r& *%&■■> :v,v* s • -■■■ :: ■>^.'' ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C. AN ENQUIRY INTO THE ORIGIN OF THE LATE E P I D*E MIC FEVER IN PHILADELPHIA: IN A LETTER TO DR. JOHN REDMAN, PRESIDENT OV THE COLLEGE Of PHYSICIANS* ' * *. FROM DOCTOR BENJAMIN RbSH. £ v v ^% P H I LA D I L P H I A : X ,V > "k >'"*- PROM THE%PRESS OF MATHEW CAREY, * Dttember n, 1793. 1344 i \V:',-'- . ' " >" J» w ^^A^^ to f I. 1 A N E N (^U I R Y, &c. ,, 4 ______ BEAM SIR, TT AVING publickly aflerted, that I believed our late Epi- . •*■ ■*■ demic Fever to have been generated in our city, I here- with enclofe you my reafons for that opinion, accompanied by a wlfh that they may be laid before the public ; for I conceive they are extremely interefting, both to our city, and to the United States. Thefe reafons are, as jallows ;— i. The Yellow Fever in the Weft Indies, and in all other countries where it is endemic, is the offspring of vegetable putre- faction. * 2. The fame caufes (under like circumftances) mud always produce the fame effects. There is nothing in the air of the Weft Indies above other hot countries, which difpofea it to produce a yellow fever. Similar degrees of heat acting upon dead and moift vegetable matters, are capable of producing it, to- gether with all its various modifications, in every part of the world. In fupport of this opinion, I fhall tranferibe a part of a *etter I received a few weeks ago from Dr. Miller, of the Deb- ware ftate—a gentleman whofe authority in medicine is fecond to no man's in the United States. Ice/97 ( 4 ) " Dover, Nor. 5, 1793. " Dear Sir, " Since the middle of laft July, we have had a Bilious Colic epidemic in this neighborhood which exhibits phocnomena very lingular In this climate ; and fo far as I am informed, unprece- dented In the medical records, or popular tradition of this coun- try. To avoid unneceffary details, it will fuffice at prefent to obfeive, that the difeafe, on this occafion, has affumed not only all the efl'ential characters,but likewife all the violence, obftlnacy and malignity defctibedby the Eaft and Weft Indian practitioners. If any difference can be obferved, it feems here to manifeft higher degrees of ftubbomnefs and malignity, than we ufually meet in the hiftories of tropical writers. In the courfe of the difeafe, not only extreme conftipation, frequent vomiting, and the moft excruciating pains of the bowels and limbs, harrafs the unhappy patient; but to thefe fucceed paralyfis, convulfions, &c. and almoft always uncommon mufcular debility,—oppreflion of the praecordia,&c. are the confequence of a fevere attack. Bile dif- charged in enormous quantities, conftantly affumes the moft corrupted and acrimonious appearances, commonly aeruginous in a veiy high degree, and fometimes quite atrabilious. " The inference I mean to draw from the phcenomena of this difeafe, as it appears in this neighborhood, and which I pre- fume will alfo apply to your epidemic, is this, that from the uncommon protraction, and intenfenefs of our fummerand au- tumnal heats, but principally from the unufual drought ; we have had fince the middle of July, a near approach to a tropical fcafon, and that of confequence we ought not to be furprifed if tropical difeafes, even of the moft malignant nature, are engen. bered amongft us." ( 5 ) To the above information, it may be added, that the bIliou« fever and dyfentery, which prevailed during the late autumn in feveral of the villages of Pennfylvania, particularly in Harrifburgh and Hummilftown, were attended with a malignity and morta- lity unknown before In any part of the ftate. I need not paufe to remark, that this dyfentery arofe from putrid exhalations, and that it is like the bilious cholic, only a modification of one ori- ginal Genus of bilious fever. But futther—a malignant fever, refcmbling that which has prevailed In our city, has appeared on Penfocken and on Walklll creeki, in New-Jerfey; at NewGalloway, in the ftate of New- York—and at Weathersfield in Connecticut, during the late antumnal months, into none of which places was there a fufpi- cion of the difeafe having been Imported from abroad, or convey- ed by an inteicourfe with the city of Philadelphia. It is no objection to the Inference which follows from thefe fa&s, that the common remitting fever was not known during the above period in the neighborhood of this city, and in many ©ther parts of the ftate, where it had ufually appeared in the au- tumnal months. There is a certain combination of moifture with heat, which is effentlal to the production of th« remote caufe of a bilious fever. Where the heat is fo Intenfe, or of fuch long du- ration, as wholly to diffipate moifture, or when the rains are fo great as totally to overflow the marfhy ground, or to wafli away putrid maffes of matter, no fever can be produced. Dr. Dazilles, In his treatife upon the diftafes of the negroes in the Weft Indies, informs us, that the rainy feafon is th« moft healthy at Cayenne, owing to the neighboring moraffes ( 6 ) being deeply overflowed—whereas at St. Domingo, a dry- fea- fon is moft productive of difcafes ; owing to its favouring thofc degrees of moifture which produce morbid exhalations. Thefe fefts will explain the reafon why, in certain feafons, places which are naturally healthy in our country, become fickly, while thofe places which are naturally fickly efcape the prevailing epidemic* Previoufly to the diffipation of the moifture from the putrid maffet of vegetable matters in our ftreets, and in the neighbourhood of the city, there were (as feveral practitioners can teftify) many cafes of mild remittents, but they all difappeared about the firft week in September. 3. A quantity of damaged coffee, was expofed at a time (July the 24th) and in a fituation (on a wharf, and in a dock) which favoured its putrefaction, and exhalation. Its fmell was highly putrid and offenfive, infomuch that the inhabitants of the houfes In Water and Front Streets, who were near it, were obliged In the hotted weather to exclude it, by (hutting their doors and windows. Even perfons, who only walked along thofe ftreets, complained of an intolerable foetor, which upon enquiring was eonftantly traced to the putrid coffee. It fhould not fnrprize us> that this feed, fo inoffenfive in its natural ftate, fhould pro- duce, after its putrefaction, a violent fever. The records of medicine fuinifh in (lances of fimilar fevers being produced, by the putrefaction of many other regetable fubttances. Fourteen men out of fixteen, perlfhed by a malignant fever, a fewyeara ago, at the Ifland of Tortola, from the effluvia generated by fome putrefied Potatoes, which were taken out of the hold of a Liverpool veffel. " The effluvia (fays Dr. Zimmerman) from a little heap of flax, has been known to occafion a malignant fever, which proved fatal to the family, in which it firft began, and ( 7 ) afterwards fpread its contagion through a whole country.'* Dr. Rodgerc In his tteatife upon the difeafes of Cork, mentions a malignant fever which fwept away a great number of the Student! of Wadliam College in Oxford. " The fingularity of the die (addt the Doctor) engaged all the gentlemen of the faculty, in a ferioil8 inquiry into the caufes of fo remarkable an effect, and all agreed that the contagious Infection arofe from the putre- faction of a vaft quantity of Cabbages thrown Into a heap out of the feveral gardens near the College." Lanciffi relates, that one end of the city of Rome was nearly defolated by the effluvia of fome rotted hemp, which lay in the neighbourhood of tke city. The fame author remarks, that " fevers often prevail at Constantinople, which owe their origin to the hemp wliich is brought froth Cairo, and which is put wet into the public grana- ries, and fuffefed to ferment during the fummer. It is after- wards fold, and the feeds of thofe difeafes are afterward* fpread among the people."—Many other facts might be addu- ced of radlihes,tumips, garlic, and fundry other vegetables, generating by putrefaction, fevers, fimilar to thofe which have been mentioned. a. The rapid progrefs of the fever from Water (treet, and the courfes through which it travelled into other parts of the city, affotd a ftrong evidence that it was at firft propagated chiefly by exhalation from the putrid coffee. It is remarkable that k paffed firft through thofe alleys and ftreets> which were in the courfe ©f the Winds that blew acrofs the dock and wharf where the coffee lay, and that perfofts were affected at a much greater diftance from Water ftreet by that means, than was afterward* known by means of the contagion which was generated by is* fected pcrfo-'*- C 8 ) y. Many perfons who had worked, or even vlfited in the nefghbouihood of the exhalation from the coffee, early in the month of Augnft, were indifpofcd afterwards with ficknefs, puking, and yellow fweats, long before the air of Water ftreet was fo much impregnated with the contagion, as to pro- duce fuch effects ; and feveial patients whom I attended in the yellow fever declared to me, or to their friends, that their in- difpofitions began exactly at the time they inhaled the offenfive effluvia of the coffee. 6. The ftricteft Inquiry, accompanied with the greate ft fo- •icitude for proofs, has not been able to difcover any other eaufe of our late Epidemic. Every account of the importation of the 'Ufeafe, has been difcovered upon examination to be inac- curate, contradictory and without foundation. The nrft cafes of the yellow fever have been clearly traced to the failors of the veffel who were firft expofed to the effluvia of the Coffee. Their fick- nefs commenced with the, day on which the coffee began to emit its putrid fmell. The difeafe fpiead with the encreafe of the poifonous exhalation. A journeyman of Mr. Peter Brown's, who worked near the corner of Race and Water ftreets, caught the difeafe on the 27th of July. Elizabeth Hill the wife of a fifher- man was infected by only failing near the peftilential wharf, about ihe firft of Auguft, and died at Kenfington on the 14th of the, fame month. Many other names might be mentioned of per- fons who fickened during the laft week in July or the firft week in Auguft, who afcribed their illneffes to the fmell of the coffee. From two of thofe perfons who came under my notice, the dif- eafe was evidently propagated by contagion: from one of them, to nearly a whole family—and from the other to a girl •f eight years old, who was led by curiofity to examine the ( 9 ) •low colour which it was faid had appeared in the face of the infected perfon, after death. 7. It has been remarked that this fever did not fpread in the country, when carried there by perfons who were infected, and who afterwards died with it. This I conceive was occafioned, In part by the contagion being deprived of the aid of miafmata from the putrid matter which firft produced it in our city, and in part, by its being diluted, and thereby weakened by the pure air of the country. Duiing four times In which it prevailed In Charlefton, In no one inftance, according to Dr. Lining, was It propagated in any other part of the ftate. 8. It is very remarkable that In the hlftoties of the diforder which have been preferved in this country, it has feven times appeared about the firft or middle of Auguft, and declined, or ceafed about the middle of October—viz. In 1732, 1739, 1745 and 1748 In Charlefton—In 1791 in New-York, and in 1762 and 1793 in Philadelphia. This frequent occurrence of the yellow fever at the ufual period of our common bilious remit- tents, cannot be afcribed to accidental coincidence, but mult be refolved in moft cafes Into the combination of more active miafmata with the predtfpofition of a tropical feafon. In fpea- king of a tropical feafon, I include that kind of weather in which rains and heats are alternated with each other, as well as that, which is uniformly warm. 9. Several circumftinces attended the late epidemic, which do not occur in the Weft-India yellow fever. It affected chil- dren as well as adults in common with our annual bilious fevers. In the Weft-Indies Dr. Hume tells us it never attacked any per- fon under puberty. It had moreover many peculiar fymptorr.t B ( io ) (as I hope to fhew in a future publication) which are not to be met with in any of the hiftoiies of the Weft-India yellow fever. 10. Why fhould it furprlfe us to fee a yellow fever generated amongft us ? It is only a higher grade of a fever which prevails every year in our city, from vegetable putrefaction. It conforms, in the difference of its degrees of violence and danget, fo feafon,. as well as climate, and in this refpect it is upon a footing with the fmall-pox, the meafles, the fore throat, and feveral other difeafes. There are few years pafs, in which a plethoric habit, and more active but limited miafmata, do not produce Sporadic Cafes, of true yellow fever In Philadelphia. It is very common in South and North Carolina and in Virginia, and there ate facts which prove, that not only ftrangers, but native individuals, and in one inftance, a whole family have been carried off by it in the ftate of Maryland. It proved fatal to One hundred perfons in the city of New-York in the year of 1791, where it was evi. dently generated by putrid exhalation. The yellow color of the flcin, has unfortunately too often been confidered as the chararteriftic mark of this fever, otherwife many other inftan- ccs of its prevalence might be difcovered, I have no doubt In every part of the United States. I wifh with Dr. Mofely, the term yellow, could be abolifhed from the titles of this fever, for this color is not only frequently abfent, but fometimes occurs in the mildeft bilious remittents. Dr. Haller in his pathology de- fcrlbes an epidemic of this kind in Swifferland, In which this colour generally attended, andl have once feen it almoft unlverfal in a common bilious fever which prevailed in the Americam army in the year 1776. If any thing could furprize me after reading the public report ( II ) of our late fever having been Imported, in fpite of every pofiible evidence to the contrary, it would be, the opinion which has been publickly delivered by feveral medical gentlemen, that no fe- ver produced by vegetable putrefaction and exhalation had ever been contagious. The fevers generated by putrid cabbage mentioned by Dr. Rodgers, and by putrid flax mentioned by Dr. Zimmerman, werebothcontagious. The late Dr. Wilfon of Lew- estown, in Delaware ftate, in his hiftory of a malignant fever, in Suffex county, publifhed in the United States Magazine for April, 1775, after tracing its caufe to exhalations from favannahs or ponds, after a dry feafon, exprefsly mentions that it was contagi- ous. "Some (he fays) were taken 111 a few days after they had ften the fick, but efpecially after they had been at the inter- ring the dead. Some went a week, and fome perhaps a fort- night, and a few took it from the air, without going nigh the fick." I have feen a bilious fever, received by contagion, in, a cafe which came under my notice In September, 1778; and there are many facts which make it probable, that the bilious, or, as It was commonly called, the break-bone-fever of 1780, was propagated, In many Inftances, through our city, by means of contagion. The malignant fever, which was lately generated at Wethersfield, in Connecticut, It is faid was evidently con- tagious.—Even the intermitting fever, according to Doctor Clarke, has, in—fome inftances, generated a morbid matter which has produced the difeafe in perfons who had not been expofed to the ufual remote caufe of that diforder. A fi- milar inftance of an inteynittent being propagated by conta- gion in Virginia was communicated to me a year ago by a medical gentleman in that country. In all the five laft mentic ned cafes, the original difeafe which produced the contagion was gene- rated by exhalations fiom putrid vegetable matters. ( I* ) I am far from denying that this difeafe, has not fometimes been imported into our country. From the authority of Dr. Lind, and Dr. Mitchell, it appears that this has been the cafe in feve- ral inftances. In this refpect, it is upon a footing with the plague, which is both ait Impoited and a generated difeafe, in the cities of the Eaft. I am difpofed however to believe that the inftances of the yellow fever, being imported, are very few cempared with thofe of Its being generated in our country. What makes this opinion probable, is, that neither Great Britain, nor Ireland, have ever to my knowledge been infected by this fever, notwlthftandlng their long and frequent com- mercial fntercourfe with the Weft-India iflands. The fummers in each of thofe countries, though fedom hot enough to gene- rate a contagious yellow, or bilious fever, are notwithftanding 'warm enough, to favour the propagation of an imported con- tagion of that diforder. The jail fever which has more than once been introduced into our city in crowded fhips from Hol- land, I fufpect has been fometimes miftaken for the yellow fever of the Weft-Indies. I am aware that the opinion and facts which I have ftated, are not popular with our citizens ; butvl have not concealed them during the whole courfe of the difeafe, nor (hall I ccafe to Im- prefs them upon the public mind at every hazard, not only as the refult of my judgment, but as the dictates of my confeience, for I am pcrfuaded they involve intheir confequences the lives of millions that are yet unborn.—Commerce can no more be endangered than Religion, by the publication of Philofophical truth. On the contrary It mud fuffer mod by t'.e adoption of the traditional error which I have endeavoured to refute ; for ( >3 ) while the caufe of a malignant fever is obvious to the fenfes, it will be eafy to guard againft it ; but while It is believed that the difeafe may be imported, and no Wody know from what place, at what time, and in what manner ; we fhall not only be carelefs in the midll of filth and danger, but our city will always hold its character for health by a timid and precarious tenure. I am the more difpofed to expect forgivenefs frcun my fellow citizens for this attempt to ferve them, by the recollection of the fudden change in the health of our city which followed thc arching the offenfive dock between Front and Third ftreets in the year 1782. By advifing that meafure (ia which I flood nearly alone) I incurred the cenfure of feveral valuable citizens. The bills of mortality however foon fhewed that the meafure was right, and I have fince feen with great pleafure, the extraordi- nary heahhinefs of our city, afcribed by indifferent people, to that, among other caufes. The climate of our country can no more fuffer than the commerce of our city, by this investigation, for it fixes the late fever, and all the other malignant fevers of the United States, -, upon putrid vegetable exhalation. Without the matrix of putrid vegetable matters, there can no more be a bilious, or yellow fever g aerated amongft us, than there can be vegetation without earth, water, or air. To afcribe our late difeafe therefore to the ex lufive influence of the atmofphere, is a reflection upon our climate, which Is equally unphiloiophical and unjuft. Let It only be clearly proved, and boldly afferted, that a bilious yellow fever has been, and may be generated in our country, under the ciicumftances before mentioned, and the re- ( M ) Inrn of it, as alfo of common bilious, and intermitting fevers may every where be prevented by a due attention to the clean- Knefs of the wharves, and Suburbs, as well as the ftreets of om cities, and towns; by draining and cultivating marfhy grounds in their neighbourhood, and in the neighbourhood of farm houfes,—and where the laft cannot be done, by fhelter- ing them from the current of vegetable exhalations by means of a body of trees that are of fpeedy growth. In this manner, ma- lignant and deadly fevers have been banifhed from moft of the cities in Europe. It has been faid, that the opinion I have delivered upon the origin of our late fever has been accommodated to my mode of treating it: this is not true : my treatment of it would h/ive been the fame had I believed It to have been an imported difeafe. I fhall conclude this long letter with two obfervatlons. id. The principle of felf love which is foextenfive In its Influ- ence upon human actions, has unhappily corrupted the fcience of medicine ; hence we find dangerous and loathfome difeafes are confidered by all nations, as of foreign extraction. Even the yellow fever itfelf in fome parts of the Weft Indies, is denied to be a native of the Iflands. It Is faid by many of their writers to have been Impoited fiom Siam in the Eaft Indies. 2d. Medical, like religious fuperftitlon cleaves fo clofely to the human mind, that It often exifts under new forms, and name?, in fpite of the cultivation and pmgrefs of reafon : hence we find that malignant fevers, which In former ages were afcrlbed to celeftlal, planetary and demoniacal influence, are now with ( jj ) the fame fuperftitious indolence, and with as little truth, afcribed to importation, or to an pnknoivn fomtthing in the air. With great refpect, and efteem, I am, Dear Sir, your fincere friend and former pupil, December 7th, 1793. Dr. John Redman. BENJAMIN RUSH. * L- S r* M^d. Hist. R3S21 I7W c) NATIONAL LIBRARY OF MEDICINE NLM Qin3A«42 fl rtsBSH •■'•■■*l<£i* :,«*; H 1 Hi ^H - • "■j* •",.«: ft ■ NLM011938428