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UNITED STATES OF AMERICA
*> *  .
FOUNDED  1836
WASHINGTON,  D. C.
OPO  16—67244-1
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COMMITTEE
OF THE MEDICAL SOCIETY        •     £ <-'
OF THE
Citp ano Countp of JlSeteff otfe,
       EXPLANATORY OF THE
 CAUSES  AND  CHARACTER
       WHICH PREVAILED IN

BANCKER-STREET

     AND ITS VICIJN1TT,
           IN  THE
   SUMMER .4JVD AUTUMN OF



PUBLISHED HV ORDER OF THE SOl IKfY.

         NEW-YORK :
PUBLISHED BY JAMES V. SEAMAN
   BOOKSELLER * STATIONER,
       NO. 296 PEARL-ST.
9
1820. 

  At a Stated Meeting of the Medical Society of the county of
New-York, held on the 13th day of November, 1820, the Report of
the "Committee appointed" at a Special Meeting held on the 2nd
day of October, " to inquire into the Causes and Character of the
disease prevaiting in Bancker-street and its vicinity," was read ; and
on Motion was ordered to lie on the table one fortnight; and that
the Society adjourn to meet on Monday the 27th for the special
purpose of considering this subject.
  At a Meeting held conformably to  adjournment  the following
Report having been again read and approved ;
  On  motion of Dr. Manley, Resolved,  that the Report be pub-
lished ; and that Dr. Osborn, Chairman of the Committee on the
above Report, and Doetors Pascalis and Tappen, the Secretaries
of the Society be a Committee to Superintend the publication
thereof.
               Extract from the Minutes,
PETER C. TAPPEN, Secretary. 
■   p.:;
               TO THE

    MEDICAL  SOCIETY

OF THE CITY AND COUNTY OF NEW-YORK.
THE COMMITTEE APPOINTED- TO INQUIRE INTO THE CAUSES AKD
  CHARACTER OP THE DISEASE PREVAILING IN BANCKER-STREET
  AND ITS VICINITT,

RESPECTFULLY REPORT :

  From the commencement of alarm, even pre-
vious to the  appointment of this Committee,
several of its members had been in the habit of
visiting the cases of fever, as they occurred; and
also  of carefully examining the bodies of the
dead.
  It will be found, from the following topography
of the infected district, that ample materials ex-
isted on that spot, for the generation of malig-
nant fever.
* ■</ 
                          4              *

   ^  Although numerous cases, of malignant fever,
     occurred in the adjacent streets, yet they were
'  ♦. most frequent and most malignant in Bancker-
     street, from Pike, to  Catharine-street, and  in
     Lombardy-street on the side next to Bancker-
     street.
       Bancker an4 Lombardy-streets  run parallel
     to each other, and  to  the East River; distant
     from the river about six hundred and fifty feet,
     forming an inclined  plane towards the river, at
    right angles to the inclination of the plane ; na-
    turally of sufficient elevation and possessed of
    every favourable  circumstance for free ventila-
    tion and cleanliness; it required the cupidity of
    man  to render it confined and filthy.
       From the southern aspect of this district, its
    atmospheric temperature is  somewhat increas-
    ed ; owing to the solar rays falling on its surface,
    by a greater angle of incidence, than upon an
    uninclined plane.  The infected  section is suffi-
    ciently elevated above, and properly descend-
    ing towards Catherine and  Market streets, to
    carry off the water,  but owing to the great num-
    ber and crowded state of the inhabitants, suffi-'
    cient filth (though but a small proportion of the
    whole) is constantly  thrown into the  street, to
    impede the  water;  and instead of cleansing,
    even  rain becomes  an  additional  material of
    noxious exhalation. 
5
  The rear of the lots fronting on the south side
of Bancker-street, is much below the street, ren-
dering it impossible to get rid of the filth in any
other mode than by carrying it  into the street:
this being seldom done, most of the lots and al-
leys retain the filth and water, and every article it
may be necessary for such a crowded population
to remove from their apartments.   The manner
in which the buildings are constructed, when ta-
ken  into consideration, in connexion with the
above described natural surface of the street and
lots, will show additional difficulties for the escape
of putrefying vegetable and animal  exhalations.
There are probably more than twice the number
of houses, on a given number of square feet  in
Bancker street, than in any other part of the city.
The buildings extend to the rear of almost every
lot, the access to which,  is by means of an alley
about 3 feet wide.
   Wherever  any space  is found not  occupied
with  buildings, it,  together  with the  alleys, is
usually covered with every species of filth.
   The influence of great atmospherical tempera-
ture, operating on  the accumulated filth of the
above district, may be readily  conceived,  on a
population more crowded, it is belie ved,th an can
be found in any other city of the United States.
   In this  confined and   unwholesome district,
there are about  80  lots  of from 20 to 30 feet
wide,  and from  100 to 200 fe^et deep;  about 2$
                       2 
6
 of these lots, on the north side of Bancker-street,
 are occupied by tolerably neat and  comfortable
 buildings, tenanted by about 40 families (197 in-
 dividuals) living decently;  the  remaining  60 lots
 are covered with buildings  entirely  constructed
 of wood, (with a few exceptions  of brick  fronts)
 one and two stories high ; mostly old and  decay-
 ed ; seldom more than one  small window  to a
 room.
   From the cellar to the garret of these badly con-
 structed, decaying, and ill ventilated  houses, are
 to be found, numerous families,  in the most filthy
 state imaginable, destitute of almost every  article
 of household furniture, and literally, so full of in-
 habitants, as not to allow space for the necessary
 articles of housekeeping.
   Between 50 and 60 of the rooms  fronting on
 Bancker-street, are occupied as  dram-shops ; the
 upper rooms and back buildings are let, by those
 who hire them of the landlord, to an inferior class
 of tenants, these again let apartments for a week
 or a day, to others still more degraded than  them-
 selves.   These apartments are  never cleansed;
 and from being  the  haunts  of drunkenness  and
 debauchery,  become  loathsomely filthy within;
 and, out of doors, the offals of the apartments, and
 even the excrements of their bodies, being thrown
 into the alleys, (where all think themselves at li-
berty to deposit, but none feel it  their  duty  to re-
move,) this filth, united with  that produced by a 
/
large number of hogs, presents a scene at once
loathsome and nauseating.
   Many apartments contain no other article, as
beds, but straw or rags, thrown on the floor or
ground;  there trodden under foot,  they become
imbued with every kind of tilth, and in  this state
are suffered to rot in the  apartments, or thrown
into the alleys, there to undergo a more speedy
putrefaction, and add to the general mass of con-
tamination.   The food of these people, though
precarious,  is probably seldom deficient; not-
withstanding it  is, when  compared  with drink,
by them, considered of secondary  importance,
they  frequently enjoy  profusion,  and  while in
health,  generally  appear to  be jovial and con-
tented.
   In this section  of Bancker-street, there are
1566 persons ; they are mingled promiscuously
in the same apartments ; and frequently may be
seen, as tenants in. common,  hogs and  d' gs;
blacks and whites of both  sexes and various ages,
from ten years old to fifty.
   In August last, there were living in the before
defined district of Bancker-street alone,
                                      Individuals*
On 30 lots 234 families, consisting in all of 1096
   20    189  -------   "  842
   10    108  -   -.....-  542
     2      29  -------   -   I44,
     1      16  -------   -    81 
ft
on  this lot, which  is No. 95, there are three
small wooden buildings, and of those living there
in August, 21  have died, and 12 or 14 heen re-
moved sjck.
   In  I^ombardy-street,  one small lot, No. 54,
with  wooden buildings,  is said to be occupied
by 24 families,  among whom there has also been
great sickness  and mortality.  Since  the com-
mencement of the fever,  exclusive of those who
have died,  many  have been removed, and many
fled from fear of the fever; consequently the po-
pulation is now considerably reduced.
  Dr. Arbuthnot, in  his treatise on air, states,
that 30Q0 human beings,  living within the com-
pass of one acre of ground,  would  make an at-
mosphere of their  own  steams  about 71  feet
high, in 34 days; which, if not carried away by
Winds, would become pestiferous.
   Hence, living  in crowded dwellings,  in the
vicinity of putrefying vegetable and animal mat-
ter, will inevitably dispose to malignant fever;
and such causes  and similar circumstances have
existed in Bancker-street and  its vicinity, and
such have been the  consequences.
   It  is admitted, the causes of malignant fever
are not always  assignable to heat or  cold, mois-
ture  or  dryness; but  it is  well  known  that in
either of these  states, putrefying vegetable and
animal matter  may produce malignant fever, and
to a certainty will produce it, in a  heated  and 
9
confined atmosphere.  In addition to which, it is
well known, that rotten and decayed wood is ca-
pable of  generating miasmata, if not more dele-
terious, at least as much so as animal  putrefac-
tion.
   It is a well established and approved doctrine,
that any epidemic, which controls all ages  and
both sexes, can impart  its form, however dissi-
milar, to the ordinary diseases, or transfer those
that are incident to ordinary causes, into the only
prevailing affection; but this phenomenon requires
a truly universal epidemic.   It is from the same
law of nature,  that we  may,![by accurate obser-
vation,  discover  even during a tolerably healthy
state  of  a large population, what danger, and
what form of  disease,  will  most likely prevail,
when the atmospheric constitution is  sufficientiy
aided by local causes.   This inquiry,  we  find,
excited the attention of several practitioners dur-
ing the last, summer and autumn, which elapsed,
however, without any very remarkable degree of
mortality in the city generally.
   During the months of July, August and Sep-
tember, the range of the thermometer was higher
than  usual; as, during twenty-two days of July,
it ranged from 80° to  90° ;  ten days of August
from 80° to 93° ;  and  nine  days of September,
from 80° to 88°.  The] atmosphere was more
calm and  dry than  ordinary;  remitting fever,
cholera, and  dysentery, prevailed to  some ex- 
1U
  tent,  and caused considerable mortality, espe-
  cially among children;  in the  latter  part of
  August,  and through September, these diseases
  were  accompanied by catarrhal symptoms;  ca-
  tarrhal fever,  and pneumonic inflammation were
  not rare.
    In various parts of the city, remitting fevers of
  more than ordinary severity occurred,  and  in
  many  instances assumed  a  character of malig-
  nity.
    Throughout the United States,  distant from,
 as well as on the sea coast;  in  the  interior,  as
 well as adjacent to tide water, remitting and  in-
 termitting fevers  have prevailed,  of more than
 usual severity,  and occasioning more than  ordi-
 nary and sudden mortality.   As early as the lat-
 ter part of July, there occurred several cases of
 sudden death from fever, which occasioned the
 suspicion of the commencement of fever of a ma-
 lignant type, especially as many  cases of simple
 continued fever, usually under the  ready control
 of remedies, now began to assume a more uncer-
 tain and remitting type, and  gradually took on,
 as the season advanced, a more bilious character.
 Common bilious or remittent fevers, attended
 with some degree  or symptoms of malignity, had
 frequently been  noticed, and several of them had
 proved  fatal.  One of our  brethren, an eminent
practitioner declares,  he  has seen  malignant
symptoms characteristic of yellow fever, in seve- 
11
ral  instances of  ordinary remittents;  such as
red suffusion of the eyes,  yellowness of the skin,
mordicant heat, hemorrhage, excruciating pain of
the head, difficult and tedious convalescence, &c.
&c.  Another has informed us that cases of dys-
entery and cholera had exhibited abundance of
petechia?.
   Another writes to us that an unusual number
of  febrile diseases appeared in the City Prison
and Bridewell in July and August.
   The principal  physician in  attendance on  the
Hospitals at Bellevue, affirms that, during  the
months of July, August, and September, and the
early  part  of October,  there occurred at that
establishment,  a disease  exhibiting  many  cha-
racteristics of the Typhus Gravior, Jail or Hos-
pital Fever, accompanied with bilious symptoms,
especially among the blacks, such as yellowness
of the eyes and skin,  epigastric distress, in some
instances so great as to render the slightest pres-
sure intolerable.
   It is on the same authority, and  to illustrate
the pre-existing causes  of malignant  fever, that
your Committee  notice the case of a black boy,
whose great yellowness  of the  eyes,  and other
appearances,  induced a magistrate to order  the
examination of the corpse, which, after all, dfFer-
ed only what the  physician had  previously pro-
nounced : a violent " acute peripneumonia."  In
fine, one of your  Committee certifies  that an  old 
12
lady in the vicinity of Bancker-street, who, after
exposure to great fatigue in a damp atmosphere,
was struck with hemiplegia, and died on the 9th
day of the complaint, after long  coma: in thi3
case appeared general yellowness of the eyes and
body, black tongue and mouth, and black alvine
discharges.
  All these singular and unusual appearances, are
confirmatory of the opinion of your Committee,
that a predisposing general constitution to malig-
nant disease has existed; requiring ortly local
exciting causes to  be developed.
  Your Committee therefore,  feel authorized to
infer, that  there has  existed probably, adequate
predisposing causes for the reproduction of those
fevers, which are  more peculiar to this climate
when assisted by impure miasmatic exhalations;
in the operation of the long continued and intense
heat of the summer months, the stillness of the ele-
ments^ the absence of showers and thunder storms,
with a continual cloudless sky, during long days of
unabated and refracted heat.
  The first  cases  of Fever  in  Bancker-street
were rapidly formed and observed by more than
one physician; the first of which  we shall take
notice, was  duly  examined by a gentleman  of
much experience,  and reported by him as malig-
nant fever, on the  21st day  of August: this was
Phoebe Williams,  an Indian half breed, she died
at the old Almshouse on the  fourth  day of the 
13
disease, and within a few hours of being able to
walk about.
   On the next day, Hannah Lewis,  a coloured
woman from No. 54 Lombardy-street died,  on
the sixth  day from the attack;  and on the fol-
lowing day, William  Peck from 95  Bancker-
street, expired, after having exhibited very severe
malignant symptoms : In the first of these  three
cases, a  vomiting of black matter  took place,
before  death; and  in  the two last, both  black
vomiting and purging, and the corpse was mottled
and covered with petechia?.
   From  this period, the disease, which will be
 hereafter faithfully described,  continued to rage
 in Bancker-street,  from Catherine-street,  inclu-
 ding two blocks, up to Pike-street, till late in Oc-
 tober.
   Respecting the nature  of  the Bancker-street
 fever, your Committee are aware of many diffi-
 culties in the way  of discrimination; owing to
 some peculiar circumstances  connected with the
 disease, and because Medical gentlemen have pro-
 mulgated, perhaps prematurely, an opinion differ-
ent from that of the Committee.   With the best
motives and purest  intentions, well-informed men
 are not always sufficiently guarded  against erro-
 neous conclusions ; and lest we might ourselves
incur the  like danger, we will here  state certain
principles and characteristics,  essentially apper-
taining to Typhus fever,  by  which  it will after-
                     3 
14
  wards appear easy to define the species of disease
  now under consideration.
     We should  first, however, say, that of  late
  years,  the name of  typhus,  has been applied to
  very  dissimilar fevers,  by English and French
  writers.  By them,  the yellow fever is made an
  American Typhus; and  the plague  a Levantine
  Typhus.  Cullen,  Thomas, and others, not only
  make of the yellow fever, a variety of  the  order
  typhus ; but they  and other authors, embrace in
  the same, Jail,  Hospital,  and Camp fevers.*   It
  would perhaps  be difficult to find fault  with them,
  because the famous Sauvages, long ago, consider-
  ed peripneumonia notha a Typhus;  which  the
  professor of the theory and practice of physic in
  this city, has  defined peripneumonia typhodes.\
  Your  Committee  therefore  need  not bring  for-
  ward more  proofs  respecting the confused, or er-
  roneous application of the word typhus, as intro-
  duced and used in Medical language ;  since it is
  common to say of pleurisy,  or any other inflam-
  * For the essential character of these fevers, and their difference
 from yellow fever, or from ordinary bilious remittent, vide observa-
 tions on the Diseases of the army, by Sir John Pringle, Bart.  Do. on
the Means of preserving the Health of Soldiers, and of conducting
Military Hospitals, by DonaldMonro, M. D. Do. on Jail, Hospital'
or Ship fever, made in various parts of Europe and America, by Hen-
ry. Robertson, M. D.  Diagnosis, Acute inflammation of internal
Membranes: formation of abscesses in the viscera, sometimes in the
Lungs and Brain.  Symptoms, continued type, eruptions hemor-
rhage, discharges of pus, fyc.
    | Vide Hosack's appendix to Thomas's Modern Practice of
 Physic. 
15
 matory  disease, that it has, or will run into ty-
phus.   Your Committee infer therefore, that this
 denomination has  become synonymous with as-
 thenic, or adynamic attributes ; defining a certain
 state of debility,  which immediately requires an
 exciting or stimulating mode of treatment.
   The  only  mode of discriminating,  therefore?
 between this and any other febrile disease of adit
 ferent nature, will be, to fix  upon the essentia*
 characteristics appertaining to two opposite kinds
 of morbid condition of the human frame;  which,
 although they may frequently show many of the
 symptoms common to both, constitute however,1
 two perfectly opposite diseases:  such are  typhus
 fever,  and bilious malignant,  or  yellow fever.
   Medical writers apprise us, that  the first disap-
 pears  in warm weather, that it is most prevalent
 during cold weather,  more particularly if accom^
 panied by humidity of the  atmosphere, that the
young and robust  are the least  liable  to its at-
 tacks,  whereas the old, and those debilitated from
want of proper food and  comforts of life,  are its
 more general subjects;  and that it is  unexcep_
tionably a fever of a continued type, of protracted
and uncertain stages.*
  * For the difference of typhus from yellow fever, vide Ho-
sack's appendix to Thomas's Practice of Physic, page 8S4;on the
essential character of the first, as a long continued type, and of the
second as pestis tropicus, usually proving fatal in seven days, \IA*
Hosack's Practical Nosology, page 139. 
16
    The word Typhus also from its etymology  or
 Greek derivation, characterizes a state of stupor
 and suspension of the functions of the sensorium,
 and is generally accompanied by muscular irritabi-
 lity, perfectly characteristic of the disease it de-
 signates.
    A very different and quite opposite  series  of
 essential and characteristic circumstances, denotes
 our ordinary bilious, malignant, remittent fevers,
 or yellow fever :  even supposing-for the sake  of
 argument, that this should be considered a disease
 sui generis.
   First,  They have a remittent, or an  intermit-
 tent type.
   Secondly, Their progress is rapid and violent.
   Thirdly,  They are  expected never to break
 out, excepting during, or immediately following,
 the warmest season of the year: and frost always
 stops their progress,  and puts an end to their ex-
 istence as epidemics.*
   Fourthly, They attack the most robust, seldom
 the infirm, or those in the decaying stages of life.
   Fifthly, They show three stages, one inflamma-
 tory, of  thirty-six hours:  one asthenic, and one
  * It is  not by frost only that summer and autumnal malignant
 diseases are immediately checked as Epidemics, but also by  the
 cold weather that precedes it; yet many sporadic cases of yellow
 fever have been seen and attended by  eminent physicians, name-
 ly, by Rush, as late as November and December, during snowy
 and frosty weather. It is likewise inferred that infecting miasmata,
 when confined  in warm dwellings, may gradually change their
 nature during winter, as much as the character of their congenia
diseases into various kinds of Typhus. 
17
a series of deadly symptoms,  the forerunners of
certain death.
  These fevers may at any period exhibit pecu-
liar  bilious or  yellow  effusions, in  the  eyes,
skin, or parenchyma  of  the  liver; and in the
stomach, the  formation of dark brown or black
matter: hence, black vomit.
   From all this,  your Committee feel  authorized
 to class Bancker-street fever,  in  the last defined
 order of fevers: feeling satisfied that the facts and
 circumstances developed, together  with the de-
 scription of the disease, and the autopsic examina-
 tions will bear them out in the designation.
   From the documents obtained by your Com-
 mittee,  it appears the number of blacks affected
 by the epidemic in Bancker-street and its vicinity,
 to the whites ; is in the proportion of three of the
 former, to one of the latter ; and among the blacks,
 the  disease has  certainly exhibited a  greater de-
 gree of intense malignity and fatality.
   This remarkable   circumstance  has induced
 many persons to believe  that,  the Bancker-street
 fever having stricken those who were in fact,  by
 far  the most numerous inhabitants of that dis-
 trict,  was nothing more than an ordinary fever, as
 it occurs in jails, camps or hospitals,  or else, be-
 ing  a distemper peculiar to the African race and
 people of colour, it could bear no resemblance to
 the  ordinary bilious remittents of our  cities ; and
 much less to the yellow fever. 
18
    Although the refutation of this opinion may be
  best effected  by  the description  of the disease
  which is hereafter detailed ; yet, it will not be ir-
  relevant to mention, that the proverbial  unsuscep-
  tibility of the blacks to yellow fever, exists only
  when they inhabit their  native  soil of Africa, or
  the West India islands ; but by long residence in
  North America,  they become subject" to  every
  disease in common  with the  whites.   A great
  number of blacks died in  Philadelphia of yellow
  fever during the epidemic of 1793.   We are in-
  formed by Monsieur Deveze of Paris, who  prac-
  tised in Philadelphia during that calamitous fever,
  and  also  acquired  much  experience in relation
  thereto, in the West India islands ;  that the resi-
  dence of blacks in cold countries soon wears away
'  their unsusceptibility, and renders them eqally li-
  able to yellow fever with the inhabitants of cold
  climates.*  A lamentable proof in point  of the
  ready  or  renewed susceptibility of blacks  long
  resident in, or  natives of cold countries, is afforded
  in the recent event of the fatality  of the climate
  to the emigrants  from this  city to  Sherbrof in
  Africa.
   * Vid. Traite dela fievre jaune par. J. Deveze D. M. P. kc.
  pag. 109.
   f Extract from the London Missionary Magazine for August
  and September, 1820 (inserted in  the Boston Recorder  for No-
  vember 4th, 1820.) " On the 20th of March, the Augusta reached
  Campelar, a small  Island in Sherbro Bay, soon after the tranship-
  ment of the Colony Mr. Bankson, agent for the American Govern- 
19
  It has been objected or supposed that, many
predisposing causes originating from poverty and
want of food, might have occasioned the disease
under consideration.
  Your  Committee cannot, however, reconcile
that supposition, with the well known and obvious
fact, that want of food is seldom or never (per-
haps)  felt, by any class whatever of the people of
this city ;  especially in the summer and autumn.
  They have also the testimony of an accurate ob-
server ; who has minutely inquired into the man-
ners, and the modes of living of the blacks,  in
Bancker-street;  and he  is satisfied  their  only
wants were, those of cleanliness  and moral life.
   It appears therefore that the principal causes
of  this fatal distemper are attributable to the lo-
calities,  of extreme  filthiness in crowded cellars
and hovels, daily rendered more and more offen-
sive, by impure human effluvia, and exposure to
nightly chilness and moisture.
  Doctors  Hillary, Jackson, Hume,  Dalrymple
and all other esteemed authors on  the yellow fe-
ver of  the West Indies,  as  well  as  many of
our own  country, consider the  particular dis-

ment, Dr.  Clozel, a Physician, Mr. Townshend, a midshipman
of the Augusta, a Rev. Mr. Bacon, six men and the boy who man-
ned the Schooner died with a fever, (eleven whites) of the colour-
ed people, fifteen died. Of the survivors, Mr. Daniel Coker, a mo-
latto >\ho accompanied the Colony as a free emigrant took charge, 
20
tinguishing symptoms of that disease to  be;  n.
the words of Dr. Hume; " Sickness and inces-
sant yellow bilious, or black vomiting; attended
with an oppression and pain about the precordia,
particularly when the hand is placed on the pit of
the stomach;  laborious  and painful  respiration,
yellow colour of  the eyes and skin;  though this
is  not a constant concomitant symptom."  We
have the same authority for the following appear-
ances on dissection; ll of those who  have  died of
yellow fever, the coats of the stomach, duodenum,
and ileum, have been found" commonly more or
less inflamed and mortified, and full of black bile ;
the liver large and turgid with  bile, and some-
times sphacelated, where it lies contiguous to the
stomach; the omentum livid and full of black
blood; at other times, few or no  marks of inflam-
mation have  been observed on  the  stomach or
contiguous parts, though the preceding fever had
been attended by excessive vomiting."
   Such have  been the distinguishing symptoms,
and such has been the result of autopsic  exami-
nations generally, in the fever which is the sub-
 ject of our investigation.
    In all cases, every symptom did not occur, but
 in all, some of the distinguishing symptoms did
 exist; and the autopsic exhibition has been pre-
 cisely the same as the above named  and other
 esteemed authors led  your Committee to  ex-
 pect. 
21
  The sick were generally attacked with a sense
of chiliness, weakness and pain in the head and
loins (and in some instances great  pain  of the
bones)  sickness at stomach and  thirst, great
heat of the stomach, and a sensation of soreness
and uneasiness over the whole surface, in some
cases the pulse strong and full, in others full and
soft, seldom hard;  in some, considerable heat of
skin, great anxiety about the precordia, a short
oppressed  and   interrupted breathing; these
symptoms were usually succeeded on the second
and third day by great pain in the epigastric re-
gion, the  tongue  which in the first  stage  was
sometimes dry and white, was now moist, cover-
ed with a thick white or brown fur,  and in some
instances there was a slight redness of the cen-
tre and  great redness  of the edges; the eyes
suffused with a red, or watery appearance, which
as that  of  the  countenance,  was  like  an  in-
toxicated person; the face being flushed with an
expression of wildness and anxiety, more than of
acute pain;  nausea, and vomiting of green bil-
ious matter usually  took place  at  the onset of
the disease, with frequent stools of green coppe-
ras coloured water, the vomiting increasing in
violence, as the  disease progressed  as  also in
frequency:  and an increase of  soreness  in the
epigastric region to that degree as to occasion
exclamations of extreme pain, or excite vomiting
                       4 
22
on the slightest pressure of the hand on the pit
of the stomach.
  In many cases the pain of the head extended
from  the forehead to the occiput and down the
neck;  in  others it  was  confined  to the  fore-
head and eyes; and  in these the pain was  most
severe.
  The symptoms of excitement were  various  in
their duration; but generally, on the second or
third  day  at farthest, they were succeeded by
collapse and extreme exhaustion; the pulse often
became slow and feeble; in some scarcely per-
ceptible, in others intermitting;  and  in a  greater
number a total subsidence of heat and irritation
of the skin.
  In some cases, so great  an abatement  of all
the symptoms  previously existing, or absence of
those anticipated, occurred on the third or fourth
day, as to give fallacious hopes of safety to the
patients and their friends; but this suspension of
alarming symptoms was soon followed by others
still more so, such as violent vomiting and defi-
ciency of vital heat,  over the whole body; some-
times attended with an enlargement and redness
of  the vessels of the tunica albuginea; and yet
as stated by a competent  observer,  "  the loss
of muscular power was by no means proportion-
ed to the actual severity of the  other symp-
toms ;" to use his own words -'• I say actual seve-
rity, for the symptoms were oftentimes  by no 
23
means discouraging to the uninformed and  un-
guarded  observer, and  yet  would  terminate
quickly  in the death  of the patient;'' previous
to which,  there usually occurred a cold clammy
sweat.   On  the second, third, or fourth day, the
urine was  tinged  with bile, which also exhibited
itself in the  discharge  from  blistered surfaces,
and in the adnata ot the eyes; at the same time,
or sometimes not till the fith day; the skin  be-
came tinged yellow,  so  conspicuously as to be
plainly perceptible in blacks, communicating the
same tinge to their dark rete-mucosum.  Violent
delirium took place but in few cases; the senso-
rial  faculties generally remained unimpaired; so
that the sick were enabled to  detail  a clear and
distinct account  of the  manner of  attack, and
the  progress of their disease,  even  a very few
hours previous to dissolution.*
   In those cases  which terminated fatally, there
generally  appeared about  the  fifth or sixth  day,
petechia? or  hemorrhage; sometimes  the hemor-
rhage was from  the mouth, at others from  the
nose, stomach,  or intestines; hiccough often at-
 * In the Southern Patriot, we have lately read a well written and
detailed account of the malignant fever which has during the warm
•eason, caused such unexampled mortality in that ill fated city.
The medical author of it offers it as a subject of investigation ; in
as  much as it appeared to differ in the succession of symptoms
from the yellow  fever of other places ; and yet has presented its
most essential characters.  The reader  may now compare the
subject of this report to the epidemic of Savannah, and he will
feel con\i::erd of the simiJ; :;ity of the two diseases. 
24
tended the last stage for twenty-four hours pre-
ceding death; and  a vomiting of dark, bilious
matter, frequently of a brownish  black colour.
From the total want of conveniences in the ha-
bitations  of the sick, it was but seldom practi-
cable to procure a sight of the matter ejected or
dejected; the whole of their bedroom furniture
seldom supplying  more than one  vessel for the
use of the  sick, and that  one appropriated at
different  times to various uses, as necessity might
demand.   The matter of black  vomit has been
witnessed by many  of your committee.
  In some  cases,  the first  attack  was  extreme
exhaustion, without any preceding excitement;
in others it was hardly admitted by the sick, or
their companions,  that  they  were at  all  sick,
walking  about as  in  health to within a  few
hours of  death.
  The symptoms of the disease in those persons
who were  taken  from  Bancker-street to  the
New-York  Hospital, during the month of  Sep-
tember,   (at which  time they came  under the
observation of one of your committee) differed
somewhat  from the preceding account, assum-
ing, in most cases,  a character of bilious remit-
tent fever.
  It may be proper here ito remark, that those
cases generally  removed from the infected dis-
trict,  soon after  the onset of the fever,  and
where there appeared any prospect of recovery. 
26
were much  subdued  in  malignancy by the re-
moval.   A pure air and good attendance as to
nursing and comforts, securing a much greater
proportion of recoveries than among those who
remained.
  At Powles Hook there occurred two cases of
Bancker-street fever.  These were, two black
men who  resorted to Bancker-street; had oc-
casionally lodged there,  and  had lost some re-
latives  by  the  disease.   It is  stated  by Dr.
Hornblower, who has had  much experience in
yellow fever, that both these cases put on every
required distinguishing  mark of yellow fever.
One died on the fifth day, the other recovered.*
  It is  averred  by one  of  the gentlemen who
attended Mr. King, the  victim  of Philadelphia
fever, at our Quarantine Hospital,  that one of
the above  stated cases  showed  as  strong, and
precisely the same symptoms of yellow fever,
as were exhibited in  the case of  Mr. King.  At
the time of  his witnessing  the case at Powles
Hook, Mr. King's case  was fresh in his memo-
ry,  it having taken  place but  a few days subse-
quent to Mr. King's.
  Of 28 cases reported to the Resident Physician,
to the Mayor and  to the board  of health, by a

  * The committee have been put in possession of the descrip-
tion of a case of fever, by Dr. Thomas W. Blachford, which oc-
curred in Jamaica, L. I. and  originated in Bancker-street, similar
to those of Powles Hook.  The patient died on the 6th day, with
black vomit. 
26
single physician as Malignant fever, or suspicious,
5 had  that peculiar black matter  known to dis-
tinguish the most malignant grade of yellow fe-
ver,  and  universally  called black vomit, either
thrown up during life, or detected  in the stomach
after dissection; 9 had  yellowness of the skin;
7 hemorrhage; 4petechia?, and 4 hiccough.  The
hemorrhage was frequently from the intestines, but
oftener from the mouth and nose.   The matter of
black vomit was witnessed by some of your Com-
mittee in many living subjects, and detected  in
several others on dissection.   The subjects were
generally in the prime of life, of robust plethoric
habits, most of them from 30 to 40 years of age,
some younger, few older, and in few or no cases
appeared any  marks  of emaciation after death.
It has been long since aptly said, that malignant
fever is a dog that bites without barking, as fre-
quently proving fatal,  without appearing from
any violence of symptoms to indicate danger; this
has been  especially  the case in Bancker-street
fever, as in,many instances the patients have been
unwilling to acknowledge themselves sick, and
have actually walked  the street till within a very
few hours of dissolution, and many indeed to ap-
pearance, were able to dig their graves the day of
their deaths.   Such  has been the character of
Bancker-street fever.
   A number of bodies  were examined  by your
Committee, as  also  by many  other   Medical 
27
Gentlemen.   From six communications detailing
the exhibition,the following description Is selected
as having been drawn up by a gentleman who at-
tended most of the dissections in the infected dis-
trict, in all points agreeing with other communi-
cations as well as with the observations of your
Committee:
   "An inflamed state of the omentum, which was
frequently congested with blood ; paleness of the
liver, which in several instances put on a motiled
appearance with spots of a  pale yellow or brick
colour; the gall bladder almost universally con-
tained  dark  viscid bile of the colour and consis-
tence of tar.   The stomach  however  showed
more particularly the marks of derangement; the
inner or villous coat was highly inflamed,  easily
abraded with the finger, and interspersed with
spots of a dark colour; the  external surface gen-
erally sound and seldom marked with any high
degree  of inflammation.   The  intestines, par-
ticularly the duodenum, jejunum and ileum were
frequently found  in an inflamed state, and were
also marked,  with gangrenous  spots; the mes-
entery often partook of their inflamed state.  The
stomach in many cases contained a dark brown
matter, with black specks swimming in it, the
true coffee-ground like matter of black vomit.
The spleen was generally found much enlarged
in an  extremely soft friable state, easily broken
down by the grasp of the hand." 
28
  To the state of  things related  above,  the at-
tention of the Board of Health was solicited as
early as  the 7th  of September; in  a letter  ad-
dressed  to the President, informing him, of the
fact, that malignant fever prevailed  to an alarm-
ing extent in and about Bancker-street.   He was
apprised that a formal petition to  the board  was
contemplated, to induce it to a speedy exercise
of its  authority in the furtherance of such meas-
ures as alone appeared  to promise  security to the
neighbourhood;  and which measures, it was sup-
posed were a primary motive in  the Institution
of a board of health; viz. The removal of the sick
and cleansing of the infected district.  An entire
and exclusive confidence in the Resident Physi-
cian was deprecated as impolitic  and unjust; in
as much, as it was well known that he earnestly
contended  for the exclusive, foreign origin  and
importation  of  malignant fever,  and  it  was
asked " whether under such impressions and the
existing  circumstances of Bancker-st: he would
be  willing to admit the existence of a malignant
type of fever unequivocally of a domestic origin."
It was particularly urged that some respectable
and experienced member of the Medical  faculty,
not wedded to those opinions entertained by the
Resident Physician respecting fever, a gentleman
in whose integrity and ability of  discrimination,
full reliance could be placed, should be associ-
ated  with him,  to investigate  the  epidemic of 
29
Bancker-street and its vicinity. ' It was moreover
requested on the ground of reciprocity, as such
privilege had been repeatedly claimed and ob-
tained by the contagionists;  and as an additional
reason why such course would be both politic and
just was  urged, " the frequent misnomers  and
mistakes in regard to malignant fever, as instanc-
ed particularly in the contested cases of John and
George Van Nest, Mr.  Conrey,  John C.  Wil-
liams," &c. &c.
   That these reasonable demands were not heed-
ed  may be accounted for in the well known fact;
that the resident physician has selected and held
up in derision  to  public view, and sneeringly
branded with the epithet " Yellow Fever of Banc-
ker-street; the minor grades of fever,' 'the com-
mon every day occurrences  of our City;' " while
cases of a  decidedly malignant  character have
been no less artfully concealed from so public an
exhibition; and a long and  lingering disease,
originating  from a  different cause,  and distin-
guished by a totally different train of symptoms, a
fever generated in a cold and  extinguished by a
hot temperature, has to the repugnance of reason
and common sense, been called in to account for
a mortality unprecedented  except in epidemic
periods; and the epidemic fever of Bancker-street
has by  these Gentlemen of authority been  de-
nominated " Typhus Fever.'?
  That the constitution of the  atmosphere com- 
30
 municated a disposition to the ordinary remitting
 and other fevers to assume a malignant character,
 having been above noticed, it is thought proper
 here to state, what is also a well known and in-
 variably recorded fact, that simple remittent, bil-
 ious remittent, and intermittent fevers, often pre-
 vail in an infected district, and  even in the same
 family, where yellow fever exhibits its  greatest
 malignity.
  It appears, from the best information your
 Committee can obtain, that about  150  died  of
Bancker-street fever from the 21st day  of Au-
gust to the 20th day of October: whereas, when
alarm  was excited  at home, and dread  spread
abroad, during the existence of malignant fever
in the autumn of 1819, only from 40 to  45 died
of that disease, out of 66 well ascertained cases.
  In fine, as to the denomination of the  disease,
the causes and character of which has been the
subject of your  Committee's investigation, we
do  not hesitate  to declare our conviction of the
indentity of Bancker-street fever, with the ma-
lignant fever of authors from Hippocrates to the
present day, and  the yellow fever of  tropical
 climates and our own harbours; and that this fe-
 ver varies only, in degree of malignity, intensity,
 and extensiveness of operation, proportioned to
 local exciting causes.
   Having thus presented to your view, the result
 of, and opinions deduced from, an arduous and 
31
laborious investigation ; having accurately de-
scribed the malignant fever of Bancker-street, its
causes and effects, your Committee deem it not
transcending their duty, in endeavouring to point
out by what preventive measures (in their opin-
ion) the recurrence of the like dangerous distem-
per  can be best guarded against.   It is deemed
a duty more imperious as, from this year's expe-
rience, it may be inferred, that many circum-
stances of weather might have extended the ra-
vages of disease, and rendered it universally ope-
rative.
   We deprecate  the  idea, that  human wisdom
has no power to arrest or modify the deleterious
influence of atmospheric vicissitudes and tempe-
rature.   These, with  a  blast, can create desolat-
ing pestilences, and by a different quality and de-
gree, suddenly put  an end to their deadly sway.
If, providentially, such changes take place,  and
they can be depended upon to guard many na-
tions from total destruction, it cannot be other-
wise than by those beneficial qualities of the air,
which it is in our power to define, to analyze, and
even  artificially to create, by cleanliness, ventila-
tion, and the removal of all putrid and offensive
materials.
  We must be permitted, on this occasion, to re-
mark, although with regret, that those preven-
tive measures which had been so wisely devised
and liberally provided for, by the municipal ail- 
32
thorities of the city  of New-York, during the
last  season,  have been so unaccountably neg-
lected in Bancker-street and  its vicinity ;  and
this  is the  more wonderful and more to  be la-
mented, as at an early period  of the season, the
filthiness,  immorality and  wretchedness of the
people in that district had been the subject  of
formal inquiry and  presentment by  the Grand
Jury of  the  County of  New-York.   Besides
those evils  within the  per view and completely
under the control  of the Corporation,  there are
others in the same district,  for  the correction of
which your Committee are aware that no suffi-
cient legal power exists in  the local authorities ;
but let us  hope  that an enlightened  legislature
will  not overlook  them, if the principal  magis-
trate and the aldermen, who are constituted the
guardians of the health of the city, can eventu-
ally  be induced to  give all due attention to every
domestic source of dangerous disease.
   1.  The first of these evils is the want of a. pro-
per  declivity in  the  lots  of the south side  of
Bancker-street,—As  this  district  is part   of  a
more extensive  one,  forming an inclined  plane
towards the river, it is obvious that the above-
mentioned lots  require more filling up in the
rear, to give declivity enough to convey water
into the street.  Supposing this should be suffi-
cient in some places, yet the lots being so crowd-
ed with miserable frame buildings,  and most  of 
33
the alleys and yards not being paved, it follows,
that the cellars under the front houses must be
the receptacles of an immense quantity of filtered
human filth in substance or in vapour, for the di-
minution of the deadly effects of which, vegeta-
ble absorption (in all  such circumstances so im-
 portant,) is here altogether wanting. In the whole
 district, neither herb nor shrub grows.
   Your Committee,  however,  believe, that  the
 existing Corporation laws respecting the internal
regulation of lots on paved streets,  if duly atten-
ded to and  executed, in  this  part of the city,
would correct, in a great degree, these unwhole-
some  circumstances.
   2. The second evil, or source  of dangerous
 miasmata in  this district, is  the crowded mass of
old frame buildings, facing each other from one
lot to the other, closed up hy  the front houses,
and by the adjoining houses and fences of the
lots  of Lombardv-street in  the rear: thus each
dwelling is deprived of ventilation,  amidst mul-
tiplied sources  of decayed and mouldering mate-
rials, which in common  philosophy,  are of the
same nature  as the hold of a ship, which, with-
out cargo, with only stone ballast and water, can
by continued heat, generate pestilence;  but how
much more aggravated, as has already been said,
must the situation of the same become by the ad-
dition of an extraordinary number of human be-
                      .5 
34
ings and other animals, continually assembled in
their rags and filth?
  In populous cities it is true there must be some
place of resort for a proportionate number of peo-
ple  of that description, who seek not for comfort,
but struggle  for existence, for which they  only
provide the  means from day to day.   It is for
this description of persons that speculating land-
lords multiply small houses, on any circumscrib-
ed space of ground;  rendering it  thereby  more
productive than if covered by the richest produce
of the earth; and what still  more increases  the
avails of this  species of property, is, that no mo-
tive of pride or improvement, imposes the neces-
sity of the most trifling expense in repairs.
  Let us to this  explanation add; that  whoever
has the task of husbanding this species of pro-
perty  cannot, by simple induction, perceive that
he is himself guilty of a dishonest and immoral
stewardship.   Therefore it is, that in such cases,
public authority  should be exercised against
causes injurious to the health and moral habits of
large portions of the community, and subversive
of public welfare.   For the preservation of life, a
good police  should  assume as much  care  and
right in the  inspection of the habitations of men
on  the  land, as  the  Admiralty  of all civilized
nations attributes  to itself, of defining habitations
on  the ocean to be, or not to be sea-worthy. 
35
  This is a principle to which one of your Com-
mittee has already invited public attention, and
we subscribe to his declaration; " that it is  the
right and duty, of a Board of Health to denounce,
or interdict  any house,  as a dwelling, which in
point  of  space or locality is deprived of conve-
niences for cleanliness, and 'ventilation in  Sum-
mer ;  or in a condition  not to afford protection
against inclement weather in Winter."
   Such a provision once obtained for our muni-
cipial  authorities would break  up and  disperse
those  infectious and immoral assemblages of
people of all colours,  ages,  and  sexes,  from
their common  haunts of vice  and  disease,  filth
and idleness, where  the  cupidity of avaricious
landlords  not only arrests local  improvement 5
but in fact, contributes more than the elements to
the creation of pestilence.
   3.  The Committee will in a  few  words, trace
a third evil to  the  defective organization of the
Board of Health.
   Our institution and others  of the same kind
throughout the  whole world  are misnomers of
what they should be.   As in times of old,  they
are scarcely  any thing more than Quarantine of-
ficers or inteqiosing  authorities  against  the in.
troduction of foreign ships, men and  merchan-
dise, their only supposed vehicle of pestilence :
 but of the winds,  temperature,  seasons, and all
 other sources  of home engendered disease, our 
06
 health laws have  till recently said nothing, and
 now but little.
   Contagionists cannot and do not suppress the
 smile of  contempt  at the absurdity  of prohibit-
 ing the entrance of a person in perfect health, in-
 to Our City, who has not been within  miles of the
 pestilential district,  nor seen a  person capable;
 even in their own imaginations of affording  the
 seeds of human  contagion, when at the same time
 the Board of Health send their agents abroad to
 inquire into the circumstances of  imported pesti-
 lential disease in ships and at the bedside of the siek
where, according  to their belief, the disease is
communicable to nurses and others; and yet with-
out purification  or restriction  they  admit these
agents to free intercourse  with the citizens.
  Trusty  citizens therefore, of any profession or
occupation, are adequate to the task of executing
this kind of health-law :—But it has happened in
our time,  and especially in this country, that the
health-laws embrace not only the task of excluding
from our  harbours and  cities, all possible foreign
means of infection,  or as some are pleased to say, aU
seeds of human contagion ; but also, all  presumable
domestic  sources of pestilential fevers.   Our
own fellow citizens are so universally intent on the
faithful discharge of  this systematic  double plan
of preventive  measures,  that, in it  alone,  they
place an implicit confidence for the safety of their
lives.  If our Boards of Health, therefore should 
37
not be sufficiently guarded against errors of opin-
ion in one or other extreme of opposite theories;
or if they do not consist of a majority  of minds
professionally guided by a proper degree of diffi-
dence in controverted doctrines  of *nedical phi-
losophy, they will be led into measures, false and
absurd. They will either slumber in the confidence
of safety, while natural  causes  may  bring forth
the scourge of pestilence; or they will combat
the enemy, under  imaginary  forms;   exciting
alarm, terror, dismay and  ruin,  to the communi*-
ty at large, committed to their care.
  From this candid exposition of the estimation
in which your Committee hold the  present or-
ganization of Boards of Health,  you may antici-
pate our unanimous declaration, that  an efficient
Board of Health should consist  of  a  majority
of  Physicians,  for  which  purpose,  the non-
medical  members  might  be reduced  so as  to
leave the  Board consisting of the present num-
ber, under the  presidency of the Mayor ; the
medical members to be appointed annually by
some   competent authority; and should this
Society approve this plan of reform, no doubt is
entertained, that it  will obtain  the warmest in-
terest and support of the state Medical Sociefv,
and the ready sanction of the Honourable Le-
gislature.
  The more important the various subjects now
offered  to the  consideration  of  this Society bv 
38
your Committee, the greater is our duty to ac-
knowledge  the  obligations  we are under to
nineteen  medical gentlemen,  for the  circum-
stantial and valuable documents, they have fa-
voured us with, many of which, required great
attention and labour on the part of their authors;
and none of which, have been wanting injudi-
cious  remarks  or well-observed  facts.   This
Committee, sensible of the meritorious zeal with
which every one  of those gentlemen  has en-
deavoured to assist and concur in the beneficent
view of this respectable body, beg leave to ten-
der them their  most unfeigned and respectful
thanks.
                      November 13,  1820,
SAMUEL OSBORN/'
FELIX PASCALIS,^
JOHN WATTS, Jun.
JNO. NEILSON,
THOS. COCK,
CHARLES  DRAKE,
ANSEL W. IVES,
► Committee. 
 
 
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