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1KBWISE2.9S TCBISA!?Q&B
ON THE
YELLOW FEYER. 
ADVERTISEMENT.
®
      The ensuing Treatise, has before appeared in
detached  Essays in  the  Southern Patriot Gazette.
The talent displayed  in the Editorial department of
that Paper, and the readiness with which its columns
are opened to all such discussions as promise or pro-
mote any useful end, have secured to it a very general
circulation; it might  therefore seem scarcely neces-
sary again to bring forward opinions, which have al-
ready received extended publicity.  The author how-
ever, was solxited by his  friends to embody his ideas
in a more permanent form, and yielded the more wil-
lingly to their  desire, as the present publication af-
forded an opportunity of correcting many errors, and
supplying some  omissions, which unavoidably  oc-
curred in the haste with which its different parts were
first sent to the press. 
CHAPTER I.
           On the Origin of the Disease.

  Of the  various  opinions and theories which have
tit different times been offered to the public,  on the
subject of Yellow Fever, there are none,  it is gene-
rally  admitted, which  are at all satisfactory either
as to the nature or origin  of the disease,  or the pro-
per mode of treating it   Its late ravages in most of
our  principal  Cities, and the  probability of  its fre-
quent and even  spe<dy  recurrence  among us, are
considerations, which  render it the incumbent duty
of the Practitioners of this Country to use their most
earnest efforts in the investigation of its true charac-
ter,  and the causes of its production, and to contri-
bute to the common stock of information, any such
results of their experience, as are at all calculated
to throw the  least light  on these important  points.
Actuated  by  this sentiment, the author  of the  fol-
lowing observations comes before the public with no
object but that of serving it, and with no other pre-
tentions, than those  grounded upon experience.
  We will attempt in the  first place to establish that
the  Fever is of domestic origin.  It becomes neces-
sary to do this, as the late conduct of the Boards of
Health in Baltimore, New-York and Philadelphia, and
the opinions expressed by  some of the  Physicians
in those  places, have contributed in a great  degree
to revive, and give fresh currency to the doctrine of 
                        4

contagion,  wM^h aligns  a foreign derivation to the"
Disease.   If this opinion  be  erroneous it is of im-
portance that it should be strenuouslv opposed  ; for
among  other  strong objections  that  mav  he ur-
gjd  against it. it has the  disadvantage of tending to
pi o-luce a neglect or relaxation of Police regulations
on  which the health • four Cities so essentially de-
pends, and (> rations a resoit to svste us of non-inter-
course, and quarantine restrictions, that have a  seri-
ous  efivct upon the co nmerce of the Country, an 1
vexatiously interrupt the communication hetween the
different portions of the Union.   I hope to place the
suoje.t in an  entire new light, and to illustrate  it by
some tacts, which as far as my knowledge extends,
have never before been brought forward, or adverted
to. But though it is not my intention to go over, or re-
capitulate the usual arguments employed by the Non-
Contagionists in this dispute, their .reasonings and
statement*  are too much to my purpose to oe whol-
ly overlooked;  I shall therefore adjoin various ex-
tracts, in the form oi an appendix, which  will be
found to exhibit a view of the principal grounds re-
lied  on,  by the writers on this side of the question.
The doctrine is at once so rational, and is supported
bv so many obvious facts, that,  it had at one time made
its way to almost universal reception;  but some dis-
trust of its correctness has latterly been entertained
from its having been observed, that our Cities have
often enjoyed an exemption from the pestilence, du-
ring  those seasons,  when the causes which are  ordi-
narily supposed to be the most concerned i»  its  pro-
duction, (such  as the  effluvia from docks, drains,
sinks, £jc.)  have existed in lull operation, while, vice
vena, some of its severest visitations have occurred
at periods,  when the circumstances of the  climate,
and  the strict execution  of  our  police laws,  have
seemed to  promise us aiieedom from its  attacks: 
and that finally, in seasons of totally opposite charac-
ter, either very wet or very dry, it has still made its
appearance.   The medical world has been much puz-
zled by tfiese phenomena ; and while some few adop-
ted the notion of contagion,  a  majority of those who
have  specidated  on the point,  though they admit the
disease to he of indigenous for nation, seem  to have
come to the conclusion, that its real cause is altoge-   \
ther inscrutable, oris involved in some occult princi-  « j
pie or unknown condition of the general body of the
le  j
atmosphere.   All the above difficulties are, however,
1 conceive, to be solved, or in a measure reconcil-  v
ed. by advertence to a single fact, which has hither
to been  unaccountably overlooked; it is this;  that   ^
   every period  in which the Yellow Fever has ap-   t
   ired in Charleston, the Summer, or season at large,   ^
at
pea
has been unusually sickly, that is, the Country as well
as the Town hai* been afflicted by Fevers of a fatal
and violent tvpe  I am enabled from my own experi-
ence  and observation in the course of the last twen-
ty years, to bear testimony to this  circumstance, the
philosophical application of which seems at once ob-
vious    It is easy to perceive,  that if  to an atmos-
phere, which has already,  from various causes, be-
come so deleterious, as to occasion general unhealthi-
ness, be superadded, all those effluvia which from foul
streets,  sewers,  £jc. are  constantly contaminating
the air of Cities, a malignant disease must necessa-
rily be produced; and  accordingly  under such cir-
cumstances,  ,the Yellow Fever has invariably broken
out,  with ^cater or less violence, in proportion  to
the sickliness of the Country, or season generally.*

  * Another particular in the history of the Fever,  remains to be  ac-
counted for, which is,  that it is confined to  maritime situations, or
those within the influence of the Tide Waters of Rivers. It is probable
that tuere is always a superabundance of moisture in these situations,
whicii relaxes the human system, and throws it open to disease. The
action of the sun or the waters during dry summers, in combination 
6
* The causes arising within the City, acting alone, that
  is, during healthy Summers, are never sufficient to
'  produce the Fever; Charleston being alwiys healthy,
  when the Country around it has continued free from
  any  remarkable mortality.  The Fevers of the Town
  and Country being thus always concomitant,  surely
  indicatejbeyond the possibility of dispute, that they
  have a  common  origin, or are congenerous  to  the
  climate;  though  indeed  widely distinguised  from
  each other in symptoms and character.
     It is  scarcely necess«ry to observe, that the t\ pe
  of the diseases in  the two cases being wholly unlike,
  is simply ascribable to the difference of local circum-
  stances : the  masmata which  affect the air  of  the
  Country, are in the first place not so  much confined
  and contracted as  those of the City, and being most-
  ly of  paludal and  vegetable  ongin,  are of  conse- 1
  quence less  pernicious than the putrescent and ani-
  mal  effluvia, which arise from amidst the dense pop-
  ulation  of the latter   It will not be of  course con-
  tended, that the Fevers of the country are either  im-
  ported, or contagious ; yet that they do, as above  sta-
  ted,  make their appearance, and continue cotempo-
  raneously with the Yellow Fever, is, I reiterate, a con-
  currence, which has invariably taken place within my
  own experience.*
     Though I am unable to support this statement by
  any  direct documentary evidence, there being no  Pa-
  rish Registers regularly kept in any part of the State,

  with the agitation of the tides, would occasion a h*mi*mr of moisture
  at such seasons, nearly  as great as that which exists in rainy periods.
  This would account for the Fevers appearing in seasons of entire op-
  posite character.

    * The sickness of the last year in the Country, which constantly kept
  pace with that in the City, and even penetrated to the Pine-land set-
  tlements,  hitherto deemed  healthy, is fresh in the recollection of
  every one. 
7
yet sufficient testimony on this head may he gather-
ed  from the works of Chalmers and Huztt, who pre-
face all the accounts they give of the Epidemics which
desolated Charleston in the early part of its history,
(which  were  undoubtedly Yellow Fever) by saying
that the  summer of those years, were  unhealthy.
That in  using this language, they refered to the Coun-
try as well as the Town, is I think fairly to be con-
cluded, as those authors write the history of the co-
lony at  large;  and the  work of l)r. Chalmers is ex-
pressly  entitled an account oj the weather and diseas-
es if Carolina.
   Another proof, which assists to throw light upon the
connexion, subsisting between the states of the air in
Town and Country, is,  that a stanger, arriving direct
from  Europe, nay without risk spend the summer in
Charleston,  whenever  it happens that  the country
around  it is unvisited by sickness ; for the Town, as
already observed, then also remains healthy, though
the communication with the sea-ports of the West In-
dies where the Yellow Fever permanently exists as an
endemic, continues open and unrestricted.*  It is,
moreover, very observable, that a stranger does not
obtain security by having been exposed to a season of
this sort, but in order to be completely climated, must
actually pass through a Yellow Fever summer: The
safety acquired in the  latter case, as well as the re-
markable immunity enjoyed by natives cannot be ac-
counted for but upon the hypothesis I have been ad-
vocating, that of the domestic ingeneration of the dis-
ease.   It results from the mildness of our winter vi-
cissitudes, which  leave the system in possession of

   * Dr. Bancroft well remarks, that " while it is so notorious that
the Yellow Fever cannot be propogated a single mile from Philadel-
phia or New York, it is completely absurd to suppose that it can have
been transported  by a contagious quality one or two thousand miles
across tbe Ocean* 
8
that peculiar organical modification, which if under.
goes by exposure to the epidemic in the fir t instance,
when the plasticity of the animal economy enables
it to adapt itself to the climate and to resist infection.
The indiscriminate attack of the disorder upon both
natives and  strangers in the more Northern Cities, is
to be explained upon an analagous  principle.  The
severity of the winters in those places, while it de  -
troys all the seeds  of the epidemic, creating a totally
new climate, also  produces an entire change in the
constitution, obliterating all those summer habits of
the system, which give saf ty to the  inhabitants of
Southern  and tropical countries.   Dr.  Bancroft has
broached an ingenious theory to account for the fe-
vers  being confined,  as he erroneously believed, ex-
clusively  to strangers in warm climates.   He sup-
poses that the constitutions of those who come fr»>m
higher lattitudes, kt are  habituated  to the generation
of great portions  of animal  heat, and that the cold
which forces this habit upon them, will naturally p ^-
duce in them a considerable  rigidity and strength of
fibre, with an inflammatory diathesis, and that when
they remove  directly into an interttopical situ ttiei,
they will commonly carry with them a  great accumu-
lation of excitability which co-operating with the es-
tablished habit of generating much annn  I heat there,
may readily produce to them a most aggravated and
violent form of fever, £$c." The Doctor however was
 not aware that Children in warm climate (it is at least
 the case in Charleston,) are from the  age of one,
 up to twelve years,  equally subject  with stangers to
 the disease, this single circumstance totally destroys
 the effect of the above plausible explanation; for it
 is manifest that the constitutions of the inadult would
 become early adapted to the climate,  and would not
 be in the habit of generating over proportions of heat, 
*
any  more than the older natives. *   The liability of
Children to take the fever until a certain age, I con-
ceive to be owing to the alterations induced by growth
upon their tender constitutions,  which are constant-
ly effacing  those impressions of the climate, which
become permanent in adults and strangers:  they are
hence placed in this respect on a worse footing than
the latter, though they are certainly less apt than stran-
gers, to take the disorder.  We thus see that all the ano-
malies and peculiarities which have been enumerated*
become at once simplified, and are to be philosophi-
cally accounted for, by admitting the doctrine o* the
agency of climate and the operation  of local causes,
while they must forever remain inexplicable upon the
hypothesis of importation or contagion.   I shdl not
deem it necessary to enter into a particular investi-
gation of the merits of the latter opinion, but shall
content  myself with  proceeding to notice some of
those  local peculiarities which seem to be in a very
especial manner connected with the history of the
Fever.
   The geographical limits to which it  is so singular-
ly confined, is a part of its history,  requiring notice
in discussing the important question of its  erigin.  It
is generally known,  to be restricted in its  range, to
the littoral borders, or maritime  regions of the Ame-
rican Continent, and the West Indies;  never spread-
ing in the  Country, or beyond those places situated
within the influence of the tide-waters of rivers: for
though persons who have taken it in the latter places,
have often carried it into the interior, the cases have
always terminated  with the  individuals who have so
conveyed it.  I am aware that some of our Towns in
  * The Doctor speaks of an inflammatory diathesis, but neither dissec-
tions nor external indications, evince that there is any thing inflamma-
tory in the disease.  The fever can only be regarded as a transient ef-
fort of the vis-medicatrix of the constitution, exhibiting no marks*<v
high excHcrr'^t or inflammation.
B 
10
 inliirl, and mediterranean situations, have been sub-
 ject to epidemic visitations,  which have been suppo-
 sed to be Yellow Fever; yet that the disorder was
 mistaken in these  instances,  and was really a high
 grade of Bilious Fever, we must believe: for certain-
 ly, if the above pi ices were liable to the former dis-
 ease,  the interior Towns of the West Indies would
 likewise be subject to it, of w'uch there is, as yet,
 no example.   On the contrary, strangers n ay go to
 any part of tire West Indies,  other than a sea  port,
 vith  perfect safety,  in those seasons, when the ma»-
 ritime Towns are desolated  with Yellow Fever.   Ev-
 ery I'raetitioner who has had sufficient experience in
 the complaint, knows how often it happens that other
 diseases are mistaken for it by those who have not
 ha ! an opportunity of becoming familiar with its dis-
 tinguishi g symptoms: even fevers of a remittent type,
 are frequently pronounced to be Yellow Fever, though
 the last, as I shall hereafter more particularly remark,
 is neither ushered in by chills  or resolved by perspi-
 ration, and  consists  of but one paroxysm,  followed
 by a collapse, and  prostration  of the whole system
 which forms the second  stage of the disease.   The*
 black stuff ejected from the stomach in high grades of
 Bilious Fever, gives origin to this mistake, being gen-
 erally supposed to be Black Vomit; though when held
 up to  the light and closely inspected, it  will be found
 to exhibit a green or coppery tinge, indicating its Bil-
 ious origin,  while the Black  Vomit of Yellow Fever,
 however narrowly examined, appears in exvry light'
 of a peculiar,  and unvarying blackness.   But more
 detailed views of the distinction between the two dis-
 eases  will be given  hereafier.   It would then seem,
that there is some qualify in the air in the neighbour!
hood of the sea, and of its tide waters, which is ne-
necessary to the spread and  action of the infection.
What this airy something may be, 1 shall not at pre- 
It
sent attempt to investigate. I should also he in^'ned
to consider it as a matter of men  philosophical curi-
osity, to enquire into the nature of those peculiar \.ce-
drfttia, or specific gaseous poisons, wf ich  may con-
stitute the immediate  causes  of Yeilow Fever;  for
e\en were we enabled precisely to identity them,
their widely  diffused  and general  agency,  proba-
bly  places them beyond our control, and we could on-
ly counteract and prevent their effects,  by the same
means which we adopt in our ignorance of them; that
is. by directing attention to the cleanliness of our Ciiies,
and in proving and enforcing our police regulations. If
the foregoing views be,correct,  in order to the produc-
tion of Yellow Fever, the following exciting causes
must combine; namely, a Town of dense population
in the vicinity of the ocean, or within the influence
of  its tide waters, and, above all, a season generally
sickly.  Under a combination of  this kind, the Yel-
low Fever may always be expected, and  where the
most rigid attention  is  not paid to the means of pre-
vention,  never fails to  appear, with  a recurrence as
certain as the uprise of the sun, or any ol the most
fixed operations in the general course of nature.
  Another argument that I shall urge in proof of its
non-contagious nature, is  deduced from the  success,
which has attended the application of  poliee measures
to its prevention, in the case of Philadelphia.  Though
that city  has resorted  to the expeiiment of quaran-
tine laws, sporadic cases of Yellow Fever  take place
there every summer; yet the disease, as we have seen,
never spreads itself,  but is kept down, or confined to
\ery narrow limits, certainly by no other conceivable
means than by the vigilance with which every thin*
is removed that might favor its extension, or impair
the general state of  the air.   It being  then  a  rn.it-
ter  of record and of unvarying experience that the
Fever never originates without, nor never spreads be- 
i%
 fA)«/7 the limits of a city; when it is notorious that na-
 tives in many parts of the continent, as in Charleston,
 a«-e exempt from the malady,  which can only be un-
 derstood by admitting the influence of climate; when
 further it is an  established law of contagions, that
 ttey are not affected  by the access of cold weather,
 but on the contrary  are  arrested  by atmospherical
 warmth, which  is known to be the very reverse of
' the history of Yellow Fever ;*  can the members of
 the Boards of Health in the Northern Cities serious-
 ly believe the disease is to be kept at arms length by
 a system of quarantine, and is to be arrested within
 caiman shot of  their  shores!—This with a rever-
 sal of the application's realizing the fable of the one-
 eyed stag.   While they thus exclusively direct their
 views  to the ocean, and are keeping a vigilant look-
 out towards the  only quarter from  which no danger
 is to be expected, the disease  wafted on the wings of
 exhalation, makes its deadly approaches from behind,
 and with the true characteristics of pestilence and death,
 glides unseen along the streets, into the palace and the
 hovel, " wasting at midnight and the undreaded hour
 of noon,"  and like the wolf among the silly sheep,
 quietly selects its victims for destruction.    It is to be
 hoped that so  enlightened a  Physici  n  as  Doctor
 Hosack, who has  been cited as advocating the doc-
 trine of contagion, may on a little further  reflection
 be induced to take a more philosophic view  of the
 subject than a mere quarantine officer, and will see
 the propriety of  assisting to open the eyes of his fel-

  * " I have already noticed the constant extinction of  Yellow Fever
 by  frost, as one of those points in which it exactly resembles the
 mnrsh, and only the marsh, fevers.  This instructive and highly im-
 portant fact is however, capable of a more entensive application, for
 it not only proves the origin and nature of all these fevers, but it air
 So proves decidedly that the Yellow Fever has no power of prnpuga*
 tins: itself by contagion; and consequently, that it never proceed?
Jrom UP    Bancroft, 
13
low citizens to the real sources of the disorder.  By
an attention to these,  the managers of our Boards of
Health throughout the United States,  will  at once be
more at  home, as to the origin of the disease and  the
proper methods  of preventing its ravages.*    There
can be no doubt that in those places, in the neighbour-

hood of  New.York and  Baltimore, where the Fever


   * "Party zeal and prejudice often render men incapable of deriving
any evidence  or information from facts, but such as suit their own
views  and  purposes.   Doctor Chisholm, at page 2'>5 of his  Letter to
Doctor tlaygarth, introduces one to himself, from Doctor Hosack, da-
ted, New-York, July 9th, 180«. in which there is an abundant display of
zeal, I do  not say for maintaining the cause  of truth, but for assert-
ing the supposed contagion  and importation of Yellow Fever: heal-
so communicates his intention to write and print a letter, charging
Doctor Miller  with " want of candour," in his official report to the
governor;  which charge he founds upon the following statement,
viz.
   " As a member of the Board of  Health, he (Dr. Miller) must have   *
known that the disease was confined for many weeks to a small por-
tion of the eastern side of  the city, and that, not a case occured in
any other part of the town, that was not referable to that, as its source.
Such was  the statement of the Board of Health  to our citizens, and,
in consequence of which, they forbade intercourse with the infected
portion of  our city, and ordered an abandonment of that part of the
town,  &c."
   '• He adds, a 'few weeks  after, the infection extended a few streets
further.  The Board of Health accurately defined its limits, and again
declared, that still not a case occured but could be traced to this spot
of the city, as its source   Doctor Miller carefully enumerates the
cases occuring, and the numerous pa ts of the city in which the sick
reside, but as  carefully suppresses the observation of the  board, of
which, too, he was a member, and must have known, that the per-
 sons so taken  sick,  had, prior  to.their attack,  been exposed t» the
infection by frequenting the infected spot.''   How strangely Doctor
Hosack here mistakes  the obvious import or evidence of an important
fact! One of the strongest proofs of the local origin of  Yellow Fever,
results from the circumstance of its beginning, and remaining, almost
exclusively, in particular spots or situations.  Of this, Doctqr Mil-
ler was very  sensible; and. if  he omitted to state '• the observation
of the board," respecting it, ha could only have done so because it ap-
peared superfluous, after he had so distinctly mentioned the facts to
which  it related.  And is it then possible, that Doctors Hosack and
Chisholm  can have been so inept as to believe that these facts could
operate in supporting their opinion of the importation and contagious
nature of this disease  ? Do they conceive, that  if it were contagious,
it would have been so many  weeks confined to one spot, and  that when 
14
lately raged there existed local causes, which uniting
with a  state  of the air,  that predisposed  to  sickness,
gave rise to the disease.  I shall proceed to ollvr'some
suggestions towards  preventing  a recurrence of the
disease among ourselves. On this subject, Philadelphia
holds out to us an example, which we cannot too close-

ly imitate.  We  have, indeed, already rmmy admirable
ordinances, which only requite to be revived and en-
forced, to place  uson  alevt-1 with  that city, on the score
of cleanliness, and excellence of police.   It would i;e
expedient, also,  that the Legislature should  ai I the
City Council  topiovide for the  paving of our streets


it afterwards « extended a few streets further." those onlv would have
been attacked by it, who had vluted that  identical sp->t?  I his is ex-
actly what would happen in regard to a disease not contagious, but
arising from  nvasmata; because, the soil in which they are produced
bemg immoveable, and its exhalations incapable of causing disease, at
any considerable distance from their source, persons to be acted upon
by them must necessarily approach that source. But contagion having
no such im moveable origin  will not be  thus confined ; persons infect-
ed by it, and sickening in di^erent places,  naturally \< feet others,
who  soon spread the disease  widely,  so  that, the spot where it first
appeared  often becomes less dangerous than  most others and  its at-
mosphere does not continue to produce disease, when the sick have
been removed, and the  houses shut up, as happens in cases of Yel-
low  Fever.  With the same fatuity, Doctor Chisholm. in his letter to
Doctor Havgarth, has published one from Doctor A.  Fothergill, l.te
of Bath, who, writing to the American  Consul, at Bristol, of the Yel-
low  Fever at Philadelphia, in  1805, and mentioning that it had. in
November, received a check, apparently from the cooler season set-
ting in;  adds, •'It remained  fur some  weeksa local disease in the
southern  suburbs," (adjacant. to the nu.r»hy low grounds, at the con-
fluence of the Delaware and Schuylkill) •' but, at length, was commit*
nicated to several of the principal streets  in the city,  as iar as Eighth
Street, westward," (persons who had been exposed to miasmata in o-
tlier places,  happening to  fall sick in  these)  " but it chiefly infested
 Water Street, Front Street." (running parallel with, and next to Wa-
ter Street)  *' and the margin of the Delaware"  He adds, •* many of
the professors, and medical practioners here, deny that the disease is
contagious, and in this notion the body of merchants bear them out"
Dr.  Fothergill, however, adheres to the  old notion of contagion and
importation  and no wonder that it should have adherent1-, in men who
fancy they can see evidence of a contagious! quality, in facts which
 decidedly prove the contrary, to all who are aule to reason with im-
partiality."      Bancroft. 
15
and hne«, as paved ways are more easily kept clean,
than those, which  are all the  year deep in sand or
mud, in  which many  animal  and other putrescent
remains, are often buried and concealed, while the
exhalations  from the mud, after wet  weather,  con-
tribute greatly to impair the general state of the air.
It would be further advisable, that the City Engineer
should be employed to take the general level of the
Town, and that the inequalities of the streets should
be filled up, or levelled away, so as to afford a regular
surface, from which  by means of side drains,  run-
id ug  to  the waters edge,  every offensive matter
might ie completely carried off.   The present sys-
tem of subterraneous sewers,  I consider as of more
d. tiiment to the health of the City, than all the other
so irces of infection put together.  In addition to the ef-
fluvia, arising from the mass of obstructed matter con-
cealed wimiii them, the necessity of frequently open-
ing diem and returning their foul contents to the sur-
f ^ce, from which they are nexei removed,  so that tiie
soil of our sireets heeo nes a compost of every thing
deleterious, is  a  disadvantage which calls tor  their
obliteration, or the effectual sealing up of their grates,
as soon as proper side drains can be constructed.   I
am pHrsuaded, tiiat it  would add  much to the health
ot the town,  if the citizens would  be induced to aban-
don in the future construction of  buildings, the pre-
sentcustomof diggingsubterraneouscellars, which be-
come receptacles tor foul air, and often from springs or
rai  s. form bodies of stagnant water. The ground on
whi  h our City stands,  is of too low and springy a
nature, to admit  of tnese substructions.   Cellars
above ground would answer every purpose, and would
not be attended by any of the above inconveniences.
B.ing convinced  the dreadful malady which has  so
often arrested the prosperity of our City, is of domes-
tic ingcnei ation, I had hoped that to demonstrate this, 
16
 as far as I was able,  might perhaps have the effect of
 exciting a  more serious  attention  to  the means of
 averting its visitations.  I have pointed out some of
 these means, and have shewn that the happiest success
 has attended their adoption in other places.  It was gen-
 erally understood that the Legislature would take up
 the subject, and perceive the policy and importance of
 making every effort to render the emporium  of  the
 State, the seat of Health, to which foreign rs may
 safely be invited to  become competitors in our mar-
 ket,  for the products of our industry.   This reason-
 able expection however  has been disappointed and
 the proposition  to appropriate  a sum of-money  for
 the improvement of the City was  rejected in that
Body.
  It could not reasonably be required  of the advo-
 cates of the measure, that they should  furnish com-
 plete proof of the adequacy of preventive means to
 keep out the disease; the object proposed would  ne-
 cessarily be somewhat of an experiment,  but it is an
 experiment which ought to be  made.  If. however,
 satisfactory evidence on this head, be rigidly demand-
 ed, it may be said to be at hand, as  we  see in the in-
 stance of Philadelphia, that  an exemption from  trie
infection has been  obtained by  a strict attention to
preventive regulations.
  The last season was peculiarly calculated to test
the effect of such regulations, as  the Yellow Fever
made its appearance in all its former haunts, and a-
mong other places in Philadelphia, but  there,  as  we
have seen,  created but little  alarm  and soon  disap-
peared.   With this example  before their eyes, of an
 apparent control exercised over the disease, quietly
to look on,  while hecatombs of victims among our-
selves are almost annually swept off, is nothing less
than criminal neglect in our public authorities.  Our
 present system  of public works,  having for its uiti- 
mate object,  the improvement of the Market o^ the
Stite, the opposition to a measure, which was inten-
ded to promote the same purpose, remains o be re-
conciled with consistency.   This proceeding, by
which the work of improve Merit  was arrested  at
HV  very point,  where it ought  both to begin and  to
end, was indeed  opposed by the best talents of the
House,  and stands recorded, as  a  measure of the
wisdom and patriotism of a bare majority   Soon af-
ter the rejection of the appropriation for Charleston,
a  proposition w-.is introduced for the establishment
of a Lunatic Asiium, which it must oe acknowledg-
ed,  followed in very natural order, and ougf tto have
succeeded: the Institution it contemplated, would
have afforded appropriate accommodations for those
who on the former question,  had sturdily withstood
every evidence of truth, every  plea of  humanity,
and  manfully oppose I  the  plain  interests of their
constituents and the State  No expense, it seems, is
to be spared in the opening of our rivers, in construc-
ting roads  and canals, and producing a convergence
of all these towards the Capital ; but the la'ter is  to
be left a prey to desolation, and the career of improve-
ment is to stop  short at its gates.   The superinten-
ding care of the Legislature extends no further than
to the Lines of Charleston, there suddenly encoun-
tering a magical barrier, which cannot be overpassed,
or as if it were expected, th.it the corporation, which
has only the municipal regulation of the city, should
undertake and carry on those great objects of inter-
nal policy,  which were involved in the proposed ap-
propriation.  Bur fias corunat opus ought to be the
motto of the  Legislature on this  subject; the im-
provement and emhelhShment of  the City ought to
go on, hand in hand, with those other goodly works,
wuich have been so  happily begun, and be made to
to crown the  whole.  Were this policy pursued, our
                        c 
19
Capital would, like the human body, acquire beau-
ty as it improved in health,  and become a point of
increased  attraction to trade  and foreign enterprise.
It would enjoy its due share in the vast prosperity of
our country, and participate  as largely as any other
City of the Union,  in  its extended and increasing
commerce, which
              Ranging every azure swell,
              And floating under every s+ar.
places within our reach, the wealth and advantages
of the remotest  climes.
W*V*/kW%VWW».VWWVWT «/WW*VWW»<W»i
                 CHAPTER II.

On the distinction between Yellow and Bilious Fever,

   Although the greatest writeis on the disease have
concurred  in  pronouncing,  that it is totally distinct
from Bilious Fever,  and is  characterised by a defi-
ciency of  bile,  and  notwithstanding the  complete
proof of this fact, afforded  by  the investigations of
Dr. Physitk, and others, it is still a  very general opin-
ion with the  public,  and  an idea  yet lurking in the
minds of many of the profession, that the former
Fever is but  a higher grade of the latter, or that at
any  rate the  two diseases are mutually convertible
into each  other.  The yellow suffusion under the
skin and in the eyes, which so generally takes place
in this epidemic,  though it does not proceed from
bile, yet so much  resembles that secretion in color,
and is  so  striking an appearance, as to have the ef- 
19
feet of constantly reviving and keening un the ahove
delusion   I  shall endeavour once f >r all, to put an
end to this ignorant mistake, first by ad lucing the de-
cisive results of the dissections made by  Dr. Physiek,
whose name must ensure attention  to every thin*
which  appears under its sanction.  This great man
whose science and success  in his profession,  have
given it a new title to be called the Healing Art, and
whose philanthropy and generous sympathies, impart
to his  medical attentions,  the grace and consolations
of friendship, has shed a  broad and lasting li^htover
this subject, which ought lona; since to  have dissipated
the errors that still prevail respecting  it.  To the ex-
tra ts from his letter to Dr. Mitchell. I shall  add the
opinions  of  several other distinguished Physicians,
illustrative of the  same  point.   The following are
the results of Dr.  Physick's researches:  •' the liver
was generally found of a pale appearance. The mat-
ter of Black Vomit, commonly found  in the stomach,
and  sometimes in the intestines, was never discover.
ed in the gall bladder,  the liver, or any other viscus
or cavity.   The stomach has sometimes been  load-
ed with this black matter, while in the same subject,
not only the  liver was  free from disease, but  the bde
in the gall-bladder  was in its natural healthy state;
and  this in several cases  where a contraction of the
pylornus had completely obstructed the passage from
the dusdenum into the stomach.  The  matter of black
vomit  is, besides, essentially different from  bile; it
differs in color,  for however dark  the bile may ap-
pear in its most concentrated state, it always displays
a yellowish or greenish yellow tinge, when spread on
a white surface, or even diluted; but if the Black Vo-
mit  be treated in the s rme way, it retains its black
or dark  brown appearance.  It has also been found
that an addition of bile to the latter, altered its nature,
and  gave it consequently a  different appearance i 
to
nor could the Black Vomit be imitated by any mix*
ture of various proportions  of dark  colored bile
with the fluids found in the stomach.   It differs like-
wise most decidedly in taste ; the Black Vomit being
always insipid when  freed from other foreign mat-
ter, whereas the bile can never be deprived of its  in-
tense bitterness—The above  observations have  ap.
peared to me («< ys Dr. Physick) to overthrow the idea
of the Black Vomit  being secreted by the liver."
  Doctor Henry  Warren, in his treatise on  the Ma-
lignant Fever in Barbadoes, (17*0) observes: "That
the Fatal Black Stools and  Vomitings, are  vulgaily
supposed to be only large quantities  of black bile or
choler; which false notion *eems to  be owing to that
fixed unhappy prejudice that the Fever is purely bil-
ious.   But any one will soon be undeceived, by dip-
ping  in a  bit of white linen which will be tinged of
a deep oloody red, or purple, as I have proved by ma-
ny experiments"  Dr. Bancroft also says,  " That the
true  explanation of the most common ormation of
 Black vomit seems to be that it is merely blood, which
 has been effused from some of the small arteries, and
 coagulated within the cavity of the stomach, or on
 the suiface  over which it  was effused, and having
 been afterwards detached  and triturated by the vio-
 lent and frequent contractions of that organ,  in the ef-
 forts to vomit, has had its appearance as a coagulum
 of blood altered, and its color changed by some che-
 mical decomposition or darkened by the gastric juice."
 Tib se facts, as they decidedly shew, that there is no
 bile in the case, likewise necessarily establish that Yel-
  low Fever never can become a Bilious Disease, and
  proves in fine, the  inconvertibility of the two disor-
  ders into each other.  The Yellow Fever,  occurring
  in, or near  to those situations,  in which autumnal or
  Bilious Fevers usually prevail,  is a coinciuence, that
  V»*a l»crl » further pfteft in  nmriiiein°r  the idea of 
$i
a consimilarity between the two diseases.  I have,
however, already endeavoured to shew, that the re-
mote causes in the two cases are, to a certain extent,
distinc ; and that it is a combination of these causes
which gives rise to Yellow Fever.   I have mention-
ed that the effluvia arising from the concentrated pop-
ulation of a City, are not sufficient of themselves,
to create the latter disease, and that it is only when
they come in contact with an unusal mass of mias-
mata in  the general atmosphere, that the Yellow Fe-
ver is produced.   That therefore the country must
be  unhealthy  before  the town becomes so.   When
the great body of the air is loaded with those dele*
terious exhalations which occasion bilious remittents,
the stiperaddition of the various noxious emanations
proceeding from an ill cleansed City, necessarily in-
genders a malignant disease.   Individuals labouring
under intermirtents, having been sometimes attack-
ed  with Yellow Fever, is another misleading circum-
stance,  which has strengthened the notion of the in-
terchangable character of the two disorders;* but this
fact, surely proves nothing  more,  than that during
the prevalence of a desolating pestilence persons are
not secured against it by the presence of other dis-
eases; an impaii ed state of the health, indeed, would
only the  more readily  invite its attacks.   Neither
does the dreadful  Epidemic  we are discussing,  re-
semble  any of the Fevers of a Nervous or Typhus
type, inasmuch as it is never ushered in by any very
decided chills, or rigors, has no remissions or inter-

  * " As a farther proof of the identity of Yellow and Marsh Fevers*
I shad remark that, besides their simultaneous concurrence, and mu-
tual interchanges, as before mentioned, they  are not unfrequently
converted one int» the other, in the very same individual." Bancroft.
  Never (says Dr. ttush) has the unity of our autumnal t'ever, been
more clearly demonstrated, than in our present Epidemic.  Its four
principal grades* viz. the Intermittent, the Remittent, the Inflamma-
tory  Bilious Kever, and the Malignant Yellow Fever, have ill run in*
to each other in many instances. 
£2
missions, and never resolves itself bv perspiration, or
profuse sweatings, the system seeming quietly to col-
lapse and succumb  under the force of the disease.
It is also especially to be observed, that though it is
accompanied by  the utmost debility and prostration
of strength, the  practitioner cannot,  as in the fore-
mentioned diseases,  avail himself of the aid of stim-
uli, to arouse, through the medium of the stomach,
the dormant and flagging principles of life, being pre-
cluded from  the  use of this class of remedies,  by
the peculiar iiritability of the stomach, in all Yellow
Fever patients, which renders it little less than death,
to administer any thing of an exciting or stimulating
quality: and though  it arises like the Jail, Hospital
and Camp Fevers, from the effect of crowded situa-
tions, where animal  emanations,  or human effluvia,
meeting with miasmatic principles in the air, favour-
able to  the  production ot disease,  return in a  mor-
bific shape and act  deleteriously on the body; it is
also widely distinguished from these diseases.  It is
unnecessary to enumerate the discriminating symp-
toms, but the circumstance before alluded to, that of
the irritability of the  stomach in Yellow Fever, which
deprives us of the use of that organ as a point from
which,  by means of diffusible stimuli, to call into ac-
tion the latent energies of life, constitutes a sufficient-
ly broad line of demarkation between the  respective
diseases.  In every  view then, the Yellow Fever is
a disease strictly  sui generis^ which cannot run into
any other, or any other into it; neither of these oc-
currences being  any more  possible than that Small
Pox should become Measles, or the latter he conver-
ted into syphilis or Jail Fever.  As it is a point gain-
ed, to establish what a disease is not, as well as to
ascertain its  proper   diagnostics,  I have  thought it
right to premise thus much, as to the individual and
peculiar character of this order, to which a.Protean, 
S3
or  omniformous quality,  has  been so erroneously
ascribed.   I shall next offer my views on the subject
of its  pathology, in which there will necessarily be
some  blending of theory  with facts;, but not to the
extent of substituting mere speculation for reasoning
and the results of experience.
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                   CHAPTER III.

                Theory of the Disease.

   That on  the correct theory of a disease,  its suc-
cessful treatment  essentially depends,  is so obvious
a  truth that no labored argument is necessary for its
support.   A late writing,  in adverting to this princi-
pie, quotes a passage from the celebrated Boerhaave,
to the same effect, who says that it is a custom among
the Turks, which it might be expedient to adopt, ne-
ver to allow a Physician to prescribe for a Patient un-
til  he has given an explanation  of disease.   So far
is the Medical  w^rld at present,  ft om having attain-
ed any precise knowledge of the  distinctive traits of
the Yellow Fever, that not  only are the various ap-
pellations by which it is distinguised, confessedly in-
appropaiate,*  hut we also find the most recent wri-

  * "This Fever has been called Typhus Tctorodes, by Suavages, and
Typhus Cum Flavidine Cutis, by Cullen : among the  French it is
known by the names of Maladie de Saim, and Fievre Matelotte: and
among the Spaniards, by those of Vomito Prieto.  and according to
Coreal and Ulloa, Chapetonada.   The title bestowed by Suavages, is
improper, because (independently of any discoloration  of the skin)
it  is not connected, at least, usually, with any morbid state of the
liver or of the bile, nor with any permanent obstruction of the pas-
sage of that fluid into the duodenum, causes to which Icterus orJaun* 
24
ters on the disease, confining themselves almost ex-
clusively to the use of negative terms, in their vari-
ous attempts to describe it.   We are very correctly
told, that it is not bilious,  that it is neither putrid nor
inflammatory, but  in what its specific character con-
sists, no one has as yet been enabled successfully to
determine.   The  observation  made by Dr. Physick,
that the black vomit, as well as the dark matters eject-
ed  from  the bowels, are  secretions fiom the inflam-
ed  blood vessels of the stomach and.intestines, is in
my opinion the nearest approach which has yet been
made  towards a development  of the true nature of
the complaint.  That morbid secretion, forms the im-
mediate source of the disease, all its  various phenom-
ena and symptoms tend, I think, most clearly to estab-
lish.  This diseased process extends, in my view of
the subject, to the entire mass of the smaller arteries
and blood  vessels, and is carried on in everv part of
the System to which they reach, as is plainly eviden-
ced by the yellow depositions under the skin and
in  the eyes,  and  the effused  matters  found in  the

dice is commonly referred.  Dr. Cullen's words, Cum Flavidine Cu-
tis, as well as the English of that, «• Yellow " are objectionable terms,
because they draw the character of the Fever,  from a symptom which
is very often  wanting even in the most  severe cases of the disease,
and which, certainly, is not always of high importance when it  «loes
occur, very many persons having recovered after being remarkably
Yellow.  The term " Black Vomit," is likewise objectionable, be-
cause this symptom does not occur in a very large proportion of the
persons who are attacked by this? Fever; it is  moreover certain, that
neither the yellowness  of the skin,  nor a discharge of a dark color-
ed matter by vomiting, nor even the existence of both these symptoms
in the same patient is peculiar to the disease.  It is unquestionably
of great moment, both  for the advancement of science and the pre-
 vention  of dangerous errors in practice, that  diseases should not be
 arranged under improper titles, and of all titles none can be more im-
proper or tend more to  embarrass inexperience, than such as are bor-
 rowed from certain symptoms, which, like the yellowness of  he skin
 and the  Black Vomit, besides being wanting in the great majority of
 patients do not in general make their appearance, when present, til
 towards the close of the disease."   Bancroft. 
25
brain,  which are unquestionably secretions from the
minute ramifications of the arteries and veins of those
points.  The smaller blood vessels tukm •; on this m >  -
bid secreting action, and thus creating disorder throu;.i-
out the .whole animal econ nny, I consider in a »vord,
as the disease itself, constituting a peculiar vascular
affection, to which  I should apply the term  clonus
 Vascularis, as more appropriate ihan any otner desig-
nation which it has yet received.    Toe broken do.vn
and disintegrated state of the blood, which is remark-
ed  in  all genuine ca^es of the Fever,  probably ex-
cites  in  the first iosta ice,  and at  any rate sup dies
and keeps up the viSluted secretions winch have been
described:  It is not perhaps given to us, to live in-
to the cause of this singular condition of the vital flu-
id,  but our ignorance in this respect may not oe of
much consequence, if it can be  shewn that it does not
prevent the successful treatment of the disorder, which
is what I hope to do in the course of the present un-
dertaking.  The different effects of climate will never
perhaps  be satisfactorily accounted f»r; we see its
impression  sometimes manifested in the disorder of
paiticular Viscera, as of the li\er, in many instances ;
and thus in Yellow Fever, the lesser blood vessels ap*
pear to be specifically acted upon.  If the doctrine be
admitted, that the whole onut of the disease, falls ex-
clusively on the vascular system, not only may most
of the symptoms which present themselves in its pro-
gress,  but also the appearances which are exhibited
on the dissection  of the Yellow Fever subject, be
readily traced to an iutdliginle origin   The secre-
tions entered into by  the blood vessels of thestomach,
by ultimately occasioning the engorgement and disten-
tion  of those organs,  would necessarily  produce a
thickening and enlargement of the coats of i he st omacti
itself, and thus give rise to its peculiar  in ita iiity
which forms the most distressing and uiimauagabie
                        D 
26
symptom of the complaint.   A similar process go-
ing on in the sanguineous vessels dispersed through
the substance of the brain, will account for the stu-
por and other cephalic affections,  and particularly
for the dreadful delei ium, and those paroxysms of vi-
olence which characterise the more fatal and malig-
nant cases   The  remarkable  suspension of all the
natural secretions which  occurs so early in the Fe-
ver,  adds, I conceive, a vei\v  strong corroboration to
these views, as it takes place simultaneously with
those unhealthy secretions, commenced in the lesser
blood  vessels.   The functions of the liver seem to-
tally suspended, while the dryneis of the fauces and
paucity of urine, throughout  the  attack, indicate a
like non-performing state of  the kidnies, and saliva-
ry glands.   The inertness  of the skin, also deserves
our very particular attention, as it is greater in this
than any other form of Fever whatever, the disease
never resolving itself by perspiration, or any critical
discharges from the surface.   The brain, which is to
all intents and purposes, a  secerning organ,  as  it se-
parates from the mass of the blood ihe nervous flu-
id, to  distribute and circulate it through tne system,
partakes in like maimer of this general suppression
of the natural secretions.  The excessive debility and
prostration  of strength,  so conspicuous in all cases,
must be ascribed to an interruption of the supply of
the Fis-Fitalis, or nervous influence, on the due dis-
pensation of which all the healthy aciions and vigor
of the system seem essentially to depend.  The in-
fluence of the nervous  over the arteiial  system, is
admitted by all Pathologists,  and where we  have, as
in this epidemic, but little  Fever, with a fatal debility
and prostration of strength, the office of the brain
must  be  supposed, to be materially interrupted, if
not nearly suspended. 
27
   The last circumstances which  I shall deem if ne-
nessary to notice,  in considering t is part ot the sub-
ject, are those profuse hemorrhages,  both extern 1
and internal, which mak«* their appearance in the last
stage of the disease.  The origin of thes« is obvious,
a« cording to the foregoing ideas.   A necessary ef-
fect  of the inordinate secretions,  which I attribute to
the minuter blood vessels, would be the over disten-
tion  and final rupture of their extremities, resul in*
in those discharges of depraved  blood from the sto-
mach, and also from  the fauces, nose,  ears, and eve-
ry esmunctory of the body, which generally termin- ,
ate the catastrophe of the disorder. The short parox-
ysm of Fever, wiih which patients are  at first attack-
ed, is only to be regarded as  a transient struggle of
the vis-rnedicatrix of the constitution, against that un-
due action in the smaller sanguineous^organs,  which
I nave indicated as the primary source of the disease.
Idle indication of cure to be drawn from the survey
here taken,  after a short description of the symp-
toms, as they hive presented themselves to my obser-
tion, will form the subject of another chapter.
                   SYMPTOMS.

   Toe particular time at which persons are attack-
ed, seems first deserving of notice.   I his is gene-
rally just before  day break, at the  period when the
collapse  of  sleep is probably most  complete.  The
seizures  which occur thus early,  I  have observed to
be usually more severe, and are more apt to termi-
nate fatally, than such as take place in the forenoon, tor
persons  are rarely attacked at any  other than these
periods,  in  the twenty four  hours.   In the first in-
stance the patient  often awakes in violent tormina,
effecting  the stomach and bowels,  winch ^ecuis to 
28
pusnend, or put off the febrile action, for it is not un-
til the decli le of the pain that the fever commences.
In common,  however,  the  symptoms are such as
have often  been described; namely a sense of lassi-
tude with ►pain of the head, back and limbs, accom-
panied by  nausea, and  uneasiness of the stomach.
The fever sometimes immedia'cly  succeeds these af-
fertio: s.  at others it is ushered in by an obscure chill,
or slight rigor.   The arterial action is considerable,
attended bv a parched state of  the skin,  with flush-
ins of tha  f  ce.  and  redness of the eyes—the last
however is not an invariable symptom.   The pulse
is in most  casese tense and strong, but in a lew in-
stances, irregular and oppressed,  while  the tongue
con'ii-lies eh an and gummy, being very seldom foul
or covered with  a white furr.   The patient always
compl tins of (treat oppression of the Piaecordia, and
is exceedingly dispirited, sighs much and is often af-
fected  with slight  deleriuin  or  wanderings of intel-
lccr.   I hese  symptoms are lollowed by  frequent
retchings,  ami  the discharge  of  various foul  mat-
ters from the stomach, the chief of which seems to be
a bilious saburra,  which is probably always more or
less accumulated in the first passages In these vomi-
t:ons pure bile is sometimes thrown up, but which, as
h isb» en shewn, has nothing to do with the disease, be-
ing caused  altogether by the violence of the efforts to
vomit, which has the tfleet of emulging the biliary
(uct, as often happens in cases of common sea
sickness   Flatulence is another  distressing symp-
tom, wiiich set ins to be confined  wholly to the sto-
mach,  and  though the patient appears to  be often on
the point of getting rid of it by ucteration, a rtgurgi a-
tioii t«> the  stomach takes place, and this  wind or gas-
tric  gass thus continues to undul.de, creating giet
distussand restlessness.  The  paroxysm seld >m ex-
tends bey ona thirty-&ix hours, though ii may be pro- 
29
traded  to  fortv in a few instances.   Its subsidence,
which is never marked by any critical or perspirato-
ry discharge,  is succeeded by  a  remarkable quies-
cence, and  in fact collapse of the whole system.  The
pulse becomes equable and natural, the ski?) relaxed
and cold, the intellect clears up, and the patient ap-
pears to be doing well.   There is sometimes, how-
ever, at this  period of the complaint, a stupor, which
is always a symptom of  great danger—another bad
sign, in  a moibid irritability of the stomach, manifes-
ted by  a renewel of the efforts to  vomit  whenever
pressure is made by the hand on that organ.  It is al-
so a very  unfavourable symptom, when the patient
expresses an opinion that he is well, or that very lit-
tle is the matter with him. The  last and most fatal ef-
fects of the disease, are an inci eased debility and pros-
tration  of  strength,  a  sinking  of the pulse,  and an
exarcebation of the irritability, pain, and heat of the
stomach, followed  by  incessant strainings to vomit,
and repeated discharges  of the black vomit, or stuff
resembling coffee grounds, with a dejection of simi-
lar dark matters from the bowels.  The urine at this
time becomes  dark and fetid,  the  yellow suffusion
with petechias make their appearance, and  hemor-
rages from the fauces,  nostrils and other external
surfaces take place.  Finally, the pulse intermits, the
breathing becomes laboiious,  tie extremities gradu-
ally grow cold, and life ceases.   The symptoms here
detailed, are not, it is to be observed, invariable ei-
ther in order or occurrence.   Patients often die with-
out either the hemorrhages, black vomit or yellowness
of the  skin.   I he  last-mentioned peculia ity some
times shews itself immediately  on the decline of the
fever, and  may always be regarded  as a certain pre-
cursor of the formation of the  black vomi*.   In the
early part of the season, the cases usuallv  terminate
on the fourth day, (leckoning always the natural day 
30
of twenty four hours.) As the season advances, they
extend themselves to the sixth day, when the worst
symptoms appear on the fifth.  Towards the end of
the summer, the disease is sometimes protracted to
the eighth and  thirteenth days; during this long col-
lapse, the patient generally remains perfectly quiet,
though very much prostrated, ex ept where injudici-
ous attendants tamper with the stomach, by impro-
per administrations,  and bring on the vomiting and
other afflicting symptoms.
   Although, as I have before observed,  this disease
is dissimilar from every other whatever, it is yet sus-
ceptible of a certain degree  of modification,  as we
have*sub-grade of  it, which  in a majority of cases,
eventuates' favorably on the  third day,  by  perspira-
tion, and  is never accompanied by the Black Vomit,
Hemorrhages, or any of the more violent symptoms.
This nnld torm of the Fever, is capable however of
being exasperated into a serious disease, by impro-
per treatment, particularly by the  administration of
mercury,  which being an  excitant of  secretion,
brings on all the fatal affections which characterize
the higher grade of the Fever.   In connection with
this part  of the subject, it is  proper to observe, that
strangers are frequently seized in  the  early part of
the season,  with Bilious remitting and intermitting
 Fevers, and though where they recover from these,
they are  less likely to have the Yellow  Fever, they
 are still liable  to take it, by improper exposure or ex-
 citement of the system.  As persons in this climate
 can never have the disease but once,* there  can be

   * In the  first part of these numbers, I endeavoured to account for
 the liability of Natives to the  disease, in the more Northern Cities.
 In this 1 have yielded to the authority of Physicians in those places,
 who have so reported the fact. 1 am, however, strongly inclined to
 doubt,  whether an adult, who has  once passed through a Yellow
 Fever summer, or through the disease itself, is ever subsequently in
 <vny danger from it.  W here  the contrary hat  been supposed to ap- 
SI
no doubt, that where strangers experience a second
attack, either in the course of the same season, or at
any subsequent  period, that  the disease was mista-
ken i 1 the first instance and was not Yellow Fever.
Evils arise from a  misapprehension of this sort;  in
the first place, an erroneous  practice is adopted, for
the same remedies that cure a Bilious remittant, are
injurious  to  the Yellow Fever patient;  in the next,
the peison who has been illusively led to believe that
he has undergone the necessary seasoning to the cli-
mate, throws off all precaution, and  is liable to be
cairied off by  the  genuine disease.   From  the de-
scription which has been given, it will be seen, as ob-
served in the former part of this discussion,  th t the
Fever consists of but one paroxysm, a circumstance
which has never been sufficiently adverted to.—For
want of  attention to this fact, the mistakes above de-
scribed,  have but too often  been made, and Fevers
of a Bilious character,  which are mostly very man-
ageable by common means,  have been  pronounced
to be Yellow Fever, and the latter disease, supposed
to be cured, where it  never existed.   The  young
practitioner is apt to be deceived by success of this
sort, and  at once  imagines, that like the Chalcas  of
Horner, he  has discovered the true  means of arres-
ting the arrows of pestilence.   Those, however, who
indulge in this overweening confidence, should bear
in mind, that it is only by  experience and close at-
tention, that any accuracy can be attained in distin-
guishing between the two diseases,  and that  in fine,
there is no short way to success in this or any other
science,  not even for the most gifted minds.  The
soil of genius  is  indeed endowed  with  natural
riches,*  its surface is covered  with  flowers,  and

pear T cannot but believe that a high grade of Bilious Fever has bee j
mistaken for the mote Malignant Epidemic. 
32
its bosom filled with gems, but though the first may
be gathered  without  labor, to grace  the hand  of
Rhetoric or the wreathe of Poetry, the  latter are not
to he come at, but by a process of mental mining, and
patient toil, the hard condition annexed to every ac
quisition, that is of any real value or utility to man-
kind.
'»VW«W\WWW"«-'VV\WX.WS'»»v"»W-.» ..v\
                 CHAPTER IV.


               Medical Treatment.

  Although  there  will be found a strict agreement
between the Theory of the disease,  which has been
advanced, and the  Medical Treatment, now about to
be recommended, the latter was not originally dedu-
ced from or founded upon the former. In practising
in the Fever, it was an obvious indication, to allay or
reduce as far as possible the inquiescence of the sto-
mach, which is so afflictive to the patient, and forms so
baffling a symptom to the physician.   Finding, after
the trial of a variety of remedies, that the saccharum
saturni, or sugar of lead,  was the most effectual for
the purpose, the rationale of its operation led to those
views of the disease, presented in the third Chapter of
this Essay.   It may be light,  before entering more
directly on the present suoject, to give a general idea
of  the powers of this medicine,  and to  remove the
mistake  lespectingthe supposed danger of adminis-
tering it internally, a notion very prevalent with the
public, but  known to physicians to be without foun- 
38
 dation. T shall adduce authorities on this point, which
 will be found to be perfectly satisfactory and decisive.
 I deem it necessary to premise, that it is not my in-
 tention to hold up this remedy,  as a specific in the
 Yellow Fever, but simply to shew,  that its exhibition
 has been successful in so  many cases, as to render it
 deserving of attention, and that its known  properties
 adapt it, in a peculiar mariner, to meet the different
 symptoms of the  complaint.   It  will be in my  pow-
 er  to corroborate  my own statements respecting its
 efficacy, by the concurring testimony of  physicians
 of  eminent character in this place,  who, having tri-
 ed  it, highly approve of  its  use.   Among  these I
 will take the liberty of mentioning Dr.  Samuel Wil-
 son, sen. whose experience, extensive practice, and
 distinguished standing in his  profession,  must give
 weigh! to his attestation on such  a subject:  Dr. Fur-
 man also, whose superior intellect,  and medical eru-
 dition, entitle his opinions to peculiar attention; ha-
 ving given a full trial to this medicine, is  convinced
 that its  administration in  Yellow Fever, is attended
 with the highest advantages.   The  public production
 of names,is always a matter of delicacy, 1 cannot  how-
 ever refuse  myself the satisfaction of adding to the
 above, that of Dr.  Win. Warley, whose talents, judg-
 ment and integrity, must  give inipressiveness to his
 testimony in the minds of all  who know  him.   He
 informs me, that though his experience in the disease,
 and with the use of the remedy,  haW been limited,
 he has been struck with the admirable effects of the
 lead, and thinks that it will prove a valuable remedy
 in the  Fever.  I  should state, that it was not  until
the complete failure ol mercury as  a cure, that I re-
sorted  to the article in question.   It will hereafter be
 shewn,  more at length, that murcury is not merely
ineffectual, but inert, in the wors^  cases, and only op-
erates when, by an effort of nature, the disease has
                       is 
8t
token a  favourable turn, and the revived sensibility
of the system  enables it to act, or, in  other woids,
to salivate after the  danger is past.  Salivation and
recovery being merely coincidental  and not connec-
ted in the order of cause and  effect*  I am further
countenanced in recommending it, by the high opin-
ion of its powers  expressed in a personal communi-
cation  by Professors  Chapman and  Physick,  the pre-
seit luminaries of the University of Pennsylvania;
an institution, which  in the learning and ability of its
teachers, and the  number and  proficiency of the gra-
duates, whom it  annually  adds to the  ranks of sci-
ence, is on a level with the most celebrated seats of
lcai ning in the old world.   That it may continue to
flourish, must be the wish of every friend of science
and of the glory of this countiy; and it is consoling to
reflect, that  its extensive reputation and venerable
standing can never suffer diminution, while  its most
important  chairs  are filled by such illustrious orna-
ments of their profession, as a Physick and  a Chap-
man. l)v. Cullen in speaking of the effect of the sac-
charum Saturni in repressing hemorrhagy, observes,
that if there be an article of theMateria Medica, which
is entitled to the character of  a specific, it is this, as
in arresting the efflux of blood, it certainly exerci-
ses a power more striking, and more directly conser-
vative of life, than any other medicine whatever.  Of
its efficacy in uterine,  and also in pulmenary hem-
orrhage, Dr. Barton, in his edition of Cullen, thus
jxprcssts himself:—'* The observation of the respec-

  * From  500 to a 1000 grains of Calomel have been given in some
eases, without producing any sensible ell'ect, the prostrated state  of
the vital powers affording it no basis on which to  act: as soon how-
ever, as the renewed vigor of the system allows it to operate, it pro-
duces all the inconveniences distress and injury, of  salivation, besides
retarding the cure.  Those who thus surchage their patients  with
quicksilver, should not be  surprised at their dipping through their
jiiigers, as they so often do. 
85
 table Dr.  Reynolds of London, are well known: and
 the experience of other Physicians, has, I think, suf-
 ficiently established, the vast and unequalled powers
 of this article,  as a sedative or astringent, in dange-
 rous bleeding from the  various parts of the body,  hi
 many cases of such bleedings, either uterine, or from
 the lungs, I have exhibited the sugar of lead,  gene-
 rally, in combination with a pitance of opium, or some-
 times with a portion of Ipecacuanha.   Seldom have
 I been disappointed in my expectation of benefit from
 the medicine, which of all the articles  of the Mate-
 ria Medica, seems to possess the greatest command
 over the arterial system.  In no instance have  I per-
 ceived any dangerous effects, and rarely any tempo-
 rary  inconvenience from the employment of lead."
 Dr.  Chapman,  also says,—"Not a doubt do I enter-
 tain of the utility of the  acetate of lead in uterine
 hemorrhage.   The testimony of so cool, so cautious,
 and  so deliberate an observer as Dr. Barton, whose
 scope of  experience with it, has been  very wide, is
 alone satisfactory to me,  but to those who are less
 acquainted than  myself, with  the acuteness of the
 discernment and the accuracy of the judgment of that
 truly philosophical Physician, it may not be altoge*
 ther improper  to mention, that his original account
 of the success of this medicine, ii uterine hemorr-
 hage, has  been fully convinced by the subsequent ob-
 servations of a very large number of respectable prac-
 titioners throughout the country.'"
   Dr. DeWees, in his abridgement of Heath's trans-
 lation of Buideloque's system of Midwifery, remarks,
 that  his author  '• was not in possession of one of the
 most powerful remedies yet discovered,  for the sup-
 pression of hemorrhage, the acetate of lead."   Af-
 ter giving  some general directions as to the treatment
 to be pursued before exhibiting it, he goes on, "The
acetate of lead  may be given with freedom and cer- 
86
tainty, from three grains to ten, every half hour, un-
til its effect is obtained.   It will perhaps surprise,
when the remedy is recommended in such large quan-
tity,  and in  such quick succession ; but I have not
only found it safe,  in such quantities,hut necessary."
A case of epilepsy, cured by this medicine, is report-
ed in the gd  volume of the Medical Repository, by
Dr.  Earle, of Manchester,  Pennsylvania, who states,
<w that from  the first exhibition  of the remedy, the
disease  never returned.  He (the Pa ient) however
continued to  use the medicine for five successive pe-
riods of full moon,  in order more effectually to break
through the former morbid habits of his system. He
now enjoys perfect health, nor did he experience any
ill effects from  the lead during  the time he  took
it, except some slight cholic pains,  a few days  after
he had taken the first dose." These evidences, while
they  are sufficient to shew, that it may be taken in-
ternally without danger, also prove it to possess cura-
tive  virtues of the highest  order.  But  if it be  thus
Useful in the cases, which have been described, it  must
be a si ill more valuable application in the hemorrha-
ges  of  Yellow Fever, which are the   result   of  a
general diathesis,  and particularly in the  stomach,
constitute a pathognomonic symptom. Dr. Cullen ob-
serves,  that  it is more especially in those bleedings
which result from a relaxation, or loss of tone in the
extremities  of the blood  vessels that the lead  does
good; and precisely of this description,  are those
o< zings  of blood  from the ends of the arteries and
veins, which  occur  in  the Yellow Fever.  It  is an
opinion with many Practitioners, that it is apt to con-
flict idiosyncracy.  or particular habits of constitution,
but  so far from finding this to be the case, it has in
my hands been more uniform in its effects than any
article 1 have  ever imployed, this being, according to 
sy
ges.   I have before remarked, that in Yellow Fever,
the stomach  is incapable of diffusing stimuli of any
sort, owing; to its peculiar irritability, the whole sen-
sorial power  appearing to  be concentrated upon it,
through the medium of the  nerves.  It is surely then
a desideratum to find a remedy, which shall at once
allay  this irritability, and at the same time exercise
snbtonic powers upon the system at large.  This ad-
vantage appears to be supplied  by the sugar of lead,
which while it tranquilizes  and  is retained by the
stomach,  has  the  effect of construing the  muscu-
1 r fibre,  and imparting tone to the vital powers gen-
erally.   It also acts indirectly as  a tonic by quieting
the sy stem, and allowing Nature an opportunity of revi-
ving and the vis-medicatrix  of the constitution to come
into play. Its impression conveyed through the chan-
nel of the nerves to the sensorium communce. gent-
ly excites the vital energies, and occasions a saluta-
ry diffusion of the nervous influence throughout the
system,  being the only  medicine that can produce
this  desirable effect,  without offending  or irritating
the stomach.   It is supposed by many, that it  is lia-
ble to produce obstinant constipations, but this is a mis-
take; the first does even very frequently operate as
cathartics and the  bowels always retain their sensibil-
ity,  when the highest doses are given.  I think it ap-
parent then, that in directing ourselves to  the symp*
toms of the  disease, as they are presented to com-
mon  observation, and without reference to any theo-
ry, the practitioner would  have every inducement to
adopt this medicine, and would give it a preference,
simply  for is effect in composing the stomach, the
seat of so much inquietude, and  of so many formi-
dable and fatal symptoms.  It seems to have been de-
monstrated by the investigations of comparative ana-
tomists,  that the  stomach  forms the  most essential
organ of the  living system,  as there is no example 
38
of any organized being in whom it is wanting, while
there are many ani nals,  who  are wit'tout the other
important viscera, such as the livu\ lungs, and even
brain.   Another  proof  of its  primary importance
in the animal economy, is, that fevers affecting the
whole system (as is observed by Dr.  Webster, an
eminent European Physician) are often cured by re-
medies  addressed to  the stomach alone.  An emet-
ic dislodging its foul contents, and arousing its ener-
gies into action,  has often succeeded in breaking and
dissipating a fever, that has resisted every other mode
of treatment.   I  conceive it therefore to be of the
utmost consequence in the Yellow Fever, to obtain a
mastery of the stomach,  not only as it appears to be
primarily affected, but as it affords the proper point
from which to act with success upon the sensient or vi-
tal  principle, and counteract the disease. Opiates and
stimuli of all  kinds are found to exasperate its irrita-
bility in the highest degree, and even calomel, though
it is better retained than the former, is yet extreme-
ly oppressive and must  therefore be injurious.   A
dose of calomel disorders this organ in the healthy
subject, and  of consequence cannot  but be pernici-
ous to the diseased stomach of the Yellow Fever pa-
tient. I have thus endeavoured to shew that the use
of  the saccharum saturni is called for, even accor-
ding to  the usual views entertained of the disease;
but if there be any correctnesss in the idea broach-
ed in the former part of this essay, that the  disor-
der arises from,  and depends wholly upon morbid
secretion, the employment of this remedy  seems to
be  more especially  demanded.  The first effect of
the saccharum saturni, is to tie up and  correct those
viciated secretions, which are constantly acting up-
on and destroying the texture of the blood, and thus
directly invading the source of life, and giving rise
to those violent affections of the stomach, brain, and 
39
other viscera, which are unhappily familiar to the un*
professional as was well as the practitioner.   The
rejection of mercury, which is an excitant  of secre-
tion, necessarily follows from these ideas, but a dis-
tinct section will be devoted to the consideration of
the Ptyalismal treatment which is still so much reli-
ed  on.   I  shall now proceed to detail,  the general
treatment  which I have pursued in the  disorder:
  Notwithstanding the prejudice which prevails against
the use of Emetics, in this disease, they may be re-
sorted to on the first access of the fever, and before
the irritability of the stomach commences,  with very
great advantage.  In all cases, the stomach is loaded
with various foul matters,  which can never be effec-
tually dislodged  by cathartic medicines, and on-
ly to be got at by  the direct  operation  of emetics.
In  the commencement,  therefore,  of the febrile
stage, an emetic will be found useful, though its re-
petition  is never adviseable.   During the  progress
of the complaint, saline purgatives, occasionally ad-
ministered, according to the  state  of the bowels,
will  answer every further purpose of evacuation.
Great caution, however,  is necessary in having re-
course  even  to these, for the disease is marked
by so much  debility, that, every care must  be ta-
ken to avoid weakening  the patient, or exhausting
the vital principle.  Depletion therefore, as a mode
of cure,cannot be too much reprobated, as every thing
should  be done to conserve the strength,  and keep
the  system easy and undisturbed.   The abstraction
of blood can but rarely be  requisite, and the practi-
tioner has only  one great and  plain rule to observe,
that of keeping his hands off the patient as much as
possible,  and allowing nature to do her part, only oc-
casionally favouring and assisting her efforts.  He is
above all to avoid tampering with the stomach, which
is so easily exasperated into incurable irritability by 
40
administrations of an exciting quality.  The ulterior
effects of the disease certainly shew themselves most
conspicuously in the stomach and bowels, but prac-
titioners  in  endeavouring to relieve these,  though
right in their object, have been often  wrong in their
practice.   Bark and wine, and stimulants of all kinds,
do  infinite harm  in  this disease, and are forbidden
by  every view of its phenomena and  symptoms.
Where we have, as in the second, or collapsed -tage
of the complaint, a sunken pulse, livor and paleness
of the countenance, with uneasiness of the stoinaeh,
and every evidence of excessive prostration, connec-
ted with irritability, to tranquilize  and support the
patient are  surely the leading indications.   Blisters
are beneficial,  both  during the  frebrile action,  and
after  its  decline, and may  be applied in greater or
less number as the nature of the case may demand.
Their application  over the region ofythe stomach,
seems to produce the most good, by diverting  irri-
tation to the surface, and  tending to translate se-
cietion from the internal cavities to the skin. It is on
the decline of the fever, that the exhibition of the sac-
charum  saturni is  recommended. It may be given in
doses, of from two and a half grains every two hours,
to three  gr, ins every four hours, either in pills or so-
lution, hut  always uncombined.   The intervals be-
tween the doses, are to be shortened or extended as
the greater or less urgency of symptoms may require.
Some of the profession,  who have been induced to
use this  medicine, have complained of being disap-
pointed  in  its effects, but, in these instances, it has
seldom  received a fair trial,  not having been resort-
ed to until every other remedy has failed,  and was
thus  employed too late or not persevered in suffici-
 ently.   Bark does not always cure intermittents, or
 mercury eradicate syphilis,  and thus the saccharum
saturni,  though it deserves, 1 think, to be considered 
 as a valuable remedy in Yellow Fever, will yet m
 doubt, often fail of the desired effect.  After haviog
 given the fullest trial to various nlethods of cure, par-
 ticularly to the plan of mercuridlization,  and  the
 course of super-venesection, once so strenuously re-
 commended by Dr. Rush, and th^ ultra-phleboomists
 of his school,  I have found the simple mode of treat-
 ment above laid down,  to succeed  better  than any
 other; producing  a favorable result in majority  of
 instances, and always mitigating the symptoms even
 where the disease terminated  fatally.
   As the Yellow Fever is a subject which materially
 concerns the interests of the city and  community, I
 have thought it right to offer these facts, the result of
 long experience in the disease, to the public.   I  vy
 no means flatter myself, that the re nedy I have been
 recommending, will be  very  readily  adopted  by  my
 professional brethren.   In  every  science,  an oppo*
 sition is generally  manifested to whatever wears  the
 air of novelty or innovation ; and by no body of nen,
 is this oppugnation of what is new,  more  apt to be
 displayed than by the members of the Medical Fa*
 culty.   I am far however from objecting to  this cau-
 tion, for though it often assumes the appearance of il-
 liberality, I  am convinced t »at it is  in the  end pro-
 ductive of good, as it prevents the success of empi-
 ricism, and  gives  currency  only  to  those  just and
 sterling ideas, which  have received their  stanm ift
tne mint  of  experiuiem  and time.
f.
,] 
48
                  CHAPTER V,


    On the Mercurial Practice in Yellow F-ver.

  Mercury, though with justice ranked among, what
fiave been*emphatically termed, the heroic remedies,
being unquestionably one of the  most valuable arti-
cles "of the Materia Medica, has  yet been so exten-
sively abused and misapplied in practice, that it may
well*be doubted, whether it his not much oftener
done harm than good, being always more of a poison
than an antidote, in the hand- ol  the rash and inju-
dicious.  By  many of  the  profession, indeed, it  is
treated as a Panacea or universal  medicine, and is re-
curred to in ill cases, whether the disease  be Con-
sumption or Yellow Fever, an eruption ol the skin or
a fit of hypochondriasm: both the mala mijora and
mala  minora,  are equally supposed to he under the
power of Mercury, and  either exhibited internally
or laid on  by  inunction, it is applied as a sovereign
remedy for ad  evils bodily and  mental.  To touch.
the mouth,  seems to be regarded  as little  less than a
magical operation, for in too  many of the cases  in
which salivation is  induced, it would be  vain  to
seek for any rational indication,  warranting a resort
to it.  These observations are, however, chiefly appli-
cable to some of the  practitioners of this country,
for on the other side of the water, physicians seem
to be rapidly passing to an opposite extreme from this,
and now question the necessity of employing vlercu-
ry, even in those diseases which  it controuls with the
most effect, on the ground that these may be cured
by other medicines, which  are  not attended by the
inconvenience and injury of salivation.  Dr. Thomson,
professor of Military  Surgery in tne  University  of 
4S
ErtnburKh. has recently written against its u«e erei*
in Lues Vaieria, maintaining that this disease,  can
a* well be cured by sarsapaiill\ in conjuctiou with
other means, as by  Mercury;  and prefers  the  for-
mer, as not being foil owed by any permanent or ill
consequences  to the  constitution.   Dr  Shepherd,
another late writer, is  for rejecting  Mercury in all
f> vers or pyrexial disorders ; and in the Clinical Re-
ports, also, of the E iinburgb Royal Infirmary, tha
s.divating practice is condemned in this cla-s of dis-
eases.   The writers on this side of the question, have
reduced their doctrine to the following axi »m:—•• lb t
the Mercu'ial  unsusceplibility  of the  system, is in
the ratio of the concentration of the  disease;" or in
other words, that it is only in the milder grades of fe-
ver that Mercury acts as aayllagogue, (which, there-
fore, could be cured without it), while in cases of a
moie violent type, it proves totally inert.   I need not
urge that these opinions are deserving  of serious at-
tention, not only on account of  the authorities on
which  they  rest, but also  from the  intrinsic impor-
tance of the subject.
  The lasting  injury often done  to the constitution
by Mercury, is certainly a consideration which ou^ht
to lead to its disuse,  in every instance in which it is
proved, that the disease  can be conquered  by other
and  more innocent means.  Without, however, go-
ing the length of the writers here cited.  I shall  con-
fine myself solely to the consideration of the Mercu-
rial  Practice  in Yellow Fever; and  shall  oppose it,
first upon the principle just noticed, that of the insus-
ceptibility of the system, to the Mercurial impression,
in all concentiated cases;  and next, on the ground
of the excitive effects  of Mercury on  the secretory
organs, the primary affection of  which,  I  consider
as forming the foundation of the disorder.   The de-
bility vvnich it  induces, is  another objection, which 
44
will he urged,  a«t prostration and weakness, consti-
tute the leading difficulties which we have t> con ten J
with in t;,e course of the disease.  Dr. Bancroft, on
the first point observe*, " I am not convinced of the
supposed  benefits of Mercury in this complaint;  for
should it  even  be the case, as is pretended, that the
patients in whom a salivation can he excited, generally
recover, I do not perceive that we  could thence f.tirly
infer, that their recovery was effected by the saliva-
tion.  It is well known that in many cases, more than
500 and in some more than a lOUO grains of Calomel
have heen given internally to a single patient, without
producing any sensible eff ct on the salivary glands,
or even on the intestines; and although, to explain this
inactivity  of the Mercury, it has been supposed that
in such cases the absorbents alone were in fault, by
not taking up the Mercury;  this  explanation cannot
be admitted, because the intestines have been as lit-
tle  excited by the calomel thus introduced as the sa-
livary glands;  and it seems,  therefore probable, that
a general torpor, or defect ot excitability, and of vi-
tal energy, existed in such patients, and that the Mer-
cury proved inefficacious in  them only because they
bad  aire xdy made considerable approaches towards
the condition of a dead body, in which it is obvious
that no quantity of (hat medicine however large, could
exercise a stimulant power,  if ti.is reasoning be just,
there will be room to suspect at least, if not to con-
clude, that when patients die of the Yellow Fever, af-
ter  all attempt to excite salivation in them have fail-
ed,  their deaths have resulted, not from the want of
any good  effect which salivation may  be thought ca-
pable of producing, but becatise the condition of their
living or sensorial power, and of the functions depend-
ing luereon, had already become so morbid  as to ren-
der tneir recovery impossible: and on the other hand,
tn«a where peisons ha\e recovered from the Yellow 
                        45

Fever after having been salivated, their recovery wn»
not occasioned by the salivation,  but was the conse-
quence of such a condition of the powers of life, and of
the functions connected  therewith,  as induced a mi-
tigation of the disorder ;* for the same reason, and
perhaps, coetiris paribus, in the  same  degree,  as  it
favoured the  operations of mercury upon such per-
sons ; and therefore that although  recovery has not
unfrequently  followed,  or accompanied salivation,
the latter was not a cause of the former.   There  is
no source of error  more  common  or productive,
than that of supposing an event which closely follows
another  to  have been occasioned by it; and it may
be doubted whether a great number of the advocates
for mercurial salivation in the Yellow Fever have any
other, or better foundation,  for  their  conviction  of
its efficacy.  In order to attain the truth upon this im-
portant subject, we  must ascertain  whether those
practitioners who excite  salivation in as many of their
patients  as may be susceptible of it,  do in fact lose
a  smaller proportion  of them than those who purpose-
ly  abstain from all endeavours to  produce that dis-
charge :  and  on this  point I must declare that,  after
some experience, assisted by  no ordinary portion  of
enquiry  and information,  I have not been able to dis-
cover that the salivators have been more successful
than the others; and,  if not more successful, their prac-
tice has certainly been hurtful;  because, in most ol the
persons who  have recovered,  the (perhaps  useless)
salivation had retarded the convalescence and produ*

  * Dr. Rush has recorded facts illustrative  of this idea, but being
ignorant of the above principle, did not know how to apply them.  He
says in his account of the Bilious Fever of '94, *' Mercury seldom sa-
livated until the  fever intermitted or declined.  I saw several cases
in  which the salivation came on  during the intermission, and went oil'
during its exercertation, and many in which there .vas no salivation,
until the morbid action had ceased altogether in the blood vessels  br
the solution of the fever." 
4«
•
ceo* troublesome affections of the tonsrue, month and
throat, with other ill consequences, as is well known,
and acknowledged, even by its advocates.   Dr.  Rush
has candily'stated,  that in the City Hospital of Phila-
delphia,  where  bleeding  was  sparingly  used,  and
where the physicians depended chiefly upon salivation
more than one half died of all the patients who were
admitted.  Dr. David Grant, of Jamaica,  avers that
" although he attended many under salivation, not one
survived, and that  they became more the victims to
the mercury than even to the Fever."" Dr. Shepherd
concludes his essay with remarks to the same effect:
be says,  " It may  appear, pet haps, fastidious, thus
to inipugn the truth of a doctrine so plausibly con.
stituted,  as to hinge  on the imposing coincidence of
a declension  of fever,  and the supervention of  sali-
vation.   But  in conclusion, I must repeat my belief,
for the reasons above assigned, that the reputation
of mercury in fever, has been derived from a fala-
cious source, that when  its uncombined exhibition
has  been followed by  salivation and recovery, the
disease has been of a mild grade, which would have
yielded to ordinary measures with greater prompti-
tude than to mercury alone, witboutthe inconvenience
of the consecutive salivation,  and that where it has
been associated with depletion and other evacuants,
the  extinction  of  Fever has been effected by those
remedies, and  not by the  specific operation of mer-
cury ; the system  under fever, being susceptible of
that effect, only when the violence and danger of the
disease have  been  removed, by such effectual prepa-
ration."   These opinions receive still further sup-
port, from a quarter where most experience has been
bad upon the subject.   Dr.  M'Cabe, in his account
of the Epidemic Fever of Trinidad, in 1817, makes
the  following statements: * To doubt the efficacy of
mercury in the cure  of the Fever of the West' In- 
47
dies, may appear extraordinary; the following elr.
cumstances, however, together with an impartial at-
tention to its effects, induce me to doubt whether
mercury is entitled to the great praises bestowed on
it in this disease, and the reliance placed on it to the
almost total exclusion of other remedies.   That the
action of  mercury does not supersede the action  of
fcver, every  Medical Officer must  have seen,  who
has ha I  charge of a hospital  in  the West Indies.
There may be frequently seen patients dying of fe.
ver while  under the iniuence of mercury; the fatal
termination of the  disease  will there be observed  to
take place during  every stage of the effects of this
medicine, from  a  slight soreness of the  gums,  to
the most  seturated stage of Ptyalisra.  I  have seen
persons using mercury  for  the. cure of other disea-
ses, and when  Ptyalism was present, attacked with
Fever and die  of it.   In  such cases  it   also ap-
peared that the progress  of putrefaction during the
disease, and after death, was  even more rapid than
n ordinary cases."
   In the third chapter of this Essay, I have labored
to prove, that the disease depends  on, and is entire-
ly ascribable to a morbid secretion, carried on by the
smaller arteries and blood vessels of the system, ac-
companied by an almost total suppression  of all the
natural secretions.  The illustrations and arguments
which have been used in support of this idea,  need
not be repeated here ; it is hoped that they are suf-
ficiently strong, to warrant some reliance upon the
doctrine, and if it be at all correct, the administration
of mercury, which directly keeps  up the  unhealthy
actions, which have  been indicated as the  source  of
the disease, cannot but be highly hurtful and perni-
cious.   The modus operandi of mercurial medicines,
has been a subject  e£ much dispute  in  medical seu
ence, but  it seems  to be agreed ou all hands, that 
48
they act in the first instance, as stimulants uoon the
arterial,  or  sanguiferous  system.*    This  almittel,
their more remote effects, may, I think, be explained
in the following manner:  Mercury is found  to dif-
fuse itself more extensively than almost any other
medicine, with which we are acquainted,  permeating
the minutest vessels of the system, an I  even trans-
piring through the pores of the skin, as is evidenced
by  its producing a  discoloration  of  metals in  the
pockets of salivated persons   Tins penetrating qual-
ity, which carries it to the remotest organ of the liv-
ing body, while  it enables it to excite the excretory
glands,  and bring on salivation;  also  occasions it to
act upon, and when too profusely used,  to destroy
the texture of those pellucid and delicate vessels, or
com pages of vessels, which form the periosteum. It
is in this way, that it denudes the bones and exposes
them to disease, or to that mercurial necrosis, so well
known to Physicians  It is upon the same principle
that it operates efficaciously in  discussing  tumors,
nodes and other local affections,  when  moderately
applied.   Being conveyed by its diffusibiiity to the
most  distant  parts;  it acts upon and  ultimately oo-
bterates  the   anomalous organization, fro n  which
these topical formations  take their rise,  and at  the
same time  stimulates the sanguiferous system so
as 10  excite the veins to more active absorption, en-
abling them  rapidly to take up the various morbid
matters deposited in the above disorders.  Di\ Ma-
thias, who has written upon the  Febris Mercurialis,
or Mercurial Fever,  which he aptly terms the disease
of the remedy,  attributes to mercury the  power of
producing a specific diseased action;  it is not there-

  * I hare purposely abstained from any discussion of Assimilation*
Vascular  Spasm, and other theories of absorption, as the simple
fact, that certain quantities of Mercury ^capable of pervading eve-
ry part of ttae living system, is sufficient for my present object. 
fore difficult to conceive, that its too free exhibition,
should result in the destruction of those finely ea-
borated vessels which co npose the covering of the
bones, and occasion the affections of the alveolar pro-
cesses and'other osseous surfaces, winch  so common-
ly ensue from its indiscreet uSe.   Having then no to-
nic powers whatever, and operating altogether as an
irritant, its administration in Yellow Fever is contra-
indicated bv every symptom, but more especially  by
the particular condition of the stomach, in all cases
of the disease.  A great portion of the weight of
the disorder appears to fall upon  this organ,  affect-
ftig it with a degree of supersensibility, and throw-
ing it into a convulsed and irretentive  state,  which
renders the exhibition of so oppressive and irritating
a medicine  as mercury, both  locally and generally
injurious. It is important to observe, that while  in tl is
viscus,  the nervous sensibility  is unduly accumula-
ted, rendering it peculiarly susceptible of the impres-
sion of mercury ;  throughout the rest of the system,
the powers of life are to a remarkable degree pros-
trated and suppressed, so that the medicine acts vio-
lently upon  the stomach, where it does the most
harm, but becomes immediately inert, on passing in-
to the intestines and primary passages.   This at least
happens in the worst cases, and in milder attacks, its
specific operation upon the secretions, produces sal-
ivation, which invariably aggravates the disease, and
retards  the cure.   Its debiiitating effects,  form  an
equally serious objection to its employment  in this
disease, which is  marked by a prostration,  and ex-
haustion, greater than in any other species of Fever,
Dr. M'Cabe, before quoted, speaks, " of having re-
peatedly seen calomel thrown in, in large quantities,
with the view of inducing the action of mercury in
the system,  fail in  removing the Fever, and greatly
increase the fuintness and exhaustion.*' He again says, 
00
il T have seen such a degree of faintness and exhaus-
tion,  succeed to even moderate doses, that the pulse
became almost imperceptible, and  the other func-
tions  were  equally enfeebled."  Its reputation as a
preventive,  stands on no better foundation  than its
claim as a cure. That it is not only destitute of pro-
phylactic virtues of any sort, but is actually disadvan-
tageous to  those who take it as a security,  and dis-
poses  them to receive the infection more  readily;
many instances which have come under my own ob-
servation, and others already on  record, sufficiently
establish.    The writer  last cited, mentions particu-
larly  the case of a gentleman, " a great admirer of
mercury, who, during the prevalence of a Malignant
Fever, by way of securing himself against the dis-
ease,  took three grains  of calomel every day.  This
gentleman was attacked with Fever aud died."  The
view  with which it is generally given, that  of crea-
ting a new  action, or by one disease, to drive out
another, is  at  once  so mistaken, absurd and  unme-
dical, as scarcely to deserve a  serious notice.   The
above notion  that two  diseases  cannot exist at the
same time,  in the  same  patient; the  experience of
every day proves to be without foundation.  Decisive
evidence upon this head, might be adduced from vari-
ous quarters, but the cases recorded by the respec-
table  Dr. M'Bride, ought forever to  terminate this
question.    He states that beiween the years 1765
and '67, hundreds of cases of small  pox and mea-
sles, co-existing in the  same person, occured in the
Dublin  hospitals  under his immediate observation;
and facts of a similar kind  are testified to  by other
physicians. ••• It is certainly, prima facise, a circtim-

  * Since writing the above, I have met %vith the following facts
brought together Ly Dr. Francis, in his remarks  of the modus ope-
randi of mercury, " That the human body is susceptible of the ope- 
9i
Stance unfavourable to the exhibition of any remedy,
when it is given with the express intention of crea-


torily shewn by the facts recorded by Dr. Patrick Russell, of the small
pox and measles which prevailed at Alleppo, in i765.  On the author-
ity of Bergius and Tandon, mention is made of several cases in which.
the measles and small pox appeared together in the same individual.
Dr. Willan witnessed the occurrence of hooping-cough (a  disease of
acknowledged specific contagion) during the eruption of the small pox
in the same person;  the former disorder remained a  long  time after
the latter without any material alteration   Cases of small pox com
bined with measles came under the ntice of Dr. Walker. Dessessatts
mentions the complication of small  pox with scarlatina.  Mr Leese
inoculated an  infant while laboring under  measles, and both diseas-
eases went through their ordinary course. Two cases winch exhibited
unequivocal evidence of the possibility of two distinct diseases, small
pox and measles, arising at the same period in the human constitution,
and  each preserving its ordinary course as when  separately existing,
attended with all their usual characteristic symptoms, are recorded by
Dr Tracy.  A number of cases of  small pox co-existing with meas?
les, and the two diseases, going through their regular stages in  the
same individuals,  occurred at the Foundling Hospital,  at Dublin,  as
appears from extracts from the memoirs of the  Medical  Society of
that city, communicated  by Dr. Uainey-  All these instances ofthe
continued operation of measles with other disorders of specific con-
tagion, it will be proper to bear in recollection, are cited from modern
authors: the opinions of the more ancient writers on this point being
disregarded on account of the errors into which they  were led from
adopting the principles of the  Arabian  Physicians, and considering
and generally treating these different specific disorders, small pox,
measles and scarlatina, as modifications of the same disease.
  " Mr. Maurice vaccinated two persons who had been previously
exposed to measles.   The vaccine  infection and the  measles went
through their usual course at the same time.  It appeas fro ;» the  ob-
servations of Dr. Woodville, Dr. WHan and other writers on the cow
pox, that if the constitution be submitted simultaneously to  the action
of the  small pox arid the vaccine diseases,  that these disorders go
through their course  at the same time without influencing each other.
Many cases of this kind  might be mentioned.
  " In the report of the New-York  City Dispensary, published July,
1809, the physician of the cow pox  department, recorded the case of
a child who, on the eighth day after it was  vaccinated,  had the vac-
cine disease with all its characteristics, and  at the same  time, labour-
ed under a '* plentiful eruption of the small pox," to which disorder it
had been exposed by an imprudent visit some days previous.   The t ao
diseases appeared entirely  distinct and independent of each other.
The  physician vaccinated six  children from the  fluid of the  vesicle,
who  all had the  regular cow pox, and  were afterwards  te-ted by  the
small pox inoculation without effect. Several children were inoculated
with the matter from the small pox eruption who took the disease  in
its usual form.   Dr. Adams himself, the unqualified and ii.discumi- 
58
ting a disease; and an examination into the grounds
of this  practice will  not  be found to lessen the ob-
jection to it.  The idea of creating a morbus medan-
tit,  or curative disease,  carries on the face of it, ab-
surdity;  for it is plain, that a medicine to do good,
must act, sanatively, and where  it does not effect
this, if it possesses  any  activity it must do harm;
thus the  above is not a mere harmless  paradox,  hav-
ing I am persuaded destroyed thousands, for error
ai»d evil  are indissoluhly  connected  in  the order of
cause and effect.  Dr.  Francis,  Professor of Mate-
ria JVIedica,  in the Medical College of New-York,
expresses  himself very strongly  upon this  subject.
The following  passage is  from his pen,  and deserves
to be pondered upon:—w' At the present time, the
practice  of salivation seems to owe its general re-
ception to the well known principle espoused by Mr.
Hunter,  that no two morbid actions can exist at tlie
same time,  and that one irritation destroys another:
yet nothing can be more evident, from Mr. Hunter's
writings, tban this very method of cure, met in him
a  derided enemy.   It  is  of minor consideration to
be  informed of the source which gave  origin to this
mode of treatment;  and, painful indeed, the recol-
lection of the miseries it has created  No absurdity in
medical  practice has been  the destruction  of more
lives, none the source of  more pain and calamity.
Well might Dr. Hoffman pronounce the abuse of this
remedy  in the hands of the unskillful, to be more ter-
rible than the sword.  The pages of the older wrt-
ters, as  well as the modem, fully confirm this  fact;
yet this method of cure is still popular,  still pursu-
ed both  in  private practice and  in  public institu-
tions."   Any medicine,  indeed,  given in the quam

nate panegyrist of the doctrines of Mr. Hunter, asserts, that small
pox and cw pox ' will proceed together in the same person without
the smallest interruption to each  ether's course.' " 
08
titles in which calomel is usually administered in Yel-
low Fever, would produce ill effects, and one half
of the injury done by Mercury in this disease, results
from  the excessive  use of it.  The remedy I have
endeavoured  to recommend,  the super-acetate of
lead,  or saccharum saturni, may be  said to afford a
complete contrast to mercury,  in  all its effects.   It
restrains, while the latter promotes secretion, it tran-
quillizes instead of exciting the stomach,  and sup-
ports instead of exhausting the patient.  Its effects al-
so  cease  with the disease, while those of Mercury
are perpetuated after  it, and often become perma-
nent.   The injuries done by large quantities of mer-
cury, are certainly worthy of the consideration of pa-
tients, if not  of their  physicians.  The loss or im-
pairment of the teeth,  the diseases of the bones and
other  consequences  of repeated and profuse saliva-
tions,  ought to be borne in mind  by all who value the
blessings of a sound constitution.  Dr.  Adam Hun-
ter, on this point, observes, "salivation with whate-
ver care produced, gives a shock to the system, which
is not easily got the better of, and  the continued in-
fluence of the Fever and Mercury call  into activity,
any latent pulmonic or scrofulous (and he might have
added, cancerous,) affections,  which is often attended
with deleterious consequences."* I have entered in-
to  the foregoing questions, solely with the hope of
throwing some light  upon a subject of extensive im-
portance to the community, and  having discharged
the task  to the best of my ability,  here terminate
the discussion.

  * It might be said, that mercury can seldom be given in Yellow Fe
ver, in such quantities as to create the ill effects above enumerated •
but it is known, that ounces have in some instances been administer-
ed before Ptyalism could be induced ;  and as remittents are so often
mistaken for Yellow Fever, persons are frequently subjected to repea-
ted salivations in the  course of the same seasons.  Children also
require a ireat deal of mercury to salivate them, and when the effect
is produced, they suffer more from it than grown persons. 
                       04

  Some of the topics perhaps, required to he more
enlarged upon, than they have been, but as they em-
brace matters of general interest, and the opinions
and  views  presented, are for the most part such as
have never before been touched upon, I was appre-
hensive  that  a  lengthened  or diffuse  dissertation
might prove repulsive to the majority of readers, and
therefore studied the utmost brevity and condensa-
tion, and confined the present publication within  nar-
rower limits than I should otherwise have prescribed
to myself. 
55
                 CONCLUSION.


  tn the commencement of this Treatise, I promts*
ed an Appendix which was to contain an abstract, or
synoptical view of the state of the question respec-
ting  the domestic origin of the Fever: I now how-
ever deem it unnecessary to  swell the present pub-
lication  with the additional  matter I contemplated
introducing, as I observe that the subject has  been
t-.ken up in one of the Scientific Journals of the day,
the New-York Medical Repository, in a late number
of which, there are several papers relative to the lo-
cal production of the  disease, and  the editors are
pleased to quote with  approbation the first part of
this Essay.  One  further observation on the subject I
Would make, which was omitted  in its proper place;
it is  this, that in the  West Indies, the general condi-
tion  of  the air, from the excess  of tropical heat and
other causes, is always such, that  in combination with
the deleterious effluvia of their ill cleansed Towns, it
occasions" the constant  existence of Yellow Fever,
and  renders it endemic  in the sea ports of that part
of the World; while in Carolina, from our more tem-
perate position as to latitude, the disease is only oc-
casional, occuring in  particular seasons when inordi-
nate heat, moisture and  other circumstances prevail,
wtiich are favourable to  the formation of the fever.
I cannot quit the topic,  without  once  more urg-
ing upon  my  fellow-Citizens, the necessity of early
directing their most earnest attention towards the ob-
ject  of improving our police, and to the prompt revi-
val and  enforcement of  the many excellent  ordinan-
ces which already exist.   On the commencement of
the summer, I would recommend that Commission- 
56
ers should be appointed in every Ward, charged with
the duty of looking into and reporting upmi  all nui-
sances, or local circumstances likely to be injurious,
and which they  may  deem susceptible  of removal
or remedy.
   Those selected fortius office, should be from among
the most respectable characters in our community, in
order that the  Citizens might be the more readily  re-
conciled to the disagreeable domicilary visits, to which
theproposed regulations would subject them.  One of
the Reverend Clergy therefore, (who would no doubt
willingly enteron so useful a duty,) should be attach-
ed to each commission, and one of the Medical Facul-
ty also, who would be able to direct  the attention of
his associates to the proper objects.   Were a plan of
this kind zealously pursued, there can be no doubt that
the pestilence  would either be  averted, or mitigated
in its effects, and confined in its range  A reap plica-
tion to the Legislature would also 1 think be expedi-
ent, for it is probable that if it were made  manifest to
that body, that the Medical Faculty  of this Country
are almost unanimously of opinion that the disease is
of domestic formation, and  that evident success has
attended the exertions made in Philadelphia and New
York for its  eradication; it would be induced to assist
the City with a sum of money  towards the object in
view.  In New York  where immense improvements
have  been made within a few years, the mayor and
corporation are invested with powers not given to the
Council of Charleston, and which at present can only
be exercised by our Legislature itself.
   The above is in substance, the plan proposed in a
late number of the Edinburgh Review, for preventing
the recurrence of Typhus Fever which lately desola*
ted some parts of the United Kingdom.   It is certain-
ly simple, and might he readily put in execution.   It
would be expedient also, to appoint persons to thedu- 
sy
ty of attending to the ventilation of the shipping in the
harbour  during the  Summer.   The uncleanliness
which  generally prevails on board vessels, and the
foul air in their holds, contribute very greatly to COD
taminate the atmosphere of the city. 
t 
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   errata  leaf  in  a copy of the  Treatise
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  Waring  of Charleston. 
 
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