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VIEW
FEVER
DELIVERED IN AS
ORATION
BEFORE THE
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MEDICAL AND CHIRURGICAL FACULTY




       - STATE^OE MARYLAND,












                     —         X^/>/


             Post ignem xtherea domo
               Subductum, macies, & nova febnum
             Terris incubuit cohors ;
               Semo't que prius tarda necessitas
             Leihi conipuit gradual,

             Hoc opus, hie labor est.
PRINTED BY FRYER AND RIDER.

         1808^

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VIEW  OF  FEVER,  &c.
 Mr. President, tS* Gentlemen of the Faculty,

    Impressed with due respect for this Institution, and conceiving it
 a duty which you have a tight to impose, I come forward with much
 reluctance and still more diffidence,  in obedience to your call, to dis-
 charge that duty.*
   I am ful.'y aware the subject which I have selected for this occasion,
 is involved in much obscurity, and  surrounded with many difficulties;
 and that, like  every other, where  truth has eluded philosophical  re-
 search, there will be great contrariety of opinion 1  but I know no other
 which can he  so interesting to the physician, and at the same  time
 have equal  claim on his feelings, as well as  his constant and diligent
 investigation.
   I claim your patience, and shall esteem it a flattering mark of ap-
 probation, should I be  so fortunate as to arrest your attention, while I
 take a concise view of FEVER.   Much  has been  written and"said  **(■ ..imr **
 on this subject;  and yet all disagree, more or less, in defining^"**this
 disease !  I therefore trust it will not be deemed presumptious in me,
 if I differ in some respect from the most eminent and learned of the
 profession.
   I define fever " a morbid action of the heart and arteries ; preced-
 ed by  a chill or lassitude of the body, which is generally succeeded by
 an increase of heat, attended with a general, or p-rtial  interruption of
 its functions ;  originating from noxious matters floating in the atmos-
 phere, and applied to the bodies of men."
   As to the correctness of this definition, you will have an opportunity
 of judging : for the present I will just observe, it is the reverse to that
 of health, as d' fined by the most approved authors.  " Good health,"
 says Doctor Brown, " consists in a pleasant, easy and exact use of all
 the functions."
   That the pulse  is generally quick, and that an  increase of heat on
 the skin commonly takes place, will readily  be admitted ; but on the
 other hand, it must be conceded by  every experienced physician,  that
 these are not  infallible criteria by  which we  are to judge of the pre-
 sence of fever.   Experience and observation would justify me in decid-
 ing with the illustrious Dr. Rush, that in some of  the most alarming
 casts of fever, the pulse as to frequency, is  far below the standard of
 health, and the skin preternaturally cold ; and that thesr, particularly
 the former,  are  symptoms  which augur unfavorably as to its event,

  * The author was elected at the previous meeting of the Faculty, agree hly »o
 a flanding rule,  for the j urpofc of delivering an •Oiation'  at the next mtrtivg
in o uri>, n<n withftaiiding he was not theu attending, neither had he attended
fcveral preceding  meetings. 
&
and are pretty sure indications of extreme malignity.  The irregular
and indistinct manner in which fever sometimes makes  its accession,
has created some doubt whether  every fever is preceded bv a chill, or
at least some degree of lassitude of the body.   If none but patients
capable of accurate observation, wtre subjects of this disease, the diffi-
culty would  long since haVe been solved.   So  far as I have been the
subject of fever,  and as far as my  observations have been extended,
with a fair opportunity of judging, I am disposed to decide in the affir-
mative.  Presuming on this circumstance as well established, and that
the whole animal economy is governed by " associate motions," or
sympathetic principles, as well as that animal heat is produced by a
*•* decomposition  of  oxygen air in the blood," (a very plausible doc-
trine, which it is not incumbent  on me  at this time to prove)  I shall
hope to leave little doubt  on your minds, or at least to have them fa-
vorably impressed, that, though life is sometimes extinguished in the
cold stage of fever, yet by its "intervention" the susceptibility of the
lungs lor imDibing vital air  or oxygen, is so much increased, that it is
through this  principally, as well as the  accumulation  -of initibility
throughout the wude sanguiferous system, that the heart'and  arteries
are roused into morbid action, and the sinking frame rescued from im-
pending dissolution.                          •■ '   ■
   That the brain, the stomach, *.he live, the skin, &c. are not pleasant,
easy, ex xt, and consequently interrupted in their various functions in
fever, will  app  ar in  the course of this view :  bu*  that the  morbid
changes in these functions originate from certain *■• noxious matters foot-
ing in the atmosphere, and afifilied to the bodies of men," will require im-
mediate investigation, in as  much as the Jitter will he  considered as
the remote  cause of thj former.   The remote  duse of fever is  some-
thing foreign fr. m the well-oeing  of  animal lift,  and noxious  to the
proper exercise of its functions.
   I  shall not pretend to pry into the arcana of nature.   It is enough
for us to know that life depends on the agency of external causes, such
as air, food, and drink : without the former, life almost instantly ceas-
es, and without the aid of the latter, it can exist only for a short space
of time.  Hence it has been observed by a eel. brated medical  philo-
sopher, and  p^ihaps correctly, that " life is a forced state of  exist-
ence."   By  these  agents the vital principle is excited into action ;
and  they may justly be called stimulants  to the animated machine.
If life is thus constituted, and health dep nds on a due application of
these stimuli, by which the various functions of the body are kept in
unison of action, it follows as a fair induction,  that disease will origi-
nate  from whatever will  disorder these   functions.  But one or more
functions of the body  may be disordeie.1  by intemperance in eating,
drinkin*, Sec. and yet fever, properly so  called, will r.ot arise as an ef-
fect  ; but whenever  the human body is exposed for a  certain space of
time to a vitiat-d atmosphere, the functions are disordered, and all the
characteristic symptoms of fever take  plac?.   It folio vs therefore,
that  something floating in the  atmosphere is the remote cause of
fiver..
   But does this disorder in the functions originate from direct appli-
cation of these noxious matters to some particular organ,  and thus by
sympathetic action excite general commotion in the body ? or are they
applied and received in such a way  as to be cauied through the whole 
5
system, and thus produce similar effects ? Some observations founded
on apparent circumstances would seem to  favor the for ■ er opinion,
while facts, verified by  move certain experience, would appear to be
conculsive in support of the latter doctrine.  On a subject inveloped
in so much obscurity, we are nevertheless  compelled to reason frrrt
facts and observation.  Dr. Darwin, in treating upon his sympathetic
theory of fever, relates in support of that doctrine, that he " was some
time ago stooping to look which way the  water oozed from a morass,
as a labourer opened it with a spade, to detect the south of a spring,
and inhaled a vapour, which occasioned an instant sense of suffocation.
Immediately recoiling,"  continued he, " 1 believe I inhaled it but once,
yet a few  hours afterwards, in the cool of the evening, when I returned
home, rather fatigued and hungry, a shivering and cold fit occurred,
which  was followed by a hot one ;  and the  whole disease began and
terminated in about twelve hours,  without  return.   In this case the
power of  fear,  or of imagination, was not concerned, as  I  neither
thought of the bad air of a morass before  I perceived it, nor expected
a fever fit, 'til it occurred."   More light eW*aU»wu~h thrown upon  the
subject, had  this illustrious character informed us whether or  not the
labourer was al-o affected  by this  vapour.   The presumption is,  he
was not disordered by it at all, though it is  probable  he had inhaled it
for some hours, or perhaps for many days.  Whence this difference
in effect ?  I would  make this inference; the labourer enjoyed perfect
health before  he engaged upon the job,  and was not predisposed  to
morbid action ; whereas  Dr. Dirwin  was in a state of morbid excit-
ability before  he inhaled the  vapour, and therefore it only acted, if it
acted at all,  with cold, fatigue and hunger,  as an  exciting causs  to
fever.
   In the sickly parts of  this State, if a healthy person comes  from a
healthy part of the country, just before the rav.nges of an epidemic have
ceased, he will enjoy good health during the short  rcn liniiv.:  period
of the season ; but not so if he comes a few weeks before its influence
is checked.  The noxious principles of the atmosphere  enter his body
by  ten thousand times   ten thousand  inlets, derange every  function,
produce a morbid change in  his whole system,  and ihus predispose
him to feverish action.   His  whols aninal economy undergoes i re-
Volution, and then it is " cold, hunger and fatigue" become exciting caus-
es tofever.
   The morbid change must be effected by something noxious  to ani-
mal life, called the remote cause .' It is clearly and decidedly ascertain-
ed  that a number of persons may be exposed to a vitiated atmosphere
for a certain space of time, and yet  out of that  number, only a  certain
proportion shall be apparently disordered  by it!  To what shall we at-
tribute this difference in effect, unless  we suppose this remote cause
to have operated a change in the system of same,  whic'i  the  animal
economy  of the  others was capable of  resisting; or in other words,
unless we suppose a predisposition to  fever to be effected  in some,
vhich could  not be produced in others ?
   Predisposition* is the first link to  the  chain where  fever  begins.
It is something that must  take place  in the  human  system of tcono-

  * Pretlifpofition and morbid excitability are confidered in thftajview  of fever
as terms of the fame lignification. 
6
my to indispose it to healthy action.   It is « that state of the body,"
says  Dr. Brown, '• that  recedes from  health, and approaches to dis-
ease in such a manner, as to seem to be still within the boundaries of
the former, of which, however, it is only an insidious and deceiving
resemblance."  It is the  effects of the  remote cause,  which, in a way
not easily explained, impairs every vjtal principle, and with concurring
causes, disorders all the functions of the body.
   From  hence it may be inferred, that before general fever  can be ex-
cited, the excitability must undergo a morbid change, and the body
be predisposed to morbid  action ; when  cold, fatigue, intemperance, and
the passions of the mind  may become exciting causes; and also that
the remote cause itself may, in  that state of the system, be applied to
some particular organ, act as an exciting cause to fever, and by " asso-
ciate  motion," disorder every function.  Perhaps then, in the elegant
language of  Dr. Caldwell, this nascent spark  of disease  may then
proceed,  " like the embryo ripple in the lake, at first almost a viewless
speck, expands by gradual progression  from the centre, 'til the whole
extent of the  glassy su*£*ce partakes of the tremulous commotion."
It has been surmised by some, that the " stomach is the seat and throne
of fever," and  that the noxious  cause is  received into,  and has a pri-
mary effect on it; but it  is  more than  probable this hypothesis is
built upon a very  slender foundation, particularly when we  reflect on
the nature of the passage into that receptacle for food  and  drink, and
the difficulty which " matters floating in the atmosphere,"  would find
in obtaining a constant and ready  admittance into it.   Supposing the
fact otherwise, it is nev  rtheless a reasonable presumption, while that
organ is  in the full enjoyment of its functions, that the noxious cause
in the form of gas,  would  most probably unite very readily with its
usual contents, and quickly undergo that modification  which the  di-
gestive powers are so capable of effecting : of course it must in a pri-
mary consideration become harmless  there, and  to the system gene-
rally.
   After  mature and candid reflection, it must  appear  clearly and ob-
viously  that the skin, and those parts which are open to the air in its
passage  to the lungs, and the lungs themselves are the only organs
or parts  which can be considered as altogether, and at all times assail-
able by  noxious matters  floating in the atmosphere; and that it is by
the system of absorbents, they find a constant and ready passage to the
blood, and by it to the system generally.  From hence I infer, that
though  " the blood vessels may be, according  to Dr.  Rush, the seat
and throne of all f.vers," the blood must be the  " vehicle" by which
the noxious cause is conveyed to every part of  the body.   Here then
commences the first link to fever: the  morbid excitability, and the
beginning predisposition.  Relinquish this doctrine, and we are re-
duced to the necessity of admitting, contrary to the most impartial and
accurate observation, that the moment the " noxious matters floating
in the atmosphere," arc  applied to any of the organs, such as a vapour
irom a  morass to the lungs, fever must be  the consequence with the
 small aid of "cold, fatigue and hunger," and that by " direct or reverse
eymputi.y."
   During the revolutionary war, duty  compelled me to attend the sick
 and dying soldiers of our army in  a crouded and confined ward, where
 1 think  contagion (so called) wus as much accumulated as was poss>i- 
7
ble.   Twice and thrice a day I visited ward No. 19, in the Brothers'
house at Bethlehem.  Always upon'first entering this ward, I Iclt, like
Dr. Darwin, " an instant sense of suffocation."   In the course of some
seconds, the lungs accommodated  themselves to this new and deadly
air, and the "  sense of suffocation" went off.  In this situation some
weeks elapsed before I began to feel a sense of weariness,  loss of ap-
petite,  and other precutsors of approaching fever.   Perhaps had I
been  confined to breathe this poisonous air, it would have  produced a
morbid change in my system in nearly as many days; but fortunately
I enjoyed a pure air in a distant house, except when I  was engaged in
duty.   A lapse  of more than nine and twenty years can never efface
the truth of this statement from my mind.
   To contrast my  own case  with the illustrious Dr. Darwin's in pur-
suit of truth, will not be deemed presumptions, when you are to judge
whethe: fever can  be produced by  " direct or reverse sympathy," be-
fore a morbid cause has produced a morbid change in the body, and
thus  predispose it to feverish action.
   Though  " life" may be  viewed as " a forced state of existence," the
system ol  animal  economy in health must nevertheless be considered
as  in a constant harmonious  circle of action;  and  like a  musical
iiivrument,  if every chord is not  in perfect unison, harmony ceases,
and discord is the consequence.  The great difficulty  is to d- termine
v. nere and how this discord begins  in  fever ! If the blood is the " ve-
hicle" of the noxious cause,  and the beginning of  feverish  discord;
find  it  be  admitted that it is the  "life1 of the animal, the  primuni
\iVeiH, et ultimum nvriens," or, according to the great J m » II int-
er, an I our learned, ingenious Dr. Caldwell, that it is possess! it a
living principle, like the  solids, many difficulties woaild  cpiicklv va-
nis  ; vviie 1  we might indulge a hope, that  the  operation of the re-
nu'ie cuse may yet be ascertained  by future enquiry.
   So.i, " physicians have supposed the remote cause" to consist in
certain direct stimulants, but, continues Dr. Cullen, '• the supposition"
would ;jet in to be inadequate " to account for the phenomen» attend-  *
ing the accession of fever!"   Others,  as he  does himself, .'• wr  sup-   .-
poseil it of a debilitating, or sedative quality." The advocates for either
doctrine have pioceeded  with little caution, and great rapidity; as-
suming the privilege of taking supposition for proof, and then  very
ingeniously, aud very learnedly, have left us most profoundly in the
dark.
   Dr. Darwin,  in accounting for a " torpor of the capillaries of the
air vessel > of the  lungs,  by  great  stimulation," makes the  mystery
still  more mysterious, by saying, the organs may become torpid in ar»
instant of time, by the great expenditure of the sensorial power of ir-
ritation, as paralysis frequently follows too great an  exertion of vo-
luntary power!"
   Dr. Cullen,  after stating,  that the remote causes of fever,  human,
and nijish eduvia, seem to  be  of  a debilitating, or sedative  quality,
g .es  on, and says, " they arise from a putrescent matter.   Their pro-
duction  is favoured, and their  power encreased, by  circumstances,
wiiich favor put refaction ;  and they often  prove  putrefactive ferments,
v ',,  -j< / r.t to the animal flnids.   As putrid matter, therefore, is al-
       ■•'•■.■   ep-.ct to animal bodies, a powrrf'il /sedative,  so it can be
    .    :u;b'cd, that human, and marsh effluvia, are of the same qua- 
fity:  and it is confirmed by thK that the debility, which is always in-
duced,  seems to be in proportion to other marks that appear,  of the
power of those causes."  What all this amounts to, as proof, is hardly
to be conceived. All is mere  supposition ; and we are left in the dark
in search of truth !
   When such illustrious characters as Cullen, Darwin, and others,
are obliged to take flight into  the  delusive regions of hypothesis, and
to construct systems  on little  more than the " baseless fabricks" of
their  own imaginations ; it is with extreme diffidence, I venture into
the wide field of conjecture.   It may be deemed presumption  even to
hope, that I shall throw a glimmer of light on a subject, involved in
so much obscurity.
   Supposing, with Dr. Rush, that " the blood vessels are the seat and
throne of fever," I consider it as a fair deduction, that the blood is the)
" vehicle" -fits remote cause ; buf being, by this cause, impaired in
its vital energy, it cea-.es to communicate its accustomed vital action
to the system generally, or at least to some parts p <rticularly  ; or, in
other words, the blood, the beginning source of life,  being thus inter-
rupted  in  its  important function, the  whole system, by '»  ssociate
motion" is thrown into disorder.  Thus commences the morbid ex-
citability, the first link to lever.
   But,  " to render the doctrine of fever consistent, and complete,"
waving  for the  present the arguments in support of its plausibility, I
shall  suppose a patient in this morbid state of excitability,  the blood
having  lost its vital  action in a  way,  as incomprehensible, as  the
growth  of  a blade of grass, or the mystery of Creation itself.
   In this situation, the whole  animal economy moves  heavily along.
He feels languid, dull, and dispirited, gradually receding from health,
and approximating to disease.   Every function begins to be disorder-
ed.  The heart, and arteries, no longer carry the blood through every
part with vital energy.  The  stomach loaths its  food;  the digestive
powers  are impaired, and frequently a  constant  nau-ea sickens the
whole frame. The secretions are disordered, and the patient is on the
very kkmk of the  cold stage of fever.  In this state he might possibly
continue for several days, and, perhaps, if removed from the influence
of the remote cause, might struggle through this morbid state by the
ordinary efforts of nature,  unless some exciting cause  should be su-
peradded.
   But,  supposing the patient, under the influence of the remote cause.
In ordinary cases, it  is rare,  though not without exception,  that ail
exciting cause  is not in some measure necessary to fav  ur the acces-
sion of fever, such as cold, fear,  intemperance, 8cc.  The generating
powers of animal heat in the blood, being impaired by  means of the
effects of the remote cause, aided as aboye, by the excitidg cause,  be,
now,  in the language of Dr. Cullen, exhibits signs of great uneasiness,
by yawning and stretching.  At the same time, the face, and extre-
mities become pale;  the features shrink; tie bu'k  of every external
part  is diminished ; and the  skin over the whole body appears con-
stricted, as if cold had been api lied to it.   At the  coming oi of these
symptoms, some coldness of the extremities, though 111 * I — taken  no-
tice of by the patient, may be perceived by another person. At length,
the patient  himself  let Is  a sensation of cold,  cfnin.oi.ly first jn  his
back, but, from thence, pabsing over his whole body *, and now,  his 
9
sense of cold encreasing,  produces a tremor  in  all his limbs, with
frequent successions, or rigors of the whole body.  The respiration is
quick, and every function of the body is more or less disordered.  In
this state of exhaustion, which would  appear little short of extinction
to one unacquainted with such a case, it would seem impossible for
the patient to emerge  from impending dissolution.  So sensibly im-
pressed have the most  eminent theorists been, that the powers of life
were inadequate to that purpose, that they have indulged their fancies
in supposing something imaginary, and  incomprehensible to them-
selves, as well as others! Hence,  we  find Sthal calling in the aid of
his  " anima medica,u  and Cullen,  with others,  the powers of " re-
action," and the " vis medicatrix  nature?1 But, to suppose an Al-
mighty, and beneficent Creator, would constitute man so imperfectly,
as to make his life depend on a capricious, or imaginary power, when
he saw the evils with which he would be surrounded, and the difficul-
ties with which  his existence would  have to encounter, would be to
 arraign the wisdom, and order of  his Providence. I must, therefore,
 suppose,  that the animal economy has, within itself, the means of its
 own preservation in this particular, and  critical situation, unless the
 agents of its existence are withdrawn, or the  principles of life de-
 stroyed.   This source of preservation I shall look for in  that part of
 the general system, where animation begins, combined with a general
 and  remaining  excitability; for,  I presume,  that the lungs, by that
 sympathetic affection, which pervades the whole body, having become
 more excitable  from  an accumulation of irritability,  in which the
 whole system participates, imbibe, with avidity, a larger portion of that
 " animating principle" from the atsmosphere, which gives  vitality to
 the blood, and through it, to the whole animal  system ; and, that by
 this means, the heart and arteries,  as well as  the lungs, which had
 been in a state of " torpor," now expand, and beat with  encreased
 force ; the blood, in consequence, is hurried through the whole san-
 guiferous system with great  rapidity; the respiration  is quickened ;
 the skin is hot and dry ; the tongue  is  generally parched ;  the brain
 is confused, and every function is more completely disordered.   Now,
 that very principle, which had excited the torpid heart, and arteries
 into action,  and thus  rescued  the body from impending dissolution,
 produces  great commotion, and heat is evolved to great extent by the
 chemical  " decomposition of oxygen air in the  blood ;" and it is pre-
 sumable,  that such is the state of the blcpd at this juncture, that it is
 disposed to form a union with oxygen with  much avidity, by which
 means an unusual quantity of heat  is* eliminated, and  thus the hot
 stage of fever is formed.
    Having traced fever from its origin to its acme, or exacerbation, it
 is only necessary to  advance a few steps further, and  it must  inter-
 mit, or remit; or death  is  soon the final result.  But such is the
 established order of the  animal economy, impressed by an  Almighty
 hand, that excessive action exhausts the  principle, by which it is sup-
 ported ; so,  that in  fever, unless from a concurrence  of  causes,  bo
 much action has been excited as to destroy the principles of life, that
 ijction is  exhausted,  and the fever intermits, or, at least, remits; of
 course  there cannot  be *' such a disease, as that which the schools
 have called a continent fever." To  complete an entire paroxysm in
                                  A 
ro
 the highlr descriptive language of D*r. Cullen, a  moisture How ap-
 pears upon  the  forehead, and, by degrees, becomes a sweat,  which
 gradually extends downwards over the whole body.  As this sweat con-
 tinues to flow, the heat of the  body abates, the sweat, after continu-
 ing some time, gradually ceases;  the body returns to  its usual tem-
 perature, and most of the functions are  restored  to  their  ordinary
 state.   But, experience teaches us, that, the paroxysm of fever, imy
 terminate only in remission, instead of intermission, with a variation
 of several of the above appearances, from whence it may be inferred,
 that in the one there is only a partial exhaustion of morbid excitability,
 and,'in the other a complete expenditure of the same principle.
   When fever has  thus originated from the effects  of the remote
 cause, we are not to conclude, that by withdrawing the body from
 the sphere of its action, a return of the same symptoms will not take
 place ; en the contrary, such is the constitution of the animal  economy,
 that the system, being once brought into morbid  excitability, and. ex-
 cited into morbid action, by the effects of this cause, aided by the ex-
 citing cause, its constant application is not necessary to produce a ra
 eurrence of fever,-at regular and stated periods; though, it must be
 admitted, upon the authority of calamitous experience, that this cir-
 cunjstance has had,  and will continue to  have, a very pernicious in-
 fluence.   This circumstance-being well ascertained  it will  be neces-
 sary to look further for an explanation of this fact, and endeavour to
 investigate how,, and by what means,, fever returns, or exacerbates, at
 those regular* and stated periods-.
   If, during this morbid,  and  irregular, and frequently " convulsive
 action" of the heart and arteries, the morbid impre.sion of the remote
 cause should be so far  resisted by the animal powe.'s, that the several
 functions  of the body are restored  to a harmony of action,  the fever
 passes of?, not to return again; as in the  case of Dr. Darwin, and*
 thousands of others*
   But, on the other  hand, when the principle of irritability is so far
 expended, that the blood, in an exhausted^ state,  ceases to stimulate
 the heart and arteries into proper action, and the lungs  having become
 " torpid"  from an expenditure of the same principle, so little oxygen
 air is imbibed, and, of course,  so little heat evolve I by the process of
 u decomposition," a langour commences, which s >on terminates in a
 coldness of the whole body ; or in other words the cold stage again re-
 curs with.all rs concomitarit symptoms.   In this  state of " torpor" of
 the lungs, the blood, and the heart and arteries, the principle of irrita-
 bility accumulates ; the lungs *gain, from that sympathetic influence
 already mentioned, acquire the power of imbibing,a grea'.er quantity of
 oxygen, or vital  air, and a greater energy of acion ;  at the same time
 the heart and  arteries, having become more excitable upon  the same
 principles, are excited into excessive  action, and  tke same routine of
 symptoms take  place  as at the kicFease  and declension of the  first
 paroxysm;
   Agreeably to the same train of reasoning, the  paroxysms will con«
 tinue to return either at  regular, or irregular  periods ; for  they mav
be varied  by becoming shorter  or longer, intermitting or  remitting,
 depending on a number of adventitious circumstances, until, by the
 powers of the aiimal economy^ aided by the efforts of art, the Yariou6
 ^ iunctioz.s are restored tc their ordinary state"  of health. 
H
  Before I proceed in this viai; I deem it of importance to offer some
illustrative ptoof ,in support of the above doctrine, particularly so fai-
ns the "phenomena" of the cold stage of fever may be concerned.—
And though some repetition may be used,  I shall hope for your in-
dulgence.
  That there is a principle in the atmosphere, which cvmr-'inicate^s
lift; to animated nature, though  it is frequently combined with some-
thing which proves noxious to human life, there can need no proof
rr illustration.   Without it all'animal motion ceases, and we become
dead, inanimate matter ! By the constitution of the animal  economy,
the lungs are formed to receive the '; animating principle," and im-
part it to the blood, jivh-ch, by .this agency,  stimulates the heart and
arteries into action, and thus commences and is continued the whole
circle of animal  motions, therefore-ayhatever impedes,  interrupts,  or
diminishes the power of this vital  principle, c.itber  destroys life alto-
gether, or disorders the harmony of the  whole system.  In the cold
stage of fevev, the functions of  anim d life' are impeded, interrupted
and nearly exhaus'ed,.  Can we suppose any  thing  more reasonably
adapted to resist and counteract the noxious cause, than that function,
which i. the source of  Life ? It  is a truth well  established, being  fa-
cial' to the most common observa'i"n,  that when any  part of the bey
dy ha^M;en in  a .Mate of rest, or " torpor"  for a shorter or bjMM|
dy  ha^JM;en  wi a .Mate of rest, or " torpor"  for a shorter  or ^ggg^m^fs^y^
space ot time, depending on^he peculiar  function  so  affected, The   V  \\
principled'irritabilnj* become accumulated, or the part so susceptible ->»daY^y»J^
of impressions, that an ordinary  stimulus will excite more than ordi- $^
nary action,.   A> for instance, if  one  hand be p\;t into cold water,  it - ■*%>>v
becomes p<de, so as  to show, that the arterial action is  diminished ;
hut >vben exposed to the sam.e temperature  with  the other, the one
dipped in cold water glows with heat, and manifests a quickened cir-
culation, whil« the other is not affected more  than ordinarily.   So,  if
the cold bath is applied to the whale body, a glowing heat is produced
on the surface, as soon as it comes out, and is  exposed to common
temperature  ; the lungs at the same time,  by that  sympathy  which
governs the  whole system, experiencing a  momentary  " torpor," by
which circumstance the  principle of  irritability is accumulated,  now
regain  an  extraordinary portion of  vital or  oxygen air, and  thus  a
great r quantity of heat is evolved by the process of »< decomposition"
according to  the  present doctrine  of animal heat.   The effect of the   %f
cold bath are momentary ; but in the cold stage of fever, the  effects
of the remote cause  are more permanent, having seiz d upon, and in-
terrupted the important  office of the blood, as well  as ether functions
of the body.   In the one case,  there is only an abstraction of heat ;  in
the other, though cnld might have proved the exciting cause to fever,
the process of animal beat i^ interrupted, and of course a mere accu-  v
mulation of the principle of irritability could  r.fJTfte sufficient "'ith^.v,
the accession of the " animating principle" of oxygen, which is m-
disprnsibly necessary to  carry on the  process of anhml heat by ude^
composition  of oxvgen air in the bloor:."
   I will not pretend to say, that the " phenomena" of fever, so far ns
the cold and  hot  stages are concerned, caw be entirely and satisfactori-
ly explained  by the  above hypothesis,  but I nv.v venture to hazard
nn opinion,  when the regular circle of actions in tie animal economy
i* int.-ir pt.-d !>**  anv cai>se wlsuf-ver, •!>*?.♦ imle^ so:,,,: "wenvr:.' In v..' 
12
    is admitted  according to the supposition of Dr. Cullen, " whereby it
    happens,  that  powert, which have a tendency to hurt and destroy the
    system, often excite such  motions as are suited to obviate the effects
    of the noxious cause," life would be of short duration, seeing that its
    existence is surrounded by such an host of destructive causes.   That
    the lungs are endowed with this preservative power in health as well as
    in disease, may be inferred  from the following fact, which common
    bleeders consHer as the proper test, by which they are to determine
    when a sufficient quantity of the vital fluid is  taken away.  "While the
    blood is flowing from  the orifice, if the patient sickens at the stomach,
    it will almost instantly change its color from  a deep purple to a florid
    red,* and  the shades of color will vary  in such way as  seemingly to
    depend on the state of the stomach, arising from the quantity drawn
    off.   From  hence it would appear,  as  if the  sympathetic connection
    between the lungs and stomach was such, that the preservative powers
    of the former are suddenly excited to support the functions of the lat-
    ter, as well as those of the whole body, by imbibing as suddenly a larg.
    er portion of that " animating  principle" from the atmosphere, which
    is so necessary to keep up the action of the heart  and arteries, and of
    course the whole system.  In  the cold stage of fever therefore, as in
t-^flhis case,  the same " general law of the animal economy"1 may befaW
   MMBti, and considered as a strong argument in support of 0N»pneu-
    matic  doctrine, combined with that of Sympathy.
      But admitting the plausibility of this doctrine, so far as the cold and
    hot stages of fever are concerned, a question  of some difficulty arises,
    and that  is, how are we to account for  the various topical affections,
    properly called inflammation, which are excited in the progress  of ge-
    neral fever ? If there is such a " law of the animal economy" as the

      * It is presumable in this cafe, that oxygen acts on the blood not unlike elec-
    tricity; and as *« animal'heat*'  is proved by anology' to be *' a gentle combus-
    tion," it may reafonably be concluded, that feveb  is a more violent  inflam-
    mation.  Vide  Philofophy of Medicine, vol.2.
      The wonderful " part' that oxygen, or pure vital air " plays" in animal and,
    vegetable life, particulary in giving color to the blood, and imparting heat to our
    bodies, is beautifully expressed by Dr. Darwin in his" Economy of Vegetation,"
    The goddess of Botany,  surrounded by ethereal choirs, is made to address her
    nymphs in the following elegant and instructive lines.
t*          "  When air's pure eflence joins the vital flood,
          And with phofphoric acid dyes the blood,
          Tour Virgin trains the tranfient heat difpart,
          And lead  the foft combultion round the heart;
          "L'fe's holy lamp with fires fucceffive feed,
          From the  crown'd forehead  to the proftrate weed ;
          From earth's proud realms to all that fwim or fweep
          The yeilding ether or tumultuous deep.
          You swell the «Mafc beneath the heaving lawn,
          Brood the live ieed, unfold the burning fpawn ;
          "Nurfe with soft lap, and warm with fragrant breath,
          The embryo panting in the arms of death ;
          Youth's vivid eye with living light adorn,
           And fire the rising blush of beauty's golden morn."
      That the blood will change its colour, as above stated, while flowing from ?.
    vei*|L ftandsnpon higher authority than vulgar observation.  I bled,  says Mr.
    John Hunter,  a lady whose blood was at first of  a dark color, but she faint-
    ed, and while she continued in the  fit, the color of the blood that came from the
    vein was of a bright scarlet.
fa*—
LlH 
In
one just mentioned on the authority of Pr. Cullen, as well as common
observation, it is not reasonable to suppose that those « powers, which
have a tendency to hurt and destroy the system," will 'always " excite
such motions as are suit*ed to obviate the effects of the noxious cause  '*
but that upon the sarfc sympathetic principles, " motions" may be ex-
cited," which have a contrary tendency ; particularly as it must be
conceded, that all parts of the body are not equally in a state of morbid
excitability ; and thus a greater morbid action may be excited in par-
ticular organs or parts, than generally pervades the whole system. la
this case, as supposed by Dr. Darwin and others, more " animal heat"
is generated by a " combination  or production of new fluids in those
organs or parts, in which there is  a secretion  of new blood-vessels."
Thus a morbid change in those parts takes place,  by which their ac-
tion is encreased, and they become central points\ where greater com-
motion is locally formed, and by sympathetic action extended over the
whole system.*   "  The physician," says Dr. Rush, « who  considers
every  different affection of the different systems in the body, or every
different affection of different parts of the same system, as distinct dis-
eases, when they arise from one  dause, resembles the Indian, or Afri-
can savage, who considers, dew, frost,  ice and snow, as distinct essen-
ces."   Hence  it would appear that fever is in essence the same, tho"
 it may be* multifarious in its effects from the  disorder it produces in
 different organs, and parts of the body.  Though it may not be  pos-
 sible to  explain altogether these effects,  as they may arise  from the
 noxious cause; yet if it shall appear that they proceed from the same
 cause, it will be strong presumptive evidence, that fever differs only in
 the mode of its operation on the  different parts of the animal system,
 and that it is in essence the same.
   All animal an<J^*a»getable substances, it is admitted, are composed of
 the same constituent, or elemental principles, and when deprived of life,
 are disposed, under such circumstances as tend to favor putrefaction,
 to dissolve into their original elements.   But such are the qualities of
 these matters  repelled from each other by that subtle element, called
 by  the moderns caloric,  unaltered by such natural  processes,  as are
 continually going forward in the grand Laboratory of the atmosphere,
 they become* poisons  to  animal  l.fe, and when " applied to the bodies
 of men," remote cause of fever. That  this is the case, is fatally
 proved, whenever such substances in a state of putrefaction, combined
 with minor causes, are within the sphere of their  operation on the
 " bodies of men."
    Though the mass of mankind give themselves little trouble in rea-
 soning on causes and effects ; yet there seems to be a general and de-
 cided opinion, that fever originates from something " floating in the
 atmosphere."   Indeed this is so strikingly obvious in the neighbour-
 hood  of marshes, swamps, and putrefying  stagnant waters, from their
 effects, that there can be only one sentiment  on  the occasion.   But
 that these exhalations, which are called  Miasmata, do not differ from
 those arising from other dead and putrifying animal and vegetable sub-
 stances, is more than probable, in as much as these places are  filled

   • The author is fully fenfible.that this part of his fubject may appear to some
 rather obfcure.  and that much more might have been fjudm elucidation ! Time,
 and the occafion mull {lead his 'j.\?=ie. 
u
-j-yith dead and pultifying bodies of the same nature,   h ivm this source
 the inhabitants ol low, flat countries, abounding in swamps and marsh-
 es, become year after year, a prey to fever, when concurring circum-
 stances tend to favor putrid exhalations.     jh.
   That these putrid  exhalations, whether §r5fflfanimal or vegetable
bodies, do not differ in their effects on the human body as the remote
 cause of fever, except so far as the one may evolve a greater  quantity
 of noxious effluvia than the other, is highly proba]-.}^ because  they are
 essentially the same,  being composed of the same elementary princi-
ples.  Nevertheless, it must at the  same  time be. obvious, that in as
much as they differ in the cohesion m their particles, the one will put
on the state of putrefaction, and emit .noxious effluvia* while the other,
under the same circumstances pf heat and moisture, will remain .sound,
and shew no such disposition.   Thus an accumulation of animal mat-
ter may become the remote cause of fever, while  \egetable matter,
under the same circumstances, may remain altogether harmless.
  A striking example to this effect occurred in the course of my prac-
tice a few  years ago.  An eminent farmer, with a very large family of
sixty or seventy persons,  of all  ages and sexes, caught  several cartr
loads offish of a particular sort, and without much reflection as to the
consequences deposited them in one of his  fi. Ids for the purpose of ma-
nuring his lands.   Unfortunately for the family,  as soon as the fish be-
gan to putrify in the  month of July, the wind  blew from that quarter
towards the house for some weeks, with  little variation.   The family
began to  sicken pretty generally about  the  middle of the following
month, and I think I  am  cor ect when I state, that not one of this
numerous family escaped inferior}.  Then  I saw what I have repeated:
ly seen before and since, the cause of fover operating on these  differ-
ent persons at the  same time as cold in the production  of dew, » ice,
frost and snow." It is  probable I also .did not .escaptPRf-cfion from this
source.   My first  visit to this family Was on the 19th of August, and
on the same day of the month following I  had a paroxysm of an interr
mitting fever, which was, no doubt, brought on  at that period by the
most sudden and great change in the  air,  I ever experienced, the pre-
ceding night, when I was  obliged to stay  from home, in a  very light
summer dress, which  ought on that morning to  have been adapted to
the winter.  I presume, on this occasion I was in a state of morbid ex-
citability,  and that the cold acted negatively as  an exciting  cause to
fever, which  commenced  its attack in the usual  form very soon after
the preceding stimulus of  heat  was abstracted by the  change  ip the
air, and an exposure to it in the morning.
  Now, though it could be well ascertained, that  there was at this
time the same quantity of corruptible  matters in  the swamps  contigu-
ous, the rest of the neighborhood was unusually healthy, because the
concurring causes of heat and moisture were not combined to reduce
them to a state of corruption, or putrefaction ;  and the neighboring
families were not within the sphere of the action of this mass of putre-
fying animal matter,  or the effluvia were  not wafted towards them by
the  current of air.*

  • That vegetable matter in a Hate of putrefactive  fermentation may  become
 injurious to health and the caufe of varioua types of Fever, and tof fhow at the
 fame time the abfolutc necdRty of guarding against its effects in that ftate, move 
15
  Every year we are more or less subj'ect to epedemick fevers on the
Eastern Shore  of this State; however  it frequently happens, that inf
some particular districts of the country, from partial falls of rain, heat
and moisture are so unfortunately, though exactly combined to favour
putrefaction  of dead  and corruptible matters in the swamps and marsh-
es, that the whole mass of inhabitants are involved in the dreadful ef-
fects arising from the exhalations of these " noxious matters ;" so that
every " grade"  of fever is brought into view from the fabricula  to the
nosological " typhus gravior," or if you please,  the frightful  denomi-
nation of " Yellow Fever ;'* while in other districts beyond the influ-
ence of these effluvia, from contrary circumstances existing, unusual
health will prevail.   The succeeding year perhaps the scene will be
reversed.  At the commencement of the epedemick, intermitt?nts and
remittents generally prevail uncombined,  frequently alternating  with
each other ; though not unfrequently  various topical affections occur
at the same time.   But those who have been once infected with fever,
notwithstanding they may apparently recover good health, as the sea-
son advances, become more subject  to topical affections, such as" plu-
risies, peripneunonies, 8cc. and at the  same time to relapses of inter-
mittents, remittents, and " bilious  affections,"  which  frequently as-
sume the  topical form also, and  of course become more  formidable
and destructive  to life.   At the same time in districts, where the nox-
ious matters have not been volatilized into action by the putrifactive

particularly when much accumulated, and its surface of some  magnitude, the
writer thinks it pertinent to the subject to relate a very striking instanc, whi h
occurred on his own farm in Talbot county ; hoping  at the same time it will
afford a useful hint to farmers generally, who are disposed to profit  by the er-    \
rors or neghgenc/^^-eir neighbors.                                      -yj\ .,..«s
  In the year fmW^B*"rI particular  view to improvement, he  (the writ r) d"-     ^/■*■■>
termined to let his manure, which was ir his farm yard,  covering the space, of
one third of an acre, lay there until the succeeding year, but not forgetth g  in
the spring to enjoin his overseer to plough all that he could into the eartl., which
consisted of  clay, and to be careful  in covering the whole mass with e nth if
the same kind, having experienced the advantage of  mixing clay with a light
sandy soil*.  It so happened that the injunction was not attended to, or neglige: t-
ly put off, until this accumulated matter began  to show its effects on six mm,
laborers on the farm,  who were in the  daily practice of necessarily spending
some time in the farm yard.  They all siekened about the same time w:th va-
rious types or fever, such as intermittentB, remittent and dysenteric Hver.  At
the same time there were at the farm house one old man and woman, together
with two other women and six negro  children, who, though only at the distance
of fifiy yards from the  faim yard, continued perfectly  heairhy.  Upon enquiry.
as well as  from his own partial observation, it was found that the wind had
blown almost constantly from the house towards the farm ya»d for severe weeks
during the  latter part of May and the  first of June, the tiroe when the sickne^a, _jf- *
commenced.   As soon as the cause exhibited its effects, the owner had !iis for- """
mer direction instai.tly put into execution.  The consequence was, that with
very little aid from the Doctor, the fever vanished and the whole family contin.
■ued remarkably healthy during the remaining part of  the year.  At  that time,
this was demonstrative proof to the writer, that animal and vegetable matter
under certain circumstance* will have exactly the same effects in thepnductiou
of fever, when dissolvii.g corruption volatilizes the elements of which they ara
mutually composed.                                        • •  ,
  Itwascottrmplated to have incorporated this case into the original work,
but from the fear of making the delivery of the oration tedious, the writer pur
sued his oritfinul  pjan of coaipnessiBg the whole  as much as possible,  and  of ».»
uaptiog it to the evasion. 
16
     process, neither heat nor cold, nor any other cause, has been sufficient
     to excite fever in the human system; and 1 may venture to assvit,
     from long observation, that the inhabitants will  generally continue
     healthy until these noxious matters are  again set afloat in the atmos-
     phere by the powers of corruption.
       Hence it would appear clearly and decidedly, that snimal and vege-
     table bodies produce in  essence the same noxious effluvia  ; a:.-, that
     under similar circumstances, they have the same effects on the hunun
     body in the  production of fever.
       Besides the effluvia arising from putrescent bodies,  it is asserted,
     and until lately it has been  a very generally received opinion, that
     there is another source of fever, the effluvia arising  from diseased
     bodies having something specific in their nature,  so  as  to  produce a
     specific fever, differing characteristically from all other fevers ! If the
     exhalations from a body infected with  this specific fever are specifical-
     ly different  from the exhalations or effluvia arising from  healthy
     bodies, and produce effects specifically different, when " applied to the
     bodies of men ; then it must be admitted, there is a  fever specifically
     different  from all  other fevers, not arising from these " contagious ef-
     Jiuvia."  But if it is found, after thorough investigation, that the exha-
     lations  from the  healthy bodies have produced, and continue to pro-
     duce the  same  fever, as the exhalations, or effluvia from diseased bo-
     dies, and  that the  exhalations from these diseased  bodies are harmless
     in a free circulation of the air : then it is  to be presumed, the fever pro-
     duced by  the one or the other is one, and the same. " Contagions,"
     says Dr. Cullen,  " have been supposed  to be of great variety ; and it
     is possible this may  be the case ; but that they are truly so, does not
     appear clearly from any thing we know  at present."   Such diseases as
     are fully ascertained to be contagious, are of thef0Mff^fft kind : and, as
     he further testifies, " for the most part  affect persons but once in the
     course  of their lives."
       « It is  well known that the effluvia  constantly arising from  the liv-
     ing human body,  if long retained in the  same place without being dif-
     fused in  the atmosphere, acquire a singular virulence ; and  in that
     state, being  applied to the bodies of men, become the cause of fever,**
     which  fever, according to others as  well as Dr. Cullen, " is highly
     contagious."
       That the  first  part of this paragraph is  correct,  there  can be nr>
     manner of doubt:  but that the fever  so produced is  not directly from
     the effluvia  of the bodies so confined, may be fully ascertained from
     this circumstance, that as soon as any one of those living human bo-
     dies is removed from « the place where  the effluvia are  retained/' the
(-V^ejnhalations  from this body become perfectly innoxious.  From hence
     it may be inferred, that the effluvia so confined are to be considered as
     any  other mass of corruptible matter, which will undergo the  process
     of putrefaction whenever they are placed in a situation to  do so, and
     that they, like all  other animal  and vegetable matters, are altogether
     harmless with regard to the health of the living body,  until they are
     reduced to the state of putrefaction.
        In ward NO. iy, in the Brothers' house at Bethlehem, the  soldiers
     were brought in from the camp labouring under various forms of dis-
     ease, such as intermittents and remittents, with the long train  of noso-
     logical names.   The effluvia from their  todies in  this ward, and I be-
£j*yd*/— 
17
     ImonL thern  fl  i    °f lha ^ bui,Ji»^°°n made dreadful havoc
     among them ; at the same time infecting all those who attended them.
     Three of us, hospital mates,  were fortunately  put  into a well vend
      ated room, in a separate house, where we wenT attend^ by nur e

     WU,J the h~Plta,» °p w"' afraid to do .0, used to set with us dur
     r,L.  r aX' Kand thC  T?" S,CPt in lhe room w»hout,  yet   have no
     us   o'r Z^hat  • rg-C i,UiividUal t00k an^ thin* lik* infection from
     us   or that  the  infection  spread beyond the  doors of the hospital.-.
     hlniliT    Cd '" th? C°Urse °f some weeks>  and  ^ough  I had the
     hospital  fever  or nosological^ the "typhus gravior,"  when it first
     commenced, for which  I took, according to common practice,  arge
     quantities of bark and wine ; yet, strange" to tell, at t ha?period o/Zn*
     »S2iJ/WaS !J,PPOSed * bLC °" the recovery, I was seized with a pain
     in the «*, and very probably should have soon quit the stage of life if
     Lr nl™ 5-" ^ J.udiciously tre»*d by bleeding, and other com-
     mon remedies usual in  cases of  « pleurisy."  I shall not pretend to
     make any comments on my own case,  but  shall trust you will make
     the  proper application.  As to the soldiers, though few went from the
     hospital, alive, I believe  they wanted  for nothing so  much as Tfreer
     ST   u">  ltSS  cont'm,n^d by  the putr Tying mass  of exha-
     lations from their own bodies, unfortunately confined, perhaps from
     imperious circumstances.                            l     v
       Instances  without number" might be  brought forwa d  to the same
    •E°SCK  2 Pr°VC'.  that -th0Ugh the " effluvia  arisi"g from the living
     human body  acquire a  singular virulence by being retained in the same
     place, and not diffused through the atmosphere;" yet that the efflu-
     via Irom  persons  so infected, have no such effct  when  they are re-
     moved from the infected place.   To turn over the records of medickic
     to this effect, would be a waste of time, and little short of  insult to the
     understandings of this  learned  body.  During the pr-valence of the
     malignant fever in this ciy, as also in the most of our se; po,t towns.
    which was supposed to be « contagious," under the formidable aspect
    or name of "yellow fever," persons infected with it bit the city, and
    died in, families in the country, where they received  all the offices of
    humanity; and ytt in no one instance, well  att sted,  was any thine
    like infection communicated.  From hence also it may he inferred,
    that the effluvia from the hu.^ an body, whether infect,d with fever, or
    not, are altogether harmless as a remote  cause,  until they h ve under-
    gone a change by  putrefactive  decomposition; und th..t whemver a
    person is infected with fever, it becomes necessary to look f >r it, cause
    trom other sources than  « human contagion,"  such as animal or  ve-
    getable  matters in a state of putrefaction.  But in as much as they
C««W*o ve in  that state the same noxious principl-s, it follows as a rea-
    sonable deduction, that t'w remote cause is the same ; and as the same
    causes will, cxteris paribus, produce the same effects, the fever so
    produced must in essence be the same, notwithstanding,  fro-n  the
   complicated nature  of the animal  tconom*, very different motions
   may be excited in the system.  And whence all the alarm and terror
   about the contagiousness of « yellow fever," if the  Let is well  ascer-
   tamed, that the effluvia arising from the bodies of those inf cted with
   U, are not  capable of communica ing inaction  to others !  It it U not
                                  B 
]fi
 contagious, we are compelled to search for some other source of infec-
 tion.
   The most  correct and impartial, if not the earliest account we have
 of fever of this denomination, may be found in  Dr. Hillary on the dis-
 eases of Barbadoes.  We there find it rearing its head in terrific form
 at " all seasons of the year;" and at the same time with the long train
 of nosological diseases ; and as he informs us, it confined itself princi-
 pally,  though  not altogether, to " strangers, especially to those who
 came from a colder or more temperate climate."  But as he did not
 seem disposed to enter into an investigation of  its cause, being  altoge-
 ther indifferent, whether it " proceeded from infectious miasmata," or
 "- whether it  arose frr m  the great heat of  the air and water, and the
 putrefaction of our fluids," agreeable to the prevailing notions of the
 day, I  beg leave to transcribe a passage* which will tend to prove that
 it must have  proceeded from the same source with  all the other types
 of fever,  which fell under his notice.  " The dysentery, which was
 very frequent in the two last months,  (Sept. and Oct. 1775.) upon the
 season being more warm  and dry, became much less so, and towards
 the latter  end of the month, it totally ceased.   But the inflammatory
 diseases, especially pleurisies, peripneumonies, opthalmies, and some
 quinsies still  continued, and now were attended with more pain in the
 he*d, than usual.  The hooping cough also still continued among chil-
 dren, and  some few had  the putrid, bilious or  yellow fever.'*   Many
 other similar passages to the same purpose might be txtructed  from
 this very  ingenuous,  sensible  writer.  Treating  professedly  of this
fever, he asserts most positively, " that it  has nothing  of  a contagio'stjij
or pestilential nature in it," oeing  ,f indigenous to the West Incia  is-
 lands,  tnd the continent of  America  situated between  or  near to the
 tropics ;"  and wonders, what were " the motives which induced an in*
gerf*y>us author, (Dr. Warren)  to think that this fever was first brought
from Palestine to aMarseilles, and from thence to Martinique,  and so
 to Barbadoes," ass rting that it could be proved by " several judicious
 practitioners" of medicine, that it had existed in the  West Indies al-
 most time immemorial.  He then goes on  to describe this " putiid, bi-
 lious, or yellow fever," through its  different stages  with all the most
 minute symptoms, which I think unnecessary here to recite :  but was
 I to do so, I  should be very much surprised to hear  a practitioner of
 medicine say  on such an  occasion,  he had never sten a fever  exactly
 similar, equally  malignant, and equally  entitled to the denomination of
 " yellow fever," such  as  Dr. Rush, and other practitioners have de-
 scribed in Philadelphia and elsewhere.
   If the yellow fever existed in Barbadoes,  and other  West-India is-
 lands,  fifty or sixty  years  ago, how comes it that it was never imported
 into Philadelphia, New-York,  and  other places, before the year 1793  ;
 seeing the commercial intercourse bttween those places, and the differ^**
 ent West-India islands has been almost uninterrupted  since the earli-
 est settlements of the  country ? If it ever was imported into Philadel-
 phia before that period, there is one thing certain, it never spread by
 " contagion."
   Dr.  Kuhn,  I well recollect, informed his pupils, during the revolu-
 tionary war,  that be had attended two or three cases of" yellow fever"
 some years before that period,  which he supposed were imported into
 that city from the West-Indies; which he  described very accurately, 
                               19

and gave, according to custom, the methodus medendi very minutely,
but confident I am, he never ev>.n  intimated that these cases proved
any way ontagious,  or that infection was communicated to  a single
individual, so that it  is to be presumed the " contagion" died a natu-
ral death, perfectly harmless.
  I might go further on the subject of " contagion,"  so far as it re-
gards " yellow fever," and ask why it  has never found  its way into
every country in Europe that has commercial intercourse  with  the
West-Indies : for diseases  really contagious, such as the small-pox,
visit all countries indiscriminately, whether hot or cold.   If they have
a preference for  one  country more than another, I believe it is for cold
ones !
  If the " yellow fever proceeds from infectious miasmata,  or  if it
arises from  the great heat of the air,"  according to Dr.  Hillary, we
have no reason to go beyond the limits of our seaport towns, to find the
source of the one, or the power of the other !a*Hfc view the sources of
putrid effluvia* or  " infectious miasmata, in those places, according to
Dr..Rush, and other writers on  the  subject;  and see  how the  case
stands !  Contrast the degrees of heat in  Barbadoes, according to the
observations of Dr. Hillary, and the same in Philadelphia, agreeably to
Dr. Rush, and how are th  y ?
   In Barbadoes, July 1753, the lowest the Thermometer was at in the
morning was at  78, and the highest at 80.  The lowest it was at noon
Was 82, and the  highes*- at noon wa  86."
   In Philadelphia, " July  1793." the lowest at " 6" in the mornings
was " 63,"  and the  highest *■** 78."  The  lowest at " 3" in the after-
noon was " 80," and the highest degree in the Thermometer at the
same hour was  " 91 '•'
   In Barbadoes, August 1753, " the lowest the Thermometer was in
the mornings was at 79, and the  highest that ever it was in the morn-
ing was at 82.   The lowest it was  at noon, was at 33, and the highest
at noon was 86."
   In Philadelphia, "August 1793," the lcrWest it was at "6" in the
morning, was"  59," and the  highest at the*same hour was at " 77."
The lowest at "  3" in the afternoon was at  " 66," and the highest at the  #     -\
same hour was at " 90 "
   From thence it appears strikingly  obvious,  that whether  " yellow
fever proceeds from  infectious miasmata, or arises from the great heat
of the air," Philadelphia  must have laboured  under  mu**h greater in-
conveniencies as to  heat ; and if well attested facts on be relied on.
the air must have been much more loaded with " infectious miasma^QL'
and as effects  will always be proportioned  to their causes, we have well
founded reason  for  supposing the  " yellow fever" would much more
likely be generated in Philadelphia, than in Barbadoes.
   But Barbadoes did not want for an " ingenious author," nor Philadel-
phia for a host of such " authors, or ingenious" practitioners  of medi-
cine to make the grand discovery, that  "  yellow fever"  was not  indi-
genous to that island, nor that ill-fated city, but was a fever suigeneris,
imhorted from a  foreign country,  and differing specifically from every
other fever, which had ever made its appearance in the^places before,   «/*-
both as to its cause and origin.  Why mankind should, in all ages, and
::*! all countries,  shew such a proper sity to  " refer the origin of evils
from themselves  to  ct'icrs," i • truly  astonishintj : but  alas '  snys Dr, 
i'Q
        Rush, « this principle discovered itself in  Paradise, and it is every
        where an essential feature in the character of man."
          It is probable, had not this propensity continued so predominant in
        the mind of man under the influence of " motives," which are  not to
        be accounted for, we should not have  had " ingenious authors" every
        where starting up  in this  our day, deriving fever from sources that
        never had an existence:  neither should we have had the mortification
        of seeing talents prostituted by an indulgence  in this  propensity ; nor
        the ingenuity of a Dr. Chisholm* displayed in discovering and proving
        from false f.-cts, that the fever which made  such dreadful havoc at St.
        George, in  the i«Ia  d of  Grenada, in t- e year 1793,  was actually im-
       ported from " Boullam, or Bulema, a desert island on the coast of Gui-
        nea :"  from whence it seems we have eot a new addition to our noso-
        logy under the denomination of  the " Boullam fever!" neither would
        our astonishment have been  excited by hearing in bold assertion, from
        this  very  "  ingenious^ithor," in conjunction  with  our importers,  that
        it was transported frdWThe delightful town of St. George, in the island
        of Grenada, to Philadelphia, in the same year (1793 ;)~the time when
        all the  world knows  the " yellow fever" prevailed there with destructive
        rage ;  "neither would our astonishment  have b.-en continued, by hear-
        ing from  him, that it was not the " yellow  fev r," but a " malignant
        pestilential fever," specifically different from Jthat fever, and every other
        that  had ever made its appearance in Grenada before : neither would
        our amazement have been raised to a yet higher pitch by hearing him,
        after describing his " malignant pestilential f ver"  in almost as many
        words as Dr. Hillary describes the " yellow  fever," making allowance
        for the cant of the day, declare in his postscript, [still however rigidly
        adhering  to his original doctrine,] « that it is a matter of no great im-
        portance whether the disease described by Dr. Rush under the name of
        the Bilious Remitti?ig  Yellow Fever, was produced  in the manner the
        malignant pestilential fever was in Grenada t  it is sufficient,"  says he,
        14 to  know that  the  diseases  were exactly the tame ; and that a  similar
        treatment proved successful in both."f  Here we se ,  after making
        some very nice distinctionTbetwe-n his " malignant pestilential fever,"
 -       where  it is  impossible to Vrc^ive any diff rence from  Dr. Hillary's
fr     and Dr. Rush's " yellow fever," he comes forward with his postscript,
        and settles the difference by acknowledging, " that the diseases were
        exactly the  same,"  still, however, adhering! to the  doctrine ol import.
        ation ;  while Mr. Paiba,  the gentleman that hs himself acknowledges
        ought to know more about the business than any body else, declares the
        whole  affair about the « contagion" originating from the ship Han key
     •yA-ivas  an ingenious fabrication. Thus we find the origin of the « Boullam
        fever," or in other words the « yellow fever,"  was little more than the
        baseless fabrick of this very " ingenious  author's" own ingenuity, who
        appears very much disposed to deceive  himself, as well as  every body
        else, by taking the usual short method of " refering the  origin" of fe

          • See apology in the following note.
          f If  the author should be considered as having treated this very refbectahlr
         rr tpr iv lh itnfpi  nirA>ir»ii. U k„__.u.. :-___  .      ..  .    ' ,c *Jct"**»'>lr-
txamjale to prove the " uuity
  | S*e Dr. Cluuiolms correipondence, &c. in the Medical Rcpofitory
✓ 
%l
 ■ver from the delightful town of St. George to some other place.  Had
 not the ship Hankey arrived at this critical juncture1, when this " malfe-
 nint pestilential fever" commenced it. fury, some might suppose this
 *' ingenious author" would  have had his ingenuity put to a severe tor-
 ture to derive and prove its  foreign origin or extraction.  Not so ! like
 all those whose imaginations  are  filled  with « contagion,"  we should
 have  found him  equally ingenious in discovering the  « fondtea" of
 « contagion ' some  where else, on board some other  unfortunate ship
 arriving in good  time to answer his purpose : and it is not improbable,
 if the notion of "contagion" in Philadelphia had spread a little sooner,
 we should  have found  h,im  displaying his ingenuity  by importing his
 « malignant pestilential fever" from Philadelphia, the very place he had
 transported his « Boullam fever" to.
   It would be a matter of some curiosity, and perhaps afford some in-
 struction, if not entertainment, to trace the visionary route of this « ma-
 lignant pestilential  fever,"  at first, very nicely and accurately distin-
 guished  from the  " yellow fever," and  then becoming « exactly the
 same," as a very remarkable specimen of all other contagious importa-
 tion^
   It was generated, says Dr. Chisholm !  and so say all!  It was gene-
 rated at " Boullam, or  Bulema, a desert island on the coast of Guinea,"
 where, no doubt, it acquired a peculiar ferocity from the savage wUd
 beasts.                              j^^                  °
              «  Wolves gave thee suck, savage tygert fed ."*
                                   <aV
   When, on board  the ship Hankey, freighted with colonists for Sierra
 L.eona, it, while yet ma state of infancy, rn.de unheard of destruction !
^hen, by this ship— /Here Mr. Paiba puts  a negative upon the whole
 affair of importation, 7s an  ingenious fabrication,  but no matter} By
 some invisible means it gets to  St. George, in the island of Grenada,
 Where this  "ingenious author?* tells us, and no  doubt it was so, it
frightened every  body half to death,  and actually destroyed  " different
proportions of different  classes or descriptions'' of poor' mortals !   From
 St. George, in the island of Grenada, he asserts positively, and some
 have lifted up their  voices or wiel led their pens to prove the  truth of it
 or something to the same purpose, it is imported into « Philadelphia"
 somehow, though no creature can teirfioW ! where in  spite of» Dr.
 Rush's acknowledged talents," and otrf&s,lfscares away all the rm/ior/-
 ing doctors, and three-fourths of  the good citizens from  their comfort-
able dwellings, and  actually  sends  one-third, or one-fourth of the resu
due to their long  homes ! !
   Now taking another  incomprehensible flight, it spreads terror, dis-
 may,  and death through every seanort  town in the U.  S. and by and
by, as it were  by a  contagious opposition, it is conjured up  in  every
town, village and  county, in  the wonderful form of domestic  origin !*
   Having slain  its thousands,  and t-ns of thousands,  in this ceuntry,
this extraordinary spirit of " contagion" now most unexpectedly, wafts*
itself to the Havanna, in the island of Cuba, where it stirs up the " atra-
bilia," together with several other extraordinary humours,  which had
lain dormant for-----1 do not know how long, according to seignior Dr
Oyarvide of that city, who roundly asserts, and proves to his  own sciis~

       ' See Medical Repository pafsim 
                                   2£


     faction, mat the « yellow fever" had been a total stranger in that place.
J   until imported there by the « Anglo-American/' meaning the good peo-
     ple of these States !   This is strange, passing strange indeed . but it
     must be so, when asserted by a doctor so tage and scientific as Seignior
     Dr. Oyarvide,t as well as some others.  Here authors or physicians
     of common ingenuity or  genius, might suppose,  this re»tle*s demon of
     pestilence would have stayed its fury, and stopped its destroying career,
     but not so ! We are informed by learned physicians, and other descrip-
     tions of great men, it made  a most wonderful voyage, however incom-
     prehensible it may appear,  to  old Spain,  in some of our unfortunate
     ships, landed at Cadiz, and there commenced its old trade of" havoc,"
     far, very far surpassing that of the " dogs of war  let loose ;"  where it
     is well known, his Catholic Majesty, from  a principle of extreme hu-
     manity, and by the advice of " ingeniou<"*pbysici*ns, was determined
     to arrest its progress by  drawing lines of circumvallation around that
     devoted city, and gu  rding them by troops of armed men, both horse,
     and foot;  but alas ! to little purpose,  for it  made its escape unperceiv-
     ed, and beyond all human comprehension  ; and  carried throughout a
     great part  of this humane prince's  dominions,  dismay and 4e%th !
     where we must leave learned Doctors, whether French or Spanish, to
     settle the knotty, contested point of foreign evtraction or domestic origin,
     but sympathizing at the same time  witu our countrymen for the many
     evils, as  well as vexatious  mcViveniencies,  which  are heaped  upon
     them by the pernicious,  and worse than barbarian custom  of quaran-
     tine, which, though conceived intfear, and  established through  igno-
     rance in the days of  superstition and folly  ; has  been  perpetuated to,
     and  supported  even  in this our enlightened day !  We will  foster a
     hope, that sounder policy will govern the  ruling powers of the earthy
     when* causes and their effects  are better understood.  But away with
     these* flights of fancy;  these farces of contagious ingenuity ;  these
     stumbling  blocks to free, enlightened, unbiased investigation, and say
     Whether
              ." A nauseous mass
          " Of all obscene, corrupt, offensive things^
          " Relapsing into fright'ning elements,"
     have  not in this city, risen.in judgment  against such strange, unac-
     pountable doctrine!  Viewthe-mass  of animal and vetegable matter in
     a state of dissolving, " vouulecorruption" ; and say, whether woeful
     experience does not teach us that the elements of which they are com-
     posed and  modified in various forms, and from which we also incom-
     prehensibly derive our being by the  same Almighty Hand, do not be-
     come poisons to life, and when " applied to the bodies of  men," in a
     way equally incomprehensible, do not prove themselves sufficiently ad-
      equate to the production of fever in the human system of economy ! !
        Therefore, when we see  fever under various types or forms, origin-
      ating  from the same common source  at the  same time,  and in the
      same  place, apparently  under the same circumstances;  though  we
      may not be fully able from human  imbecility, or the poverty of lan-
      guage, to explain why it  is so ; or when we see in the same fimily in-
      termittents combined with various topical affections,  alternating with
      each other, I must presume,  it is a fair, reasonable, a philosophicul

          f See Medical Repository.
*T*F 
23
induction, that " there is but  »ne fever, however different the remote
cause"  may appear to be, when originating from matters differently
modified before their putrid dissolution takes place ; and whether this
is aided " by heat or cold  succeeding to each other," whether by " in-
temperance, or a fright," still, "  I repeat it" in the language of our il-
lustrious  Dr. Rush, " there  is but one fever," and that the physician
who does not, like him, " consider the morbid affections of every'part
of the body [however diversified thf y may be in th ir form or degrees]
as derived from one  cause," is very far from " resembling the philo-
sopher, who considers dew,  ice, frost, and snow as different modifica-
tions of water, and as derived simply from the absence of heat."
   If the doctrine of the remote cause of fever is well founded, little need
be  said on the subject of its prevention ; the  means will be suggested
to every reflecting unbiase_4«aind.
   By an Almighty, Great  Ftrst Cause, the foundations of the earth were
laid, and the order of his Providence  established,  by which all things
live, and  move, and have  their being.  Plants and animals are created ;
" they live, and are nourishfBVarili quickly hasten to decay : they pass
back to their elementary  state, and  are again employed as the consti-
tuent parts »f other vegetables, and other animals.   Such, with respect
to  the material part of the creation,  is the amazing circle of life and
death I a circle in which nature keeps her steady  rounds,  and movea
agreeably to laws established by the Almighty."
    Were it possible,  while these bo«lies are passing through dissolving
 corruption, and their  elements are becoming prepared for new crea-
 tion of animals, or wgetab.es, to prevent them from exhaling into the
 atmosphere in destructive form, mankind might  become  strangers to
 fever! 1
    But alas ! when will such a system of things take place among men,
 that nothing shall be permitted to be  exposed to generateaj^the cause
 of FEVER, the  present scourge of mankind ; and all things corrup-
 tible shall be committed  to the  laboratory of the  earth in  such a st.«te
 of preparation as  to undergo the necessary decomposition for a new
 creation of vegetables, which shall pass into animals for their nourish-
 ment, and these again be returned to  the eaith ; and ihus  ke< p up the
 constant circle of" life and death" agreeably to the laws established by
 the Everlasting Creator of all things ?
    In the country boundless difficulties lie before  us!  Our marshes,
 swamps, stagnant waters and for sts, which year <ifter year prove them-
 selves  the principal source  of dist ase and premature death, are as yet
 in a state little more than  that of nature ;  and it is a lament tble re-
 flection, that years incalculable mu-t revolve  around, tre this tu e face
 of things will be changed :  when these stagnant waters  shill b  dra n-
 ed ; these  marsh, s converted  in o highly  improved me.tdow, ;  our
 swamps transform-.d into arabl- fields, and the leaves o  t ie forest* ap-
 plied to more us  ful purposes than those of evapor itin«-  i to the  ir, or
 remaining to putrify, and fill the atmosphere with put rid rxh dations.
    In our citL s, when the absurd, pernicious custom of imput ng :he ori-
 gin of evils to other countries slull be j»l*.ogethrr done aw  y  ; a u clean-
 liness among all rani^s, classes  and descriptions of p.-rso.is  shall be re-
 duced  to sys ematic habits, such as at this lime scirctlv curactenze
 one nation, we may look  forward with pleasing xpectation, that though
 fere mqV not be  banished  from the  list  of diseases;  when  it  doe? 
24
 Come, it will not appear in that awful, frightful shape which has mark-
 ed it for some years past.
   Children must be taught;  it must enter into the first rudiments of
 their education, that  uncleanness of every kind,  whether  applied to
 morals, or corruptible things, is the origin of all evil ; and particularly
 so far as regards disease, that all things in passing fiom death to cor-
 ruption may become destructive to health, and life.  Under such im-
 pressions men  might be unittd in the bonds- of love and self preserva-
 tion ; the study of nature would be the study of the general good ; and
 the meanest capacity might be scient fically and usefully employed.
   Under a system of police founded on these principles, the " amazing
circle of life and death," would be continued to the benefit and mufipli.
cation, and not 10  the destruction of the human  species :  the elements
of « life  and death" would then pass on 4g» that  regular, successive
circular ch  n  el, which was wonderfully ordained by'^n All-wise, All-
merciful and Omnipotent Creator !
    ——Here  all  1 nguage must » ■*',   mLm
   " Come then, expressive silence, muse h'spraise.'"
FINIS.
 
                          ERRATA.
Page 1, line 14, between" and,"and" said," insert muc-.
   '5       18, instead of " had," read might have.
      8       34,        of " birth," read brink,
     11       24,        of", become" read becomes.
     H       38,        of " effect," read effects.
     12       22,        of " afflicted, and consiJered," read suppose a ,
                          to take place, and perhaps considered.  Omit
                          «the" before pneumatic.
     12, in quotation from Dr. Darwin, instead of « bubb," read bulb.
     16, line 29, instead of " exceptive," read eruptive.
     16      43,       of " inhalations" read exhalations.
     17      43,        of " involve" read evolve.
     18      26,       of" contjgion" read contagious.
     18      29,        of" ingenuous" read ingenious,
     19      16,        of " We view" read Review.
     19      41,        of " miasma" read miasmata.
     19     48,        of " suigeneris" read sui generis.
     19     50,        of" the"  read these.
     20     34,        of" distinction" read distinctions.
     21      18,        of " importation" read importations.
     22     37, between " the" and « mass" read  mighty,
     23      30, after genera," omit in.
     84      14^ instead of « with" read itu 
1 
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T*&~-.;>i,

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