraid of moisture and of air. But seamen who live in perfectly moist air, are always healthy if they have good provisions. The inhabitants of Bermudas, St. Helena, and other islands, far from conti- nents, surrounded with rocks, against which the waves con- tinually dashing fill the air with spray and vapour, and where no wind can arise that does not pass over much sea, and of course brings much moisture, are remarkably healthy. And I have long thought that mere moist air has no ill effect on the constitution; though air impregnated with vapor from putrid marshes is found pernicious, not from its moisture but putridity. It seems strange that a man, whose body is composed in a great part of moist fluids, whose blood and juices are so watery, who can swallow quantities of water and small beer daily without inconvenience, should fancy * Disease? of Jamaica. See also the Med. Transactions, vol. viii. p. 521; .for a confirmation ofthe same opinion. Remote Causes of Fever. 41 that a little more or less moisture in the air should be of such importance.'1'" If moisture alone were capable of producing fever, sailors and sea-faring people would be peculiarly subject to it : for at sea the evaporation is veiy great, and the air is constantly charged with moisture, so that cotton bales and other arti- cles soon acquire a considerable increase of weight: yet provided the provisions are wholesome, and. (he vessel is kept clean and sweet, no situation is more healthy. We have already noticed the necessity of moisture as a means and requisite of putrefaction ; to this purpose, we are informed by Dr. Hunter! that the dry part ofthe country in the island of Jamaica continues healthy during the. hot weather, but as soon ns the rain sets in, it becomes unheal- thy. After heavy foils of rain, every part ofthe flat country seems to exhale the same noxious vapors as marshes, for the moisture never fails to meet with a sufficient quantity of de- caved vegetable or animal matter-! It was well observed by Sir John Pringle. that wherever the greatest cause of moisture and putrefaction in the air exists, th'^re also will be the greatest number and worst kinds of intermitting and remitting fevers. The same au- thor, speaking of the diseases of the West Indies, observes, that fevers ofthe intermitting and remitting forms, with bil- ious vomitings, become frequent in June and July, and epi- demic in August, September and October, which are there, at lea«t in Jamaica, the three most rainy months in the year. " These, fevers," says he, " are incidental to natives as well as to strangers. Put new comers are liable to a dif£$|nt species, at least to a different degree of the same.disease^ a more rapid, a more putrid, and a more dangerous fever, distinguished by black vomiting, but chiefly by the yel- lowness ofthe skin, which gives it the name ofthe yellow fever."§ Dr. Rogers, in his account ofthe epidemic diseases of Cork, says, that during the particular series of years that * percival's Essays, Med. and Experimental, vol. iii. p. 37-8. t diseases of Jamaica, p. 18. I The pernicious effects of excessive moisture or wet weather, in giving rise to diseases of a malignant character, was remarked by Hippocrates, who =ays that continual showers give rise to severe diseases, with fevers of long continuance, then fluxes of a putrid nature, &c. Per assiduos imbres morbi magni exparte oriuntnr, turn febres longa;, turn albi fluxiones, pu- tridities, comitiale», apoplexia et anginac. Aph. 16, lib. iii. see. 3. $ Diseases of the Army, p. 198. F 42 Remote Causes of Fever. epidemics were most prevalent, the several seasons were remarkable for warmth and moisture.* In dry sandy spots nearly surrounded by the sea, where there is little or no decaying vegetable or animal matter, and where the moisture is immediately absorbed by the sand, fevers scarcely ever appear. It is observed by' Dr Lind,! that the large rivers in dry seasons being confined within narrow bounds, leave a large part of their channels uncovered, which having the moisture totally exhaled becomes a solid hard crust; that when the rains fall, this long parched crust of ear'h and clay gradually softens, and the ground, which before had not the least smell, begins to emit a stench, which in four or five weeks becomes exceedingly noisome ; and at this time their sick- ness is most violent. The same author further informs us, that he was told by a surgeon who had practised some years at Senegal, that for several months during the dry season, the country was as healthy and as pleasant as zny in the world, but soon after the rainy season began, a low malig- nant fever constantly spread itself among the Europeans. It was remarkable, says this author, one year at Senegal, that at the beginning of the rainy season, in the night suc- ceeding one of those tornadoes, a great number of soldiers and two thirds of the English women were taken ill, this garrison having before been uncommonly healthy. The memorable destruction of Admiral Horner's squad- ron, at the Bastimentos, was begun by the scurvy, and com- pleted by the malignant fever and flux. In the year 1741, no 14011 er had the rainy season set in at Carthagena, where the English troops lay encamped, than the same disease ap- peared and was remarkably malignant, became contagious, and destroyed the greatest part of the army. A prevailing opinion is, that the healthiness or unhealthi- ness of any place depends, very essentially, upon the qual- ity of the water which the country affords. What has given greater currency to this idea is. probably, the circumotance of bad water and bad health being frequently found concom- itants of each other. Thus in low, level, wet, and marshy situations, the water, from stagnation, and from being im- pregnated with the decaying vegetable matter, is generally mawkish and disagreeable. In such places, also, intermit- ting and bilious fevers are apt to prevail; hence the bad quality of the water and the prevalence of the fever have * Rogers on the Epidemic Fevers of Cork, p. 25. + On the Diseases incident to Europeans in Hot Climates, p. a2 Remote Causes of Fever. 43 been considered as causes and effects. On the other hand, we find that sandy, poor, hilly, dry, and elevated coun(ries, far from marshes and stagnating ponds, are generally heal- thy ; here, likewise, the water is pleasant, cool, and well tasted : this has been considered as another argument in fa- vor of the salutary influence of good water as a preservative against disease. As the premises, however, are erroneous, the inferences which have been drawn in these instances must, unquestionabky, be equally untrue. And in many parts of the country adjacent to the rivers, where springs of cool and limpid water issue from (he pure sand and gravel ofthe bank, we find the people in such situations equally subject to fevers as those who live in places of a different description. Il is, indeed, a fact of general notoriety, that, in the state of Alabama, the water which issues from the banks and bluffs ofthe rivers is of an excellent quality, whilst at the same time it is equally well known that the vicinity of rivers and creeks is peculiarly unfavorable to health. From these considerations, we are led to conclude that the quality of the water has but little influence in the pro- duction of endemic fever; otherwise we should find this disease less under the influence of the seasons, and that per- sons continuing to drink from the same fountain, if this were the prime agent, would be subject to a perpetuity of disease through the winter as well as the summer, in situations where endemic fevers were apt to prevail. It frequently happens at sea, that the ships1 companies are obliged to make use of corrupt and sinking water, yet when their situation is other- wise comfortable, no injurious consequences ever happen from the circumstance, Although the quality ofthe water has much less influence upon the healthiness or unhealthiness ofthe place than has been generally supposed, yet it is not contended that impure, stagnant and offensive water is absolutely harmless. A great quantity of fluid is consumed in the course ofthe summer; and although the stomach has the power of changing and correcting, to a certain degree, the offensive qualities of substances received into it, yet this power itself is limited ; hence, when the water is very impure and offensive, and drunk in considerable quantity, it may aid the other remote causes of fever, or give rise to affections of the bowels in the form of dysentery and diarrhoea. But waters, by use, may become wholesome and agreeable, which, in strangers to their use, at first occasion sickness and diarrhoea. This is owing to their saline, mineral, and earthy impregnations, and frequently takes place in what are called lime-stone 44 Remote Caiucs ofFtve/". countries. But such impregnations are different liom the offensive impurities of stagnation, and are calculated lather to prove serviceable than otherwise, especially to invalids, and persons subject to constipation and viacoral obsirue- tions. It is well known that the French are particularly partial to meats and wild game in a semi-putrid and offensive con- dition, the fumes of which would occasion sickness and vo- miting in a person unaccustomed to their use ; yet the. quan- tity of vegetables which they use at the same time, and their light ascescent wines, counteract any injurious effects (hat might arise from this putrescent quality of their viands: but if men were compelled to drink water in a condition equal- ly offensive, it would probably be considered as an intolera- ble hardship, and the sure occasion of disease. I merely mention this circumstance for the purpose of showing that more stress is laid upon water in the production of disease, than in truth and justice should really fall to its share. Fresh rain water, as being more free from everv earth), saline, and hurtful impregnation, is, unquestionably, the moat wholesome water that can be made u»e of as a common drink. " Rain water," says Hippocrates. '■ is the lightest, the sweetest, the finest and most limpid."* The subject of moisture will again fall under considera- tion, when we come to speak of the predisposing and exci- ting causes of fever. SECTION 5. Of Miasmatic Exhalations. The noxious influence of marshy exhalations in the pro- duction of malignant fevers, was noticed by Galen ;* but the power of marsh miasmata in giving rise to intermitting and remitting fevers, was first more particularly observed by Lancissi, the Pope's physician, about the middle of (he se- venteenth century; since which time, the truth and justice of his observations have been confirmed by the extensive experience of numerous physicians in various quarters ofthe world. As this is a subject of interest and importance to _ * Aqua, igitur ex imbubus collectae, levissimae sunt tenuissimae et liin- pidissimae. De Aer Loc. et A<{. Opr. Om. p. ^ t De Feb. Differ, lib. i. cap. 2. Remote Causes of Fever. 43 the community at large, as well as to the physician, it may be of consequence to illustrate the matter by examples drawn from competent and respectable authority. From the remarks already made upon the influence of heat and moisture, it will be readily understood, that the circumstances most favorable to decomposition, the extrica- tion of miasmata and the consequent production of fever, will take place, where, ceteris paribus, the action ofthe sun is the most powerful, as in equatorial latitudes, the tropical and neighboring climutes. We have already noticed the apparent identity ofthe cause of fever, and the piinciple of vegetation, as occurring in marshy places and in warm cli- mates during the summer season. In a previous work* I have given my opinion that the in- termitting, the remitting, the yellow fever and plague, are only gradations and modifications of the same disease ; that they all arise from the same causes, differing only in degree of force and concentration, and that the proximate cause of each is the same. In illustration of which, I noticed the circumstance of the intermitting, the remitting, and the yel- low fever prevailing at the same time and place, and chan- ging and interchanging their forms with each other; thai which is at one time an intermitting, suddenly assuming (he character ofthe bilious or yellow fever ; and on the contra- ry, the latter divesting itself of its malignancy, and taking on the livery and characteristics of intermitting fever. These different forms of fever are the prevailing diseases in the southern portion of the United States, wherever marshes, ponds of stagnating water and corruptible materi- als are exposed to the influence of a powerful sun. From what I can learn, however, I feel authorized in contradict- ing the report of Dr. Jackson, that there is not on record an instance of a person born in Petersburgh, Virginia, and constantly residing in the same place, who has lived to the age of twenty-one. When at Petersburgh, in 1813, I saw no particular marks of unhealthiness, the men appeared as stout, active, and of as healthy a complexion as they are generally found in any part of the southern country. It may. however, be laid down as a position, that instances of longevity are fewer in proportion in the southern states than in those of more northern latitudes. The stimulating and relaxing influence of a warm climate, unwholesome exhala- tions and frequent attacks of disease, appear to be the cau- ses of the early decay of the corporeal powers and vital * On the Topography and Diseases of Louisiana. 46 Remote Causes of Freer, principle in man : yet even in New-Orleans there are found many instances of residents who have attained to honorable old age by temperance and regularity of life. Galen assigns two causes for pestilential fevers : First, the great heat ofthe weather, when the humors happen to be in a more putrescent state than usual; second, and more frequently, a putrescent state ofthe air arising from a mul- titude of dead bodies left unburied, as after battle, or from the evaporation of corrupted lakes and marshes. The noxious effects of marshy exhalations take place in Egypt after (he Nile retires within its banks, leaving the wet ground covered with a variety of putrefying animal and ve- getable substances. We are informed by Mr. Ives, who travelled from India to Europe by land, that at Bagdad, a city containing 500,000 souls, the Arabs are in the habit of taking revenge for any injury done them by the Turks in I>as?ora, by breaking down the banks of the river near this place, in consequence of which, a dreadful sickness and mortality are produced. This was the case in 1743. when the Arabs, by demolishing the banks ofthe river, laid (he environs of Bassora under water. The stagnating and putrefying water in the adjacent country, and the great quantity of dead and corrupted fish at that time lying upon the shore, polluted the whole atmos- phere, and produced a putrid and most mortal fever : of this fever, between twelve and fourteen thousand ofthe inhabi- tants died, and at the same time not above two or three of the Europeans who were settled there, escaped with life. Mr. Macgregor, in his medical sketches of the expedition to Egypt from India, says, one of the principal sources of disease in Egypt, is unquestionably the annual overflowing of the Nile ; on the subsiding of which, the soil, through a great extent of country, is covered with mud and putrid ex- uviae, which exhale effluvia noxious to the human body.—r If we add to this, " says he," the extreme filth of the inhab- itants, poor diet, close and ill ventilated apartments, much crowded narrow streets, and the bad police cf the towns, wc will not be astonished if a fever, at first intermittent, or re- mittent, should have symptoms denominated malignant su- peradded to the more ordinary symptoms of the disease.* During the summer of 1313, the United States brig Lou- isiana, stationed at Fort St. Philips, on the Mississippi, lost nearly the whole of her crew by the bilious or yellow fever. The country at this place is an entire swamp, and as the r'\> *Duncau's Annals of Medicine, vo. 8, p. 264. Remote Causes of Fever. 47 ver is too deep to admit of anchoring in the middle of the stream, the vessel was confined to the bank, so that the men were immediately exposed to the noxious exhalations ofthe adjoining morass. '• If any doubt, says Dr. Hunter,"* can be entertained that the exhalations from wet and marshy grounds, are the cause of fevers in Jamaica, attending to the following facts cannot fail to remove them. Ships lying at Port Royal with their men in perfect health, have in a few days become sickly. The men have been seized with fevers, owing to the low swampy land along shore, and at the head of the harbour, from which last the exhalations are carried every morning towards the ships, when the regular sea breeze sets in, as is sensibly perceived by the bad smell which accom- panies it." 1 have remarked in my Observations on the Topography and Diseases of Louisiana, that heat and moisture, by mutual co-operation, cause sickness to prevail with the greatest mor- tality in the months of June and July. Local circumstan- ces, however, may prevent and vary this effect; as at New Orleans, where sickness is most prevalent and malignant in August. This is owing to the number of ponds lying in the rear and vicinity of that city, which being filled with water through the early part of the season, decomposition is there- by prevented from taking place to any considerable degree in the morass beneath, till the exsiccation ofthe water is in a great measure effected by the falling of the river and the continuance of heat. From the same circumstance it happens that a rainy sea- son renders the city of New Orleans healthy, by keeping the ponds filled with water, whilst it has a contrary effect upon the country generally. In illustration of this circumstance, in the work above referred to, I ealied the attention of the classic reader to the recollection of the instance related in the history of Empedoeles, the Sicilian philosopher and po- et, who put a stop to pestilential diseases among the Sala- ceriti* bv turning two streams of good water into the morass from which they originated. Dr. Dazilles, in his treatise upon the diseases of the negroes in the West Indies, informs us, that the rainy season is the most healthy at Cayenne, owing to the neighboring morasses being deeply overflowed. It is well known that the overflowing of the Nile puts a stop to the plague h E'jjpt, by covering (he low grounds, and preventing (he progress of putrefaction in the alluvial mat- * Observations on the Diseases of the Army in Jamaica, p. 20. 48 Remote Causes of Fever. ters which lie upon the surface of the earth. The lotting out of the water from the fosses of fortified towns, has pro- due- 1 malignant remittents, and the letting it in again has put a stop (o"their progress. Sir John Pringle speaking of the diseases of Flanders, where, from the low damp situation, in- termittent fever i* the prevailing complaint, observes that when the heat comes on soon and continues throughout au- tumn, not moderated by winds and rains, the season proves sickly, the distempers "come on early, and are dangerou? ; but when the summer is late, and tempered by frequent showers and winds, or if the autumnal cold begins early, the diseases are few, their symptoms mild, and their cure easy. For m marshy grounds, intense and continued heats, even without rain, occasion much moisture by the exhalation which iliev raise and support in the atmosphere ; whereas frequent showers during the hot season cool the air, check the rise of vapours, dilute and refresh the corrupted water, and precipitate noxious effluvia. We are informed by the same author that the inhabitants of Breda, during the season of bilious fevers, secure themselves from the noxious ex- halations of a piece of marshy ground in its vicinity, by over- flowing it with wafer.* It is stated by Purchas, that 500 persons less died of the plague (he day after the Nile overflowed the ground which had emitted the putrid exhalations that produced it, than had died the day before. The manner in which the inundation of marshy grounds prevents the extrication of noxious exhalations, is not so much by the. exclusion of air, for water is always saturated with atmospheric air, by which fishes are enabled to live in this element, as by keeping the temperature of the surface below the degree necessary for the speedy decomposition. As the particles of water heated by the sun's rays are specifi- cally lighter than those beneath, it, of course, is physically impossible that they should descend, so as to impart their warmth to the subjacent stratum, as long as they retain this disproportionate superiority of temperature ; so that when the water is deep the bottom must always remain unaffected by (he heat of summer, and will consequently remain cool while the surface is warm, and in this way decomposition is prevented from taking place in the subjacent mass of vege- table and animal matter. Where, however, a thin sheet of water only is spread over the surface of the soil, the whole body of the fluid becomes heated by the sun, and decom- * Diseases of the Army. Remote Causes of Fever. 4$ position takes place with as great and even greater facility than in those places where no stagnation of the water oc- curs. Water, however, is not so easily heated by the sun as the earth, and for two very sufficient reasons ; 1st, the re- flection of the sun's rays from the surface, by which they are prevented, in a great measure, from penetrating this fluid t 2d, the evaporation which takes place from the surface of the water, cooling the subjacent portion. The refrigerating power of evaporation will be explained under the head of Prevention. Offensive exhalations, from whatever source, are probably analogous in their chemical and morbific properties to marsh miasmata, and are calculated by their offensive odour to in- form us of their deleterious quality. There is probably no situation of the like dimensions so likely to generate fevers of a typhoid character as a ship, owing to the following causes: 1st, a vessel always contains a greater or less quan- tity of bilge water, which soon becomes putrid, as well from its own nature as from the mixture of various substan- ces in the hold, and consequently emits unwholesome va- pours: 2d, the close and confined construction of a vessel, and its many crannies and corners excluding a free circula- tion of air, and h'.vouring the accumulation of filth: 3d, the crowded state of a vessel, and the little attention paid by sailors to personal cleanliness: 4th, the frequent want of fresh and wholesome provision : 5th, the qualities of the cargo, which frequently become offensive, and generate dis- c-use. " There was no sickness," says Dr. Blane, in the Ville de Paris, when in possession of the enemy, and the sickness which prevailed after her being captured seemed to proceed from what maybe called simple putrefaction.— There was an instance of (he same kind in one of our ships of the line, in which a bad f?\cr broke out in the month of July, which seemed to be owing to the foul air of the neg- lected hold, for there was a putrid stench proceeding from the pumps, which penetrated the whole ship."* From the degree of putrefaction which often takes place in the hold of a vessel, we need not be surprised that fever of a malignant character, and even the yellow fever itself, should sometimes be generated on ship- board. It is stili fresh in the recollec- tion of m tny, how great a mortality occurred on board the Macedonian frigate, after a cruise of two months among the West India islands, in the summer of 1822. She arrived in Hampton Roads about the 5th of August, having lost 77 * Blane on the Diseases of Seamen, p 136. 50 Remote Causes of F Remote Causes of Fever. 55 -A a greater distance from the town. That the drains, cis- terns, and cellars of the town, and the pits for rotting the flax and the hemp, should be yearly cleaned in the months of '4 January and February, that the slaughter-houses should be removed out ofthe city, and set in such places where the filth exhaled, might be constantly washed away by every rain. These orders being effectually put in execution, the fevers did not return the following summer; and the town remained free from them to the time that Lancissi wrote in 1716. The citizens wrote an inscription on one of (heir gates, in commemoration of their deliverance from these pestilential fevers, and ofthe means by which it was procu- red. On the 1st of May, 1707, the hilly grounds to the southward of the town of Bagnarea, after continued great rains, began to fall into the river which was near that town, in such a manner that whole vineyards were moved from their places, and some houses entirely, without falling: in one of them a woman was delivered of a child, while the house was on its march. The channel of the river was choked and filled up. Numerous cracks, gaps and holes, were left in many parts ofthe ground, in which the waters stagnated and became extremely offensive to the smelh la the summer heats, the color of the inhabitants became of a dead swarthy yellow, and grievous pestilential fevers seized (hem. These were confined to the southern and lower parts of the town, while the other parts which stood high and at a distance from the stagnating waters, out of reach of the va- por which arose from thence, remained healthy, as usual. The channel ofthe river, by order of (he magistrates, being clefared, drains made for carrying off the water, the places where it stagnated cleared, and the cavities, which could not be drained filled up, the inhabitants were the next summer freed from them till the time that Lancissi wrote, and he doubts not that they will continue so as long as they shall continue to keep the town and adjacent parts clean and free from stagnating water. In the public thanksgiving, ordered for this deliverance, the bishop declared the obligations they were under to Lancissi, by whose advice they had been de- livered from such pernicious diseases. Lancissi was so much confirmed by long experience, that these kinds of fe- vers are occasioned by stagnating waters, that whenever ho heard of such fevers breaking out in any place, he didfaot hesitate to affirm that they were occasioned by filthy offen- sive water, or slime stagnating in those places, and frequent- ly before the inhabitants themselves had taken notice of the cause. This his conjecture was always confirmed upon a 56 Remote Causes of Fever". proper inquiry. Ramazzini likewise observes, that in 16D0. the inhabitants ofthe low moist parts of Modena were seiz- ed with epidemical fevers, while those of the high part of the city remained perfectly healthy. " 1 remember," says Dr. Golden, "that several years since when I was at Bris- tol, in Pennsylvania, opposite to Burlington, whicli is situa^ ted to the northward of a large piece of swampy ground, they told me that they had been, from the first settling of Bristol, subject to intermitting fevers of a malignant kind, and, indeed, the aspect of the inhabitants showed the ill ef- fects ofthe air which they breathed. They assured me, at the same time, that not above two or three children, born in that village, since its first settling, had attained the age of maturity ; but since that time, these swamps having been drained, and conver(ed into profitable meadow grounds, I am informed that Bristol is in a great measure freed from those annual epidemical fevers. A fresh water pond and meadow of stagtiating water, not a mile to the northward of the city of New-York, has been lately drained for the benefit of the soil, without any thought of any advantage to (he health of the neighboring inhabitant, though its effects in that respect are very manifest. Every summer the inhabi- tants of the houses on the north side of it, before it was drained, were subject to malignant intermittents, and seve- ral, in the few houses there, yearly died. Since the drain- ing of that place, these houses are become as healthy as any in the neighborhood. Caspar Cantarini, in his account of the republic of Venice, mentions a new college, or council of magistrates, appointed not long before his time, to take care ofthe health of that city, and whose business, among other things, was to cause all filth and other nuisance to be removed, and the city kept clean. He observes, that before this institution, Venice had been frequently subject to pes- tilential distempers, insomuch, that many of the inhabitants for that reason had deserted their houses, and removed their families to the continent; but, that after these magistrates ■were appointed, who continued vigilant in their duty,, (he city had always remained free from any malignant pestilen- tial distempers." Antoninus Galatheus attributes the unheal'hiness of the once famous Brundu-iu.m, to the neglect ran\ carelessness of its inhabitants. "Moreover," says he, "cities situated in a healfiry climate have been destroyed. Cities, indeed, like men, have their vicissitudes, but the neglect of its inhabi- tants has been the ruin of Brundusium; for had outlets Remote Causes of Fever. . 57 been made for its waters, it would never have acquired such an unhealthy distinction." Dr. Robert Hamilton ascribes the fever which prevail- ed at Lynn in 1779, and the five following years, to an inundation from the sea, leaving on its recess a mass of animal and vegetable matter to putrify upon the shore.— This fever he considers to be of the same nature as the yel- low fever of the West Indies, as described by Dr. Hillary ; the tertian of Minorca, by Cleghorn ; and the remitting fe- ver of Bengal, by Clark. He observes, that many conva- lescents from this disease became scorbutic and dropsical.* It is remarked by the celebrated Zimmerman, that exha- lations from marshes do not seem to be so noxious in cold as in hot countries, yet malignant fevers occur, as in Zea- land. In Germany, these exhalations produce tertians; in Hungary, petechial fevers; in Italy, the hemitritase;! and in Egypt and Ethiopia, pestilential fevers..! It would be a curious and interesting subject of investiga- tion, to trace the gradually increasing malignity of endemic fever from the northern boundary ofthe temperate to the torrid zone. We should find, that, other circumstances be- ing alike, there would be a progressive increase in the se- verity ofthe symptoms as we approximate towards the sul- try climate ofthe equatorial latitudes; and that locpl cau- ses, which, as far north as New-York, would merely give rise to regular tertians, in Georgia and Alabama would pro- duce the yellow fever, or the malignant bilious remittent. This influence of change of climate in mitigating or aggra- vating the character of endemic fever, corresponds with the progress of the season in changing the type of local epi- demics. In Zarbat, in Scotland, a putrid fever sometimes occurs, £nd after death the body turns yellow : this may be ascri- bed to certain natural locks or ponds which sometimes dry up in the summer.§ One ofthe most remarkable diseases incidental to an ar- my, recorded by Diodorus the historian, broke out among the Carthagenians at the siege of Syracuse, about 410 years * Observations on the Marsh Remit. Fever, p. 87. + "Thefebrishemitritea, or semi-tertian fever," says Senac, "wemay consider as a continued double tertian. Such, however, is the peculiarity of its type, that one of its paroxysms is ushered in by a cold fit, whilst the next is not, and so on, alternately. Senac on Intermitting and Remitting Fevers, p. 105. J Zimmerman on Experience in Physic, p. 131. & Sinclair's Scotland. H 58 Remote Causes of Fever. before the Christian era. This was at the time of (he fa- mous expedition of the Athenian generals, Eurimedon and Demosthenes. The disease originated from an offensive marsh in the vicinity of the city, and increased to such a degree of malignancy as to destroy nearly the whole army.* In the 14th book, chapter 7th, f!ie same author gives a de- tailed account of a fatal disease which invaded the Carlha- genians the year before Christ 39 1, when encamped upon the same ground that had been formerly occupied by the Athenians. He calls it a plague; and tells us it was first ascribed to the vengeance of the gods, for the rifling and plundering the temples of Ceres and Proserpine. Physical causes, however, of a local nature, were considered by him as the principal occasion of the disease. The ground was wet and marshy; great multitudes were confined within a narrow compass, exposed to the scorching heat of the sun by day, and by night to the cold damp air, and noxious steams and exhalations, arising from (he marshes and from the bo- dies of those who lay unburied. The symptoms were ca- tarrhs and swellings of the throat, which were caused by the stench of the dead bodies, and the miasms from the swamp3 and low grounds. These symptoms were followed by fe- vers, pains in the back, heaviness ofthe loins, dysenteries, blotches and boils over the whole body. Some, in a state of raging madness, ran about the camp and beat all that came in their way. It is said of Syracuse, that " the least stagnant water is sufficient, in the heat of summer, to poison the atmosphere ; its effects on the countenances ofthe poor people who live in its vicinity, are very evident: and a stranger who travels through the island in this season, ought to avoid ever pass- ing a night near them." (Ec nigc Berichten, &c.) '«As soon as the sun enters the lion, this country becomes the house of death : fevers of the most malignant hind, seize upon the imprudent or unfortunate wretch that spends a night near them, {ponds and marshes ;) and few escape with life when attacked by so violent a disorder.''! Fracastorius attributes the pestilential fever attended with petechias, which appeared in Italy about the year 1530, to an extraordinary inundation of the Po, which upon receding left the marshes to corrupt and infect the air through the summer. * Diodorus, lib. xiv. cap. 2. t Swenburn's Travels, Vol. II, $ 49, Dublin edit. Remote Causes of Fever: 5$ It is recorded by Forestus, that from the putrefaction of the water, the city of Delft, in which he practised, was scarcely, two years together, free from the plague or some, pestilential distemper. In the year 1694, a fever broke out at Rochfort, in France. which, on account of the uncommon symptom? and great mortality, was at first believed to be the plague. But M.' Chirac, who was sent by the court to inquire into its nature, found the cause to arise from some marshes that had been made by an inundation of the sea. He observed, that the offensive effluvia, which smelt like gun-powder, were car- ried to the town by the wind, that had long blown from the quarter where these marshes were situated. Such was its mortality, that two thirds of those who were seized, fell vic- tims to the disorder.* It is remarked by Assalini, in his account of the diseases of Egypt, that the heavy rains which fall during the winter at Damietta, Rosette, and Alexandria, contribute greatly to produce disease, which the south winds, the fogs, and the exhalations of the marshes, render more dangerous; and that the diseases are most frequent when the inundations of the Nile are high and of long duration." " At this day," says he, " the lakes, the marshes, and the filthiness which one finds in the cities of Lower Egypt, are the principal cau- ses ofthe frequent diseases to which they are subject, and which can never be eradicated until we have found means to purify the atmosphere of their environs. This important advantage maybe obtained by draining off the waters of the lakes, and filling them up ; by keeping the cities clean, and giving a free exit to the rain water, which stagnating in dif- ferent parts of the cities becomes corrupted, and conjoined with filth, infects the atmosphere." Baron Laray informs us, that from the 21st of August till the autumnal equinox, the inundation of the Nile increases, and all Egypt is like a sea, in which the towns and villages appear like so many islands, and the inhabitants communi- cate with each other by means of boats. Towards the end of September, the waters retire, when they cultivate the earth. The sickly season begins about the first of March, and generally continues to the end of May.! * This statement is quoted by Sir John Pringle, from Trails du Fievres Maligns. Oeuvres Posthum. de M Chirac, Eleg. de M. Chirac, par M. de Fonlville In those who were opened, says Sir John Pringle, the brain was found either inflamed or loaded with blood, the fibres ofthe body were un- commonly tender, and the bowels were either mortified or in a state of suppuration. t Laray's Memoirs, Amer. Edit. Vol. I, 60 Remote Causes of Fever. We are informed by Dr. Lind,* that in the month of Au- gust, when the thermometer often rose to 82° in the middle ofthe day, the marines, who were exercised three times a week, early in the morning on the South Sea beach, suffer- ed much from the effects of an adjoining morass. Half a dozen of them at a time, were frequently taken ill in their ranks, while underarms; some were seized with such a gid- diness in the head, that they could scarcely stand ; oihers fell down speechless, and upon recovering their senses com- plained of a violent head ache. When such patients were received into the hospital, some few had a regular ague, but far the greater number labored under a remitting fever, in which, indeed, there was no perceptible remission for pome days. A constant pain and giddiness in the head were the most distressing and inseparable symptoms ofthe disease. Some were delirious, and a few vomited a quantity of bile; in all, the countenance was yellow. It is related by Lancissi, that thirteen gentlemen and la- dies of the first rank in Rome, having made an excursion upon a party of pleasure, towards the mouth of the Tyber, the wind suddenly shifted, and blew from the south over the putrid marshes, where the whole party, with the exception of a single individual, were immediately seized with a ter- tian fever. Cabbages, as abounding with azote, approach in their chemical properties to the nature of animal matter, and in undergoing decomposition, become extremely offensive and unwholesome. Instances of fever originating from this source, have frequently occurred. One is related by Dr. Rogers,! and another, much to the point, is given by Dr. Bailey, in his Treatise on the Epidemics of New-York in 1795, page 84, et seq. " Some time since," says the Doc- tor, " I was called to visit a young man about eighteen years old, in a family in the skirts ofthe town. (Hartford.) He was violently attacked with most of the characteristic symp- toms of yellow fever. The next day, a second was taken in the same manner; and on the morning of the third, three more were taken sick. This led me to suspect some par- ticular cause. I searched for it in vain that time. The next morning, in passing through the kitchen, I smelt some- thing that was very offensive, which none ofthe family had noticed. On opening the cellar door, I found that it pro- ceeded from the cellar. Two persons went down to exam- * Essay on the Diseases incidental to Europeans in Hot Climates, p. 23. t Essay on the Epidemic Diseases ef Cork. '■' Remote Causes of Fever\ 61 ine, and found in one corner of a small tight room, a quan- tity of June cabbages, on which the sun had shone about three hours in the day. They had rotted, and sunk down in a heap of putrefaction. They run a stick under them and lifted them up, and there immediately issued such an intolerable stench, as obliged them instantly to leave the cellar. A vomiting was brought on, which lasted more than an hour. Notwithstanding that the doors and windows of the cellar were thrown open, it was two days before they could clean it out. No other person in the family was ta- ken afterwards, and those who were already seized soon re* covered." Aheap of cabbages, in a state of putrefaction, gave rise to a malignant fever at Oxford several years ago, which proved fatal to several students of that university, and to many ofthe inhabitants ofthe place. Dr. Rogers, in his account of epidemic diseases, ascribes the unhealthiness of the city of Cork in his time, to the fol- lowing circumstances. The city of Cork is built on islands, surrounded by branches of the river Lea, in their own na« ture marshy, and which were subject to the overflow ofthe spring tides, till the ground was raised by art: it is situated in a deep valley, where the rest of the marshes, both of the east and ofthe west, are constantly covered by the over- flowing ofthe spring tides; and in the interim, putrid vapors are exhaled from them ; continued ridges of hills bound this vale on the north and south, on which (he suburbs are built. Besides this situation of the town itself, he mentions four other concurring causes. First, the great quantities of filth, ordure, and animal offais in the streets, and particularly the close, confined alleys and lanes. Secondly, the great num- ber of slaughter-houses, both in the north and south suburbs, especially on the north ridge of hills, where are vast pits for containing the putrefying blood and ordure, the steam and vapors of which taint and corrupt the wholesome breezes. Thirdly, the unwholesome and foul waters, that great num- bers ofthe inhabitants are necessitated to make use of du- ring the dry months of summer. Fourthly, the vast quantity of animal offals used by the meaner sort, during the slaugh- tering seasons; which, according to our author, occasions stili more mischief, by the quick and sudden transition from a diet of another kind and different nature.* Pulo Bay, in the East Indies, is remarkable for the pes- tiferous quality ofthe air, occasioned by the lowness and swampiness of the soil, full of ponds of stagnating water, * Rogers on Epidemics, p. 36-7, 62 Remote Causes of Fever. which exhale an offensive effluvium. Capt. Delano says, that he lost there twenty men of his crew, in half the num- ber of days.* The indigenous fevers of Batavia, Calcutta, Goree and Surrinam, are universally acknowledged to originate from the exhalations of putrefying animal and vegetable matter. In all spots ofthe East Indies situated near large swamps,! on the muddy banks of rivers, or the foul shores of the sea, the vapors exhaling from the putrid stagnating water, either fresh or salt, from corrupted vegetables and other impuri- ties, produce mortal diseases, especially during the rainy season. There is a place near Indrapour, in Sumatra, where no European can venture to remain, or sleep one night on shore during the rainy season, without running the hazard of his life, or at least a dangerous fit of sickness. And at Padang, a Dutch settlement at Sumatra, such is the pesti- lential quality of the air, that it is commonly called the plague coast. There a thick pestilential vapor or fog ari- ses after the rains, from the marshes, winch destroys all white inhabitants. I shall here add a few remarks on the climate of Batavia, as illustrative of the subject on which we are treating, and serving to show the powerful influence of heat, moisture and putrefaction, in the production of diseases. The following paragraph is extracted from the Edinburgh Encyclopedia. After describing the abundance of its productions, and the beauty of the country, the author draws the following mel- ancholy contrast. " In the midst of plenty, beauty and gaiety, every countenance indicates debility and languor. There is pestilence in the air, and poison in the water. The atmosphere is constantly infected with deleterious vapors, which rise from the surrounding swamps and morasses ; and the trees with zohich the quays and streets are crowded, impede the free circulation of the air, zohich otherwise would, in some degree, be dissipated, (qr. renovated.)t Fevers, which are here the general denomination for all kinds of illness, are continually raging in the colony. Of strangers, who came to settle at Batavia, three out of five are reckoned to die the * Delano's Voyage?, p. 153. + Lit;d on-the Diseases of Hot Climates, p. 85. t These lines marked in italics are exceptionable, since, as has already been shown, the growth of trees and plants is one of the greatest natural preservatives of health; and so far from causing an obstruction to the wind, when planted in straight lines parallel with the streets, as they should be, they aid its circulation, by producing a greater degree of coolness in their vicinity and shade. Remote Causes of Fever. 63 first year; and it appears from calculation, that the compa- ny lose annually one fifth cf their servants. Such is the general apprehension of the unhealthiness of this colony, that even the temptation of quickly amassing a splendid for- tune is insufficient to induce those who can reside at home with any comfort, to seek a settlement in Batavia. Many offices and professions are thus necessarily entrusted to per- sons little qualified for fulfilling their duties; and it is wor- thy of remark, that one ofthe clergymen, and the principal physician, had originally been barbers." Dr. Ffirth, in his account of Batavia, has, likewise, some interesting observations.* He represents the exhalations arising from the mud and stagnating water as extremely dis- agreeable, and of such pungency and strength as to occasion opthahnia, vertigo, nausea and vomiting, upon exposure to them. " In going up the canal," says the Doctor, " from a ship lying in the harbor, you are certain to meet large quan- tities of putrid animal matters floating down. What with the sight of dead Malays, in every stage of putrefaction, and torn in pieces by the alligators, dead horses, cows, &c. producing an intolerable stench, and the inundations from the banks of (he canal, and the meadows already mentioned, combined with the intense heat ofthe sun, and its reflection from the water, you are certain to have a considerable de- gree of nausea, with head-ache and great languor produced. Strangers, on the slightest irregularities, are sure to suffer, as it only requires an exciting cause to produce the disease at anyr time." Dr. Ramsay, in a letter to Dr. Mitchill, enumerates the following as the causes of the pestilential sickness in Nor- folk, Virginia, in 1795.1' The warmth of the season; the low situation ofthe town; accumulation of animal and ve- getable matter in the gutters, which being obstructed form- ed a mass of corruption ; a part of the town being construct- ed of wooden houses, built upon large log frames, tilled in with small wood, and many of them not tilled in at all, but serving as receptacles to all manner of filth ofthe poor who lived in them, and who, being mostly foreigners, used large quantities of beef and fish. The noxious influence of the marsh miasmata from the borders of Onondaga lake, (N. Y.) are related by Dr. Van- dervoort,in his essay on the analysis ofthe Ballston mineral * See Dr. Ffirth's Account of his Voyage to Batavia, in Dr. Cox's Phila* slelDhia Med. Muroum, Vol. I. p. 48, et scq. t Webster's Collection of Papers on Bilious Fever, p. 1 ,■>'»'. G4 Remote Causes of Fever. waters. " The marsh effluvia," he observes,'; in this west- ern territory, in many places, and particularly in this place, operate so powerfully on the human body, as to induce a paroxysm of an intermittent in the course of four or five hours, and frequently death the seventh day. From ocular observation in these marshes, it appears that the poisonous effluvia are generated from the putrefaction of vegetable matter, which, in its resolution, undergoes certain changes, which produce this noxious air. It is also evident that this does not operate where the marshes are inundated." In the account of Mr. Andrew Ellicott's voyage down the Ohio river, in the month of November, 1796, the following facts are related. " Many of the inhabitants (of Gallipolis) this season fell victims to the yellow fever. The mortal ca- ses were generally attended with black vomiting. This dis- order certainly originated in the town, and, in all probability, from the filthiness of the inhabitants, added to an unusual quantity of animal and vegetable putrefaction, in a number of small ponds and marshes within the village. The fever Could not have been taken there from the Atlantic states, as my boat was the first that descended the river after the fall ofthe waters in the spring ; neither could it have been taken from New-Orleans, as there is no communication at that sea- son of the year up the river : from the latter to the former of those places, moreover, the distance is so great that a boat could not have time to ascend the river after the disease ap- peared that year in New-Orleans, before the winter would set in."* It appears from the account given by the Rev. Azel Back- us, in a letter to Dr. E. H. Smith, of New-York, that the epidemic which occurred in the town of Bethlehem, Con- necticut, in the year 1750, and which the neighboring phy- sicians called the plague, from the severity and mortality which marked its progress, was occasioned by the letting out ofthe stagnant water of a pond, that had been made to accumulate in the valley, for the purpose of destroying a growth of small vegetables. "With its stream," he ob- serves, ''the pestilence issued, which carried off between thirty and forty ofthe most hale and robust inhabitants."t Fads relative to the Black Vomit, Dysentery, eye. as they occurred in Mifflin County, Pennsylvania, during the hot weather of 1797 '98 and '99. By Dr. William Harris.\ " It is now twenty-five years," says the above mentioned au- * Steam-boats were rot then in use. t Med. Repos. Vol. IV. p. 74. % Med. Repos. Vol IV. p. 105-6. Remote Causes of Fever. 65 thor, " since the first settlement of the country, notwith- standing the ponds of water, which during the whole sum- mer have been kept full, the inhabitants have enjoyed good health till within these three years. The water is now ex- posed to the rays ofthe sun, and becomes nearly dried up towards the latter end of summer. It is in many places co- vered with a greenish scum, from whence arises a very un- pleasant s,m;,U. The consequence is dysentery, infermit- tents, and highly malignant febrile complaints, which in some instances prove mortal in forty-eight hours, and three days, having every symptom as described by medical au- thors, ofthe pestilential disease, or yellow fever, of New- York and Philadelphia. In the year 1797, it was as fatal in Mile-d>oro;j-^Li, which lies upon the Bald Eagle Creek, according to the number of inhabitants, as it was in Phila- delphia in 1793. A large pond of water stood within the neighborhood of the town. The season being very dry and warm, the water, which before was shaded by trees, was now exposed to the sun, and was, in a great measure, dried up. The pond abounded with putrefying vegetables, the stench of which proved very disagreeable. Few in the town eseaped sickness of the most malignant kind, which continued through the months of August and September. The pond has since been drained off, and the inhabitants are a? healthy as usual." The same author remarks, page 106 ofthe work above referred to, that many vomited a dark, filthy, brown substance, and sometimes nearly as dark as ink, which was so offensive as to cause nausea, and even vomiting, in the attendants. We are informed by Dr. John Scott,* that between the years 1792 and 1796, a gentleman, a few miles above Ha- verstraw, New-York, began to erect a furnace and forge in the mountains, for which purpose he built a dam across a large stream of water, and overflowed an extensive tract of land ; small houses were erected for his laborers, who car- ried on the work with vigor until autumn, when the pond, from the heat of weather, became dry, and his laborers were soon after attacked with a malignant fever, which proved fatal to most of them ; the few survivors fled, and the work remains abandoned. A malignant fever originated in the town of Greenfield, Saratoga county, (N. Y.) in the year 1797, in consequence of the erection of several mills in the town, which caused much land to be overflowed. In the fall subsequent to this * See Med. Repos. Vol. X. p. 240. I GG Re mute Causes of Fever. erection, the water became dried up, and whole families were seized and carried off with a malignant bilious fever. This fever was attended with the same symptoms that char- acterized the yellow fever ofthe same season in the city of New-York. The succeeding years, the new ponds were emptied every May, and not tilled till fall, and their malig- nant fevers visited them no more. The following fact is communicated by Dr. Watkins, from his personal knowledge.* There is a village called New Design, about fifteen miles from the Mississippi, and twenty from St. Louis, containing about forty houses, and two hun- dred souls. It is high ground, but surrounded by ponds. In 1797, the yellow fever carried off forty-seven ofthe inhabi- tants, or more than a fifth. No person had arrived at that village from any part of the country where this fever had prevailed, for more than twelve months preceding. Our informant resided in the village at the time ; and having seen the disease in Philadelphia, he declares it to be the same that prevailed at New Design. He also mentions an Indian village depopulated by the same disease two or three years before. Dr. Warren, in a letter to Dr. Eliphalet Pearson, descri- bing the yellow fever of Boston, says,t " Having almost eve- ry fall, seen a considerable number of cases, very similar to the above, not excepting the black vomit, nor the yellow skin, together with other circumstances usually attendant on fevers of this denomination, I have been induced to believe, that the disorder in question was no other than what has, moie or less, prevailed here every year, and is what is pro- perly termed a bilious remittent fever. That it originated from noxious substances, exhaled into the atmosphere from putrefying animal and vegetable substances, or both, is ex- tremely probable, from the places in which it was most prevalent." Dr. Drisdale, in his account of the yellow fever of Balti- more in 1794, says, it was impossible to ascertain any means by which the yellow fever could have been imported ; and reasonably imputes it to the existence ofthe black, putrid, and offensive water under the floors of those stores where the sick resided, and to putrid exhalations from the dock and from an extensive marsh when the north wind prevailed.£ A fever of a malignant character, and such as Dr. Hamil- ton and Dr. Alibert have deno/ninated the malignant mtcr- * Med. Repos. Vol. X. p. 74. t Ibid, Vol. I. p. 135. .% Cox's Philad. Med. IIus. Vol. I. Remote Causes of Fever. 67 mittent, originated in the town of Sheffield, Massachusetts, on the Housatonic, in the years 1793, '94 and '95, from the putrefaction of the neighboring morasses.* The banks of the river were interspersed with coves and extensive marshes of stagnating water, in addition to which were two mill dams, which caused a considerable tract of country to be over- flowed with water, and which drying up as the heat of sum- mer increased, exposed a vast bed of offensive and putrefy- ing animal and vegetable matters. The consequence was fever of a malignant aspect, in some cases attended with yellowness of tho skin. I have annually observed a number of cases resembling the fever above spoken of, less malignant than the bilious remittent, but much more so than the ordinary intermittents of temperate climates, and which, if neglected, soon assu- ming the character of the bilious remitting or yellow fe- ver. A similar fever occurred in 1779, in Ontario county, (N. Y-) Its remedies were plentiful purging at the com- mencement with calomel and jalap, and the liberal use of the bark as soon as the remissions would admit of its exhibi- tion.! I am aware that it has been attempted to be shown by some physicians, and particularly by Dr. William Ferguson, that endemic and yellow fevers arise from something differ- ent from putrefactive exhalations, from the circumstance of their prevailing in certain dry seasons and situations, where no putrefactive sources apparently existed. In answer to this, I will subjoin the following observations of Dr. Rush. "Dr. Gordon informed me,| that five hundred persons died ofthe yellow fever in Berbice, (Surrinam,) between July, 1804, and May, 1805, during which time there fell not quite three inches of rain. The earth, in this case, was every where dry and parched. Bilious fevers, Sir John Pringle tells us, occur in a part of Holland in very dry seasons, but in these cases the earth cracks, and putrid exhalations es- cape from water which stagnates below its surface. The same cause which produced these fevers in Holland, proba- bly induced the fever at Berbice, mentioned by Dr. Gor- don, as also all such bilious fevers as appear under the same * See Dr. Buel's Letter in Webster's Collection of Papers on Bilious Fe- vers, p. 53 & seq. t The attention of physicians was first called to the consideration of this form and variety of fever from the accurate description of Morton; and more recently the inquiry has been industriously and ably conducted by Torti, Lautter, VVerlhof, Senac and Cleghorn. \ Inq. and Obs. Vol. IV, p. 181. iS 68 Remote Causes of Fever. circumstance of apparent absence of moisture and putrefac- tion." In further illustration of this fact, I would observe, that in the months of June and July, in 18 23. during a hot and dry spell of weather, a high grade of bilious fever pre- vailed in various parts ofthe piairies in Alabama. The soil in those parts ofthe country where the fever made its ap- pearance, was exceedingly rich, deep aid black; but ex- cept in the hollows, the surface was dry, parched, and cracked open. Upon removing this crust, however, which did not exceed half an inch in thickness, the soil was per- fectly moist beneath; and from the offensive smell which issued from it, and which was very perceptible after sun- set, appeared to be in an active state of putrefaction. It may be asked if the bilious, endemic or yellow fever, is produced by heat and putrefaction, why does it not occur every season in places which have once been visited by it? To this I would answer, that certain seasons and circum- stances are more favorable than others to the decomposition of animal and vegetable matters, and to the developement of the semina of bilious fever. It is not contended that pu- trefaction, in every instance and situation where it may ex- ist, will necessarily and inevitably give rise to bilious fever. But it is maintained, and without the fear of contradiction, that wherever this disease has prevailed in our country, there have existed in the vicinity of its prevalence the ma- terials and requisites of putrefaction and decomposition in no inconsiderable degree. It has been remarked by Lancissi and others, that the mixing of the salt water with the fresh along the sea coast, and places accessible to the tide, is peculiarly favorable to putrefaction, and the consequent production of disease.— The experiments of Sir John Pringle would seem to prove that a small proportion of salt promotes instead of retarding putrefaction. But as it respects the mixing of salt and fresh water in bays and harbors affected by the tide, the truth of the position, I believe, has not been proved by general ex- perience, nor has it been found that putrefaction in such places is moie rapid than in fresh water ponds and marshes. It is well known, however, that in ail large sea-ports there is a very considerable accumulation of filth about the docks, occasioned by the wash of the cities, the lading and unlading of vessels, which corrupts and infects the air from its own intrinsic tendency to putrefaction, and not from any adven- titious agency of salt water. It was well observed by For- tunatus Fidelis, that " some unknown mischief is engender- ed in places along the shores of harbors. For there many Remote Causes of Fever. 69 vessels are moored, all their nastiness is accumulated, and the excrements of cities deposited. Wherefore, although the maratime aspect of the place promises something highly encouraging to health, yet it is all marred by this horrible mixture of things.'* The fact would seem to be, that the pure muriate of soda possesses, in any quantity, an antisep- tic property. Liverpool salt, however, prepared as it is by artificial evaporation, possesses many impurities foreign to the preserving virtues of the pur;e muriate of soda. And we are informed by Dr. Percival, that Sir John Pringle told him "he had long believed the septic quality of the sea salt, as employed in his experiments, was owing to some hetero- geneous substance blended with the article, and not to any putrescent quality in the mere muriate of soda, or pure sea salt itself." Some have pretended to deny the pernicious influence of effluvia arising from the putrefaction of animal matter ; and it has been brought forward as an argument in favor of this opinion, that butchers, tanners, oil sellers, or dealers in oil, the manufacturers of ammonia, &c. remain healthy notwith- standing the offensive effluvia with which they are surround- ed. Such instances of exemption, howerer, can furnish no conclusive argument that such occupations are in themselves peculiarly healthy, any more than the argument, that be- cause an unusual quantity of spirits does not produce intox- ication in an habitual dram drinker, it is therefore destitute of any inebriating quality whatever; for we know that long familiarity with, and exposure to, otherwise noxious agents, fortifies the body, by custom, against their pernicious influ- ence. In this way are we enabled to account for the ex- emption of the butchers from the yellow fever which pre- vailed in Philadelphia in 1793. " It has been often remark- ed," says Van Swieten, "that workmen employed in tan- neries, in the preparation of skins, intestines, animal glu- ten. &c. who continually breathe an air charged with pu- trid exhalations, enjoy good health, while strangers cannot, with impunity, approach the place where these foetid sub- stances are manufactured."* One of the most conspicuous abettors of the opinion, that animal putrefaction is exempt from any injurious conse- quences in the production of disease, is Dr. Chisholm, an advocate, also, for the contagion and imported infection of the yellow fever. It appears that Dr. Hosack is likewise inclined to this opinion. Though it can hardly be suppo- * Van Swieten. Comment, in Boerhaave. Alph. 70 Remote Causes of Fever. sed that every animal whose carcass rots upon the surface ofthe earth, should occasion a pestilential atmosphere in its vicinity, yet instances upon a larger scale are too nume- rous to admit the conclusion, that the putrefaction of ani- mal matter has no noxious or morbific tendency. This opinion of Dr. Chisholm and Dr. Hosack, is akin to that of Alexander Benedictus, whom Lancissi styles the frst patron of stinks, and adviser of their remedial operation. " Some have entertained the notion," says Lancissi, '' that the efflu- via of corrupted substances had no manner of noxious ope- ration, because they had read that these very agents were sometimes considered as remedies in some pestilential sea- sons. Thus Alexander Benedictus stales, " that he had heard from a merchant of Candia, that all the dogs were killed during the prevalence of a violent plague, and by or- der of the physicians thrown about the streets. The air was soon filled with their corrupting exhalations, and their remedial operation immediately restored the place to health." Very near akin to this story," says our author," is another related by George Pictorius, " who heard a man from Uto- pia affirm, that in an epidemic plague, nothing was more wholesome and excellent than three times a day to snuff up the fumes of a privy, or of a sheep-fold," So also Joseph Quercetanus adduces the case so familiar to the people of Paris, to wit, that of the nastiness of their streets being con- sidered by manyr physicians as checking the putrefactive taint of their atmosphere. Nor are there wanting o(her au- thorities from very serious writers, collected by Caspar a Rejes, by which it is shown that bad smells are sometimes valuable auxiliaries of nature. But we have nothing to ap- prehend in making a full reply to these observations. As to Alexander and Pictorius, the experiments were not made by themselves, but told on the credit of others. The former got his story from a Cretan merchant, and the latter from an Utopian traveller." In relation to this subject, Lancissi makes the following remark. " What satisfies us of (he ease with which wise men commit blunders, when they start wrong, is (his, that our opponents have mistaken the antidote for the poison, and the remedy for the matter of mischief."* The noxious influence of animal putrefaction will be bet- ter illustrated by a few examples. We are informed by Alexandrianus, Diodorus Siculus, and others, that plagues have arisen from the putrefaction * Translation of Lancessi's Work by Dr. Mitchill, Med. Repos. Vol.XNT' p. 126. tiemote Causes of Fever. 71 of dead bodies after battles. In confirmation of this fact, we are referred by Diemerbroeck {De Peste) to Hieroni- mus, Augustinus, Sobalius, Wolfius, Angelus, Parseus, and Agricola. Diemerbroeck, speaking of his own experience, says that a very bad malignant fever was produced by the putrefying remains of 8000 Germans, together with horses which were left slain on the plain of Juliers, in the summer of 1642, and that a similar disorder immediately appeared after the severe engagements between the Austrians and Swedes, owing to the neglect of burying the dead. Forestus relates that a dead whale cast upon the shores of Holland, occasioned an extensive pestilence in Eo-mont. The same author mentions a fever which originated in Ve- nice, in his time, from the putrefaction of a quantity of small fishes, which abounded in that part of the Adriatic. And Paraeus informs us that a severe plague which spread over the whole extent of Tuscany was produced by allowing a whale to putrefy, which had been thrown upon the shore. The circumstance, that on other occasions dead bodies have putrified upon the ground without producing any pes- tilential disorder, will not invalidate the conclusion, that such effects have in other instances been occasioned by them ; and in these exceptions, the want of exposure to the exhalations, and the season ofthe year, may have been the cause of their not proving equally injurious. We are informed by Dr. Lind,* that at Bencoolen, the diseases that always raged violently during the month of October, are occasioned by dead fish and other animals left by the Ganges; and that the unhealthiness of Gambroon arises from vast quantities of little fishes left upon the shore, which soon become putrid, and contaminate the air. It is related by historians, that in the year of Rome 628, and B. C. 126, a most destruc(ive pestilence was occasion- ed in Africa by dead locusts: A strong east wind brought the swarms of these animals towards Numidia and Utica in such astonishing multitudes, that they devoured every leaf of vegetation, and even the bark of the trees. A south wind drove and precipitated them into the Mediterranean, and being washed on shore in the hot season, they putrefied and caused a most dreadful plague. We are told that 800,000 persons perished in Numidia, 200,000 on the sea-coast of Carthage, and 30,000 of the Roman troops.t It is said by * Lind on the Diseases incidental to Europeans in Hot Climates. t Livy Epit. 60 Orosius lib. v. p. Diac. August. Hiat. 613. The reader of Jacred writ will call to mind the Mosaic account ofthe plague3»f liscustsin 72 Remote Causes of Fever. Orosius, that the effects of this pestilence were not confined solely to the human species; such was the corruption of the air, that a general mortality of birds, cattle and wild beasts, marked the progress of its destructive ravages, and served to increase the dreadful calamity and desolation. Dr. Monro gives an account of a pestilential fever, or plague, which appeared among the soldiers encamped about Warburgh in 1760, occasioned by the putrefaction of an in- finite number of dead horses and men, scarcely covered with earth.* A barbarous stratagem is related by Mr. Gibbon, in bis account of the Saracens, when they overran Africa : One fortified place was impregnable to their warlike machinery; and as they did not choose to starve it to compliance by a siege, they therefore gathered all the inhabitants of the country round about, and murdered them, and left the dead bodies round the walls; in consequence of which a violent fever, or plague, soon obliged the place to submit, after most of its defenders were dead, and the remainder debili- tated by sickness and fatigue. M. De Lassone gives an account of a malignant fever and dysentery, produced by the putrefaction of animals that had died of an epidemic disease in Paris and its environs. By bein? but slightly and imperfectly covered with earth, putrid effluvia were evolved, and produced disease among the neighboring inhabitants; which ceased, upon the dead bodies being effectually covered with lime and earth.t It is reported by Lancissi, that near Rome is a place where the carcasses of horses and mules are carried to be skinned and cut into meat for feeding hounds and cats.— When this business is negligently performed, and the bowels and limbs thrown into the river lodge in the nooks and cor- ners of the bank, the neighboring inhabitants immediately suffer from the corrupted condition of the air, and become afflicted with malignant and pestilential fevers. Egypt, in the time of Pharaoh, B. C. 1491 ; which we are told was preceded by a strong east wind, which continued to 1 low for a day and a night, and in the morning brought the iocu.4s in surh tnyriaos, that "before them there were no such locusts as they, neither after them shall be such. For th»y covered the face of the whVie earth, (Egypt,) so that the land was dark- ened ; and they did eat every herb of the laud, and all the'fruit of the trees which the hail had left; and there remained not any green thing in the tree', or in the herbs of the field, throughout all the land of Egypt."— Genesis, chap. 10. * Monro on the Diseases ofthe Army, Vol. I. p. 226. t Med, Comment. Vol. VIII. p. 58. Remote Causes of Fever. ^3 When the vapors of animal putrefaction are pent up and confined in a narrow space, they are thereby rendered more concentrated in their virulence and more fatal in their ope- ration. In illustration of which, the following instances >n\v be considered as striking and instructive. We are informed by Mr. P. C. Varle, that in the summer of 1783, "»l. Faure, a merchant of Norbone, in Lower Lan- guedoc, in France, bought a house which had been previ- ously occupied as an anatomical hall; and, being desirous of having a cave dug in the cellar, employed three men to do it. In digging, (hey came to the wall of a necessary, which had been the common receptacle of the remains of human subjects, and which was covered, to prevent detec- tion : and on extracting a few ofthe stones with their picks, an offensive putrid matter rushed through the aperture; and such wa? its virulence, that it produced instant suffoca- tion. M. 17-me, coming to see the workmen, descended hut two or three steps before he fell senseless. The neigh- boring people, perceiving the putrid smell, went to the house ; and of nine that entered to bring out the sufferers, six died. M. Faure was recovered from the first impress- ion, hut die.] four days afterwards; and the unfortunate la- borers survived but a day or two. In Pierre Cotte's Treatise on Meteorology, he gives the history of the case of a grave-digger in 1773, who by acci- dentally opening a coffin that had been buried a year be- fore, v,a•• suddenly killed by the vapor that issued from it. He further add:?, that in the same year, during the time of a funeral, there arose a vapor from the coffin of a person re- cently buried, and of 120 persons who were present, 114 were taken ill with a putrid fever. A similar occurrence is said by Dr. Robertson to have taken place, some years ago, in West Linton : a school boy, getting into a new made grave, set about to open the projecting corner of a coffin, which as soon as he had penetrated, there issued from thence a strong nauseous smell, on which he exclaimed he was suf- focated ; on being removed from the place, he recovered from the fir-t effects, but was immediately seized with a pe- techial fever, of which he died on the seventh day.* A pes- tilential fever occurred at Pan-, on clearing the burying ground belonging to the church ofthe Innocents. It is related by Sir John Pringle, that the greatest number and worst cases of jail or lio-pital fever, were in one of the ■* * Robertson on the Atmosphere and Epidemics, Vol. II. p. 341. K 74 Remote Causes of Fever. ships, in which there happened to be two men with morti- fied limbs; fhis accident was not only the means of spread- ing the infection at sea, but also in the wards in which they lay after their removal.* Besides Pringle, Ramazzini, Porteus and others, who have written on the diseases incidental to armies, have con- sidered (he offensive effluvia of the excrement of man and beast, as a powerful cause of those putrid diseases which often prove so destructive to soldiers in encampments and fortified places.! To the excessive use of animal food, and to the putrefac- tion which took place about their camp, we may reasonably ascribe the dreadful plague with which the children of Is- rael were afflicted at Kibroth-hattaavah, (or the graves of lust;) when, despising the manna that fell from heaven, they longed for the luxuries of Egypt and the flesh of beasts.— The sacred historians inform Us, that " the mixed multitude that was among them fell a lusting; and the children of Is- rael also wept again, and said, who shall give us flesh to eat ? We remember the flosh we did eat in Egypt freely; the cu- cumbers, and the melons, and the leeks, and the onions, and the garlic: but now our soul is dried away ; there is nothing at all, beside this manna, before our eyes." * * " And there went forth a wind from the Lord, and brought quails from the sea, and let them fall by the camp, as it were a day's journey on this side, and a day's journey on that side, round about the camp, and as it were two cubits high on the face ofthe earth. And the people stood up all that day, and all that night, and all the next day, and (hey gathered the quails ; he that gathered least gathered two homers, (240 bushels,) and they spread them all abroad for themselves round about the camp." In the conclusion of this account, we are in- formed by the sacred writer, that kt the Lord smote the peo- ple with a very great slaughter."]: Cases of yellow fever are said to have been produced in the West Indies by the putrefaction of a quantity of her- rings.§ An occurrence similar to the preceding, and from the same cause, is related by Dr. Kollock, of Georgia, to have taken place in an American frigate, on her passage from * Diseases ofthe Army p. 68. + In using the phrase putrid diseases, I merely speak in conformity to the opinion and phraseology of others; the doctrine of putridity will be treated of hereatter. \ Numbers, chap. xi. & Med. Repository, Vol. III. p. 409. Remote Causes of Fever, 75 Newport to Havana.* And in the Medical Commentaries, Vol. VI, p. 248, the reader may find a similar instance re- corded. The deleterious operation of fcecal exhalations, is men- tioned by Dr. Mitchill, as exemplified in the blacks who were employed in removing those offensive accumulations in the city of New-York, in April, 1800. The effects were c itarrhs, inflammation of the eyes, pains in the bowels, gri- ping, tenesmus, bloody stools, or dysentery, to which was added a febrile commotion in the constitution, of various degrees of violence, sometimes terminating in death, t We are informed by the same gentleman, that the inspector general of beef and pork in the city of New-York, examin- ed, during the summer and autumn of 1799, several thou- sand barrels of corrupting meat. (I pass over the Doctor's speculations on septic acid.) Of those forty men, thirty- eight, the inspector general himself being one, were affect- ed with dysenteries, of various degrees of violence, besides which, a considerable part of them were affected with ca- tarrhal symptoms, nausea and fever.]: The mortality which took place in the Dutch army, whilst it was besieged by the troops of Java, is stated by Bontius to have been occasioned by the dead bodies of the soldiers which were thrown into the river, and corrupted the waters. The air was likewise tainted with the putrefying carcasses of men and beasts that had died of famine and wounds, and lay unburied in the fields, in consequence of which, a malig- nant fever and dysentery were occasioned.§ * Med. Repos. Vol. IV. p. 1. t Ibid, Vol. III. p. 409. % Ibid, p. 309-10. '" Bontius on the Diseases, Natural History, &c. ofthe E. Indies; 7$ Origin, eye of Endemic Fevee. CHAPTER II. OF THE NATURE, ORIGIN AND CON- TAGION OF ENDEMIC FEVERS. SECTION 1. Ofthe Nature and Origin of Endemic Fliers, These are subjects upon which much has been s^id, but to how little purpose may be learnt from the gre.it diversity of opinion that still prevails. It may appear arrogant in me to attempt to settle a dispute which has been discussed with so much learning and ingenuity by individuals, societies, col- leges, and councils ; but as long as facts, common sense, the experience and observation ofthe intelligent and judicious, are my authorities and guides, I may reasonably hope of gaining the attention of the unprejudiced and impartial, who give their confidence and assent, not to the mere adventi- tious circumstances of rank, authority and number, howev- er imposing, but to the demonstration of reason, and the evidence of truth. In the preceding chapter, the causes of endemic fevers have been pointed out, as arising from the putrefaction of animal and vegetable substances, operated upon by heat, moisture and exposure to the atmospheric air. To establish and illustrate this point, a number of facts were adduced, and references made to different authors for a fuller and more satisfactory confirmation of these circumstances ; from which it appears, that the general agreement of experienced physicians has established, as an unquestionable fact, the noxious influence of these external and remote causes of endemic fever. This may be considered as an important step in the progress of medical science, advanced upon sure ground, and from which there seems to be no danger of re- ceding. It will be readily understood, that the results of putrefac- tion will be modified in their nature, according to the diver- Origin, fyc. of Endemic Fever. 7? si.ty of substances subject to the decomposing process : and which will consequently cause a difference in the effects which they occasion. A further difference will arise from the degree of virulence and concentration in those noxious exhalations themselves, as influenced by the degree of heat and moisture, and the quantity of corruptible materials to be acted upon. The mildest degree of their operation seems to be that whereby they occasion catarrh, and slight \ febrile affections, with disorders of the stomach and bowels; the next, is that of intermitting fever, (hen mild remitting, bilious remitting, yellow malignant, pestilential fevers, and plague. Between these extremes there are a variety of degrees and modifications of symptoms and appearances; but under whatever names the disorders thus produced may be known and designated, as there is a similarity in their causes, so is there an affinity or identity in their nature. Where animal bodies are confined in a close unventilated apartment, the various excrementitious matters that are constantly escaping from them, either by respiration, per- spiration, or otherwise, must, by warmth and stagnation, un- dergo putrefaction, and in the end be productive of disease ;* but as in this instance the materials operated upon are dif- ferent from those of ordinary putrefaction in the open at- mosphere ; so likewise, are the morbid symptoms resulting therefrom. Wre know that the small and close apartments of a prison, which have been a long time inhabited by their unlucky inmates, become very offensive to the smell from the degree of putrefaction which has taken place in the filth of their confined habitation : and instances are recorded of persons being suddenly infected with disease from exposure to such noxious effluvia, though the health of Jhe prisoners themselves had not been thereby deranged. The exemp- tion ofthe latter, and the infection ofthe former, are to be as- cribed to the influence of habit, diminishing the sensibility of the system to stimuli and agents gradually increasing, and habitually and constantly applied. The circumstance of the butchers in Philadelphia remaining uninfected during the mortality of the yellow fever in 1793, is to be explained upon the same principle. This circumstance is illustrated upon a larger scale among the native inhabitants of hot cli- mates and unhealthy situations, who are much less subject to disease than emigrants and strangers lately arrived : in the former, the fever^ where it occurs, assumes the character of * This putrefaction of perspirahle matters is exemplified in the offensive smell which a pocket handkerchief soon acquires in the summer season. 78 Origin, fyc. of Endemic Fever. a mild remittent, whilst in strangers it puts on the terrific and malignant aspect ofthe bilious yellow fever. Upon the subject of contagion, we know that some dis- eases are contigious, and that others are not contagious; the small pox, chicken pox, measles, lues, &c. belong to the for- merdenomination ; scrofula, rickets, diabetes, gout, &e. to the latter. But there is a family of disorders, which some es- sayists contend are contagious, and others aver with equal confidence that they are not contagious; besides which, there are still others who hold, that the diseases in dispute are, or aie not contagious, according to circumstances. Any disease that may be communicated from one person to an- other, whether by contact or through the medium of an in- tervening substance is understood to be contagious. Thus whether the disorder it received from inspiring the breath of an infected person, or by smelling or wearing the clothes of one who has died of the disorder, it is equally the effect of contagion. But as in epidemics it is impossible to trace every case to either of these causes, it has been maintained by some, that the infection introduced into a town or coun- try propagates itself by the power of fermentation; that is, by converting a portion of the atmosphere to its own nature ; but as without some limitation, such an effect would ex- tend itself ad infinitum, it is supposed that a certain condi- tion of the atmosphere was necessary to this process; just as warmth and humidity in flour are required to give efficacy to the fermentative quality of leaven, enabling it to commu- nicate its own properties to the whole mass. Again, say they, the effect must be limited to the contagion of a par- ticular disease ; thus" if the atmosphere is disposed to the fermentation of the yellow fever, it would be in vain and without effect to introduce the contagion of the small pox or plague ; nor, if the atmosphere was disposed to the fermen- tation of the plague, would the introduction of the conta- gion of the yellow fever have any influence in checking its progress or changing its action. For both the propagation of the plague and yellow fever, it is contended that a foul air is necessary ; but then this foul air must be of a particu- lar quality, so as to dispose it either to a pestilential fermen- tation, or a yellow fever fermentation. In this way they endeavour to account for the prevalence and propagation of the yellow fever, &c. without having recourse to the pro- cesses of animal and vegetable decomposition, as produced by heat and moisture. Thus it appears that an unknown variety and concurrence of circumstances are required for the production of these dreadful epidemics, and that though Origin, <£-c. of Endemic Fever: 7S every other cause conspire, yet if the fatal leaven is not applied no danger can possibly arise. Thus ten thousand dead horses, and filth of every description, operated upon by a summer's sun, may taint and infect the air with their suffocating and offensive stench, yet if the leaven is not in- troduced no evil consequences need be apprehended. From this opinion of atmospheric fermentation, however plausible and satisfactory it may be to its advocates and sup- porters, I beg leave to differ: 1st, because the supposition ap- pears to be entirely gratuitous and unplilosophical; we have a notion of the fermentation of vegetable juices, of flour and water, &c. ; it is, however, the vegetable matter in these substances undergoing partial decomposition and forming new combinations, that causes such fermentation ; but we have no instance of the fermentation of gaseous substances; oxygen, hydrogen, nitrogen and carbonic acid may be mix- ed and mingled in any quantities and proportions, yet their qualities remain the s une ; no fermentation, either vinous, acetous or putrefactive tak; s place: 2d, because the intro- duction of such a supposed ferment can seldom be traced or ascertained, even by the advocates of this hypothesis themselves: 3rdlv, because other circumstances are suf- ficient to account for the production of endemic, yellow fe- ver, or plague without the supposed influence of this undis- covered and impalpable ferment and leaven. For if a foul or impure atmosphere is necessary, even according to this doctrine of fermentation, for the propagation of these dis- eases, how is this impurity of the atmosphere to be account- ed for, unless from animal and vegetable decomposition, as occasioned by heat and moisture :* but if it can be shown that the yellow fever has ever originated in the midst of win- ter, when all decomposition was suspended, it will then be conceded that other states of the atmosphere, besides that produced by putrefaction may give rise to this disease : but the admission of this impure slate of the atmosphere, which even the doctrine of fermentation supposes, renders the supposition ofthe introduction of any extraneous leaven en- tirely superfluous. For whether is it easier to imagine the adventitious presence of this particular leaven, or to ac- count for the different appearances and modifications of the * That other impurities ofthe atmosphere may exi.-t independent of those caused by putrefaction is readily admitted: this seems tohave been the case id the production of the winter or spotted fever of the northern states.— This ;e^er and its causes, however, do not tall within the scope of thr present subject of inquiry. $0 Origin, 4r. of Endemic Fever. disease from the different degrees and combinations of heat, moisture and corruptible materials ? If it be contended that the yellow fever is a specific dis- ease, invariably marked by a peculiarity of symptoms, it may be answered that no two authors have ever given the same account of this disorder, or discribed the same set of symptoms; but represent it as being so diversified by dif- ference of climate and season, as never to appear under the same form. The yellowness is admitted by most authors not to be characteristic, and the other symptoms are equal- ly variable and uncertain. Even admitting the yellow fever to be specific in its nature, it is not more so than a tertian intermittent, which is universally considered as arising from noxious exhalations. If a ferment is necessary for the pro- duction of yellow fever, why is it not equally necessary for that of the fever and ague ? If the latter is produced with- out the agency of any such fermentation, what reason have we to suppose the existence and operation of any such prin- ciple in the production of the former ? It would be a mere waste of time to attempt the further refutation of an opin- ion «o perfectly visionary and unsubstantial. The exotic parentage and imported contagion of the yel- low fever is another opinion necessarily maintained by the advocates of the preceding doctrine of leaven andftrmen- taiion : who contend that the contagion is imported from the East Indies, Tuihcy, Africa, and the West Indies, by suc- cessive propagation : but what if the inhabitants of Turkey and Africa should maintain (hat it was imported to their country from America, and should enforce a system of quar- antine against our vessels, as we do against those of (he West India Islands? They could certainly trace the intro- duction horn America with equal facility as our Cis-Atlan- tic fraternity scent the infected breeze from the shores of Africa. And what are the circumstances in those remote countries necessary to the origin and prevalence of epidemics, as the yellow fever and plague ? These have been already point- ed out under the head of causes. It was (here shewn that heat, moisture and putrefaction were invariably the antece- denbaud attendants on those fatal disorders. Whatbuta con- currence of similar circumstances is necessary to produce similar effects in any situation? The effects will be in propor- tion to the causes: wherever the degree of temperature is highest, concurring with a greater proportion of moisture and corruptible materials, there also will prevail the most malignant disorders. 1 speak of the epidemics of summer' Oiigin fyc. of Endemic Fever. 81 and autumn, and such as arise from an obvious concurrence of the external causes already mentioned. We according- ly find that wherever (he yellow fever, as it is improperly called, has prevailed in our country, there has been a re- markable combination of the circumstances which we have noticed. A defective police; the accumulation of filth; a long continuance of hot weather, during which the pestilential atmosphere was not dissipated by salutary breezes, produc- ed the yellow fever in Philadelphia in 1793. Similar caus- es concurred to give rise to the same disorder in New York and various other places at subsequent periods. The fact is that the yellow fever, or to speak more prop- erly the bilious malignant fever, is the natural offspring and production of a widely extended country7; comprehending in its circle the torrid and considerable portion of the tem- perate zone: viz. Africa, the East and West Indies, the South Europe and Asia, a considerable portion of South America, and its extent and prevalence in various parts of North America are too well known to require to be partic- ularly mentioned here. Wherever its essential causes, heat, moisture and corruptible materials exist in the greatest de- gree, there will bilious and endemic fevers prevail with the most malignant fatality. The more temperate or cold the climate, the less subject will it be to bilious fever j and on the contrary, the hotter the climate, and the more marshy and abundant in putrefying materials, the more sub- ject will it be to this disease. These are truths which may be said to be as immutable as the laws of nature. Wa3 the yellow or bilious fever ever known to exist in the frigid, zone, in Lapland, Sweden, Norway, Denmark or Green- land ? No, and for an obvious reason, because the heat of those countries is never sufficiently great or long continued to produce the necessary degree of putrefaction and decom- position. As we approach the equator, we observe the dis- ease more frequent and malignant; until arriving at the tropicks, we there find it existing as a permanent epidemic. Having shuwn the insalubrity of low and marshy situa- tions, and of towns and places abounding with putrescent and corruptible materials, it scarcely appears necessary to point out the circumstances and situations opposed to the evolution of noxious effluvia, and the consequent produc- tion of fever. The peculiar healthfulness of high, dry and hilly situations, remote from marshes, rivers, and stagnating waters, has been universally observed, as well in the south- ern portion ofthe United States, as also in the West India islands and the tropical parts and sea coast of South Ameri- h 82 Origin, iyr« of Endemic Fever. ca. So well are the inhabitants of towns, cities and settle- ments situated upon the sea coast and rivers in the United ^ States convinced of this fact, that families of competency and fortune in unhealthy places, annually leave their winter residence upon the approach of hot weather and retire to the hills in the country, remote from stagnating water and sources of putrefaction, and reiurn again in the fall, after the appearance of frost has suspended the process of de- composition, and purified the atmosphere. In this way they avoid the infectious sources of disease. The successive and gradual change in the salubrity of the climate of St. Domingo, in receding from the sea coast to the more interior and hilly parts ofthe island, is wci! re- presented by Dr. Jackson, who observes,* that u In most situations on the sea-coast, the character of the endemic is strongly marked : in the wet or unhealthy season, the febrile form of disease chiefly prevails; in the spring and earlier part of summer, more paiticularly under slight and accident- al rains, diarrhoea is not uncommon. In higher situations, on the first chain of mountains, intermittents or diarrhoea are frequent in wet weather, sore legs are troublesome at other times. In situations still more interior, on the moun- tains, or in the valleys lying under (be second chain of moun- tains, intermittents and diarrhoea, though occurring occa- sionally, become gradually more rare ; sore legs take their place, and appear actually to be the endemic disease of that tract of country. In (he highest situations, or on the cen- tral ridge, neither fevers, fluxes, nor sore legs are known, at least they occur so seldom as not to deserve notice." The same author remarks,! that the form and degree of endemic disease follows nearly the same rule in Jamaica, as in St. Domingo. The character of endemic fever is strongly marked at Spani -h Town and Kingston ; diarrhoea has'ifs season, but sore legs are of rare appearance. At Stoi.ey Hill, intermittents an^ diarrhoea occur sometimes, but the fever is seldom of a dangerous kind ; sore legs are frequent, and of difficult cure. At Maroon Town, levers and fluxes are not often seen ; but sore legs are not uncommon. It may be presumed, though not yet ascertained by trial, that m still higher situations, sickness and sere legs will be as little known, as they are on the central ridge ofthe moun- tains of St. Domingo." The healthieess, in the West In- dies, of hilly situations, remote from marshes and sources of •Outline ofthe History and Cure of Fever, p. 90. 11bid, p. 'j3. K Origin, $-c. of Endemic Fever. 83 putrefaction, is also attested by Dr. Davidson, in his letter to Dr. Rush.* fc' I have mentioned (says the D.\) an in- stance ofthe remarkable good health which the 66th regi- ment enjoyed at St. Vincents for several years, upon a high hill above the town, removed from all exhalations, and in a situation kept at all times cool by the blowing of a constant trade wind. They did not lose, during eighteen months, above two or three men." As to the degree of northern latitude to which yellow fe- ver has extended, in (he United States it has prevailed iu Boston, situated in lat. 42. 22, N. and in the various sea- ports to the south of that city on the coast of the United States. Endemic fevers, of a malignant character, origina- ting from heat, moisture and putrefaction, in European coun- tries, have been mostly confined to the coasts of Spain, Italy, the islands of the Mediterranean, the sea-ports of Greece, and the southern coast ofthe Black Sea, scarcely exceeding the 42d degree of north latitude. I am aware, however, that fevers of a malignant nature, approaching nearly in character and degree to the yellow fever ofthe United States and the West Indies, have, on some occasions, prevailed as far north as the 52d degree of north latitude, at Walcheren, Lynn, Breda, Delft, in different parts of Flanders, Hungary, and other districts and situations where the land is low, wet, and abounding with stagnating water. In such places, an unusual continuance and degree of warm weather through summer and autumn, may produce intermitting and remitting fevers of an aggravated and ma- lignant character, differing only in degree from the yellow fever of North America and the West Indies. Thus the fever which prevailed in Lynn in 1779, and the five follow- ing years, was considered by Dr. Robert Hamilton to be of (he same nature as the yellow fever of the West Indies as described by Dr. Hillary ; the tertian of Minorca by Cleg- horn ; and the remitting fever of Bengal by Clark. In the production or origin of yellow fever, it will be pro- per to remark, that a greater degree of heat will compen- sate for a less quantity of corruptible materials, and the greater abundance of the latter, will make up for a less de- gree of the former: but where both abound in excess, there the epidemic will be liable to prevail with the greatest ma- lignancy. Consequently the bilious or yellow fever, as it is called, may and does originate in any place where there is sufficient heat, moisture and corruptible materials, whether * Rush's Inq. and Obs. Vol. IV. p. 253. 84 Origin, &C of Endemic Fever. on the sea-board or in the interior ofthe country. Thus it has been known to prevail with as great fatality in the into* rior ofthe states of New-York, Pennsylvania, Ohio, and all the southern states, as in any of the large sea ports of the United States. The difference is. that wherever the bilious yellow fever makes its appearance in any populous city, particularly of the northern states, where the disease is more rare and terrific, the deaths which take place produce an alarm among the panic-struck inhabitants, disproportion- ate to the real cause and grounds of apprehension. At Sa- lina, in the interior of the state of New-York, the bilious yellow fever prevailed in the summer of 1822, with greater mortality than in the city itself, where it had produced the most alarming consternation, and where the affrighted pop- ulace were flying with precipitation from the presence of this terrific epidemic. Whilst, at the same time, at Ballston and Saratoga they were totally exempt from this disease, notwithstanding their want of quarantine laws, and the great numbers that were constantly thronging to those fashionable places of resort from the city of New-York, the very seat of infection. How will the advocates of imported and export- ed contagion account for all this? Must they again be driven to their far-fetched hypothesis of fermentation? One part of their explanation is involved in so many difficulties, that it may fairly be set aside on their own grounds. And as for the yellow fever making its appearance in the interior of a country, without the aid of importation, though it should be attended with every symptom of this fatal disease, yet as it cannot be traced to a foreign origin, they consequently will not admit it to be (he yellow fever. The prevalence ofthe yellow fever at Salina without the aid of importation. and the exemption of Ballston, notwithstanding the free communication with the infected city, is to be accounted for, from the physical condition of the two places. Salina, the place ofthe salt works, being a low, flat, wet situation, abounding in ponds and stagnating water; from which evils Ballston and#Saratoga are in a great measure free. In proof of the importation of the yellow fever, it has been said that it is confined to sea ports ; whereas, it is well known, as already stated, that this disease has frequently appeared in inland situations, where its introduction from abroad could not possibly be suspected; having, at various times and places, prevailed in the interior of the states of New York, Pennsylvania, Ohio, Virginia, North and South Carolina, Georgia, Alabama, &c. in none of which was its Origin, #-c. of Endemic Fevev-. 8# introduction from a foreign port ever suspected by the in- habitants.* If it be contended that the yellow fever is the natural en- demic ofthe West Indies, and thence introduced into the United States, I would ask what circumstances necessary for its production in the West Indies do not abundantly ex- ist in various parts of our own country? The heat of the southern parts of the United States is equal, during (he sum- mer season, to that of the tropics. The degree of tempera- ture in the northern states is seldom sufficiently intense and long continued to occasion its production, consequently it is there a less frequent disease. Dr. Pinkard, speaking of the yellow fever, says, " To look for it in ships and vessels, or to strain the eye across the ocean, in order to fix its birth place on the opposite coast of the Atlantic, or to trace its descent from the shores of the Indian seas, were to overlook the reality in search of/ a phantom. It needs no foreign parent; the prolific earth is its mother, its father the bright god who governs the day." If the yellow fever is an imported disease, why was it never introduced into Philadelphia during the interval from 1762 till 1778 ? At the time here alluded to, there were no quarantine, regulations to serve as guardians to the public health ; and a regular, extensive and uninterrupted inter- course was maintained with the West India islands. " The appearance of the yellow fever," says Dr. Ed. Miller, "in many of the interior parts of the country inaccessible to foreign contagion, confirms the opinion of its domestic ori- gin, while it entirely invalidates that of its importation.— There is not a state in the Union, which has not offered ev- idence ofthe production of this disease, in situations where importation was impracticable. In the course of the season of 1805, a malignant fever, in all essential points the same as our yellow fever, prevailed in many parts of this state, (New-York,) and occasioned more mortality, in proportion to the population ofthe district, than took place in this city. There can be no reasonable doubt, that the disease called * For facts relative to this subject, I refer the reader to the following au- thorities: Ellicott's Voyage down the Ohio. Dr. Watkins' communication in the Medical Repository, Vol. IV. p. 75. Account of the Black Vomit and Dysentery in Mifflin county, Penn. Ibid, p. 105. Dr. Blond's Obser- vations on the Yellow Fever of the valley of Patia, in South America. Ibid, Vol. VIII. p. 75. The Rev. Mr. Black's Account of the Yellow Fever of Bethlehem, Con. in 1750. Ibid, Vol. II p 88. Dr. Scott on the Yellow Fever of Gennessee Co. N. Y. Ibid, Vol. X. p. 248. Some of which have been already partially quoted in a preceding part of this treatise. 86 Origin, <^c. of Endemic Fever. the lake fever, in the inferior of this state, possesses all the essential attributes ofthe yellow fever."* Can we suppose that nature is so uncertain and changea- ble in her operations, as not to produce analogous effects from similarity of causes? Is it more difficult and unphilo- sophical to suppose the domestic generation of a pestilen- tial disorder, than that an epidemic should be imported from a foreign country, where disease under a different character existed ? Plants and animals may be exported and propa- gated in a land foreign to their parental country ; but disease is every where connected with physical causes and with (he frail constitution ofthe Iranian frame. The very elements are in a constant state of conspiracy against man's health and existence; and the same sun that warms and cherishes the seasons, and restores renovated verdure and beauty to the vegetable world, dispenses with the boon of plenty the pes- tilential principles of disease and death. Trace nature in her work of destruction from Bengal to Batavia, from Bata- via to Africa, from Africa to Syria, from Syria to Constanti- nople, thence to Egypt, the West Indies, and to the United States, and in every country we shall find nature working by the same laws and modes of operation, the same agents and principles of disease, and a similarity of disorders.— Shades of difference in the diseases, like the varieties in the human figure and complexion, are observable in each. But as human nature, though disguised under the uncomely exterior of a negro, is human nature still, so endemic fevers, however diversified in appearance, are \ et allied in every essential circumstance. The plague has prevailed at various times in different parts of Europe, Asia and Africa, from the 29th to the 56th degree of north latitude. By the term plague, I merely al- lude to diseases which have gone under that denomination, and not to any specific disorder invariably marked by the same set of symptoms: and by this appellation I under- stand an epidemic fever of a highly malignant and fatal character. Diseases vary in their features according to di- versity of seasons and situations; and the presumption is, that in what is called the plague, there is as great a variety of symptoms, as there is between the endemic bilious fevers ofthe United States and those ofthe East Indies. It has been formerly remarked, that a greater quantity of corrupt- ible materials will compensate for a less degree of heat, and that the excess ofthe latter will make up for the compara- Report on Yellow Fever. Life of Miller, p. 118. Origin, fyc. of Endemic Fever. 87 tive deficiency of the former. We are hence enabled to explain how diseases, strictly the offspring of hot climates, may sometimes spring up in more northerly latitudes. In this way, we may account for the prevalence of pestilential fevers in London, during the fifteenth century, though situa- ted in the 51st degree of north latitude ,* in Marseilles, in the 43d degree; and in Moscow, in 1771, in the 55th degree. These diseases, though like the yellow fever, more common to the south of Europe and the north of Africa, yet, under favorable circumstances, set geographical limits at defiance. According to the accountof Sir James McGregor, in his Medical Sketches of the Expedition to Egypt, the plague is subject to as great a diversity of symptoms as the bilious fe- ver; depending on variety of season, situation, and other circumstances. When the disease first appeared in the In- dian army, the cases sent from the crowded hospitals, were, from the commencement, attended with low typhoid symp- toms. The cases of this disease which occurred when the army was encamped near the marshy ground of El Hamed, were all of the intermittent and remittent type ; those which took place in the cold rainy months of December and Janu- ary were of an inflammatory character; and towards the end of the season, at Cairo, Ghiza, Boulac, and on crossing the isthmus of Suez, the disease appeared uuder the aspect of a mild continued fever. " You would be astonished," says Lady Montague, "to find that the plague is nothing but a fever." And Dr. Rus- sell, in his account ofthe plague of Aleppo, says ''it com- menced in the suburbs in the form of a remitting fever." '• Why should it surprise us," says Dr. Rush, '• to see the yellow fever generated amongst us ? It is only a higher grade cf a fever which prevails every year in our city, from veget- able putrefaction."* The scientific and judicious Dr. Ed. Miller, in a letter to Dr. Rush, dated Dover, November 5th, 1793, observes, that " from the uncommon protraction and infenseness of our summer and autumnal heats, but particularly from the unu- sual drought, we have had, since the middle of July, a near approach to the tropical season, and that of consequence, we ought not to be surprised if tropical diseases, even of the most malignant nature, are engendered among us." In enumerating the symptoms of (his disease, he remarks, that " bile discharged in uncommon quantities constantly assumes the most corrupted and acrimonious appearances, common- * Rush's Inq. and Obs. Vol. III. p 208. 88 Origin, fyc. of Endemic Ftver. Iv eruginous in a very high degree, and sometimes quite atrabilious."* . When the materials of disease are diffused and intimately blended with every portion of the air that is received into the lungs by respiration, it is vain and nugatory in the ex- treme to search for the general calamity in individual sour- ces of contagion. Where all breathe the same impure and infected atmosphere, all are liable to the prevailing disease. no matter whether they remain secluded in their houses, inhale the open atmosphere, or are exposed in their attend- ance upon the sick and the dying. Admitting that the air of the apartment of a patient laboring under yellow fever may be more corrupted and impure than the external at- mosphere, we know that all contagions by dilution and dif- fusion lose their virulence, so as to be incapable of produ- cing disease at a short distance from the patienfs bod\.— This law applies even to the small pox, the most contagious of all diseases. Dr. Haygarlh, though an advocate for im- ported contagion, is yet satisfied, from observation, as to the limited sphere of its operation. " 1 have proved," says he, " by facts, that the sphere of variolus infection, in moderate cases does not extend in the open air to the distance of half a yard, and in the worst, but a few yards from the poison.t The same rule, he thinks, applies to the American pesti- 1 nee, or yellow fever.t We are informed by Dr. O. Ryan, that he placed a per- son in the eruptive fever of the small pox by inoculation at about half a yard from four children properly prepared; each exposure continued an hour, and was repeated daily for a fortnigh(, till the pustules had become perfectly dry, and that not one of the four received the infection.]: An instance equally striking is mentioned by Dr. Odier. "At Geneva," says he, "we have frequently inoculated a great number of children during the years when the small pox was not epidemical. These children went about every day even after the eruption had a'ppeared. They were sent into the streets, and the public walks, and have communicated free- ly with children, who were susceptible of infection ; yet the small pox did not spread by this intercourse. There even did not come to my knowledge an instance clearly proved of the infection being communicated to a single individual, either in the streets or public walks." * Rush's Inq. and Obs. Vol. Ill p. 208. t Haygarth on Small Pox, p. 161. t Dissert, sur les I ievres Infect, et Contagieme Origin, iyc of Endemic Fever, . 89 Dr. Rush was of opinion that the vapors from marshes might extend to the distance of two or three miles; others arc equally liberal in their calculations. Such conclusions, however, seem to have been adopted without sufficient in- vestigation of the subject. To whatever distance noxious vapors may extend, it is not probable that they are in gen- eral capable of producing disease at a greater distance than two or three hundred yards from (heir source, and the pro- bability is. that they fail in their effect short of this calcula- tion. When the epidemic prevails over a large extent of country, it must be evident (hat no certain conclusions can be formed upon the subject. For although there may be insulated spots, which in themselves might prove healthy, on account of their physical exemption from the local causes of disease, yet being surrounded with an impure atmos- phere on every side, highly charged with miasmata, every wind which blows must dissipate the poison, and waft it to a distance more or less remote from the place of its gen- eration. It has been remarked, however, that dilution de- stroys the infectious and morbific quality of noxious miasms, and as they must become more and more diluted by diffu- sion, and proportionably weakened by mixing with the gen- eral atmosphere, they must consequently soon lose their noxious and infectious properties. We are informed by Dr. Blane, that when the ships, in watering at a place call- ed Rock Fort, anchored close to the shore, so as to smell the land air, the health of (he men was affected; but that upon removing two cables length no inconvenience was perceived.* We are told by Lanci^-i. that at Rome the south-east wind, termed by the Italians sirocco, which passes over the adjacent marshes, is most unsalutary ; and yet the effects of this wind have been experienced to extend only to those parts of the city which lie nearest to the marshes, occa- sioning there an epidemic fever, whilst the rest ofthe city remained free from infection-. On several occasions, when the fever, or plague, as itwa6 called, raged in Rome, it was confined to the low grounds along the margin of the Tiber, leaving the drier and more elevated parts of the cjty unaffected; and it was a matter of astonishment to •Baglivi, the medical historian of the times, that so short a distance should make such a differ* ence in the qualities ofthe air. * Blaae on the Diseases of Seamen, p. 22p. M $$ Origi7i, <(•<% of Endemic Fever. It is observed by Dr. Lind, that when the British squad- ron, in the months of July and August, 1744, lay off the mouth of the Tiber, one or two of the ships which lay near- est to the shore began to be affected by the pernicious efflu- via from the land; whilst the others Iving further out at sea, at but a very small distance from the former, were en- tirely exempt from disease.* Dr. Lind thinks, that in the open air the sphere of infection does not extend beyond fifty or sixty feet from its source. We are informed by Dr. Rush, that the yellow fever has never been known to pass from Philadelphia to the Jersey shore; and the miasmata generated on the east side of the Schuylkill rarely infect the inhabitants on the opposite side ofthe tiver.t De»genette says the infection ofthe plague never crosses the Nile, and that its progress is arrested by means of ditches, dug and filled with water for the purpose. It was remarked by Dr. Whitman, that the plague never passes the Dardanelles at Constantinople, from Turkey to Europe. Many persons escaped the plague which prevailed in London in 1665, by flying to the ships which lay in the mid- dle ofthe Thames. And we are told by Dr. Rush, that no instances of yellow fever occurred in those families in Phi- ladelphia that confined themselves to ships in the middle of the Delaware in the year 1793. As to the extent of contagion, it is remarked by Dr. Walker, that the contagion of small pox, measles, jail fever, and even of the plague itself, being emitted from a body or from fomites, in which the infectious particles are lodged, daily observation shows, that contact, or a very near ap- proach to the source of infection, is absolutely necessary to propagate the disease.f " If one speaks of an infected person," says Howard, "shut up in an unventilated chamber, it may be said that the whole atmosphere is dangerous; but if one speaks of a patient exposed to the open air, it has been proved that the sphere of infection does not extend above five geom- etrical paces from his body. Beyond this distance, one is in safety."§ " The sphere or origin of contagion," says Dr. Jackson, " appears to be very confined; a general epidemic disease * Lind on the Diseases of Seamen, p. 66. + Inquiries and Observations. J Walker on Small Pox, p. 481. } Howard's Account of Lazarettos, p. 34. Origin, fyc. of Endemic Fever. 9 J cannot easily be supposed to result from it; a direct com- munication, or near approach to the source being necessa- ry." The same author, in his remarks on the medical de* partment of the army, observes, that in the West Indies, *' the dtead of imported contagion is a bugbear; the fact (opinion) of importation in the manner alleged, is not sup- ported by one authentic history, and it is not consistent with the nature of things." Even Dr. Chisholm, one ofthe most strenuous advocatet of contagion, admits that a person may safely enter the cham- ber of the sick, provided he avoids coming in contact with the patient or bedding; and thinks that the infectious efflu- via at most do not extend to a distance of more than six or ten feet.* If such is the difficulty with which malignant and infec- tious diseases are propagated by contagion, how are we to account for the prevalence of epidemics? Surely not upon the principle of contagion. How are we to account for the simultaneous appearance ofthe small pox, in different parts of the same town or district, and in persons who have never approached or seen a patient laboring under the disease? How are we to account for its sudden appearance and its as sudden decline, unless by referring it to a general cause ex- isting in the atmosphere, requiring not the precarious and equivocal intervention and aid of a diseased person and hu- man contagion for its propagation ? And how vain is the idea of exterminating this disease, when the causes of its origin are unknown ? But there are other diseases with the origin of which we are better acquainted, and whose rise and prog- ress are evidently connected with physical causes, which it is in our power to prevent or avoid. Such are the intermit- ting and remitting fevers, the yellow fever and the plague* But Dr. Chisholm, as sanguine, and more unreasonable in his conjectures with regard to yellow fever, than Dr. Hay- garth is in relationio the small pox, cherishes the chimerical idea, that by the aid of quarantine regulations, the yellow fever will be completely exterminated.! In contradiction to this opinion I would observe, as a melancholy fact, that since the adoption ofthe system of quarantine in the United States, the yellow fever has been far more frequent, even in the sea-ports and cities where these regulations have beea rigidly enforced, than it was previous to their adoption* * Essay on the Malignant Pestilential Fever, p. 135- t See b» letter to Haygartb, p, 246. £2 Origin, <^c. of E.idemic Fever. I am not disposed to make the unqualified assertion, that the plague and yellow fever are absolutely never conta- gious, under all circumstances; analogy leads us to suppose that they may sometimes be communicated in (his manner; and besides, if we may believe (he reports of the contagion- ists themselves, there are well authenticated instances of eporadic cases having originated in (his way : and though such an effect should not happen more than once in live hundred instances of exposure, yel (he ciicumstance of id having once taken place removes the doubt as to the possi- bility of such an occurrence. It is obvious, however, that the contagious nature of a disease can never be determined in the impure and corrupted atmosphere to whieh all are equally exposed. When each individual is enveloped in the common miasms of disease which fill the atmosphere of the infected town or settlement, it is altogether gratuitous and absurd to say, that such a person caught the complaint from visiting or attending the sick. The power of com- municating the disease can only be determined by removing the patient to a healthy atmosphere ; if in this situation per- sons take the disease from visiting or attending the in- fected, the disorder may then be pronounced to be conta- gious.; but if no such communication of disease takes place, we are bound, by every principle of reason and common sense, to pronounce the disease absolutely uneontagious.—. The latter has been the general experience in bilious or yel- low fever; of which there are but very few unequivocal ca- ses on record of its ever having been communicated in a pure atmosphere: and even the few that are recorded rest upon the partial testimony of the prejudiced and avowed advocates of contagion. But even admitting that on some rare occasions a person has caught the disease from coining in contact with the sick, receiving his breath, or by wearing, handling, or washing the clothes of a person who has died pf the yellow fever, or by vapor from a bale of cotton, old clothes, or other substances, such instances go but a little way in the production of an epidemic. Upon this subject the ancients had more rational ideas than many of the moderns. Hippocrates, the father of phy- sic, and Sydenham the leader of medical improvement in £urope, have explained the general prevalence and diffu- sion of epidemics by attributing them to a certain noxious constitution of the atmosphere. Since the days of Syden- ham a similar opinion has been adopted by many of the most eminent physicians, who have written on the subject, among whom we may meution, Boerhaave, Van Swieten, Origin, fyc. of Endemic Fever-. 93 Mead, Hoffman, Ramazzani, Haxham and De Haen. In what this constitution or quality of theatrnosphere consists, they do not pretend to inform us; though Sydenham sup- poses it to be an exhalation from the bowels of the earth. After a revolution of so many years it is curious to see this opinion revived in our own country by Mr. Webster. From the observations that have been already made, and from what remains to be advanced upon the subject, we shall, I think, be able to account for the origin of the diseases under consideration upon more rational and satisfactory grounds, and to establish the fact of their causes as arising from sour- ces less mysterious and occult than the bowels of the earth. Such an origin,' however, suited the hypothesis of Mr. now Dr. Webster; who has endeavoured to prove that epidemics are connected as causes and effects, with the appearance of comets, the eruption of volcanoes, and the convulsions of earthquakes ; that pestilence is disseminated from the fiery tail of a passing meteor, and that yellow fever, small pox, &c. are vomited forth with the fire and brimstone of Etna and Vesuvius. Though plague was formerly supposed to be a specific disease, originating, in every iustance, from morbid poison perpetually existing, yet this, like the yellow and other fe- vers which derive their source from animal and vegetable decomposition, has been ascertained by the experience and observation of numerous physicians to arise from local causes. Whether the other species, varieties, or forms of fever, such, for instance, as are not so evidently connected with obvious causes, as the spotted and malignant fevers which have of late years made their appearance during the winter and spring, in different parts of the United Stales, as also the small pox. measles, influenza, he. whether these derive their origin from different modifications of (he same causes, is a question which does not come within the scope of my present inquiry, nor does it admit of being so easily deter- mined. But the query may be suggested whether these dis- orders may not arise from morbific miasmata, the result of animal and vegetable decomposition existing in the atmos- phere, and variously modified by the season of the year, and the state of the weather, as it respects heat and cold, humidity and dryness ? Or may not the spotted or winter fever arise from some change in the elementary part ofthe atmosphere itself? As a diminution of oxygen and a dis- proportionate increase of nitrogen, from (he consumption of the former, affected by the processes of respiration and 94 Origin, ire. of Endemic Fever. combustion, the latter of which is very considerable during the winter season, and which by withdrawing the vital por- tion of the air occasions a disoxigenation of the blood, aid by this abstraction of stimulus, producing direct debility in the system, or causes the formation of a tertium quid with a portion of the fluids destructive to animal life. From the evident connexion which is frequently observed to exist between epidemics characterized by diversity of symptoms, we are led to suspect an affinity and analogy in the causes which produce them. Such a connexion has long been observed; and whilst it enables us to trace the simple operation of nature in bringing about the complicat- ed appearances of effects, it serves to break down the wall of partition which separated them by the unnatural and ar- bitrary laws of human compulsion. Judging only from the most striking and remarkable features, without considering the less visible but more immediate and important clue of connexion, physicians have been led to infer that a diversi- ty of symptoms was sufficient to establish a radical differ- ence in epidemical diseases. Though in natural history the animal kingdom may be classed according to the external resemblance of the individuals which compose it; yet in the pathological arrangement of diseases, the rules and princi- ples of art must yield to the less obvious, though no less cer-~ tain laws and principles of nature : here the classification should be made, not upon the capricious concurrence of a similarity of symptoms, which are perpetually changing, but upon a knowledge of the proximate cause. Until this is ascertained, the classification of diseases must continue arbitary and defective, The most common precursors ofthe more malignant epi- demics are measles, catarrh, influenza, angina, and hoopr ing-eough, which are also apt to appear upon the decline of the more malignant disease. Nor does an epidemic often arise without a progressive order and increasing malignan- cy in the diseases which have preceded it. This precurso- ry epidemic is of longer or shorter duration according to circumstances : and it appears from the London bills of mortality that malignant diseases were generally increased in number and violence during the spring months which pre- ceded the plague in 1625,1630, and 1665. The same thing has been remarked in many instances, where the yellow fe- ver has prevailed in different parts of the United States.— The bilious yellow fever of Philadelphia in 1793, according to the account of Dr. Rash, was preceded by the influenza and the milder forms of bilious fever. The same disease in Origin, fyc. of Mndemic Fever. $3 1794 was preceded by obstinate intermittents. " From the inflammatory complexion ofthe diseases of the spring, and of the beginning of June," says Dr. Rush, " I expected the fevers of summer and autumn would be of a violent malig- nant nature. I was the more disposed to entertain this opin- ion from observing the stagnating filth of the gutters of our city; for the citizens of Philadelphia having an interest in rejecting the proofs of the generation of the epidemic of 1793 in their city, had neglected to introduce the regula- tions which were necessary to prevent the production of a similar fever from.domestic putrefaction."* The same ob- servation was made by Dr. Caldwell.t We are informed by Dr. Bailey, that the epidemic which prevailed in New- York in 1796, was preceded by angina trachealis, attended with anomalous symptoms, cases of obstinate dysentery, and by febrile disorders accompanied with bilious evacuations. Early in July, these facts were noticed at a meeting of the medical society ; and the society, from the conviction of something uncommon in the state of the atmosphere, came to the resolution of making particular observation on the nature of the diseases which might occur previous to their next meeting, but in the mean time the growing disorder declared itself in the unequivocal character of a prevailing epidemic. Most persons, and especially physicians of observation, have remarked, that when bilious or yellow fever of an in- flammatory character has prevailed in summer, the fevers which succeed in the winter partake ofthe same character, are attended with bilious discbarges, yellow skin, &c, but are distinguished by this remarkable peculiarity, that the in- flammatory symptoms are of short continuance, being sud- denly succeeded by typhus. From their rapid disposition to assume the typhoid character they are often more fatal than the diseases of summer, and without impropriety may be called the pestilence of winter, sometimes denoting an epidemic of the succeding summer. The same aggravation of disease from the cold of winter has been observed ofthe email pox. Itw£3 remarked by Sydenham, that in those y^ars in which the small pox was epidemic and mild, it usu- ally began about the vernal equinox ; but when it was epi- demic and of a dangerous kind, it usually began in the Bnonlh of January, seizing whole families, and sparing none * Rush Inqu. & Obs. vo. 3, p. 358. f Appendix to Alibert on Malig. Intermit, p. 44, $6 Qrigin, <$-c. of Endemic Fever. of whatever age or sex they might be, unless they had pre- viously passed through the disease.* Lord Bacon, who lived at a period when the plague was frequently epidemic in England, observes, " the lesser infec- tions of the smallpox, purple fever, agues, he. in the pre- ceding summer, and hovering all the winter, portend a great pestilence of the following summer, for putrefaction rises not to its height at once."t We may remark this connexion of malignant diseases with the universal plague,' which prevailed successively in 1635, 1636, and 1G37. The progress of these diseases is distinctly traced by Diemerbroeck. He remarks, Chapter de Peste, that " the spring of 1653 was warm and mode- rately humid ; to which succeeded a very hot dry season, in which appeared many malignant epidemics. In the first place a severe plague broke out at Leyden, by which more than 20,000 persons were destroyed. At Nimeguen, in Guil- ders, and other regions, a certain pestilential fever spread with dreadful mortality. In autumn, severe heat still con- tinuing, with excessive drought, many other malignant dis- eases appeared, as small pox, measles, diarrhoea, and dysen- tery of a very bad type; but more especially the above mentioned purple fever, called in Italy petechial, increased in extent and violence, until it had turned into the true plague.J He further remarks, that from November, thiough the winter, scattering cases of plague occurred at Nime- guen : that in January, 1636, it increased, and in March spread and became epidemic J rose to its height in April, and continued till October. The circumstance of spotted fever gradually assuming the character of plague, until at length it became converted into the plague itself, seems to be fundamentally opposed to fhe doctrine of-specific contagion, as essentially necessa- ry for the propagation of this disease : and contradicts the opinion of Doctors Mead, Cullcn, and others, who contend for its specific nature.§ " The fact," says Dr. Webster, " is * Swan's Sydenham, p. 96. t Baron's Works, vo. Ill p. 59. % Donee tandem in apertissimam pest°m transient. } 1 here make my acknowledgments to Mr. Webster, for directing my attention to some useful and interesting references It ur-.y be proper to inform tho*e who are unacquainted with the circumstance that Air. now Dr. Noah Webster has written a work in two volumes octavo, for the pur- pose of proving that epidemics owe their origin to the appearance of comets, the convulsions of earthquakes, and the eruptions of v»lcanots. Though there is much visionary speculation in ihie performance, the reader is, in some degree compensated for his trouble, by the many interest!^ fact* which the lea.rned author has recorded. Origin, £c. of Endemic Fever. 97 undisputed. In the distressing period from 1569 to 1677, when Europe was almost depopulated by the spotted fever, physicians observed that the disease frequently ran into the plague and the plague into the spotted fever. The same fact was often noticed by authors ofthe 16th and 17th centuries, in which the plague frequently overran Europe. These two diseases are, therefore, two distinct forms or modifica- tions of pestilence, probably bearing an affinity to each other, like that between the distinct and confluent small pox." " This fact,'' says the sime author, " shows that the distinction made by medical writers, between pestis kndpes- tilentia, the plague and pestilential distempers, however useful in practice, is not authorized by truth and philoso- phy. The ancients classed all contagious epidemics togeth- er, and denominated them pestilence, and this distribution, in regard to their causes and origin was doubtless most phi- losophical."* The same connexion is noticed by Reverius in his Praxi- osM'dendi, lib. 17. " Many deadly diseases," says he, "ac- company the prevalence of pestilence; as phrenitis, angi- nas, pleurisies, peripneumonies, inflammations of the liver, dysenteries and many others." And Bottinus, after des- cribing the circumstances connected with the origin of the plague, as impure air, bad food, intemperate seasons, &c, pays its invasion was preceded by epidemic diseases, such as petechial fevers, small pox, measles, dysentery and epidem- ic pleurisy.! The universal prevalence of malignant dis- tempers, which immediately preceded the plague of 1565, was noticed by Sydenham with his usual accuracy. " I nev- er knew," says he, " pleurisies, quinsies, and other inflam- matory diseases, more common than they were some weeks preceding the plague in London in 1665." Those inflam- matory diseases which prevailed in the winter and spring, yielded as the season advanced and the weather became milder to a malignant fever, which appeared as the imme- diate precursor of the plague; into which it changed by such insensible degrees that Sydenham himself was at a loss to determine whether that fever was the plague or not; and what appears as a convincing argument of their being but different degrees of the same disease, is the circumstance noticed by Sydenham, that when the plague in autumn be- gan to abate, the same malignant fever reappeared.J— * Webster on Epidemics, vo. 2, p. G2. + De Febribus, p. 265. X Sydenham, vo. I. p. 122, 136. v '»3 Origin, &c. of Endemic Fcvei. Which is but saying that as the season progressed, (he dis- ease lost by degrees its pestilential character of glandular swellings, and became less malignant. The same facts a;e noticed by Hodges and Morton. In 1719, the year before the great plague in Marseilles, a pestilential fever broke; out in the city, which, in some cases, was at'ended with bu- boes and carbuncles. From which it appears that the plague actually began six months previous to the pretended intro- duction of infection from Syria. We are informed by Dr. Russel, that the plague which appeared in Aleppo, in I 742, was preceded by an acute fever ; and after the disease abat- ed in July, diarrhoeas and dysenteries of malignant type, at- tended in many cases with petechias, made their appear- ance ; as likewise intermittents, which often proved fatal.— These diseases, in (heir acute forms, prevailed also with the plague, which at this season was less malignant than usual, nor did it predominate to the entire exclusion of other dis- eases. The dreadful plague which prevailed at Messina in 1743- and which destroyed two thirds of its inhabitants, was immediately preceded by a malignant fever. One physi- cian alone, out of thirty three, pronounced it the plague; but the others denied it, because the disease was not at- tended with glandular swellings. A similar fever preceded the severe plague at Venice in T 576, and the physicians and magistrates were at first embarrassed with the same un- certainty. The terrible pestilence which raged at Na- ples in 1656, was ushered in by its usual precursor, a ma- lignant fever; one physician alone pronounced it the plague, and for his presumption, the Viceroy condemned him to imprisonment. The extensive pestilence which from 1 75{J to 1763 spread its destructive ravages over all the countries and islands of the Levant, was every where preceded by a similar increase of malignant diseases ; and more especial- ly by the petechial fever which prevailed at Aleppo in the year preceding the appearance ofthe disease, under the full marked character of the plague. " Yet Patrick Ru-.-el, the author of this account," (says Mr. Webster, who refers to this circumstance, with his usual dryness,) labors very grave- ly to trace the disease to the Turks from Egypt, and' their old clothes. The malignant disposition of diseases at certain times was noticed by Hippocrates. ''There are times" says he, '-when almost all the diseases which occur are ex- tremely malignant and as generally fatal; so that coughs, pleurisies, anginas, are ail equally f;»u»l." He assures us that the truth of Ins observation has been confirmed in countries very remote from each other, and in a variety of seasons Origin, <$-c. of Endemic Fever. 99 and climates. The plague of Aleppo in 1742, which first showed itself in the suburbs in April, was preceded in March by an acute fever. Schenkius says that the plague of 1574 was preceded by malignant fevers. " In the same manner," says he, "small pox, measles and dysenteries are very often the precursory heralds of the plague." Those epidemic in- fluenzas and catarrhs which frequently prevail over exten- sive districts of country, we are often unable to trace to any change of temperature, or prevalence of dampness:—■ They therefore seem to he connected with some secret cause in the atmosphere itself, independent of cold or hu- midity. Between these diseases and the measles there is an evident affinity, not only in their nature and symptoms, which require a similarity of treatment in both, but like- wise in the cause or causes from which they originate; as satisfactorily appears from their preceding and following one another as epidemics. This circumstance, and the evi- dent connexion which exists between epidemics in general, are well illustrated by Dr. Webster. "In the year 1772," says he, '• the catarrh and measles raged in the same year, from Boston to Charleston. To these succeeded anginas and dysenteries for a series of years. In 1781 and 1782^ catarrh pervaded the globe. In 1783, began measles in May, and anginas in August. In 1789, measles preceded the influenza. In 1757, influenza preceded the measles." The same author, speaking of the plague in Europe, says, "At the same time raged in America a series of epidemics, par- ticularly measles, anginas, and the bilious plague; the lat- ter appearing in Philadelphia and Virginia in 1741, and in New-York in 1743, in the same year with the dreadful pes- tilence of Messina. The plague appeared in Philadelphia in 1762; and the fatal epidemic pleurisy in 1761."* Dr. Rush divides the patients affected with yellow fever in 1793 into three classes, according to the progressive ma- lignancy of the symptoms. In the third he includes all those in whom the miasmata acted so feebly as not to confine them to their beds or houses; of these he says some died, who conceived their complaints to be occasioned by a common cold, and neglected to take proper care of themselves, or to use the necessary means for their recovery.! The con- nexion of intermitting fever and scarlatina anginosa was ob- served by the same author in 1789. " The intermitting fe- ver," 3ays he, " which made its appearance in August, wa? * Webster on Epidemics, Vol. II. p. 103. . t Inq. and Obs. Vol. Ill, p. 137. 100 Origin, fyc. of Endemic Fever. not lost during the month of September. It continued to prevail, but with several peculiar symptoms ; in many per- sons it was accompanied with an eruption on the skin, and a swelling ofthe hands and feet. In some it was attended with sore throat, and pains behind the ears. Indeed, such was the prevalence of this contagion which preceded the scarlatina anginosa, that many hundred people complained of sore throats without any other symptom of indisposition. The slightest exciting cause, and particularly cold, seldom failed of producing the disease.* The tendency which epidemics have to confound them- selves with each other by prevailing at the same time, was accurately noticed by Dr. Sydenham j and the fact has since frequently been observed by others. Dr. Bard, speaking of the malignant pleurisy at Huntington in the year 1749, says the distemper was brought into the city when the erup- tive fever was epidemical: and immediately the small pox was propagated by inoculation in a great many different parts of the town, whilst the constitution of the air which favored the eruptive fever, was at its height. The conse- quence of which was, that so long as the symptoms of (he small pox appeared from inoculation, the then prevailing con- stitution of the air changed its symptoms, in a great measure, to its own likeness; most of the characteristic symptoms of the preceding fever, accompanying those of the small pox: until by degrees the small pox, spreading over the city, ex- tinguished the eruptive constitution, and then existed in its own simple form ; after which inoculation was practised with its usual success.! A less degree of the same causes which give rise to the more aggravated forms, will produce the intermitting fever; and in the southern states it is not unusual to observe, in the progress ofthe season, the successive degrees of increasing malignancy, from the simple intermittent to the bilious or yellow fever with black vomit. Every accurate observer has remarked the striking con- nexion which exists between what is called yellow fever and the inferior gradations of endemics, down to the intermitting fever itself. Indeed, one of the most frequent terminations ofthe yellow fever of the southern states, is in the inter- mitting fever; which is often a more obstinate disease than the former: nor is it uncommon for the intermitting to change its character to that of the yellow fever. This I * Inq. & Obs. Vol. I. & Vol. III. p. 145. | American Medical and Philosophical Register, Vol. I. p. 420. Origin fyc. of Endemic Fever. 101 have frequently observed ; and in times ofthe general prev- alence of bilious fever, I have made it a point to stand upon my guard against such insidious and deceitful appearances; for if neglected, after one, two or three repetitions of the paroxysms of fever and ague, the disease is apt to become continued, and to assume the most malignant aspect. A disease, which at first would have yielded to venisection, an emetic, cathartic, or a few doses of Peruvian bark, by neglect, becomes converted into a case of malignant and fatal yellow fever. All these different grades of disease prevail at the same season ; and the fever appears under different characters and types, according to the constitution of the subject, the degree of predisposition, and the force of the exciting causes. Dr. M'Lean observes, that he has "often seen the inter- mittent commence the attack, and repeat its form for one or two paroxysms, and afterwards, as the cause gained strength, assume the remittent shape, and prove fatal." He further remarks, in another place, that after all the instances of the yellow fever which he has witnessed, and all the attention he could pay to it. he is of opinion it is the common remit- tent of the West Indies, rendered formidable by being ap- plied to the English constitution; that the variety which appears in its progress depends entirely on the variety of the several constitutions which it attacks; and that the yellow- ness which gives it a peculiar name, only marks its worst stages, and is rather an accidental than a peculiar charac- teristic* Dr. Robert Jackson, speaking ofthe diversity of aspects which is often assumed by the endemic fever ofthe West Indies, makes the following observations.! The cause of endemic fever, continued, remitting, or intermitting is one, but great variety is produced in the form and manner of ac- tion. The disease, in the more violent forms, is, or appears to be continued in some situations, in others, it is remitting and of regular type. In wet weather and on swampy grounds, the endemic of the country is usually remitting in form; and under this form, exhibits appearances of jaundiced yellow- ness, of black vomiting, purgings of black matter, haemor- rhage from different parts of the body, petechias, livid- ness, &c." * M'Lean's Inquiry into the Nature and Causes of the great Mortality among the Troops in St Domingo. Lond. 1797. p. 73 & 86. f Outline of the History aad Cure of Fever, p, 20.2, 102 Origin, iW. of Endemic Fever. It is said that during the prevalence ofthe yellow tevei in New-York, in 1 798, every grade of disease, from the mild- est febrile affection to the most malignant and pestilential was exhibited in the course of the epidemic. Except in a few instances, however, the number of mild cases greatly predominated over the malignant. Some assumed the char- acter of intermittents, and yielded to a very slight treatment; more appeared under the form of remittents, without any symptom of malignity, and speedily yielded to the proper remedies. As a proof of the affinity and resemblance exist- ing between this epidemic and the plague, we are informed that cases of anthrax and buboes were observed ; that one patient was affected, for twenty-four hours previous to his death, with spasms of the pharinx, neck, back, and arms; exhibiting the combined horrors of tetanus and hydropho- bia.* It is remarked by Dr. Caldwell, that the yellow fever of Philadelphia in 1805 was preceded by intermittent fever, diarrhoea, and dysentery.) It is remarked by Dr. John Hunter, that the fevers ofthe West Indies are similar to what are called the marsh and remittent fevers in Europe, only more malignant; and arise from (he same causes, viz. noxious exhalations from low, wet and marshy grounds.J It was observed by Dr. Rush, that the epidemic of Phila- delphia in 1802, assumed four principal grades, viz. the in- termittent, the mild remittent, the inflammatory bilious fe- ver, and the malignant yellow fever; all of which, in many instances, ran into each other. " A tertian," says he, " has ended in death, with the black vomiting; and a fever with the face and eyes suffused with blood, has ended in a quo- tidian, which has yielded to a few doses of bark."'§ In the further prosecution of the subject ofthe relation between the regular tertian, or the fever and ague, and the yellow fever, he remarks, " The bilious fever indicated its descent from this parent disease. I met with many cases of regular tertians, in which the patients were so well on the interme- diate days as to go abroad. The tertian type discovered itself in somr people after the more violent symptoms of the fever had been subdued, and continued in them for several weeks.'" * Med. Re .jo.-. Vol. Fi. p. 198-9. + Essay on the Yel. Few Aj.pen to Aiibert on Mulig. Intermit, p. '14. X rln.i'.r on the Diseases of the Army in Jamaica, p. 15. ) See. his ktle:- in the Med. Repos. Vol. VI. p. 169- Origin, fye, of Endemic Fever. 103 C'-.tses of intermittent, remittent, and typhus fevers, were observed to prevail at the same time in the same family, by Dr. Trotter. The remote causes of those fevers appeared to be the same in all, viz. a cold, damp house, and deficien- cy of diet. The same thing was observed by Dr. Trotter in the navy and in the public hospitals. A similar observa- tion was made by Mr. Crawford, that on board of every ship, at the time the yellow fever was the most fatal, there were a number of cases of intermittents. Mr. Crawford was of (he opinion that the cases of intermittents originated from the contagion of (he patients laboring under (he yellow fe- ver.* A more probable presumption is, that they all ori« ginated from a common cause, viz. heat, moisture and pu- trefaction. The different quantities and degrees of heat, moisture, and corruptible materials, in different places, will occasion a corresponding diversity in the endemic of the same season. As the causes of disease in large cities generally exceed those of the adjacent country, we can easily account for the great- er severity and malignity of symptoms in the endemic of the former than (hat of the latter situation. This circumstance is ably represented by Dr. Edward Miller, in the following words: "As the materials of putrefaction and the degrees of heat, in a large city, greatly exceed what is found in the adjacent country, so the diseases arising under such circum- stances must be proportionally more malignant. The pes- tilential fevers of our city (New-York) differ only in grade from the bilious and remittent fevers ofthe country. They prevail in the same climates ; they come on at the same sea- son ofthe year; they-are chiefly disposed to attack persons ofthe same constitution; they commit their ravages on the same organs of the body, and produce symptoms differing only in degree ; and they decline and disappear at the same season and under the same circumstances. In the city we often sec in the same family, and under equal circumstances of exposure, the malignant forms of pestilence and the mild forms of remittent fever; and in the country, while (he great mass of cases are generally mild, we occasionally meet with some which exhibit the violent attacks, the intense maligni- ty, and the rapid dissolution, which more frequently mark the pestilential fevers ofthe city.!" Wear* informed in.Sir George Staunton's Account of the Embassy to. China, that the malignant fevers of Batavia end- ed in the tertian form. ■'* Trotter's Med. Narr. Vol. I. p. 185, and Vol.. II. p. 99. t Report on Yellow ('ever. Life of Miller, p. 92. 104 Origin, fyc. of Endemic Fever. From the survey which has been taken ofthe nature, ori- gin and causes of epidemic and endemic fevers, it will be seen that there is a general analogy, and a chain of connex- ion, observable in the whole, from the mildest form, or in- termitting fever, to the more aggravated grade, under the name and character of plague. What has been considered the most characteristic feature of this disease, viz. the ap- pearance of glandular swellings, buboes and carbuncles, takes place but in a small proportion of cases. Such affections have likewise been observed in the yellow fever; so that from every consideration we are led to conclude that (he plague is nothing more than a high grade of endemic fever, marked with some peculiar symptoms of malignity; and like the yellow or bilious remittent fever, owing its origin entirely to local causes. It should be considered as a subject of regret that no name more appropriate and generally applicable than that of yellow fever, has been selected to designate the endemic of our country ; since the yellowness of the skin is by no means an inseparable characteristic ofthe disease. In many malignant and ftal cases, as well as in those which termi- nate in recovery, this symptom is never observed. Dr. Moselcy, speaking of the endemic fever of the West Indies, remarks, that "yellowness of the skin, like black vomiting, is not an invariable symptom of this fever: those who are fortunate enough to recover, seldom have it; and many die without its appearance." Besides, yellowness of the skin takes place in other diseases. An epidemic is mentioned by Haller, in which the body turned yellow.* We are in- formed by Lasonne, in the Medical Commentaries, that he sometimes observed it in a disease occasioned by putrid cat- tle : and Dr. Lind mentions its occurrence in several cases of typhus. There are instances of jaundice accompanying fits ofthe intermittent fever in England. And Dr. Hunter observes, that he has seen two examples of yellowness or jaundice in the hospital, or jail fever.! This symptom can only be considered as an indication of redundancy of bile in the prima? vise ; which may, or may not, according to circum- stances, be absorbed and conveyed into the circulation in such quantity as to produce a yellow suffusion on the sur- face of the body. That the bile is absorbed and conveyed into the blood in yellow fever, there can be no de*ibt; and we are informed by Dr. Lind, that he found the serum of * Haller Opera. Monor. Vol. III. p. 374. + Hunter on the Diseases of Jamaica, p. 91. 'Origin, Origin, c\-c of Endemic Fever. that the disease was not contagions, nor communicable from one person to another. From this circumstance they con- cluded it could not be the plague, whose essential chaiac- ter, they said, was to be highly contagious. Physn ians, surgeons, confessors and barbers, generally escaped it, though they attended the sick in the hospitals. The dis- temper, however, continued to increase with so much vio- lence and mortality, that on the 4th of June, it was allow- ed by all parties to be the true plague. Known by this ter- rific appelation, the disease was afterwards deemed conta- gious. Professor Thomas Fasano, published a book at Naples, on the epidemic fever which desolated that city in 1764.— It is entitled Delia Febre Epidemica Sofferta in J\"apoli I Jin- no 1764, Libra iii. Di Tomasso Fasano. " He is so wholly convinced ofthe local and domestic origin, that he does not even mention any thing about a ship." And this in a sea- port, says Dr. Mitchill, is a very remarkable circumstance. With much good sense, Fasano lays it down as a principle, that an epidemic is a slight, plague, and that a plague is a powerful and furious epidemic. And in like manner, Michael Sarconc. who wrote a history, in two volumes, of the dis- temper which prevailed at Naples, in 1764, under the title of Istoria Ragiomata di. Mali osservati in Mapoli neW intero corso dell* Anno 1761, does not pretend that this epidemic was any thing else than a pestilence, consequent upon the extreme scarcity and famine of the preceding year.* The pestilence which prevailed iu the French army at Jaffa is judiciously ascribed by Assalani, to (he circumstan- cesof their situation. The water of the Nile, and the want of ditches to drain the ground, occasioned several ponds or marshes, which could only be earned off by evaporation.— The French army on its arrival at Jaffa, encamped close to one of (hese ponds, the water of which supplied their wants, till their departure for Acre. On the taking of Jaffa, by assault, the number of Turks killed and half buried; the bodies of those which the sea threw back, and left on the shores; the miasmata arising from the putrefaction of the horses and camels, left dead upon the ground, or dragged scarcely beyond the walls; the want of fresh provisions; the filthiness of (he inhabitant, the hordes of Bedouin Arabs who blockaded the city, formed a combination of circum- stances, from which the army in a few days was overwhelm- *See the introduction to Assalini on the Plague, by the American Pub- lishers, Origin, fyc. of Endemic Fever. 119 etl with all the horrors of war, famine and pestilence.*—> Assalani himself, prefers calling this disease by the name of the epidemic fever. The plague, spotted fever, scurvy, and other malignant diseases which prevailed in London in the 16th century, seem to have originated from causes similar to those above mentioned ; and from the nature of the diet of the inhabi- tants, which consisted principally of animal food, and the filthiness ofthe streets and houses. Erasmus, in a letter to Franciscus, Cardinal Wolsey's physician, ascribes the sweat- ing sickness, a species of plague, from which the English were scarcely ever free, in a great measure, to the incom- modious form and bad exposure of their houses, and to the sluttishness within doors. The cabins were constructed of mud and clay, and served as common sinks for all kinds of tilth; such as the matter rejected by vomiting, the urine of men and dogs, soup and dish water thrown upon the floor, the cleanings of fish and other sordes too shocking to mention.t In 1389, the streets of London were so abused by the dung and garbage of the common lay stalls, to the great annoyance of the citizens, that a proclamation was made throughout the city by authority of parliament, " that no person whatever presume to lay any dung, guts, garbage, offals, or any other ordure, in any street, ditch, river, &c. upon penalty of twenty pounds, to be recovered by any information in chancery." When the plague pre- vailed in London in 1569, orders were issued kt to warn all inhabitants, against their houses, to keep chanels clean from filth, by only turning yt asyde, that the water may have passage." From these circumstances, we are not sur- prised that the city was overrun with epidemical diseases; which according to the season, and the strength of the re- mote causes, assumed different appearances. It is said by Burnet, in his history of the reformation, that in the last year of Queen Mary's reign, "intermitting fevers were so uni- versal and contagious, that they raged like a plague." We are informed by Morton, that remittent fevers were very destructive for several years before the great plague of 1665. In 1658, Oliver Cromwell died of this fever; and he siys that the death of his own father was also occasioned by this disease, which likewise affected his whole family. He proceeds to say, that the cold weather afterwards check- * Assalani on the disease called the Plague, Amer. Edit. p. 8 & 9. t Foven3 sputu, vomitus, mictum canum et hominnm, projeclani cer*- visciam, el pisceum reliquas, aliasque sordes non nominandos. 120 Origin, &c. of Endemic Fever. ed this disorder; yet the seeds of it were by no means de* etroyed, and continued to show themselves under different forms. He observes, that during the winter, intermittentsj quartans, tertians and quotidians, arose from a milder de- gree of the same poison, and were almost equally epidemic, as the continued or remittents were in autumn. And that the same fever under the continued type, more especially in the character of a simple and legitimate quotidian or ter- tian, was very common ; and in autumn he observed it to be more or less epidemic, till the year 1664. He informs iiSj likewise, that in the two years immediately succeeding the great plague, dysenteries were very frequent, and we are afterwards told that the same disease returned every au- tumn, attended nearly by the same mortality. Maj. Grant, whose observations on the British mortality were published in 1662, says, " the diseases, besides the plague, which make years unhealthful in (his city, are, spotted fever, small pox, dysentery, called by some the plague in the guts; and the unhealthful season is autumn. At the approach of winter the plague subsided ; and the morbific causes operated in a milder way by producing agues, and other diseases of a less aggravated character than those of autumn. We are in- formed by Sydenham, that from 1661 to 1664, agues were epidemical in London, and again from 1677 to 1685. From the same author we also learn that dysentery was epidemi- cal four years together; and the bills of mortality show the sum of deaths under the title of bloody flux and griping in the guts, in some years to have exceeded 4,000; and for five and twenty years successively, from 1667 to 1692, the number each year amounts to above 2,000. The principal circumstance worthy of notice in the above account, is the striking connexion existing between what was called the plague and intermitting fever; from which we learn that the endemic fever, upon becoming milder and less malignant, assumed the intermitting type, more espe- cially upon the approach of cool weather, and in certain years, when the causes were not sufficiently powerful to produce the more aggravated forms of disease. Such was the want of delicacy and improvement among the .Europeans, at the time here alluded to, and such their ignorance ofthe operation and effects of natural causes, that the neglect of cleanliness was not considered either as a physical or moral evil: and we accordingly find that (he same causes of disease prevailed in almost every town and village throughout the kingdom. From a similar neglect of cleanliness, and from accumulation of frith, the same dis- Origin, fyc. of Endemic Feven 121 tfases likewise prevailed at Oxford. To the preceding cir- cumstances is to be attributed the scurvy which was fre- quently epidemic in England. Hodges, in hi3 account of the plague in 1665, says, that "a scorbutic affection was very epidemic amongst thenm" And Hurtzner, in his trav- els at the time of Queen Elizabeth, remarks (hat " the Eng- lish are often molested by the scurvy." Willis, who wrote a particular treatise upon this subject, describes it as an en- demic in many parts of England, and almost every where sporadic. And Charlton represents the scurvy as an en- demic disease. One great cause of the diseases of London, it was ob- served, was the narrowness of the streets ; in which filth of every description was permitted to accumulate: and the great fire, which, at the time, was considered a calamity, Was doubtless an occurrence of national prosperity and hap- piness, and an event of providential goodness. The inhabi- tant*, emerging from their supineness, ignorance and filthy profited by the experience of the past: the streets of the rising city,were made straight and spacious : cleanliness was enforced j and as a revard for their sufferings, plague, dys- entery, scurvy, &c. rapidly declined ; so that, in a few years, the pestilence which had so long spread wretchedness and desolation through the streets of London, was known only by name. From those authors who have given a circumstantial ac- count of the plague, as it prevailed in other parts of Europe, it appears that the same causes every where Contributed to its production. These causes are principally to be found in the politic:*! calamities ofthe country, and in the manners and habits of society. In illustration of this point, see the account ofthe plague of Denmark in 1690, by Thomas Bar- tholine; that of Cologne and Paris in 1570, by Forestus; that of Toulouse and Marseilles, by Diemerbroeck : and the Traite de la Peste. The progress of civilization in the na- tions of Europe, their improvement in the comforts of do- mestic life, their cultivation of the arts of peace and agricul- tural economy, and the light of science, have changed the physical aspect ofthe nation, and instead of noxious marshes, polluted kennels, offensive streets, and dirty houses, and their baleful progeny of diseases, cheerfulness and beauty smile upon the face of nature, and health follows as the re- ward of industry, cleanliness and virtue.* * The words industry, cleanliness (iivl virtue, are used in a relative, not an absolute sense. Q 122 Origin, &c. of Endemic Fever. Considering (he baseness of its origin anH. tyc. of Endemic Fiver. that the plague rages with more violence during the prr.ivi- lence of the south winds, than when they blow from tiie north or north-west, in which case it diminishes, and rarely appears if the cold winds continue for a lonr^ time."**' Our author informs us, that the same appearances were observ- ed upon dissection in the plague as in the yellow fever. - The liver was found larger than natural; the gall Madden foil of black bile. The (ruth of the matter appears to be, that the yellow fever and the plague of Egypt are the same disease. Or mother words, they are the common endemic fever of the country, and very similar to that ofthe United States. An account of a pestilential fever is recorded by Sir.John Elliot, which originated in Naples in the summer of 176 1, in consequence ofthe famine occasioned by a large expor- tation of corn. It is stated that 200,000, out of :.\000,000 of inhabitants that the kingdom contained, perished by the disease. The inhabitants of Naples, we are informed, aro extremely remiss in regard to cleanliness, both within and without their habitations, which, together with the heat of the climate, and want of food, our author thinks is suffi- cient to account for the calamity. In July, the disease be- came highly infectious, was attended with petechias, swell- ings ofthe parotid glands, obstinate delirium, violent vom- iting and fluxes of blood. It was observed that the sick who were removed into the hospitals which stood near the sea, recovered much quicker (ban in other places; and that' few of them died there. In those well ventilated hospitals, open to the sea air, the progress of the contagion was en- tirely stopped, and none of the nurses or attendants on the sick were infected with the distemper.! It has been commonly observed in the prevalence of epi- demic diseases, that the poor are the greatest snllerers, m consequence of their fillhiness, close and crowded habi- tations, and the numerous inconveniences and privations which they suffer. Orosius, in his account of the pestilence which prevailed in Rome, B. C. 461, observes, that though many of the pa- tricians were victims, it was more especially fatal to tin *Lar. Mem. Amer. Edit. Vol. 1. p. 189. ■tLind on the Diseases, incidental to Europeans in Hot Climates, p. J99 et scq. In the treatment of Ihis disease, vegetable acids were "'iven in large quantities. Ice water and hark, we are told, were the grea&t reme- dies. Musk was likewise found.extremelv useful in relieving the head-ache Mineral acids-, where livid blotches and other high symptoms of uu'refe- tion appeared, were administered with the best efiect. ^' Origin, fyc. of Endemic Fever. 125 poor. It is also stated by Livy, in relation to the same dis> ease, that many persons of rank and affluence perished, but that among the poor and indigent its ravages were extensive. According to Diemerbroeck, it was the practice in Italy and France to expel the poor immediately from the towns upon the appearance of the plague. The plague which prevailed at Marseilles in 1720, appeared first in the west part of the town, inhabited by the poorest people.* At Aleppo, it always begins in the Kusarias and Judida ; the former are small huts, with few or no windows, which stand crowded together, and are inhabited by the lowest Arabs; the latter are the dwellings of the inferior Jews, " whose houses are small; or if large, the different apartments are crowded with different families; many of them are more than a story below the level ofthe street, in a condition half ruinous, dirty in the extreme, damp, and badly aired; and the wretched inhabitants are clothed with rags.t In Hol- stein, in 1764, it first appeared at Rensburg, among the pris- oners, who, on account of offences, were condemned to pub- lic labor.J At Moscow it broke out in a very large house, which was used in baking bread for the soldiers; three thou- sand persons of both sexes were employed in this occupa- tion, of whom the poorer portion, comprehending about one third, inhabited the inferior part of the building.§ And the same author says that the plague which raged at Moscow was almost solely confined to the common people ; and that amongst the nobles and richer merchants scarcely any were attacked. In London, the plague in 1626, and 1636, broke out at White Chapel, a part ofthe town which abounded with poor, and with slaughter houses. We are told by Hodges, that the plague which prevailed in London in 1665, was entirely confined to the poor, on which account it was called by some the poor1splague. It is related by Lord Clarendon, that when he and other people of condi- tion, who had fled from the plague, returned to London, they scarcely missed one of their friends or acquaintances, the mortality having been confined almost entirely to the lowest orders ofthe people. London was subject to the plague at different times from 1593 to 1666. The week ending the 5th of September, * Timon on the Plague of Constantinople. Phil. Trans. Abr. Vol. VII. f City Remembrancer. X Russel on the Plague. { VValdschmidt de singularibus quibusdam Pestis Hoist. Haller Dispu tat. Vol V. l-2(> Origin, cVr. of Endemic Fever. 1665, 6,988 persons died of this disease; of 97,306 deaths in 1665.. 68,590 were of the plague. The whole number of deaths this year amounted to 96,306, of which 68,596 were ofthe plague.* Previous to the great fire in London, the streets were so narrow, and the stories ofthe buildings projected over each other so much, that the houses of (he opposite sides of the streets nearly touched ; so as in a great measure to exclude the light of day, rendering the air damp, stagnant, and con- fined, and giving to-the city the gloom and appearance of a vast dungeon. The plague which, for many years, afflicted the Romans, was entirely of domestic origin. The marches and low grounds, in the vicinity of the city, as described by Tacitus and Livy, were no doubt the principal cause of this disorder. If to this be added the pover(y ofthe common people, their crowded habitations, and frequent scarcity of provision, we need be at no loss to account for its production. At the time here alluded to, the Romans were ignoraut of com- merce, nor did they own a single ship till more than two centuries afterwards. It has been contended by some, (hat the plague which raged at Athens, at the time ofthe Peloponnesian war, was an imported disease. Upon inquiry, however, we shall find that such a presumption is not authorized by historical facts; since every cause which has been known to contribute to the production of pestilence in other situations, existed, in a remarkable degree, at Athens. The city was crowded with people, who took refuge from the war. So that from a population of 50,000, the number was augmented to more than 400,000 inhabitants. Of such a multitude, a great portion were without houses to lodge in, and were crowded together in booths and temporary hovels. From the de- struction of the harvest in the country, famine prevailed in the city, which added to the crowded state and confine- ment of the people, the accumulation of filth, want of habit- ual exercise, and an inclement season, soon spread pesti- lence and destruction through the city. The plague which prevailed in Rome B> C. 461, appears to have originated from similar causes. Livy represents the disease as being grievous and powerful, both in the coun- try and city, and equally severe upon man and beast. The disorder was aggravated in the city by the vast influx of peo- * Hebberden's Obs. on the increase and decrease of'different Diseases, and particularly ol the Plague. Origin, fyc. of Endemic Fever. \ 27 pie, flocks and herds, who fled for refuge from the enemy. The filth of such an assemblage of various animals, suffoca- ted the ciiizens with a stench to which they were unac- customed, whilst the populace from the country, crowded in narrow hovels, were still more distressed by heat and want of rest.* SECTION 2. Inquiry into the Doctrine of Contagion, Importation and Ex- otic Origin of the Yellow Fever. The instances of simple fevers arising from contagion are to few, that the contagious nature of any of them can scarcely be considered as existing; much less should it be an occasion of alarm or apprehension either to those whose duty and profession require their personal intercourse with the diseased, or to friends who may visit them, or to nurses w>:ose duty demands a constant attendance. In the course of several years experience in the fevers of hot countries, I never had reason to suspect a single case to have arisen from contagion. What proof, indeed, can be brought in support ofthe propagation of disease by contagion, when all are equally subject to the influence of a common cause ? But if the limited extent of the endemic allows the patients to be removed to a wholesome air, and if in this situation (he disease is not communicated cither to nurses or others, there is then but little ground for considering it contagious. To,this purpose we are informed by Dr. Rush that in the fever of 1793 many people who were infected in the city were attacked by the disease in the country, but they did not propagate it even to persons who slept in the same room with them.t The death of the adventurous and enterprising Dr. Valli, has, by some, been attributed to contagion. In the ardor of his pursuit and experimental reseaiches, and bidding defi- ance to contagion, he had (he boldness, and a petit mftitre might say the indelicacy, to smell a dirty shirt in which a person had died of the yellow fever, and to rub it over dif- ferent parts of his naked body, as also to apply different* parts of his own body in contact with the corpse; as he was soon after seized with the fatal malady, (here, is some * Tit. Liv. lib. iii. c. 6. + Inq. and Obs. Vol. III. p 154. J 28 Origin, re us, .eeede so far from their principle, as to acknowledge the identity of diseases, which, according to their own doctrine, dif- fer so essentially in their nature and symptoms. 1 have seen a disease, similar to the one described by Dr. Cn.s- holm, as prevailing on board the Hankey, generated on board the United States brig Louisiana, at Plaquemme j* but as different from the bilious remittent fever ol i hdaiiel- phia, in its symptoms, as is the small pox from the measles. And the fever which prevailed in Philadelphia, in 1793, is too well described by Dr. Rush, to admit of being con- founded with the jail or ship fever of the Hankey. It appears that none of the men, who were sent on board this vessel, received the infection; nor did fever appear in any of the ships of war, which lent her assistance, in con- sequence of (his communication. This subject is taken up by Dr. Trotter,! who considers it probable from these facts, that the Hankey did not import the infection that produced the Granada fever, " for after (he disease was worn out," says he, '' she had a passage to make to the West Indies, of many hundred leagues. It is also doubtful how the effects left in the Hankey could produce the fever, for the bed- ding was thrown away, and what clothing remained, had been aired, and probably, had scarcely been in contact with (he body after being sick. Mr. Smithers, surgeon, who went on board the Hankey. while en her passage to the West Indies, was examined before the Governor of Grana- da on the subject, and gave his opinion, decidedly, that the Hankey did not communicate this fever to tie colony ; from our people remaining some days on board, at sea, and es- caping with impunity, is a strong support to (he evidence of Mr- Smithers. Dr. Chisholm has laboured his arguments to prove, that it was a new disease; though perhaps, only the common endemic of the country, more aggravated by a greater number of Europeans being the subjects of its in- fluence, than he had been accustomed to observe before." It even appears that Dr. Chisholm has given an exaggerat- ed account of the endemic of Granada. Lieut. Governor Young, in his Return of the Bulama Adventurers, speaks of the fever as being of the intermittent kind, and not infectious, * See account of this Disease, in Observations on the Topography an$ Diseases of Louisiana. t Medecina Nautica, Vo. l,p. 331. Origin, &c. of Endemic Fever. 141 while the mortality is ascribed by Mr. Paiba, to various cau- ses, some having intermittents, some more violent fevers, some diarrhoea, others dysentery, and others again fell mar- tyr? to the indiscreet use of opium, and spirits, which they took as preservatives.* It app :ars, moreover, that the ship Hankey did not airive at St. George, in the island of Granada, till the 19th of March, whereas we are informed by Mr. Paiba, (hat the fe- ver prevailed in Granada, as early as the 1st of the same month, and Dr. Chisholm himself observes, that " from (he beginning of March, to the first of May, 200 out of 500 sailors, who manned the ships in the regular trade, died of this fver." The sickness and mortality which prevailed in the (own of St. George, in the Island of Granada, is abun- dantly account for, by a reference to local causes, without bringing in the aid of importation. The town where Dr. Chisholm's malignant pestilential fe- ver raged, in 1793, is situated on a narrow strip of land, bounded on the one side by the bay of the. same name, and on the other by the Careenage. The Careenage is a long inlet or arm of the sea, running up on the south and east side of the town of St. George. It is low, little moved by winds, and nearly stagnant, as the river never rises or falls there, more than four-, five, or six inches. The shore of the Careenage, on the town side, is remarkably low, narrow, and crowded by numerous little buildings, chiefly of wood, winch are separated only by lanes, situated on, or near the wharves, and inhabited by the lowest of the people, ill-ac- commodated, and devoted to intoxication and every species of debauchery. At (he head, or cast end of the Careenage, is a large marsh; which, at all times, but especially at low water, sends forth the most noisome and offensive smell.— Into this inlet, vessels are general brought to refit and ca- reen, and indeed for protection, as they are perfectly safe from the winds. At the time ofthe Hankey's arrival, it appears to have been unusually crowded with shipping; and that ship was brought round from the Bay, into the Ca- reenage, very soon after she reached Granada.t Now, if in addition to an this, we take into consideration the geograph- ical position of this island, in the 12th° North latitude, under a vertical sun beaming upon a mass of corruptible materials, we can be at no loss, as to the origin of a disease of unusual malignancy, or to account for the mortality which took place *Edinb. Med. and Surg. Journal, Vo. V., p. 341. t Med. Repos. Vo. l, p. 459 and seq. 142 Origin, &c. of Endemic Fever. among Europeans lately arrived. We further learn, that in different places, (he disease assumed different aspects of severity or mildness, according as particular parts ofthe isl- and were more or less marshy and low, or elevated and dry. Notwiths(anding all his endeavours to trace a foreign deri- vation, Dr. Chisholm describes a similar fever which pre- vailed in the Island of Granada, in 1791, and which he ac- knowledges to have been of local origin.* But because (he ship Hankey had been upon the coast of Africa, in 1793, where she had engendered disease, and subsequently arrived at the island of Granada, a place more unhealthy from local causes and situation, than Bulam itself, he vainly endeav- ours to trace the fever to a foreign origin ; though the Han- key, previously to her arrival at Granada, was thoroughly purified, and had for many weeks been free from infection and disease. We are informed by Dr. Le Blond, in his Essay on the Yellow Fever, that as long ago as 1770, the Careenage was a sickly place. The yellow fever was frequent, and par- ticularly fatal to strangers. Its malignity was dreadful, in consequence of (he unhealthy exhalations from the marsh, near the port and town of St. George. Dr. he Blond, practised there two years. There were, then, local causes enough for the disease, and the importation from Bulam had not been thought of. For misrepresentation of facts by Dr. Chisholm, respect- ing the origin and propagation of the yellow fever in the island of St. Thomas, I refer the reader to the statement of Mr. Eckard, Danish Vice Consul, in the Medical Reposi- tory, second Hexade, volume 1, page 336. Dr. Chisholm, with much gravity and form, endeavours to point out the distinction, between the plague and malig- nant pestilential yellow fever, and thinks that he has settled the difference in the following manner. "First, the differ- ence between the plague and malignant pestilential fever, appears chiefly in the mode of communicating the conta- gion, in the plague, Dr. McGregor thus states it " but ex- cept from actual contact, there never appeared to be any danger." It is, therefore, and the fact is further confirmed by some observations of Dr. Russel, pretty evident, that contact is necessary to produce the disease. In the malig- nant pestilential fever, around the diseased person, there is an infectious atmosphere of a determinate radius, within which the disease may be communicated : in it contact k *Edinb. Med. Comment for 1793; Origin, <$-c. of Endemic Fever. 14$ not a necessary condition : Secondly, a second distinction is perceived in the atmospheric temperature necessary to give prevalence to each disease respectively. This is a very curious circumstance, and certainly, in many respects, a very important one ; the contagion of plague can be prev- alent, only in a temperature between 40° and 80°, a tempera- ture above or below these degrees extinguishes it; the con- tagion of the malignant pestilential fever becomes preva- lent only in a temperature between 70 and 90 degrees; but it is extinguished or suspended in a higher, and probably cannot exist in a much lower,* This distinction, which the Doctor endeavours to estab- lish, if rightly understood, is no distinction at all. In the first piace, as to contact being necessary to produce the one and not the other ; it is proper to understand, that a gen- eral disease is never communicated by primary action on the surface of the body ; as it will be hereafter shown, that ho cuticular absorption ever takes place, and without such absorption, we are unable to account for the production of disease in this manner ; since the cuticle is destitute of nerves and blood vessels, and therefore insensible to impres- sions calculated to affect the vascular and nervous systems. As to the second distinction, that plague can only be prev- alent at a temperature between 40° and 80°, is allowing al- most all possible variation from the heat ofsummerto the cold of winter; and as plague, if it prevails at all, must appear in one of the seasons embraced between the ranges of this temperature, it is no more or less than saying, that this dis- ease mu,t become prevalent in one or other of the four di- visions and seasons ofthe year; the truth of which was suf- ficiently known, before the profound discovery of Dr. Chis- holm. As Dr. Chisholm does not stand so high as to give his as- sertions the weight and implicit evidence of oracles, he should have adduced authority to show that a temperature above 80 degrees of Fahrenheit, extinguishes the plague, or that a degree of heat above 90, puts a stop to the malignant pestilential fever, if by this denomination he designates the bilious yellow fever of the United States ; if so, his posi- tion is untenable, for this disease has prevailed in various places, where the temperature in the sun was as high as 115 of Fahrenheit. He was however tolerably safe in limiting the degree to 90, as the natural temperature of the atmos- phere, in the shade, seldom exceeda, or even reaches that, *Chisholm'£ Letter to Haygarth, p. 156-6 and 7. 144 Origin, <§rc. of Endemic Fever. in the hottest latitudes. It is well known that a high temperature is necessary to the origin of all fevers of an endemic character, and no less so in the plague than in fe- vers of inferior malignancy. It is not, however, at the same time denied that diseases of a very malignant character, and such as have received the name of plague, have prevailed during the winter season, and under a low temperature of the air: but, as the term plague has been extremely vague and indefinite in its application, there is no doubt that dis- ease* of a very different character have been baptised with this appellation, as a generic term, for all malignant disor- ders wi(h which physicians were unacquainted. Thus, the term cold plague, winter fever, spoiled fever, pneumonia ty- phoides. he. have all been given by different persons to the winter epidemic of the United States, which, however, dif- fers very materially in its causes, from the endemic bilious yellow feyer or the plague of hot climates, arising from heat, moisture and putrefaction. Dr. Chisholm wishes to establish the peculiar and specific character, of what he calls the malignant pestilential fever, which he says originated on board the Hankey, and was a true jail fever, afterwards propagated into various parts of Europe and America. Had not this opinion been embrac- ed by some respectable gentlemen of the profession, in our own country, as well as in Europe, I should have consider- ed it too weak and unsubstantial to deserve a moment's con- sideration; but, as the removal of error, is no less important, than the advancement of truth, I have bestowed the more pains oil this subject, than its merits might intrinsically seem to require. In the distinction attempted to be established, by Dr, Chisholm, we are informed that the yellow fever is not con- tagious, and that the malignant pestilential fever is contagions', and, although he had never been an eye witness of the fever of any of our seaports, and with very little experience in the West Indies, he has the confidence to assert, that the fever which prevailed in Philadelphia, in 1793, and in subsequent years, as also indifferent parts of the United States, was the malignant pestiknlial fever, and not the yellow fever, as represented by Dr. Rush, Dr. Miller and others. But. to follow Dr. Chisholm, any further in his speculations, would be. to forsake the substance, in pursuit of a shadow. Dr. Pinkard, who practised in the West Indies, where he had frequent opportunities of observing (he endemic fever of the climate, after affirming the identity of (he disease, known by the distinctive appellations of yellow fever, sea- Origin, #-c. of Endemic Fever: 14& soning,-Bulam, &c. and ascribing their diversity of aspect to the soil, situation and circumstances of the person at- tacked, he continues, "in negroes and Creoles it is fre- quently an ague, in those who are in a degree acclimated ;• remittent, and in new comers a continued fever; preserv- ing in each case a distinct type throughout its course, while in other instances of its attack upon Europeans it shifts its form and runs its progress with the most uncertain irregu- larity ; in proof of which 1 may remark, that I have receiv- ed newly arrived soldiers into the hospital, at one and the same time, with the seasoning malady, under all the vari* etie.? of an intermittent, remittent and continued fever, and although each had been differently attacked, all of them have died in the cour.-e of only a few days, with every symptom of the-most inaiignant yellow fever." On the subject of contagion, he observes " of all the multitudes of black men and women, whom I have had occasion to see employed constantly in the hospital, and who have exercised all the menial duties about the sick, the dying and the dead, I never yet knew a single instance of any one of them, either male or female-, taking the disease." In a letter from Dr. Senter of Newport, dated January 7th, 1794, is (he following fact, in support of the principle (hat the yellow fever does not spread by contagion, or pro- pagate itself by imported fomites. "This place," (New- port. R. I.) says the Doctor, " has traded formerly, very much to the W est India islands, and more or less of our peo- ple have died there every season, when the disease prevails in those parts; clothes of these unfortunate people have been repeatedly brought home to their friends, without any accident happening to (hem." If such is the difficulty attending the propagation of yel- low fever, it may be asked, wherein consist the use and necessity of quarantines ?* Not as a means of preventing the importation of the plague or yellow fever, which, as ep- idemics, never can originate from contagion ; but the sole utility of this practice, founded as it is upon erroneous principles, consists in making captains and masters of vessels attentive to the cleanliness of their crews and of the vessels under their command : the fevers which often commit such destruction on ship-board are of iocal origin; quarantine regu- lations are founded on the presumption that they are exot- ics and of foreign growth. The captain of the infected * See the Questions proposed by the Government of the Duchy of Qldc»- hur£. T 146 Origin, ire. of Endemic Fever. vessel knows to the reverse, and as by care and cleanli- ness he has it in his power to prevent this inbred pesti- lence; the expense and delay attending the quarantine of an infected vessel, might have an influence in making him attentive to the health of his crew, ll is conceived, that this is the oily benefit attending the practice of quarantine. But it is still a matter of doubt, whether this consideration would operate more powerfully in the preservation ofcleanli- ness, than that of private interest, safety and advantage, in- dependent of all laws and quarantine regulations. Against the practice of quarantine, several objections may be urg- ed ; and one of the most considerable and weighty is, that by directing the attention of the police of cities and sea- ports from domestic nuisances to the importation of a for- eign foe. cleanliness and the means of self preservation are neglected at home; and thus 'he disease, arrayed in all its terrors, arises in ambush, from the fostering indulgence of ignorance, blindness and neglect. The evidence in proof of importation ia, at best, equivo- cal. All that can be advanced in its support is, that previ- ous to, or during the prevalence of the yellow fever at a particular city, a vessel or person arrived from an infected port; whereas, had the same vessel or person arrived at any other time no notice would have been taken of the circum- stance. As such arrivals, however, in large sea-ports, take place every week, there is less difficulty in tracing the im- portation, than in accounting, upon (he principles of ihe con- tagionists, for the general exemption from disease. But, in support of the position that the yellow or endemic fever of hot climates arises from local causes the proofs are nume- rous and conclusive; and when principles are established by facts and philosophy, speculation and error should yield their pretensions. Dr. Ffirth. speaking of the fever of Batavia, says, "the disease is certainly local, being engendered by the causes already mentioned, (see page 63.) and is never contagious. The people here, have no idea of the fever being spread or communicated by contagion ; yet. if (he fever was to pre- vail in the sea ports of the United States, it would be call- ed malignant fever, and said to be ve:v contagion:-. It shows many of the symptoms of the yellow fever of Ameri- ca and perhaps the only reason they are not exactly alike, is, the ditference of climate, t violently inva-ded; the French next: the Spaniards, Portuguese and kalians suffer less ban either of the former. The yellow fever, ac- cording to Dr. Le'Blond, is engendered in the road where vessc Is ride ni St. Pierre's, in Martinique, among the crews ofthvir newly arrived ships rather than in the town. At Angus!ura, he saw a most malignant distemper arise from th. corrupt qua!it\ of (lie bread which the men were obliged to feed upon. At St. Thomas, on the right bank of the Orojioko. there is a great unhealthiness durii g the summer. Putrid bilious [even affect the inhabitants. And our author says, lie has no doubt, if an European regiment should ar- rive there in the summer, that the yellow fever would break our, and destroy the greater part of them. At St. Lucia, in 1707, there was as destructive a yellow fever as ever was known on board the American vessels anchored in the road, while the inhabitan's on shore were exempt from it. In one vessel not a *oul survived ; and new comers fell sick with alarming rapidity. At St. Vincents he was repeatedly told by the Creoles, that they never heard of the yellow fever until after the arrival of the English. At Ca)enne, new comers from cold countries contract yellow fever, not by catching contagion from any sick person, but from the heat, gaseous impregnation, and other qualities of the atmosphere. 'I hose, while they inspire the natives with health and vigor, * Webster's Collection of Papers on Bilious Fever?, p. 70. X See the Mel Repos. Vol. X, p. 65, to which I am indebted on this, as on many other occii..o.:s. 152 Predisposing and Exciting Causes. exert a deadly malignity upon strangers : insomuch that they often die on the first or second day of the attack. They rarely survive the third, and more rarely still the fifth. The unhealthiness of French Guiana, to men from the colder climates, is evinced by the unfortunate expedition under General Degouges, in 1802. This officer arrived at Cay- enne, with a body of three hundred men, in the midst ofthe greatest heats. The atmosphere had become loaded with exhalations from the drying and rotten marshes. In about a month the yellow fever appeared among the soldiers, and in a short time cut off two hundred of them, together with their general, the commandant of the place, and several other officers. And although these men were quartered in the same barracks with the old battalion and the regiment of blacks, not a single one received any contagious impress- ion. Only a lew hard drinkers among these old slanders had putrid bilious remittents, which, however, differed from the yrellow fever, only by their longer duration and milder symptoms. But the yellow fever, though it favored those who had previously been seasoned, was as fatal to the newly re rived passengers and sailors as it was to the soldiers.— And while the fresh emigrants were sorely afflicted, the peo- ple ofthe country experienced only the fevers and ordinary disorders attendant on calms which succeed (he intense heats of summer. The pernicious influence of miasmatic exhalations to foreigners and strangers, is strikingly exemplified in the va- rious military expeditions that have been undertaken in tro- pical climates. To a destructive mortality occasioned by an unhealthy season operating upon constitutions unaccus- tomed to the climate, have justly been ascribed the failure of Admiral Vernon's expedition to Carthagena in 1741, and the unhappy fate of Hosier at Porto Bello in 1746. A sim- ilar fate attended the expedition of General Dallingto Span- ish South America in 17G0. Of 1800 persons who embark- ed upon this enterprise, 380 invalids only survived to re- turn towards the end of the year. A similar mortality oc- curred among the Europeans who took Fort Roanoak, (a town at the bottom ofthe Bay of Honduras.) in 17 79. Dr. Blane, in his Observations on the Diseases of Seamen, remarks, that it sometimes happens, that a ship, wilh a long established crew, shall be very healthy ; yet if strangers are introduced amongst them, who are also healthy, sickness will be immediately produced; and Dr. Rush confirms the observation of Dr. Blanc from the experience ofthe i evolu- tionary war. " The history of diseases," says Dr. Rush, Predisposing and Exciting Causes* 153 " furnishes many proofs ofthe truth of this assertion. It was remarked that while the American army at Cambridge, in the year 1775, consisted only of New-Englandmen, (whose habits and manners were the same,) there was scarcely any sickness among them. It was not till (he troops of the east- ern, middle, and southern states, met at York Town and, Ticonderoga, in the year 1776, that the typhus became uni- versal, and spread such peculiar mortality in the armies of the United States."* Young men from fifteen to five and twenty, especially those of i fleshy, sanguine and plethoric habit are more lia- ble to fever than those more advanced, in life. At the pe- riod of five and twenty, the constitution seems to have ac- quired its perfection of vigor and maturity, and is less af- fected by the changes of temperature and the seasons; the nervous and muscular systems become then less sensible to morbific agents, whilst at the same time they acquire more strength aud steadiness of action. Persons of dry, spare, and withered habits; who look tough, hard, and sun burnt, are much less subject to attacks of fever than the fair, plump, moist and florid. It ha? been thought that women and chil- dren are less subject to fever and other malignant disorders than men. If this, however, can be admitted as a general rule, there are many exceptions to it; and it is well known that in the state of Alabama, in 1823, the epidemic was pe- culiarly fatal and severe among small children. Dr. Rush likewise remarked in the yellow fever which prevailed in Philadelphia in 1793. that children were equally liable to be attacked as adults.f A scorbutic habit of body may be considered as affording a predisposition to an attack of the prevailing epidemic in its most malignant form. It was observed by Dr. Huxham, that the scorbutic habit of body common to sailors increased the ma'ignity of the small pox.J We are also informed by Baron Larrey, that some navy surgeons wilh scorbutic hab- its, on entering upon the duties of their office to which they * Rush's Inq. & Obs. Vol. I. It has been remarked in Alabama, that stocks of healthy cattle, from Tennessee or Kentucky, upon mixing with those of Georgia and the Carolina?, also healthy, become immediately dis- eased and die off in great numbers. It has been said, in the way of half jest half earnest, that the Georgia and Carolina cattle always carry infec- tion about them, but from being accustomed to it are not subject to disease, whereas those from Tennessee, being entirely free from distempers, catch the contagion and die. t Rush's Inqu. & Obs. Vol. III. X Huxham on Epidemics, Vol. I. p. 94. U 164 Prcdisp,-;.iiig and Exciting Causes. Were called, were seized almost immediate]) with the plague and died.* It has likewise been remarked in the plague, that persons of a dry habit, infants with a fine skin and flaxen hair, young people of a sanguine tempevament and irritable fibre, were more liable to the plague than those advanced in age.t The same observations apply to bilious fever. Among the predisposing causes of fever should likewise be mentioned the use of animal food and spirituous liquors; as this subject, however, will be considered more fully un- der the head of Pnve-ilion, I would here just remaik that, as elsewhere shown, both animal food and distilled spirits contribute essentially to produce a scorbutic habit of body, to give occasion to the generation of a morbid excess and quality of bile, and to produce that state ofthe system which may be considered as affording the strongest predisposition to fever. By disordering (he function ofthe liver, they lay the foundation of permanent disease in that organ ; a disease frequently fatal in our southern climate. This disorder and its causes were not unknown to Hippocrates, ihough wine was at that time the strongest drink with which mankind were acquainted.! While all the functions of (he body are performed with regularity and strength, the system is less susceptible of mor- bid action, and less easily impressed by any noxious agent; but as soon as this equilibrium and harmony of movement are destroyed by any violently exciting or debilitating pow- er, a predisposition to fever takes place, and the constitu- tion is liable to be invaded by disease ; and the noxious ma- terials, which before lay dormant in the body, and might have been expelled, or prevented from exerting any injuri- ous influence by the natural powers ofthe system, seize the unguarded moment, (if I may be allowed "the expression,) and immediately exert their deleterious agency. Hence it happens that so many arc seized immediately subsequent to a fit of intoxication; and hence it is that a lic'aithy constitu- tion, and regular and temperate habits, are the be=t preserv- atives against disease. * Larrey's Memoirs, Vol, I. p. 219. t Assalini on the Epidemic Fever or Plague 'of Egypt, p. 29. X "In the disease of the liver," says I iippocrates, " there is a pain in the region of this organ, the person loses his former complexion, and be- comes of the color of a pomegranate. In the summer season the disease comes on suddenly ; and is produced by the use of beef and drinkiu- wine too freely. For at this season ofthe year the-e things are most hurtful to the liver, and give a great determination of bile to this or-an." Hivvoc. Be Intern. Afftc. Optr. Om. p. 549. Predisposing and Exciting Causes. 15£ Cold, or the diminution of heat from a high to a consich erably reduced temperature, may juslly be considered as an exciting cause of fever. The effect is the same, whether applied through (he medium of fog, dampness, cold water, orcold air. The night air, in low and marshy places, is pe- culiarly injurious to health. In a former work,* I took oc- casion to observe, that it frequently happened at Plaque- mine, upon the Mississippi, (hat (he men who were sent upon picquet guard at night returned in the morning affected with dysentery or fever. Their station was about half a mile from the fort, on the margin of a bayou, a place which was extremely low. wet and marshy. Upon my suggestion, a, large barge was floated down the bayou and moored in the stream; on board of this, the men were more comfortably protected from the unwholesome damps and vapors of the night; whereby the evils consequent upon exposure, were, in a great degree, prevented. Cold being a sedative power, it follows (hat its effocts will be more considerable on the body where the latter is in a state of debility, than when un- der the opposite circumstances of strength of fibre and ac- tivity ofthe circulation ; for when the circulation is languid, the process of generating heat is less energetic, and the nat- ural warmth of the body is diminished : under such circum- stances, the body'is incapable of adapting itself to sudden changes of temperature, and the application of cold opera- ting with increased power deranges the functions of health. There seem to be three reasons why the night air is pe- culiarly unhealthy. First, the coldness aud dampness ofthe atmosphere, impeding and checking perspiration ; secondly, the concentration of febrile miasmata, occasioned by this reduced temperature. We know that all fluid and aeriform substances are expanded and rarified by heat; and on the contrary, that they are concent' ated and condensed by cold, If. then, marsh miasmata and morbific effluvia are aeriform substances, (and I presume no person wiil contend (hat they are not,) it follows, by a general law, that the more con- densed they are in volume, and the greater their concentra- tion, in the same proportion are they inerea-ed in activity and virulence. Whilst, on the other hand, they may be so rarified by heat as to lose their infectious quality and become perfectly innocent. This seems to be the reason, at least in part, why the blowing of the hot land wind puts a stop to the plague in Egypt. But it should be understood that the heat and effect of this wind cannot be imitated by the feeble* * Observations on the Topography and Diseases of Louisiana^ 156 Predisposing and Exciting Causes. powers of ordinary combustion, no more than (he faint glim- mering of a candle can rival the mid-day eflulgence of the sun. Such is the intensity of (he heat which accompanies this wind, that, in the sensation it produces, it is described as coming from the mouth of a furnace. It is therefore in vain to attempt to put a stop to a prevailing epidemic by f he- kindling in the streets of artificial fires. Excessive heat operating upon the human body is found to act as the exci- ting cause of fever. Thus Dr. Rush observes that bakers, hatters and blacksmilhs were more liable than others to be affected by fever. The experiment of kindling fires in the street was tried in London during the prevalence of the plague; and on the night which succeeded three days that the fires had been kept burning, the number of deaths amount- ed to 4,009, although during the three or four preceding weeks no more than twelve thousand had been destroyed. It is said by Dr. Hodges, that the practice of kindling fires was found hurtful in (he plague of London. " Heaven wept," says he, '-for the mistake of kindling them, and mercifully put them out with showers of rain." The same experiment was tried at Toulon, when a most fatal plague prevailed there in 1721, by kindling, at the sound of the bell, a fire in frOnt of every house in the city ; the piague, notwithstanding, continued to prevail with unabated vio- lence, and in the course often months destroyed two thirds of the inhabitants. The same thing was had recourse to during the prevalence ofthe plague at Marseilles, and with no better success. It has been observed in the preceding paragraph, that there are three reasons why the night air is peculiarly un- healthy: "First, the coldness and dampness of the atmos- phere, impeding and checking perspiration ; secondly, the concentration of febrile miasmata occasioned by this redu- ced temperature." Thirdly—the third manner in which night air proves peculiarly unhealthy, is the attraction which moisture has for miasmata. That dampness is favorable to the diffusion of marsh miasmata, appears from the circum- stance that all natural odours are more perceptible in the damp air of the niuht. immediately after a shower of rain, Or during the exhalation ofthe morning dew. Of this fact, few, probably, are ignorant, as it must be familiar to all who have entered a flower garden or a blooming orchard under the circumstances and at the time above mentioned. The smell of marshes and of all putrefying and putrescent bodies is always more sensible and offensive after night-fall.— Odours, which remain unnoticed during the day, become Predisposing and Exciting Causes. 15? very perceptible after sun-set. It is well known that the odour of a skunk, which in the day time is palpable only at the distance of a few rods, at night, under favorable cir- cumstances, is perceptible at the distance of more than a mile. It appears to be from the disposition of miasmata to at- tach themselves to humidity, that a shelter of any kind, by excluding, in some degree, the dampness, serves as a pro- tection against disease ; and it will be at the same time ob- vious that the drier the apartment and situation, in the same degree will they be found conducive to health. One great intention of the sense of smell is to prevent Our inhaling offensive effl ivia. Thus nature points out to Us the manner in which noxious miasmata prove injurious to the system. The circumstance of fever originating in this way, Dr. Currie thinks justifies a practice, winch he has been informed is common among more experienced seamen, on the coast of Guinea and other warm climates, who, when exposed, during the night, to a breeze from the marshes, wrap their heads in a sea cloak, or other covering, and sleep fearless on the deck with the rest of their bodies exposed. The manner in which this may be explained is this ; the mois'ture on the cloak attracts and arrests the mias- mata, and prevents their entrance with the breath. Though we do not contend that an atmosphere is unheal- thy and infectious in proportion as it is offensive, for we know that the air of a particular place may be very offen- sive from the putrefaction of a dead animai, and yet no dis- ease may be the result; and on the other hand, very viru- lent infectious miasms may exist in the atmosphere without being perceptible to the sense of smell. All this, however, does not prove that this aerial and infectious vapor is abso- lutely free from odour, anymore than if it were contended that no water exists in the atmosphere because it is not per- ceptible to the sight. Our sense of smell is not remarkably acute : and the matter may be sufficiently virulent to pro- duce disease, though it be too much attenuated to be oovi- ous to the senses. And as the water in the atmosphere is rendered manifest when condensed into drops of rain or dew—so may infectious miasmata be concentrated and again rendered perceptible by such substances as possess an attraction for them. Such appears to be the case with most humid bodies, and particularly water, which in warm weather, and in unhealthy situations, by standing in a vessel soon contracts a disagreeable and offensive smell: and in this way infectious vapors being received into the 158 Predisposing and Exciting Causes. mouth and lungs by respiration, and attaching themselves to the moisture therein contained, may find admission into the mass of circulating fluids. The disposition which noxious exhalations have to attach themselves to humid substances, is probably the reason why fogs in or near wet and marshy places are particularly un- healthy: the same circumstance will explain why exposure to the damp air of the night is more injurious than the dry air of the day; and it might be a question, if the air were entirely deprived of humidity, whether it would not there- by be purified from noxious miasmata, and rendered perfect- ly healthy. In support of this opinion, as already stated, we are informed, that the blowing of the hot land wind, puts a stop to the plague in E^ypt. This fact seems to be prov- ed from the circumstance of an opposite state of the at- mosphere being found so injurious to the system, and so favorable to the propagation of disease. It has been ob- served in epidemics, as typhus, small pox, plague, &c. that their activity and virulence are increased by a stagnant, damp and foggy state of the atmosphere ; and (hat they de- crease when the weather is dry and moderately warm. It was remarked by Dr. Smith, that a contagious palient be- comes greatly more so when his clothes are- wet and his body heated by exercise, so as to be in a slate of perspira- tion. In illustration of the same fact, it was observed by Volnoy, that in Egypt the winter increases {fomenle) the plague, because it is mild and damp; and (hat the summer destroys it because it is hot and dry, {"Pete la detruit, parce- que il est chaud et sec.'''' It is remarked by Dr. Brockles- by, that he found nothing more productive of ague than sol- diers lying on the damp ground in camp. Dr. Lind repre- sents the employment of cutting wood and clearing the land of trees and bushes as extremely unhealthy; and gives in- stances in illustration of the circumstance. He likewise cautions against exposure to the night air in swampy and unhealthy countries, or where there are great night fogs. "The duty alone," says he, "of fetching fresh killed butch- ers' meat at night, for the use of our ships' companies in the East and West Indies, has destroyed every year several hundred seamen. In those parts of the world butchers1 meat must be brought on board at night, immediately after it is killed, otherwise it will not he fit for use the next day. During the sickly season at Batavia, a boat belonging to the Medway, which attended on shore every night, was three times successively manned, not one having survived that service. They were all taken ill at night when on Predisposing and Exciting Causes. 159 shore ; so that the officers were at length obliged to employ none, but the natives of the,country on the business."* It is probably upon the principle of the attraction existing be- tween water and miasmata, that vessels lying at a short dis- tance from an unhealthy shore remain secure and exempt from disease ; the miasms being absorbed by and blended with the water. Thus, we are informed by Dr. Rush, that many persons escaped (he yellow fever of 1793 in Philadel- phia, by remaining on board of vessels anchored in (he mid- dle of the Delaware. It is perhaps from this circumstance that the water carriers at Cairo, according to Mr. Volney, escape (he plague. Does not the attraction which water possesses for infectious miasmata suggest the propriety of keeping vessels filled with this element in the rooms of fe- brile patients, removing it from time to time as it becomes charged with infect>ou ? It has been observed that the fust high grounds in the vi- cinity of noxious exhalations or the low grounds near to the source of such infectious vapors, are more unhealthy than the plains below. This circumstance nay be accounted for upon the presumption that the infectious miasms attach themselves to the particles of moisture that are exhaled from the low grounds or-marshes, and which are observed to be attracted by and to settle upon the neighboring mills. Points and eminences are objects of attraction both of elec- tricity and vapors, and fogs before they are dissipated are observed to settle upon the higher eminences ofthe adja- cent hills. From the power of cold in concentrating infectious mias- mata, we may also account for the frequent increase of ma- lignant epidemics at the approach of cool weather. The fever of 1793 in Philadelphia, proved most fatal in (he latter part of October. In this epidemic, we are told by Dr. Rush, that the night air, even in the warm month of September, was often so cold as to exci(e the disease, when the dress and bed clothing were not adapted to it; and that every change in the weather, (hat was less than that which produ- ced frost, evidently increased the number of sick people. This was obvious after the 18th and 19th of September, when the mercury fell to 44° and 45°. " The hopes of the city received a severe disappointment on this occasion, for 1 well recollect," says the Doctor, "there was a general expectation that the change in the weather would have * Lind on the Diseases incidental to Europeans in Hot Climates, p. 152. 1 GO Predisposing and Exciting Causes. checked the disease.*' The same increase of the number of sick ttas observed to follow the eool weather which suc- ceeded the 6th and 7th of October, on which days the mer- cury fell to 43° and 4G°.* It was observed by Sydenham, that the greatest mortality of (he plague happened about the autumnal equinox; and the same author advances the position, that the effects of cold upon the human body, have exceeded the combined ravages of war. pestilence and famine.! As to the influence ofthe protracted use of cold bathing in exciting both intermitting and remitting fevers, many in- stances have fallen under my own observation. During my residence in Louisiana, many ofthe soldiers were in (he daily habit of swimming and bathing in the river; and in the indulgence of this amusement, frequently remained in (he water above half an hour at a time ; in consequence of which it not unusually happened, (hat three or four ofthe number would be reported sick on the ensuing day with fever and ague, frequently relapsing and running into the bilious re- mittent. This injurious practice was at length limited to once a week, after which the attacks were less frequent. Captain Delano, speaking ofthe practice which his com- pany were in, of bathing in the river at the island of Timor, says, " we paid dearly for the pleasure of fresh water bathin^. We took it so frequently, and s(aid in the water so long, (hat we brought on intermittent fevers, and several of our offi- cers died. All would have died, had we not left off this in- dulgence. Europeans must be always cautious how they bathe in fresh water in hot countries. The effects of it in Timor is not the first instance of the kind which I have known from personal observation."t Low and damp places, by favoring fhe diffusion of mias- mata, are more unhealthy than those (hat are high, dry and broken. For the same reason those who live on the ground floor are more obnoxious to fever than those who live in the upper stories of the same houses. Dr. Russel, during his re.-i Jence at Aleppo, was in the practice of prescribing, from the second story to several hundred of pestilential patients, who assembled every morning beneath his window. In many parts of our country we see people with sallow, sickly, and bloated countenances, inhabiting the vicini- ty of a low and marshy valley or reed brake, for the sake * Med. Inq. & Obs. Vol. III. p. 91, 92. t Sydenham's Works, p. 74. X Delano's Voyages, Boston, 1817, p. 107. Predisposing and Exciting Causes. 16$ of convenience to water, and who, by fixing their residence at a greater distance, instead of agues and dropsies, might enjoy health and longevity. It is observed by Dr. Munro, that the more moist the season, the more subject an army is to agues. A damp air and foggy weather have always been found to be more fa- vorabie for the origin and spreading of malignant diseases, parti y on account ofthe reason already assigned, as facilita- ting putrefaction, and favoring the diffusion of morbid poison, and partly by checking perspiration. Dr. Lind and Dr. Smith supposed that a damp air increased the strength of contagion, from the idea that humidity was more favorable to its diffusion through the atmosphere. Assalini observed that the citadel of Cairo, on account of its elevate 1 situation, preserved the inhabitants of this fort arid its environs from (he plague. " If the inhabitants of this fort.1' says he, " in spite of their daily intercourse with those ofthe city, were preserved from this disease, it must be be- cause the damp and infected air, which had destroyed the health ofthe inhabitants of Lower Cairo had not sufficient elevation to reach the*highest part of the citadel and its environs, a/id consequently could not impair the health of those who lived there."* The presumption is, that infectious miasmata are mostly confined to the surface ofthe earth, and never rise to any considerable distance above it; or if they do, by being blend- ed and diluted with the common atmosphere, they lose their virulence and infectious property. The circumstances under which the application of cold to the body proves most prejudicial, are, on the part of the per- son, debility ; and with respect to the cold itself, a sudden transition from a high to a reduced temperature, its protract- ed application to the body, together with a state of dampness. When applied to the surface ofthe body through the medi- um of wet clothing, its power and effects are more immedi- ate and prejudicial than when applied to the inner superficies ofthe lungs, by respiration. As water is a denser medium than air, its application will convey a stronger sensation to the body than air of (he same temperature ; partly because it is a more rapid and better conductor of heat; but it is principally on account of the evaporation which takes place from the surface ofthe body when a person has become wet in a shower, that the sensation of cold is experienced. Wa- ter is here only the medium by which the cold acts upon the * Assalini on the Epidemic of Egypt, p. 58. W 170 Predisposing and Exciting Causes. body, and provided no evaporation took place, the sensa- tion of cold would not be produced, nor would any evil con- sequences ensue. Dr. Lind advises that in unhealthy cli mates and situations, as the East and West Indies, the crews of vessels be kept at work, upon deck, as little as the nature of the service will permit, before sun-rise and after sun-sctting, and only when the sea breeze blows. This advice is founded upon the conclusion, that when the sun is above the horizon, the nox- ious land vapors are more dispersed ; they are then much rarer than in the night, or even in the evenings and morn- ings when they become denser and more apt to infect, and when the atmosphere is more charged with miasmata in consequence of its greater humidity. Dr. Lind relates it as a matter of constant experience, that the greatest suffer- ers in unhealthy harbors are the boats' crews, and such as being employed in the necessary business of wooding and watering the ship, are obliged to sleep on shore, where (hey are exposed to the unwholesome land air: since in sleep their bodies are in a state of relaxation, and in (he greatest danger of infection. We are further told by the above named author, that this circumstanced so well known at Rome, that scarce an inhabitant of comfortable circumstan- ces would venture, during the summer and autumn, to sleep a night at Ostia, or in the neighborhood ofthe marshes ad- joining the city. " A clergyman of long observation in such matters," says Dr. Lind, " assured me that few ofthe farm- ers, reputed early risers in his parish, which is near the level coast of Holderness, live to be old."* It has been suggested by some, that the moon in its chan- ges has an influence upon the constitution in disposing the body to be affected by intermittents. This opinion has been advanced and defended by Dr. Jackson, Dr. Lind, and Dr. Balfour; though the two latter, from subsequent experience, seem to have receded from their former belief. The ideal in- fluence ofthe moon and stars upon the human body, is a relic ofthe old astrology, witchcraft and superstition, which gov- erned and led the weak minded in the days of our Trans-At- lantic ancestors. The mind, as well as the body, was thought to be under the influence of the queen mistress ofthe niodit, and persons laboring under derangement were (he supposed victims of her displeasure, and, in compliment to her di- vinity, styled lunatics. It would appear, however, (hat (he only remote influence which the moon can have in (he pre- * Lind on the Diseases of Seamen, p. 7.1-4. Predisposing and Exciting Causes.. 171 duction of disease, is by occasioning, at the change and full, a greater elevation ofthe tide, which upon receding leaves the marshy grounds, with the animal and vegetable matter, to undergo putrefaction. This effect will be most remark- able in warm climates, where the land is low and subject to inundation. As marsh miasmata, as well as contagion, are limited in the extent of their diffusion, a removal to a short distance from these infected places, will be sufficient to en- sure safety and protection from such noxious exhalations. Among the natives and old residents of warm and unheal- thy climates, the miasmata, or semina of disease, frequently lie dormant and inactive in the body, producing little or no derangement of the health; the constitution, from long habit, being accustomed to those unwholesome exhalations, be- comes, in a great degree, insensible to their operation.— They, however, frequently, in such persons, give occasion to an increased secretion of bile, which, after accumulating in considerable quantity, often effects its own expulsion, either by vomiting or stool; and, as observed by Dr. Clark,* we may frequently see the natives of warm climates vomit- ing and discharging great quantities of bile one hour, and; the next hour riding into the country, quite relieved from every symptom of indisposition. * Observations o,n the Diseases which prevail in Long Voyages to Ho^. Countries. 1*2 Operation ofthe Remote Cause?,. CHAPTER IV. OPERATION OF THE REMOTE CAUSES. Of the primary mode in which Infection or Miasma comes to operate upon the System in the production of Disease. That marsh miasmata, and the exhalations from putrefy- ing animal and vegetable matters, in any other situations, act as the essential causes of endemic fever, there are pro- bably but few who have the skepticism to doubt. There appear to be but three ways in which ihe prima- ry operation and impression of febrile infection in producing disease can be explained. 1st, Either by referring this effect to its action on the surface of the body ; or, 2dly, On the lungs through (he medium of respiration ; or, 3dly, On the stomach and bowels. A secondary consideration is, whether its operation in the production of fever is upon the vascular or nervous systpm. Darwin, Gardiner, Turner, Senac, Lind, Hunter and Bal- four, were of opinion that the infection of fever'is received into the stomach; and this seems to have been the prevail- ing opinion among those physicians who have expressed their sentiments upon the subject. The opinion of Dr. Fcrrier that infection may produce disease by direct impression on the olfactory nerves, is scarcely entitled to consideration. Dr. Moseley seems to express a belief, that pestilential fevers are produced by a primary impression on the surface of the body. Fernelius, Pugnet, Bell and Currie express their belief ofthe infection being received by the lungs in respiration. Fracastorius seems doubtful whether contagion is not communicated by absorption from the surface of the. body; but at the same time supposes (hat in the majority of cases it finds admission from the air in respiration. Operation of the Remote Cause*. 17S With regard to the opinion of infection* being received into the stomach, it may be observed, that the inference is drawn from appearances not altogether satisfactory and conclusive, viz. the nausea and vomiting which frequently occur at the commencement of fever. But these symptoms are also common in other cases, wherein we know that no infection has been received in this manner, and consequent- ly that (his disorder ofthe primae viae may be satisfactorily accounted for from an affection of the general system. This is exemplified in the inoculated small pox. It is well known that the stomach is a very important organ, and much dis- posed to sympathize in affections ofthe whole or of partic- ular parts of the system. It is upon (he healthy condition of this viscus that the soundness of every part of the animal economy essential depends. Pain destroys the appetite, as do also distressing passions and affections of the mind. A dissection of a dog by Dr. Cooper, that died with hydropho- bia, exhibited all the usual marks of inflammation and effu- sion which take place in common malignant fever. And the affections of the stomach in this disease are no less re- markable than in the yellow fever: such as nausea, a burn- ing sensation in the stomach, vomiting and costivencss. So that this affection ofthe stomach can afford no proof of the morbific matter of fever, being primarily applied to it. But in relation to the manner in which infection is received, is it not improbable that a sufficient quantity of the febrile vi- rus should have been absorbed by the saliva, to produce dis- ease ? It is well known that the symptoms of fever have been suddenly produced, in consequence of a few moments' exposure to virulent and concentrated febrile infection.— Lancissi, Lind, Pringle, &c. give instances of persons who were exposed to the exhalations of marshes, being suddenly affected with sickness, vomiting, delirium, and other symp- toms of fever, which continued till the disease had run its usual course. In such instances the short period of expo- * As I may frequently have occasion to make use of the words infection and infectious, it is proper to define the sense and acceptation in which I employ them, in order to draw the line of distinction between infection and contagion. For this purpose I would observe, that an impure atmosphere, whether occasioned by animal putrefaction, marsh miasmata, or other cau- se* capable of producing disease in the person who breathes it, is infectious; and where disease is communicated from one'itk person to another, either through the medium of the air or by contact, it is understood to be conta- pous,°thou»h in both instances the matter producing disease may, with the strictest propriety, be called infection. The first may be styled the infec- tion from putrefaction, or infection from external causes; the other the in- fection from disease. 174 Operation of the Remote Causes. sure, and the sudden and violent commotion produced would seem to forbid the idea that the morbific virus had affected the sanguiferous system through the medium of (he prima) via3. Moreover, "instances are recorded wherein persons have swallowed the infection of small pox and lues venerea with impunity.* Again ; persons, from sleeping in un- healthy places on shore, have received the seeds of a fever, which did not ripen into disease till after the vessel had been ten or fifteen days at sea ;t can we suppose that the semina of disease could have lain all this time in the primae viae without having sooner disordered (he functions of health? Besides, we know (hat very offensive things have been taken into the stomach as articles of food, or otherwise, either with impunity, or else the offending substances have effected their own expulsion by vomiting, or by the production of diar- rhoea, which ceased as soon as the offending matter was ex- pelled. These miasmata are aeriform substances ; and we know that carbonic acid gas, an aerial fluid, the most de- structive to animal life when received into the lungs by res- piration, is perfectly innocent and even salutary when taken into (he stomach. It is scarcely consistent with the present state of anatomi- cal and physiological sciences to suppose that disease is communicated through the medium of the surface of the body. The cuticle is destitute of nerves and blood vessels, * We are informed by Dr. Rush, that in Maryland, the negroes eat, with safety, the flesh of hogs that have been previously bitten by mad dogs; and that he has heardof the milk of a cow, at Charleston, in the same state, hav- Lig been used, without any inconvenience, by a whole family, on the same day in which she was affected with this disease, and which killed her in a few hours. In confirmation of similar facts, he quotes the authority of Dr. Baumgarten, in the Medical Commentaries, who observes that the flesh and milk of rabid animals have been eaten with perfect impunity. Rush's Inq. and Obs. Vol. II. p. 326. No direct conclusions, however, can be drawn from lhe?e circumstances; and as to the venereal matter being swallowed, as related by Bell, Hunter and others, without producing any disorder, we should recollect that the stomach possesses the power of changing the qual- ity of most substances taken into it—that the gastric juice or fluid is a pow- erful agent—and that as the stomachs of all animals not exclusively carni- vorous, contain a greater or le3s quantity of acid, of course all alkaline substances will become neutralized ; and whether alkaline or not, will be materially changed from their original qualities. But there is a point be- yond which this corrective agency of the stomach ceases, and where the poison received abounds in excess, in consequence of the quantity being too great for the neutralizing or corrective powei ofthe stomach, the same effect will be produced as if the infection had been immediately received into the mass of circulating fluids. This appears from the experiments of Fontana, which will be hereafter noticed. t Badinach Med. Obs. & Inq. Vol. VI. Blane on the Diseases of Sea-. men. Lind on Hot Climates. Operation ofthe Remote Causes. 175 and, therefore, seems to be incapable of sensation, or per- forming the function of absorption; and in order for the miasmata of disease to act upon the system, from applica- tion to the surface they must enter the pores ofthe cuticle by absorption. But physiological researches, as well as the phenomena of health and the symptoms of disease, seem to prove that transpiration, and not absorption, takes place from the surface of the body. Doctors Rosseau, Clapp and Dangerlield, have illustrated this subject in (heir experi- mental inquiries,* from which it appears that even spirits of turpentine, when applied to the body in (he form of a bath, does not impregnate the urine with its odour, provided the person avoids (he vapor, by breathing the external air through a tube; but (hat the impregnation becomes very pungent from breathing (he vapor for a short time, though the spirits had not been applied to the surface. The same experiments were made with mercurial ointment and with a similar result, with (his difference, that the person who applied the friction to the others protected his hand by a glove, but being exposed to the vapor through the medium of respiration, he became impregnated with the mercury, whilst the others to whom the mercurial ointment was ap- plied, and who avoided the mercurial vapor, remained un- affected. Richerand, however, who stands high as a physi- ologist, is of opinion that absorption does take place by the skin, and founds his opinion on the following arguments.— "The increase of the weight of (he body after walking in damp weather; the abundant secretion of urine after re* m lining some time in a bath; the evident swelling of the inguinal glands after lon^ continued immersion of the feet in water, an experiment often made on himself by Mascag- ni; the effects of mercury administered by friction, &c. 5 incontestibly prove that absorption is effected by the skin, under different circumstances with more or less activity."! In support of the same opinion, it was found by Stuart that the color ofthe urine was increased by the immersion ofthe body for an hour or two in a bath tinctured by an infusion of madder, rhubarb, &c.| The instances brought forward by Richerand, however, are most of them explicable by re- ferring them to the absorbing power ofthe lungs. A curi- ous fact in support of cutaneous absorption is mentioned by * See their Dissertations on Cutaneous Absorption in Caldwell's Collec- tion of Medical Theses. t Richerand's Physiology. On Absorption. X See Experiments and Observations in defence of the doctrine of Cuta- neon« AbsorptieH. By Josepbuj B. Stuart of Albany. 176 Operation ofthe Remote Causes. Dr. Simpson, of a youth who, laboring under a fever, was seized with a diarrhoea ; whilst in a state of stupor, his whole body was burning with the fever, no drink could be administered, nor his mouth moistened ; in this condition his feet were immersed in cold water, upon which the fluid in the vessel suddenly diminished in quantity, and the same water, scarcely colored, was immediately discharged per anum, as if from the operation of a cathartic* 11 in cer- tain instances absorption does take place from the surface, the presumption is, that this is not effected in any consider- able degree under ordinary circumstances, to which the garments that invest the body would form a considerable obstruction. The modern experiments of chemists would seem to prove that absorption by the lungs is not required in order that the necessary changes may be effected on (he blood by the action of the atmospheric air; that the change of the blood, from venous to arterial, is effected in the lungs, prin- cipally by the loss of its carbon which is given out, and com- bining with the oxygen received by inspiration, forms car- bonic°acid gas, which is thrown off with the aqueous vapor and the unconsumed nitrogen. If absorption can take place from the surface of the body, we may reasonably suppose that this process is effected with more facility by the lungs, where the membrane interposed between the blood vessels and absorbents and the air received in respiration is much more delicate and thin than the cuticle. And although oxygen itself may not be absorbed, this does not foi bid the supposition that other aerial substances may find admission. Lymphatic and absorbent vessels we know are plentifully distributed through every part of the animal frame, and we should suppose that in such an organ as the lungs, the ab- sorbing power would be nearly as great upon their contents as those of stomach and bowels are upon the chymous fluid. In support of this opinion it may be remarked, that Fontana found, whilst he was under the operation of a brisk purga- tive, that his weight was increased several ounces during a walk in the evening for an hour or two, when the atmos- phere was moist. A case still more striking is related by Dr. Watson. A boy who had been sweated and starved down to a certain weight, in order to fit him as a rider in a horse race, acquired an additional weight of thirty ounces in the course of an hour, (hough he had only drank half a * Simpson De Re Medica. p. 133, quoted by Percival. Ess. Med. & Ex per. Vol. II. p. 162. Operation ofthe Remote CauseSi. 177 glass of wine in the interval. "There are many cases," says Dr. Rob'i'son, from whom I have borrowed the above instance, '• where the quantity of urine voided by a diabe- tic patient, is not lessened, even when the skin has been Covered with greasy applications ; and in such instances, the excretion in (his way has been found to exceed the whole injesta : in these cases, (he absorption of water could only take place through (he lungs.* The following fact gives, likewise, an additional confirmation of this opinion. Several people, who were under (he necessity of passing their tsmo in a very damp situation, perceived that they had regular calls during the night to pass urine; which took place repeatedly when their skins were covered with per- spiration, and after a die.ner of animal food, with a few glasses of wine, and when no supper, or any hqu>d had been taken for many hours before going to bed. This circum- stance continued to be the case for several weeks, til' the increasing temperature of (he atmosphere lendered their situation somewhat dri r.t Goodwin thought he had observed a considerable ab- sorption of niiro^en or azotic gas in respiration; but his experiments on (his subject were not decisive, and were consequently disregarded. The later experiments of Mr. now Sir Ihrnphrey Davy, put the fact beyond a doubt; and if any confirmation of it were wanted, it is furnished by (he experiment of M. Pfaff. It is remarked by the editors of liie Medical and Chirurgical Review, that the azote or nitrogen absorbed during respiration, enters into the com- position ofthe fluids, and serves to render them more high- ly annualized or azotized. In this way, say they, we may account for the transformation of chyle into blood, during its passage through the lungs. Besides, in animals exclu- sively herbivorous, whose muscular fibres consist of a great proportion of nitrogen in a solid state, there is no other way of satisfactorily accounting for the entrance of this element into the composition of the body, except from its absorption from the atmosphere. It is related by Dr. Kiel that a young * The argument which the Doctor draw9 from this fact, though plausi- ble, i< not conclusive. For we know that in diabetes there is a rapid wast- ino-'of the body, and we therefore conclude that Ihe solids themselves are melted down, taken up by the absorbents, and carried off by urine; so that. unless the quantity of urine voided exceeds both the injesta and the wasting ofthe body, making due allowance for pulmonary and catamous perspira- tion, we cannot reasonably suppose that any absorption has taken place by the lung-, or '.-.kin. ■e Robert^m** lieiory ofthe Atmosphere and Epidemics, Vol. fj. p. 301. X 170 Operation ofthe Remote Causes. man gained, after much Ailigue, during the space of one night, sixteen ounces. The vapour of melted lead will ex- cite the cohca pictoneum in those who are exposed to it, as is the case with plumbers, potters, and shot makers ; and globules of mercury have been found in the bones of the skulls of those whose occupation obliged them to be expo- sed to the vapor of this metal. It has also been ascertained that the absorbing power of the pulmonary lymphatics is much increased by long fasting and a state of inanition. From which we deduce the important pracfical conclusion, that it is dangerous to expose one's self to infection with an empty stomach. We know that (he noxious exhalations which produce fe- ver are in an aeriform state ; they7 must, therefore, necessa- rily be received into the lungs in respiration, and by being immediately applied to the mouths of the pulmonary ab- sorbents, may thereby be received into the mass of circula- ting fluids. It does not appear that the absorbents possess any particular appetency, or discriminating power, whereby they reject such substances as are deleterious, and receive only (hose which are salutary ; were this the case, mankind would be exempt from an infinite number of calamities ; but w • find that these delicate vessels absorb with apparent in- difference the blandest lymph, the venereal or pestilential virus, the small pox infection, or any other matter of suffi- cient tenuity for their reception.* It has been generally supposed that carbonic acid gas proves destructive to animal life, merely by its negative properties in excluding vital air, and thereby preventing the purifying operation of the latter on the blood as it cir- culates through the lung-. It appears, however, that the deleterious property of carbonic acid gas is owing, not so much to its negative qualities, as to its absolutely deleteri- ous property. It is stated by Mr. J. Hunter, that fishes will survive longer in water deprived of air, than in that which is impregnated with carbonic acid ; and it is observed by Dr. Black, that when the respiration of birds is prevented by closing; (heir nostrils with suet, they live longer in carbo- nic acid gas. than when they are permitted to inhale it. It would appear, therefore, that in such instances carbonic acid, or the carbon separated from the oxygen, enters the circulation and acts immediately upon the heart and arte- ries. The venous blood returned to the heart abounds wilh lickshank, take up the most :s. p. 123. Operation ofthe Remote Causes. 179 an excess of carbon, which it is the function ofthe lungs to separate, but if instead of this, it becomes still more highly carbonized, as by the respiration of carbonic acid, life will be more speedily destroyed than by a mere negation of the common atmosphere. It is ascertained that vegetable, mineral, and morbid poi- sons are taken up by the lymphatic ofthe stomach and bow- els. Of this, instances will be given hereafter. But to il- lustrate the fact that morbid poisons will act upon the gen- eral system when taken into the stomach, it may not be ir- relevant to notice the following (act. A poor man is men- tioned in the Medical Repository, who, unable to pay the expense of inoculation, and being himself ignorant of the process, procured a quantity of the variolous scabs, and hav- ing pulverized them, spread them plentifully on a piece of bread and butter, which he gave to his children, and with the desired success; we are further informed that the dog, also, who partook ofthe repast, was in like manner seized with the small pox.* Admitting that the infection producing fever is received into the prima? vias, the quantity to take effect must, to use a common expression, be infinitely greater than if received by the lungs: for we know that the stomach possesses the power of changing the qualities of substances taken into it, in such a manner as to convert them to a different nature. * Med. Repos. Vol. I. p. 247. It may be- considered as a physical fact, that, in general, the inferior order of animals, or the brute creation, are not subject to the same diseases from morbid poisons and from pestilen- tial constitutions of the atmosphere as the human race; to this, however, exceptions are recorded by different authors. We are informed by a res- pectable writer, that in an epidemic season of the confluent small pox, tur- keys, fowls and other poultry were carried off by the disease in great num- bers, and had the same symptoms usually accompanying every stage of this distemper in the human species. HohcalVs account of the manner of inocu- lation, as quoted by Walker on Small Pox. It is remarked by Dr. Rush, that malignant and mortal epidemics are often preceded by uncommon sickness and mortality among certain birds and beasts. They have both appeared among wild pigeons and cats in the United States. The mortality among cats, previous to the appearance of epidemics, has been taken notice of in other countries. 'Dr. Willan says it occurred in the city of London, between the 20th of March and the 20th of April, in the year 1797, before a sickly season, and Dr. Buneiva says it preceded a mortal epidemic in Paris. The same thing was observed in the plague which prevailed in R,ome, B.C. 461, which, according to Livy, affected both men and cattle with equal malignity. And it is said by Dionysius of Halicarnassus, that the disease seized horses, herds of cattle, and flocks of goats and sheep. We are abo told by Orosius, that the plague which originated in Africa, B. C. 126, was not confined solely to the human species, but that a general mor- tality of birds, cattle and wild beasts marked the progress of its, destruc- tive ravages. 180 Operation ofthe Remote Causes-. Thus, in various instances, (he variolous infection, (not, how- ever, in the quantity above mentioned.) the virus of hydro- phobia and of the venereal have been swallowed without producing any inconvenience or indisposition* .Xon gnslu, sedin vulnere nocent, says Celsus, '"poisons do not piove injurious from being taken by the mouth, but from the in- fliction of a wound." Plenk observes, that the poison of vipers is taken wilh impunity into the stomach.t The fam- ilies ofthe Psylli in Africa, and ofthe Marsi in Italy, v^ere supposed to cure (he biles of venomous serpents by the power of enchantment, or by some invulnerable idiosyncrasy of constitution ; and what was then surprising to the mi I gar, that (hey should suck out (he venom of the wound with their mouths and remain uninjured, is divested of mystery by physiological knowledge.j It is said that the ivoorara poi- son may be taken into the stomach without any ill conse- quence ensuing.§ These facts do not. prove absolutelv that poison in any quantity taken into the stomach is innocent and free from danger, they only prove that the quantity received was not suflicienlly great to withstand the neutralizing powers of the stomach. And there can be no doubt that had the quan- tity been much larger, (he effect would have been as fatal as if it had been inserted into a wound. It appears from the experiments of Fontana, that poison acts in proportion to its quantity and the size ofthe animal to be acted upon ; that, for instance, the thousandth part of a grain is sufficient to kill a sparrow, by introducing (be venom immediately into the muscle by incision. Suppo- sing the sparrow to weigh an ounce, he calculates that twelve grains of venom will be necessaiy for the destruc- tion of an ox of 7501b.; and two grains and a half to kill a man, supposing him to weigh 150lb.; that admitting a viper to contain two grains of venom, it will require the venom of six vipers to kill an ox. and nearly two to kill a man; but as the viper does not discharge all its venom at a bite, it may require twenty vipers, each biting only once, to * Galen de Temperament's, lib. iii. cap. ii. Mead's Works, p. 151. Fo- dre. Med. Leg. torn. iii. p. 674. Rush's Med. Inq. & Obs. Vol. III. p. 409. Hunter on the Venereal. Bell on the Venereal. + Venenum viperinum ventriculo ingestum impure fertur. Toxicolog. p. 10. See also Boerhaave de IMorb. Ner. torn. i. p. 207. Rhcdi. Obs. on Vipers, &c. p. 17 X See Mead's Works, p. 29. Plin. Hist. Na*. lib. vii. cap. 2. .Elian. Hist, Animal, lib i. c. 5C, and Lucan, lib. ix. ver. 1591. J Dr. Bancroft's History of Guiana. Operation ofthe Remote Causes.. 181 kill an ox, and five or six with the same restriction,to kill a man.* But it appears that it requires a thousand times as much to produce death when the venom is received into the. sto- mach as when inserted in a wound. Thus six grains were necessary to kill a pigeon when the venom was giver, by the mouth ; and according to the same calculation, five ounces, or the venom of 240 vipers, are required to kill a man in the same way.t It appears also from the experiments of M. Delile of Paris, that a larger quantity of the poison of the Bohon Upas, or the Upas Tituete of Java, is neees-ary to destroy an animal when taken into the stomach, than when it is inserted into a wound. Such is the power ofthe stomach in changing, resisting or neutralizing poisons.— However interesting, it does not come within the liuiiis of my present inquiry to examine and discuss the action of morbid poisons in all their various modes of operation ; this much, however, was thought necessary in the investigation of the subject under consideration. It is not conclusively proved, however, from what has been advanced, that ihe in- fection of fever may not come to act upon the system through the medium of the stomach and bowels; it shows, however, that its chance of affecting the general system is much w Ev- ened, and that a large quantity is required to take cfleet when received into the stomach. In support of the opinion that the infection is received by the way of the lungs, we have previously noticed (page GO) the circumstance mentioned by Dr. Lind, of the marines being suddenly taken ill while exercising on the South Sea beach; as also the instances mentioned by Lancissi. J of a company of gentlemen and ladies being suddenly attacked with fever, from exposure to marshy exhalations, whilst re- turning to Rome from an excursion of pleasure; likewise the instances of sudden death.§ and the cases of fever im- mediately produced in 114 persons by the vapor which is- sued from a coffin, mentioned by Pierre Cotte. Similar in- stances are quoted by Sir John Pringle, from Show's Chron- icle, of several hundred persons being suffocated and sud- denly attacked with fever from the air of an infected prison. It may be urged that in those cases where dea(h or suffo- cation is instantly produced by exposure (o noxious effluvia, the effect must be ascribed to their immediate operation on * Fontana on Poisons, Vol. I. p. 286-7. t Ibid. X See page 60 of the present work, i See page 73. 182 Operation of Ihe Rcmoi<- Causes. the nervous system :* this is probable ; for we know that in many instances the symptoms suddenly occasioned in this manner subside and disappear, without terminating in an established fever; and therefore conclude that the affection has been merely nervous; but when fever is the conse- quence of such exposure, a reference to the nervous system alone, will not explain the circumstance : for did these fe- brile agents act exclusively upon the nerves, it would be reasonable to suppose that no perceptible time would be necessary to elapse between the application of the cause and the appearance of the effect: for experience teaches us that stimuli, or agents applied to the nerves, evince (heir immediate operation : besides, were the action of these causes confined to the nervous system alone, should we not embrace an improbability in supposing (hat they could lie in contact wilh the nervous expansion, in the air cells of the lungs, or in the nose, trachea, or stomach, for the space of ten or fifteen days, and then, and not till then, exert, for the first time, their deleterious operation? In the meantime, what should hinder their being expelled with the same breath by which they found admission, or of being carried off by stool ? If their mere presence in the lungs or stomach, without being taken into the circulation, were all that is re- quired in the production of disease, instead of accumulating force, these miasms, like other agents of long continued ap- plication, would lose their efficacy. It is not impossible, however, that febrile infection may, in a certain degree, find admission into the circulation by the way of the stomach and bowels; but, from what has al- ready been said, the probability is, that under ordinary cii- cumstances, this is not the channel of admission. * It has been a received notion among some physiologists, that there was a shorter and more direct communication between the stomach and the bladder than the circuitous one ofthe lacteals and blood vessels. For the purpose of deciding this question, M. Fodera has performed some inter- esting experiments. See the Medical and Physical Journal. In one of these he introduced a catheter, with a cork adapted to it, into the bladder, and then injected a solution of the prussiate of potass and iron into the sto- mach ; as soon as the salt was detected in the urine, (an occurrence which in one instance took place in ten, and in another at the end of five minutes,) the animals were instantly opened, and the "prussiate was found in the blood ofthe vena cava inferior, of the heart, and of the aorta, in the thoracic duct and other parts. Should these experiments be confirmed by subsequent researches, the difficulty physiologists have encountered in explaining the quick transmission of fluid substances from the stomach to the bladder, will be obviated, in the demonstration ofthe rapidity ofthe absorption and pro- gress of such substances through the ordinary channel of the lacteals or lymphatics and the sanguiferous system. In this way, also, might be ex- plained the sudden operation of infectious miasms. 4 Inquiry into the Seat of Fever. 18S Fernelius says that what comes in contact with our breath, is carried through the lungs to that noble viscus, the heart, thence into the arteries, seizing at length upon every part of the body; disordering first the spirits, {spiritus) then the humors, {humores) and lastly, the substance of every part. {Postremo substantium ipsarum partium labifaclat.) CHAPTER V. INQUIRY INTO THE SEAT OF FEVER. Facts in support of the opinion that the Immediate Cause of Fever exists in the Circulating Fluids. That the mia-ms of fever are received into the general mass of circulation, we have the strongest arguments for be- lieving. We know that when the matter of small pox is inserted into the skin, a certain time is necessary for it to take effect, and as the skin abounds with absorbents, we have every reason to suppose that the variolous, as well as the venereal virus is received into the circulation, and commu- nicates its properties to the mass of fluids. We can scarce- ly suppose that the sympioms which follow the infection of the small pox are merely the consequence of an impression on the nervous system. Can we believe that an almost in- visible atom, barely sufficient to cover the point of a lancet, should lie inactive in the body for the space of a week, and then suddenly break out, as it were, in an explosion on the general system ? And if the essential operation of these morbid agents is upon the brain and nerves, why are the heart and blood vessels excited into action ? Shall we, with Dr. Cullen, con- fess our ignorance at the onset of the inquiry, and refer the effect to the conservative interposition of the vis medicalrix nalura? We know that a change of the nervous does not necessarily involve that of the sanguiferous system. We frequently see the body agitated with convulsions, or made 134 Inquiry into the Seal of Fever. ri^id with the lockjaw or tetanus, without communicating febrile com.notion to the heart and arteries. But although the brain, nerves, and nviscular fibres of the limbs may be i .olen'iy affected without disording the muscular system; yet the converse of this does not hold equally true, and for a very obvious reason : because the blood is the stream and fountain of life, and the source of health, nourishment, and :-upp -i. to every part ofthe animal frame. If the blood be ;:he<-ed from its healthy s(3te, not only (he heart and arte- ries, but every part of the general system partakes of the c =-order. That (he blood is subject to vitiation, there can be no doubt. This I have attempted to demonstrate in another work, when treating of scurvy.* Suppression of urine, on some occasions, gives rise to the symptoms of violent delirium and fever, attended with an urinous smell in all the excretions from the patient's body. It is remarked by Dr. Ferrier, in his Medical Histories and Reflections, as being a well known fact, that in fatal cases of ischuria, when the patient dies comatose, the ventricles of the brain are filled with a fluid which has the sensible quali- ties of urine. And i( is remarked by Bromfield, that if the cause of ischuria is not immediately attended to, a violent fever comes en, with retchings to vomit, sometimes coma ensues. A temporary relief is frequently obtained by a profuse sweat coming on. which is extremely offensive, from is strong urinous smell.t ;" A sufficient attention," says Ricln-rar.d, " has not hitherto been givento the symptoms of urinous fever, an affection occasioned by a too long reten- tien ofthe liquid in the cavity ofthe bladder.'' I have fie- quentlv had occasion to observe that no disease gave better marked. sige£ of what physicians call putridity. The urin- cusand ammoniacal odour exhaled from the whole body in Hckness. ihe yellow greasy moisture covering the skin, the great thirst, tiie dryness and redness of the tongue and throat, the frequency and irritation of the pulse, joined to the softness and fiacridity of the celular membrane, all indi-i cate that the animal substance is menaced wilh speedy and prompt decomposition.\ It has been previously remarked, that the lymphatics ab- sorb indifferently every substance that is presented (o (hem of sufficient tenuity to be received by their orifices; and * Pe- O'^mtions on the Topography and Diseases of Louisiana* t Bromfield's Chirurgical Obs. aud Cases, p. 293. 1 Richerand s Physiology, p. 95. Inquiry into the Seat of Fever. 1§5 in this way the blood becomes impregnated with the odour and qualities of substances taken into the stomach, or inhal- ed in respiration. Mr. Menghini found by experiment, that the blood of persons who take martial preparations, con- tains more iron than it does in an ordinary state. And Mr. Lorry observed, that the urine of a sick person, to whom had been exhibited iron in a state of extreme comminution, was colored by nutgalls, thereby demonstrating the pres- ence of iron.* The liquor amnii was found tinged with saffron in a woman who had used a large quantity of this article.! The use of indigo imparts its colour to the milk; and madder and the Indian fig give it a red tinge.% The exhi- bition of wormwood renders the milk bitter, and thyme, garlic, and onions impregnate it with their odours.§ A cathartic given to the nurse purges the child ; and spir- i'uous liquors taken by the former, will occasion intoxica- tion and convulsions in the latter ;|| and it is related by Dr. Peroival, on credible information, that cabbage and other flatulent vegetables, taken by the nurse, have occasioned * It is the function of the excretory organs to separate such excrementi- tious substances from the blood as are incapable of being animalized, and are consequently unfit for the nourishment of the body. The lighter and more attenuated matters, and such as are capable of being volatilized by the animal temperature, pass off by the skin and lungs : in these excretions we may discover, when the persons have taken the substances that afford these odours, the smell of garlic, onions, assafcetida, sulphur, and most of the essential oils. Substauce3 of a gross consistence, yet being soluble in the animal fluids, as the various earthy and saline matters, which have ei- ther lost by age the qualities which rendered them serviceable in the ani- mal economy, and have become too much animalized by long continuauce, or which, when taken into the stomach, are unfit for nutrition and incapa- ble of undergoing-assimilation, such substances are principally determined to the kidneys and pass off by urine. The conversion of alimeneiry substances into animal matter, is chiefly ef- fected by the loss of its iarboa ;. which change i?, in a great measure, ac- complished in the lungs, by the combination of the oxygen of the air with the superfluous carbm of the b'o.'d, formiag carbonic acid gas Between the function of the skin and that of the kidneys, there is a great analogy, so that when the one is increa>ed, tKe other is diminished, and vice versa—In warm climates, and in the summer seasor, the perspiration exceeds the se- cretion of urine, which is smaller in quantity and high colored, abounding with alkaline salts. It is likewise worthy of remark, that in warm climates the perspiration is more acrimonious than in cold ones. Hillary says that in hot climates the sweat is so very salt and acid, as to taste like salt or spi- rits of hartshorn, mixed with water in considerable proportion. Hillary en the Diseases of Barbadoes. This observation, with some abatement, is correct. + Haller. Elem. Physiol. Vol. iii. de fcetu. X Ibid Vol VII. de lacte. i Ibid Vol. III. Numan's Chemistry, p. 569. [| Boerhaave Proelect. sec. 690. lialler Elm. Physiol. Y 186 Inquiry into the Seat of Fever. gripes in the child.* It is said by Boerhaave, (hat ale, taken' by a fasting uurse, has in a short time been discharged by the breast.| G me din states that the milk of such as are salivated, will occasion salivation in a child. By slow evaporation, Dr. Hunter discovered globules of mercury in (he milk of a woman laboring under salivation. It is proved by the experiments of Dr. Alexander, that nitrate of potash rc(ains its nature and properties after it has gone through the circulation.! A purgative quality is given to the milk of cows which have fed upon hedge hyssop. It is related by Diascorides, that the milk of goats that feed on the scammony plant and spurge, proves cathartic. We are told by Haller, that field fares, by feeding on the berries of the rhamnus caiharli- cus, are found purgative to those who eat them.§ The medicated qualities communicated to the milk by the vegetables on which animals feed, was not unknown to the ancients; and such was their conviction of their efficacy in this way, that in some diseases they prescribed the milk of animals which had fed on vegetables, proper for the cure of those diseases. "According to the strength and difference of the food," says Crantz, "such is the diversity of the milk; from the former, the chyle is good or bad, bitter or sweet; so also, is the milk from the latter; as are the injes- ta, so is the chyle ; as is the chyle, such is the milk asserted to be, and is confirmed by experience."|| The milk of goats which have fed on astringent and balsamic vegetables, has been recommended in diarrhoea ; and cows having fed upon lettuce, pelatory, madder, or purslain, afford milk so imbued with the unchanged qualities of these plants, as to communicate their usual effects to such as use the milk thus impregnated.^ In jaundice the bile is taken into the mass of the circu- lating fluids : and Maribilli says the urine of a person labor- ing under this complaint, has an intensely bitter taste. In jaundice the urine has an orange yellow colour, and com- municates the same tint to linen. Muriatic acid renders this urine green, and thus detects the presence of a little bile.** * Percival's Essays, Vol. I. p. 257. t Praelect. $ 688. X Experimental Essays. { Med. and ( hirurg. Cases. [| Cr'vrlz \1. M.p. 80. t Percival's Essays. ** Thompson's Chemistry p. 05'j Inquiry into the Seat of Fever. 187 The urine is sometimes changed to a bloody hue by taking the extract of logwood.* Beets possess the same, property. It is impregnated with the odour of asparagus, carrots, pars- nips, fennel, the oil of savin, turpentine, &c. when these sub- stances have been taken ; the smell of the latter is sufficient to communicate the odour. A species of fungus is found to retain its intoxicating quality, after passing into the urine.t The urine is coloured for many hours after taking rhubarb. It is remarked by Dr. Russel, of the people of Aleppo, who take large quantities of oil, that the same is seen to ex- ude through the skin. Ichthiophagous birds and hogs fattened upon fish, as they are in some places, have a disagreeable fishy taste. The odour of carrion is communicated to the flesh of vultures. It has been disputed whether the poisonous qualities of fish, in certain situations, are communicated to the flesh while the animal is alive; and it has been affirmed that the poi- son which is taken in with their food, transudes through the bowels after death ; and that when the animal is dressed im- mediately upon being taken, its flesh is free from any dele- terious quality. Dr. Thomas, Dr. Buckley and Dr. Hodge, are the advocates of this belief.J It is very doubtful, how- ever, whether the opinion of these gentlemen is correct: from the analogy of the instances already mentioned, we see no reason to doubt that poisonous matter taken in with the food, may likewise be communicated to the flesh of the animals feeding upon it; it is evidently not poisonous to the animals in which it is found, otherwise they could not eat the substances which afford it with impunity; and from the redundancy in which it exists in the stomach and bowels, there can be no reasonable doubt of its entering the circula- tion, and thence imparting its poisonous qualities to the body generally. There is a weed or vegetable which grows in the river and creek swamps and low grounds in (he state of Alabama, of which cattle are very fond, and which so thoroughly imbues every part of the animal with its foetid and disagreeable odour, that the effluvium is perceptible at a considerable distance; the same odour is communicated to the milk and flesh, which are thereby rendered offensive and unfit for use; the bones and marrow are also tainted with the the flavour of this noisome weed. There is ano- * Percival's Essays. t Haller Elm. Phys. Vol. VII. de urine. X Memoirs of the Lond. Med. Soc. See also, Caldwell's Collection of Theses, Vol. II. 188 Inquiry into the Seat