>-» SURGEON GENERAL'S OFFICE LIBRARY. Section No. 113, W. D.S.G. 0. no. J7..6.6&.... w<..--^ f-v. ■:.¥.' •«: i: /: ft ^ V . .#. A i J&nr* •• •• \_ *w p^w %^'#4i ACCOUNT // ^(./fr OF THE (4/ Mr EPIDEMIC YELLOW FEVER, ^T AS IT APPEARED IN T H r. CITY OF NEW-YORK IN THE YEAR 1795. CONTAINING, BESIDES ITS HISTORY, Isfc. THE MOST PROBABLE MEANS OF PREVENTING ITS RETURN, AND OF AVOIDING IT, IN CASE IT SHOULD AGAIN BECOME EPIDEMIC. By VALENTINE SEAMAN, M. D. e'T ay THE PHTSICUXS OF THE HEALTH COMMITTEI- OF NEIV-TORK IN 1795- And tho' the putrid South Be Ihut; tho' no convulfive agony Shake, from the deep foundations of the world, Th' imprifoned plagues; a fecret venom oft „. C-. •* ■ ' t Corrupts the air, the water, and the land."{ r ''■ Even Albion, girt with kfs malignant ^ies. , --.-{. Albion the poifon of the Gods has drunk, _, \— / / , And felt the fling of monfters all her own." ...- .• . ' 'jt J Arm;tsonj NEW-YORK: PRINTED BY HOPKIXS, WEBB 13s CO. N°. 40, PINE-STREET. —1796.— [ET.'TE!'r.D ACCORDING TO LAW.) .y To BENJAMIN RUSH, M.D. PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDI- CINE, IN THE UNIVERSITY OF PENNSYLVANIA. 1 HY general liberality of fentiment, together with the unparalleled manner in which thou durfl, in the noble caufe of humanity, to introduce innovations in the treatment of the Epidemic Fever of Philadelphia in 1793, amidfi the perftcuting /hafts of thy opponents, point thee out as a mofl proper patron for the free thoughts advanced in the folloioingpages. Befides this, Ifhould confider myfelfgreatly deficient, was I to neglecl this opportunity of acknowledging the high fenfe. of gratitude I entertain for the benefit received, not only from thy valuable public inflruclions, but alfo from thy ever ufful private converfations. Wifhmg thy long continued and increafing u/efulnefs, in thy profeffion and in the dijfufon of Medical knowledge, I remain, With refpecl and efleem. Thy Friend, t/al&ntlh& zj&aman. Wfc —'-- e*~-::'- '■■" -• - ' . - \ '-: ■■ - — - ■"-: '■-• .. Ai'ds*. v_■;JC> - -.3? "'■"■'■*""'■-' : " '--■ ■.v.l-.AiI-?ia.-.:.-0! ■':-'-r--''• ■- ■'- "- - ''. .,"'.Kl-il^.l^ ;i ./?„-*'•.- - ^ '-'■iS'i'-.." «ivk\ih^ /iOIITTJAan T O John Broome, Robert Bowne, Gabriel Furman, Nicholas Carmer, Andrew Van Tuyl, Isaac Stoutenburgh, John Campbell, Samuel Bard, Robert Lenox, George Jane way, and Theoph. Beekman, Nath. Hazard, Surviving Members of the Committee of Health of New-York for 1795— Whofe undaunted attention te the objecls of their appoint- ment, and whofe perfevenng care for the relief of their affliBed Fellow-Citizens, mujl, no doubt, have been followed by the a-ratifyingjenfe of well done, in their own bofoms :—Blffid be their reward. As the following obfervations were drawn up partly at their folicitations, and as the ideas and opinions advanced ip them, are confidered as meriting their ferious attention, they are mofl rcfpeclfuUySubmitted by Their Friend and Fellow-Citizen, THE AUTHOR. i an T . OTL:3 In jell v!l'- " PRE FACE. 1 HE utility of accurate Hiflories of Epidemics to the improvement of- medicine, has never been doubted from the time of the early and valuable pub- lications of Hypocrates, to the late and no lefs judi- cious obfervations of Dr. Rufh: but as the Yellow Fever has been fo accurately and fully defcribed and treated of by feveral phyficians in the Weft-Indies, in Philadelphia, &c. it may be thought entirely fuper., fluous to give any account of it as it appeared in this city. Fully fenfible of the force of this remark^ I long declined attempting any thing of the kind; but as feveral facls have occurred to me, a general know- ledge of which I confider as highly interefting to hu- manity and of importance to the community at large, and efpecially to the inhabitants of this city, I aia finally induced to fubmit them to the confederation of the public, particularly as the Medical Society* which had made fome progrefs in the bufmefs, have declined the profecution of it. The many accounts and complete defcriptions al- ready given of this difeafe, feem to render it unne- cefiary to enter into a minute detail of its feveral fymptoms in this place; I have therefore been very mort upon that part of the fubjecr, referring the more [ viii ] nice inquirer to the beforementioned authors, particu* larly to Dr. Rufh's account of it, as. it appeared in Philadelphia, in 1793, where he will find its various appearances very particularly and accurately deli- neated. As the following obfervations have originated al- moft entirely from facts and circumftances of the dif- eafe, as it appeared in this city; the reader will find himfelf much deceived, if he looks for references to long catalogues of eminent authors, or for an elabo- rate account of the difeafes of the Weft-Indies, pef- tilences of Europe, or plagues of Afia: and as my conclusions are drawn chiefly from cafes and occur - ances, that have come within my own perfonal know- ledge, (which favored by my local fituation in the center of the Epidemic, and my providential prefer- vation from its influence, till it was nearly extinguifh- ed, were confiderably numerous) he will alfo find that my remarks have not been much either influ- enced or Supported by the uncertain communication of my brother practitioners or other citizens; hence, if decided and undoubted fads, {hall hereafter appear which fhall difprove them, my error mould be affign- ed only to my general fcepticifm reflecting current medical reports, and the limited nature that I have impofed upon my fources of information. As fome thoughts which I have advanced, are de- cidedly oppo'fed to the common fenfe of the faculty in C * ] general, I wifh it to be confidered, that they are not the offspring of any "favorite theory, or influential hypothefis; for I had heretofore been taught and be- lieved very differently, till the ftubborn obtrufion of fa&s upon my mind, forced me to change my opi- nion. I am well aware of the lofs of reputation that I may fuftain, from attempting, in the courfe of this eflay, to fupport opinions which are very unpopular with the inhabitants of this city; however, the im- portance of the fubjed, has fwallowed up all perfo- nal considerations, and determined me freely to com- municate what I confider as highly eflfential to their welfare; and I (hall be richly paid, if my temerity mall in the leaft degree, tend to the prevention of a difeafe, which in its partial* operation, in lefs than three months, Swept off upwards of feven hundred of our fellow-citizens; which ftiould be fufliciently alarming to put us upon our guard in future, far fliould it again arife, in a feafon more favorable to its Spreading, perhaps its more, univerfal devaluation will not be checked till it has numbered thoufands in its mortal lift. B * It being chiefly confined to a particular part of the city. A n A C C O U N T EPIDEMIC YELLOW FEVER, &c,. Of'the State of the Air, and' Difeafes precedlizg and accompanying the Epidemic, and a Hijiory cf ih" Difeafe. I* ROM tfie tables of Meteorological observa- tions, inferted immediately before the considerations on the caufe of the difeafe, it appears, that in the be- ginning of the Sixth month (June) the weather wag pretty warm, but became more moderate on the Seventh and eighth 'days, and that its temperature wa| Suddenly increaSed on the 9th cf the month, raifing the Mercury n\ degrees in Fahrenheit's thermomer ter in the Space of twenty-four hours; it was warm on the tenth, then became cooler for fouri or five days, after which time it continued very, warm and ful.trJF for feveral days; on the 19th the thermometer flood at 87 °, and varied between that and 69 ° the re- mainder of this month—we had rains on the 2d, 1 ith, 20th, 24th, 25th, and 30th. The meari tem- perature of this month \tfas 730*. * Thefe were the ftates of the thermometer at one o'clock, P. M. 2 AN ACCOUNT OF THE It gradually became cooler for the firft five days in the Seventh month (July); on the 6th the mercury roSe to 83°, which was 13° higher than it ftood the day before; the next day it fell 1072°; after which, in the courfe of fix days, it rofe to 890 without any material Sudden change; the weather then moderated in fome degree, fo that in the laft nine days of this month it did not rife above the 8o° and in one of them it ftood at 68°—the mean temperature of this month was 81 °: it rained on the 3d, 1 oth, 18th, 23d, 24th, 27th, 30th, and 31ft. The thermometer ftood near 900 moft of the time during the firft ten days of the eighth month (Au- guft);onone day it was upwards of 930; in the re- mainder of the month it varied between the 60th and 88th°—great part of this time it was above 8o°, and there were but a.few days wherein it was below 720; the medium temperature of this month was 83°; we had rains on the 3d, 9th, 10th, nth, 12th, 13th, 20th, 21 ft, 23d, and 31ft days, and feveral of them were very great. The firft week in the ninth month (September) the mercury remained between yo and 750; m the fecbnd and third week it varied but little, one way or the other, from 80°; but we had fome cool days in the latter part of the month, the mercury being as low as'58°-on the 22d and on the 30th; mean tem- perature about 730; we had five rainy days, viz. the 3d, 7th, 13th, 19th, and 20th. In the tenth month (October) the temperature of the air was at no time above 75°, but varied between that and 490 irregularly; the men: temperature was 620; the latter prr of this T-o-ith we frequently had white frofts at night; it raince -on the" 10th, 20th, and 31ft. EPIDEMIC YELLOW FEVER. 3 Mufquetoes were never before known, by the old- eft inhabitants, to have been fo numerous as at this feafpn, efpecially in the fouth-eaftern part of the city ; they were particularly troubleSome to foreign- ers, many of whom, had thofe parts of their bodies that were expofed to them, covered with blifters from their venomous operations. Our fummer fruits in general were no ways extra- ordinary ; water-melons particularly, from the wet- neSs of the feafon, were very flafhy and infipid. It was remarked that many laborers employed at the different buildings, gave Out at their work, from the excefllve heat of the weather. An unufual number of perfons fuffered in the warm part of the feventh and eighth months, from drinking cold water; and feveral fell down and died in the ftreets, whofe deaths were afligned to that caufe, when it more probably was induced by an apo- plexy, brought on by the exceflive heat of the fun; one cafe came under my particular obfervation which was certainly of that kind, although currently report- ed otherwife. The cholera infantum, was very common in the early part of the fixth month, and increafed as the weather became warmer. Bilious cholics and dyfen- teries became very prevalent in the feventh and eighth months. At this time alfo the cholera morbus carried off a number of grown perfons. In the beginning of the ninth month, the mciAes made their appearance, but they fuddenly vanifhed with the above mentioned difeafes, as foon as the yellow fever had Spread itfelf among us: I did not 4 AN ACCOUNT OF THE obferve but a Single cafe ef it during the dominion of this powerful epidemic. The common remitting bilious fever, was no ways uncommon in the Summer months, but this alio gave way, or rather perhaps, run into the .yellow fever, as that gained ground in the city. Ac early as the fixth of the feventh month, I was called upon in conjunction with Dr. Treat, then health-officer to our port, to vifit Thomas Fofler, a patient brought into the alms-houfe, whom we found affected v/ith all the full marked and decided fymptoms of an highly malignant yellow fever; the adnata of his eyes and his Skin were of a bright yel- low, the latter covered with purple fpots, his mind deranged, his tongue covered with a dry black for- des, with hemorrhages from his gums and nofe, and a difcharge of black and very offensive matter front his Stomach and bowels; he died on the ninth. Dr. Treat was taken on the 22d of the feventh- month, and died on the 30th. Several other un- doubted cafes occurred, about this time, in the neigh- borhood" of Dover-ftreet, but the firft one that came under my particular observation, was that of James Dalton on the 12th of the eighth month, then in the fifth day of his illnefs, of which he died the day fol- lowing as yellow as gold. From this time the dif- eafe became more and morefreciueiit ; yet as we find by the accurate accounts of the Health Committee, not above two a day upon an average died of it," till the 24th of the moi,th. The increasing prevalence of the epidemic at the upper par^ or Water-ftreetand in Cherry-ftreet, and in all the neipM'^ng low ground between them and Ck-.thaip. and the lower part of George-ftreets, in EPI£EM!£ BELLOW 1'EVER. § the forepart of t\i£L ninth, mouth, became, fo alarming as to drive many, of the moftopulent of their inhabit- a«ruts to the country, while the lefe prudent and the more indigent remained expoSedtoa difeafe, which, from this limited fpot, in leis- than three months, car- ried as many, as fivehundred to their graves. The difeafe was noty however, confined entirely to this part of the city ; for in. everyt other fituation, faVoring the accumulation of filth and Stagnation of putrefactive materials, there it was no ftranger : it raged with peculiar violence in the vicinity of a moil intolerable pent up fink, to the weft of Peck-flip, which is the receptacle for all the refufe kitchen arti- cles, and yard wafh of a number, of lots fronting- Pearl and Water-ftreets, that back upon it; it was like- wife very prevalent, in the neighborhood of the- Fly- market, alfo in and about Skinner-ftreet, as well as in fome. of. the unregulated grounds, on the north fide of the town. If an account of the epidemic, as it pervaded the, different parts of the town, could,be accurately, af- ceitain.edj.and depicted in colors, heightened in pro- portion to the combined early time of attack, and the numbers anfecledj blazoned ■ by. its comparative ma- Ugniry, there can be no manner of doubt, but that. the low ground in the foutheaft of the city; as above mentioned, would appear as jh.e grand center, of the. calamity, diiiuflng its effects, like diverging, rays, to, the adjacent parts ; aiding by its moft. powerful influ- ence, different Secondary centers, already fmoking hot, to flame out its pestiferous operation;;. The ma- ny folitary cafes c^ the difeare that have occurred in diiiant healthy Situations, appear to have been kin- dled up by imprudent individual expofures too near tiiefe Sources of infection. 6 AN ACCOUNT OF THE The black people appeared to be as fubject to the difeafe as the whites, but it was not fo fatal to them ; of eight that I prefcribed for, only one died, and with her, the complaint having ftolen in under the deceit- ful form of a common cynanche, was permitted to run on for fome days, before medical aid was called for. By report of Dr. S. L. Mitchell, in behalf of a com- mittee cf the Manumitting Society cf this city, it ap- pears that not a Single Scholar cf the free black fchool, under their patronage, died with it. Several circumifances tended to render the difeafe particularly fatal to the more indigent part of the community : i ft. The higher prices of houfe-rent in the other parts of the city, having concentered a great proportion of them in the epidemic neighborhood, and crouded them in very fmall confined apart- ments ; a number of houfes contained as many fa- milies as it had rooms in it. 2d. Their poverty not permitting them to quit their place of refidence when thediSeafe came around them. 3d. The great difficul- ty of getting nuries, and their exorbitant prices pre- venting them from getting proper attendance before their Situation became known to the Committee of Health, cften-times a whole family being taken down about the fame time, their panic ftruck fair-day friends quitting them in their diftrefs, from the fear of infection. 4th. The neglect of obtaining early medical afiiftance, from a hope that their difeafe was not the prevailing one : and 5th. The refufal of ma- ny, after they were taken ill, thus miferably fituated, to go to Belle Vue., " left (to ufe their own expreflion) they fhould catch the Yellow-Fever and die." Foreigners who came from a more temperate cli- mate, as the Fnglifh, Irifh, Scotch, &c. and people from the country, who had not long refided in town, were particularly obnoxious to this complaint. EPIDEMIC BELLOW FEVER. / the French from the Weft-Indies, feemed proof againft the influence of this epidemic, a numerous family of them continued in the midft of it, and view- ed without danger the death of a great many, and the difeafe of nearly all their neighbors who remain- ed in town; not one of them Suffered the leaft in- diSpofition: In another boarding houSe of them, con- taining at leaft thirty or forty peribnG, not far from Peck-flip, not any of them took the complaint, al- though numbers of the other inhabitants were drop- ing away with it, on every fide of them. The difeafe fpared no age or fex, although it was moft fatal to the young and thofe in the prime of life. Symptoms of the difeafe, as exhibited in the different parts and functions of the body. i ft. The vital functions fuffered extremely in the firft attack of the difeafe, it generally coming on with chillnefs, an anxious and interrupted refpiration, with a total abfence of perfpiration ; this however, in fome inftances, came on very copioufly, after the great heat that generally followed the chill, had exifted for a time, but in moft cafes the fkin continued dry and parched, except a fweat was induced by artificial means. The pulfe was as variable as the hues of the ca- meleon; in moft caSes it was frequent, and after-the chill had fubfided, it became Somewhat hard: yet in- ftances occurred of a preternatural flownefs. I met with one cafe in a black man, where it beat only for- ty-two ftrokes in a minute; and in another perfon there was a complete intermiffion of it in every twelfth or fifteenth pulfation : and in other patients, C 8 AN ACCOUNT OF THE particularly in the 3d or 4th day of their complaints, were phyficians to judge from the pulfe alone, they would declare them in a ccnvalefcent State, at the very timethey were in the moft imminent danger and fometimes within a few hours of their end. Al- though I firmly believe with my moft eminent teach* er Dr. Rufh, that the pulfe is our belt guide in the knowledge of difeafes, yet in no complaint that has ever occurred to my obfervation, have I found this moft fure index of the State of the fyftem, fo little to be depended on. Hemorrhages from the nofe^ gums, Stomach, uterus, &c. were very common at the com- mencement, as well as in the more advanced peri- ods of this difeafe. 2d. In the animal functions this difeafe in its firft attack, produced latitude, and an averfion to all kind of bodily exertion with a fenfe of general debil- ity, attended with violent pains in the head and back, fometimes fhooting down the legs : thefe fre- quently preceded the chills, and in moft cafes ac- companied it and continued afterwards, as a very diftrefhng fymptom of the difeafe. The mind was oftentimes very much dejecled, with imperfect vifton and memory, followed by delirium,fubfultus, tendinum, Sec. before death. There was in many cafes an evident, though flight, •remiffion in the violence of thefe Symptoms Some- times in the courfe of twenty-four hours'from the time of the attack, as alfo at fome other periods ; but in the hurry of the raging epidemic, I was unavoidably prevented from gaining an accurate knowledge of them. 3d. No part of the body appeared to fuffer more than the natural functions, which includes the alimentary canal and fecretions. The flomach, as in epidemic yellow fever. 9 all fevers, was affected with a degree of naufea, and fometimes vomiting at the firft acceffion of this dif- eafe, which frequently fubfided for a while, but is fncceeded.about the third day, if proper means are not ufed to prevent it, by an almoft unconquerable irrita- bility and retrograde movement of this organ, throw- ing up large quantities of green or yellow bile, and re- jecting immediately every particle of medicine, food or drink, that was taken into it—afterwards discharging an aquceus fluid containing a number of light dun co- lored fpecks in it ; this, if not checked, was followed by a puking of a fluid exactly refembling coffee, with its grounds floating in it, which by Standing, would Settle to the bottom.. The vomiting which occurs about, the third day,. frequently, is the only diftreffing Symptom that the. patient labors under, his pulfe becoming natural, fkin cool and moift, with an entire freedom from pain, and a perfect clearnefs in the. mental opera- tions, that infuperable circumftance ftanding alone, as it were, to humble the pride of phyfic, and to warn, in cool blood, the unhappy fufferer of his precarious existence.. A hiccoughing often was very troublefome in the dif- ferent ftages of this complaint. The bowels were very uniformly and cbftinately coflive: there were fome ca, fes it is true, that were attended with frequent evacu- ations, but thefe generally feemed rather of a partial dyfentery nature, and not free difcharges from the whole, courfe of the inteftines. The fecrelion of bile was greatly increafed, as ap- peared by its copious difcharge from the flomach in vomiting, as well as from the bowels when excited by proper purgatives. The flow of faliva and exerc- t:ons from the mouth and fauces were not much in:.- to an account of the peded ; in the beginning the tongue appearing morft and a little white, after a few days it became more thickly furred and affumed a deeper hue, but fre- quently in the latter ftages it became quite dry and covered with a black cruft. The appearances on the.fuperfcies were various, the fkin oftentimes retained its natural appearance, but frequently, though not uniformly, as the difeafe advanced, it affumed a yellow tinge. Mufquetoe bites, which before had entirely difappeared, Shewed them- fe.lves in all the parts that had been expofed to them, in fmall purpleifh red fpots; thefe were often taken for petechia, which fometimes, but more rarely ap-. peamd. Unfeemly Scabs, oftentimes in the latter .Stages*. formed about the mouth, which, on being fcratched off, frequently were followed by troublefome little hemorrhages. Thefe eruptions did not in this fever- as it does in others, indicate any favorable event of the complaint. The adnata of the eyes, in the beginning where the attack was fevere, generally were tinged and fuffufed with a reddifh color, changing with the fkin to a vel- low, as the difeafe advanced : there were many, how- ever, even among thofe who died, whofe Skin noE eyes Shewed the leaft appearance of this color. DIAGNOSIS. If it fhould be eftablifhed, that this fever is as highly contagious as is, perhaps, too generally believed, its diagnosis or peculiar Symptoms diftinguifhing it from others, would become a matter of the greateft im- portance, both to individual fafety. and to the wel- fare of the community at large. epidemic YELLOW FEVER. II This part of the Study of medicine has, of late, been confidered of lefs confequence than formerly, fmce the fallacy and imprudence of preferibing for the name of a diieafe, has been fo fully expofed and juftly condemned by the generality of'phyficians ;— however, in this particular complaint, as the hopes of a cure depend, almoft entirely, upon the means uSed in the firft two or three days of its attack, it certainly muft be of prime neceflity to know it in its early ftage. We cannot be too careful in detecting the exiftence of this difeafe, for in its commence- ment, its evident fymptoms are oftentimes no way in proportion to the danger. Hence, as Dr. Jackfon obferves, (in his treatife on the fevers of Jamaica) " perfons unacquainted with the nature of the difeafe, 44 would be difpofed to believe that the patient ex- " preffed Sufferings that v/ere not real." And hence phyficians are Sometimes led to neglect them till it is too late to fave their patients. In the firft ftage of this fever it is oftentimes with difficulty diftinguifhed from the common bilious re- mittent, its fymptoms in general being exactly Simi- lar, only aggravated in degree ; the pain in the head and back are more Severe and conftant, and the re- miffions, whenever they are obServable, are more obfcure ; Thofe who are well acquainted with the diieafe, may often recognize it by a certain undef- cribeable appearance in the countenance of the fick. the eye is often more red, and the face more flufhed than the heat of the body and the general action of the fanguiferous fyftein, would lead us to expect. The remarkable irritability of the flomach, that generally comes on (when the difeafe is permitted to run an uninterrupted courfe) about the third 01 fourth day, whereby a conftant naufea and retching; 12. AN ACCOUNT OF THE to vomit, immediately brings up every thing as foorr as Swallowed, feems to be a pretty diftinguifhing mark cf this difeafe at this Stage of it. The yellow fkin, and coffee ground or black vornit- inp-s, as they fometimes occur in the more advanced ftage, may be looked upon as decided and unequivo- cal evidences of this complaint; but they cannot be confidered as pathognomic fymptoms, for although they are to be found in this fever only, yet in the great-. eft proportion of cafes they do not attend it. The prevailing epidemic Should always have a great. influence in fixing our judgment with refpect to this, as well as other difeafes. Whenever it is found, from decided cafes, that it really exifts in any particular Situation, I Should confider every/ever, in that neigh- borhood, attended with aggravated fymptoms of a common bilious remittent, to be of this kind ; for I. fhould fuppofc the powerful operation of its caufe,. would certainly predominate over the milder cau,fe&~ cf more moderate maladies. PROG II O S I S. The prognofis is to be drawn from the difpofition and constitution of the perfons affected, as well as from the particular fymptoms. Thofe who had been much debilitated by previous difeafe, great anxiety of mind, drunkennefs, &c. moft generally admitted ci but an unfavorable profpect as to the event of this difeafe/ as iikcwiic did the refciute and hardy, who would not early Submit to their complaints, but en- deavored to Shake them off as they would a common catarrh. I iffed to warn Such ones at my firft vifits, that I fear ad from their difpofitions, that they would undertake to wreftle with their difeafe, and that if they did they would furely fall under it, and unfor- EPIDEMIC YELLOW FEVER. 13 tunately their conduct too often verified my fears and juitified my prognostic. In the early ftages of the complaint, if it came oil very moderately, 1'itheut much artcrion of the head, if the eyes and countenance were not much adected, and the bowels were eafily moved by the medicines) hereafter to be mentioned, we, in general, were war- ranted in pronouncing a favorable termination. But when the faae and eyes v/ere fuiiuied v\uh a reddrfh tinge, or great diftrefs and anxiety were exprcffed in the countenance, with fevere pain in the head and back, avs had great caufe to fear the confequences, particularly if the bowels v/ere obftinately conftipat- cd ; this laft circumftance, in every inftance, por- tended the greateft danger ; indeed, it feemed to me that the degree of danger was, very generally, in proportion to the ftubbornnefs of the coiiftriction cf thefe vifcera and their infenfibility to the impreffon of purgative medicines. In the latter ftages of the complaint, when the conftant vomiting came on, there was always great danger to be apprehended; yet fome have recovered after discharging the coffee ground like matter before- mentioned, "but theSe cafes were confeifedly very rare. The ether fvrnptoms of putreieency, as a black tongue, petichise, &c. were generally unfavorable, although I did not find hemorrhages fuah terrible occurences a$ they are, by the generality of authors, ftated to be. In the ninth month ^September) 24th, in a communication to the Committee of Health, among other things, I obferved, that " in taking a " retrospective view of u;y different patients with " the prevailing complaint, I found among them five - who had had hemorrhages, either from the role, 14 AN ACCOUNT OF THE " Purns, Stomach or uterus, and one who had loll " Some blood from an accidental wound in his head; " thefe were all the patients that I had attended, " who had been affected with any hemorrhage what- " ever, neither of them had died, three had recover- " ed, and the other three were much better than they " had been."-—Thefe three alfo afterwards recovered; neverthelefs, fome. patients afterv/ards died, whofe complaints were "attended with hemorrhages ; ftill thefe facts prove that they do not indicate fo much danger as is commonly believed. Having given a curfory account of the feafon im= mediately preceding and during the continuance cf the difeafe, and alfo a hiftory of its moft material fymptoms, together with the moft effential circum- stances refpecting its diagnofis and prognofis, I pro- ceed to ftate Some facts and free thoughts relative to a queftion, in my opinion highly interesting to the caufe of humanity, and greatlv important to the community, for on it depends the welfare of the af- flicted individual, as well as the method of prevent- ing or eradicating the difeafe in general, viz. Is the yelLw fever communicated by contagion* or not? Unfhackled from all prejudice, I Shall venture to mention feveral facts that oppofe the idea of the con- tagious nature of this difeafe, which, if they have not determined me to quit the beaten path of that old eftabliShcd opinion, in which 1 have been edu- cated, they certainly have Staggered me very much, * By ccvtPi-ion I mean a matter or " effluvia arifing dire&ly " or originally from the body of a man under a particular difeafe, " and exes'-ing the fame kind of difeafe in the body of the perfon " to whem they are applied." Cullcn's firft: lines. EPIDEMIC YELLOW FEVER. 15 t therefore Submit them to public confederation, conceiving that they merit the moft ferious and can- did attention. ift. In feveral inftances, perfons have been taken with this difeafe, who had avoided, with the utmoft care, any communication with the fick, and fome that came to my knowledge, who had not been out of their houfes for feveral weeks, nor had any affect- ed perfon been within eighty feet of them, were at- tacked and feverely handled by it; hence if it was induced by contagion, this complaint muft be the moft highly contagious of any other; the contagion of the plague itfelf, as appears by the report of phy- ficians -moft converSant with it, does not extend at fartherft above ten paces from the infected body. (Howard on Lacerettos.) 2d. Although many of the nurfes and attendants oh the fick, in the part of the city where it raged, took the complaint, yet others, who lived in the fame neighborhood artd cautioufly avoided fuch em- ployments, did not more generally efcape it. And notwithftariding many from New-York died with this difeafe in different parts of the country, on Long- Ifland, in Jerfey, Albany, &c. yet I have not heard of a fingle well authenticated caSe of any nurfe 6? attendant of the fick, or any other perfons taking it except they had lately been in the city. It is true, popular reports have oftentimes Spread the difeafe about the country, yet upon clofe inquiry that I have made in feveral inftances, to aScertain their validity, I have found them to have originated from .difeales of an entire different nature, and fometimes from deaths that occurred about the fame time, and which would have happened, had the yellow fever never exifted: even Should i^ appear that fome perfons were taken D 16 AN ACCOUNT OF THE with a fever in confequence of the anxious fatigue 1 of nurfing, and the diftrefs from the lofs of near and dear relatives, which finally proved fatal to them, we are no way juftified in fuppofing that it was this complaint; for had like attention been paid to perfons with a pleurify or rheumatifm, like confequences might have followed: further, Should an inftance be produced wherein a perfon who had had an inter- course with one in the country affedted by this dif- eafe, fhould afterwards be taken v/ith a like com- plaint, it would not be a conclufive proof of its contagious nature, fmce fporadic cafes have occurred at many places where there was not the leaft fufpi- cion, or poflibility of its having been produced by effluvia arifing from a perfon under a like difeafe ;.* the communication with the fick, might in fuch an inftance, be merely an accidental and no way's an | effential concurrence. Dr. Lining in a letter to Dr. Whytt, (Effays and Observations Phyfical and Literary, vol. 2d) mentions that, when this difeafe raged in Gharlefton (South- Carolina) " If any from the country received it in J ' X J > E Joa hd with putrefactive materials that they had collected from the ]:■?■-:— (See deiiuitiwu of eontag'011. p. 28.) 24 AN ACCOUNT OF THE not left town but a few days previous to his being- taken ill. Frederick Steymets, one of the Committee of Health, fuppofed his complaint to be the effects of contagion, received by examining fome papers that had belonged to a patient that died at Belle-Vue hof- pital. Is it probable, that thefe papers, which per- haps had not been within ten feet of the patient after his difeafe had put on fuch a ferious afpect, Should imbibe and convey the cauSe of his complaint three or four miles, while the effluvia arifing directly from his body, had no effect upon thoSe who were constantly about him, and performing the moft me- nial and loathfome fervices for him? This valuable citizen's activity and perfeverance in the noble caufe of humanity, often led him in the moft Sickly parts of the city; whence, more probably, his complaints muft have originated. The u pofitive facls" infifted on by Dr. Lind, (DiSeaSes incident to Europeans in hot climates, page 195) I confider as very exceptionable proofs of the contagious nature of this fever, for although an in- fected perfon came on board one of the floops of war which lay in the river Gambia, two or three days be- fore the ficknefs began in them, yet it is very likely they would have been fick at the fame time had he not come on board, as they had not been but eight or ten days in that river, for the fame author obferves that fymptoms of indifpofition in fome inftances, do not occur till twelve days after having received a taint from the land air. Robertfon's cal'e (p. 195) is by no means conclusive; the little fpafmodic Shock that he Suftained, being, no doubt, an accidental occur- ance; which, had it happened at any other time, per- haps never would have been noticed; his being taken EPIDEMIC YELLOW FEVER. 25 with a fever foon after, proves nothing but that the feeling the pulfe of a perfon dying, did not prevent him from getting a like complaint from the operation of caufes that had been previously applied. Nor is what occured on board the Merlin Sloop (page 196) more Satisfactory: all the conclusion that I can draw from them, is, that different claffes of the men, were taken earlier or later with their complaints, accord- ing as they had been more or lefs expofed to the noxious land air. To thefe remarks may be added the obfervation of the experienced Dr. Hunter, (Difeafes of the ar- my in Jamaica) when Speaking of the yellow fever, that " It is a matter of fome confolation in the histo- ry of fo grievous a difeafe, to be able to fay with cer- tainty, that it is not contagious." It has been faid, and I fufpect with too much truth, that were all the phyficians in this city to affert, that our late autumnal epidemic was not contagious, they would not be able to make the people in general be- lieve them, fince So many think they are well ac- quainted with decided proofs of its being fo. This, however, will not carry a full conviction to the minds of the more confiderate and reafonable part of the community, Since the moft popular opinions are not always the moft juft. ISuppoSewere all the faculty in America to unite, and declare their disbelief in the power of the imagination to mark the foetus in utero, that they could not perfuade the generality of women, but that, croffed appetites, unSatisfied cravings, and frightful fights, will patch their offspring with roaft pig, plumb cakes, ftrawberries, &c. or give them hare lips, Stain them with bloody Spots or Something of the kind; for moft of them fancy they have facts enough within their own knowledge, fully to fup- 26 AN ACCOUNT OF TFIE port the opinion of that moft influential operation of the mind. Should it be afked, whence could the general idea of this difeafe being contagious, have originated? I anfwer, perhaps from no better foundation than the popular belief in witchcraft arofe, in a'part of Maffachufetts about one hundred years ago, as well as in different parts of Europe fometime before, i. e, from the credulous fears of the people, worked up- on by the erroneous opinions and publications of in- fluential perfonages*. Nineteen perfons were exe- cuted in and about Salem in 1692 from this demonic acal delufion, and no doubt, but ten times that num- ber have been fhamefully permitted to die of the yel- low fever in Philadelphia! and New-York, in confe- quence of neglect from the fear of contagion, when perhaps the unhappy fufferers, were as free from the power of afflicting their friends, as the New England witches were. * Hutchenfon's Effay concerning Witchcraft. -j- See Carey's Account of the Malignant Fever in Philadel- phia, 1793. EPir.!lilIC YELLOW FEVER. '■ METEOROLOGICAL OBSERVATION"-, MADE BY GARDINER BAKER, AT THE EXCHANGE THE CITY OF NEW-YORK, IN J 795* Sixth Month (June) Days 1 Thermometer obferved at Pre v:ui!i: ;T Obierv^. of the 1 8 a. jm. I P. M. 6 I'. M. wind... the we Month. deg. hun. deg. hun. deg. hun. 8. 1. 6. A. M. I 57 1 6:) «5 N W I ciear 1 2 65 7° 5° 62 w S \v N \V rain 1 0 58 50 73 .- 74 N iv ch'ar 4 67 50 73 67 N s do. 5 63 76 5° 76 50 s w 1 do. 6 71 50 79 75 \\r s do. 7 74 72 50 67 N SE do. ] 8 64 67 ^5 N r. do. 9 66 78 50 77 s w CO. IO 71 50 79 74 s w - CO. i r 65 65 62 N E S E E rain 12 62 65 60 50 E clear *3 61 66 50 60 S E d~>. H 58 60 50 59 N E SE cloudy *5 63 50 71 69 M W clear 16 72 78 50 76 N \Y SE cloud v 17 59 65 61 N \V SE do,' clear 18 67 79 77 5° S *9 75 87 79 5° s do. 20 66 74 5° 68 s rain 21 7^. 76 76 s w char 22 70 75 78 S W S W cloi'.dy 23 72 76 50 73 5° w S SE clear 24 69 74 5° 7b N E do. 25 65 69 68 N N W N cloudv 26 63 73 72 N \V do. 27 66 76 76 N \V W ch'ar 28 70 80 50 77 N W E do. 29 73 74 73 S E S UO. 3° 72 1 73 5° 69 S ; do. AN ACCOUNT OF THE METEOROLOGICAL OBSERVATIONS, MADE IN THE CITY OF NEW-YORK, IN I 795* Seventh Mbnth (July) Days I Thermometer obferved at I Prevailing I Obfervations oh of the j 8 A. M. 1 r. m. 6 P. M. winds the weather. Month. deg. hun cleg, huri deg. hun 8. 1. 6. A. M. r. M. I 71 50 75 72 S S E cloudy It. wind 2 68 70 66 50 S E E N E do.' do. 3 66 71 50 68 E X E rain 4 65 69 67 50 N E E cloud}' 5 67 69 50 68 S E S clear It. wind 6 68 83 82 S s v.- do. 7 65 71 69 5° N thund. &%ht. ir 60 50 79 77 N NW clear hi. wind 9 71 50 84. 80 S\V W do. IO 76 86 78 50 \v N W light. and rain 11 75 82 50 76 w S clear It. wind { j 77 5° 89 &7 s do. J3 70 50 85 87 XE S \V do. 14 7i 82 81 50 N x £ uv. It. wind l5 72 50 77 / .i X S E do. 16 73 5° 77 7- S E W 3 w do. *7 1 -\- 78 50 76 S W s do. 18 74 82 76 50 SW S s v.* cloudy th. rah; l9 79 84 87 s w clear It. wind 20 77 87 50 82 w s do. 2 1 77 81 7^ NE S do. It. wind 22 76 85 88 S \v cloudv 23 74 5° 78 74 s N L s E do.' th.Sdig. 2 1 r 73 75 5o / 4 K E rain cloudy 23- 78 80 74 N E cloudy tt. wind 7-6 7i 76 5° 73 E SE do. clear 2 7 70 50 73 5o 69 50 s r. N do. rain ■28 69 75 79 5^ 7l! 50 N N V," clear !t. wind < ."-9 73 78 - j 74 NE S W do. 30 69 50 67 ro ; 66 E 1 N do. rain 31 72 50 | 73- 1 / ,> E 1 N 1 ' jt.rainl EPIDEMIC YELLOW FEVER. 29 METEOROLOGICAL OBSERVATIONS, MADE IN THE CITY OF NEW-YORK, IN 1795. Eighth Month (Auguft) Days 1 Thermometer obferved at | Prevailing \ Obfervations on of the ' 8 a. m. 1 p. m. 6 p. m. winds. the weather. Month.'deg. hun. deg. hun. deg. hun. 8. 1. 6. 8. 1. „ I 73 25 1 80 77 5° w SE s w cloudy 2 79 50 86 78 SW s clear 3 73 71 50 74 E SE ftorm & rain 4 77 82 80 w N W cloudy It. wine 5 80 88 50 83 w s w clear 6 80 89 50 86 w do. 7 82 93 5° 84 w do. 8 82 75. 87 78 w SE w do. 9 79 87 82 50 s S W gt.rain 10 80 50 87 78 w 3 W clear rain 11 75 79 76 N E SE s cloudy It. win 12 74 80 75 N W SE rain x3 69 75 5° 75 N do. H 69 71 75 72 50 N E S w cloudy 15 7i 73 5° 73 N E s w clear 16 69 78 77 $ W w do. 17 75 85 5° 76 N W J w do. 18 79 50 88 50 82 50 s w N'W w do. It. win l9 77 86 82 W do. 20 79 5° 88 63 w N do. rain 21 57 50 60 50 59 ' N N E rain It. win 22 61 50 66 67 50 N E cloudy do. 23 66 50 68 50 68 N E SE E do. rain 24 69 71 70 E ss do. 25 73 81 77 SE s w clear It. win 26 76 84 77 N s SE do. calm 27 75 81 74 SE s SE do. z8 72 79 76 s do. 29 73 75 82 80 50 s cloudy 3° 76 85 79 s do. cleat S1 1 78 75 74 72 s clear rain AN ACCOUNT OF THE METEOROLOGICAL OBSERVATIONS, MA.DE IN THE CITY OF NLW-YORK, IN 1795. i.iiui: jkcnth (September) : 'i:, I S "■ •-■ 1 P. V. (> i. M. winds the wei-.thcr. \ :'.'i]i jd,-g.l.un -1.^. 1..... c;rg. hun. 8. A. M. P. M. f 66 75- j 77 w IN cloud} It. wind -" |. 7° 1 «fj \E rain highdc. J ■ °5 ■7i | 7i w l clear **■ 64 75 73 in wj i c'cv ,5 67 74 5° 72 [nv . cloudy 6 ;■ 70 75 73 i'kw! i clear 7 68. 50 74 N | h-J, vain 8 71-50 78 77 j s ;s v ! | chu^y | It. vhd {> I 75 83 50 77 |5 VI j ch-ar j 75 82 76 S \i [ j Co. iT 74 84 50 79 S V, 1 1 v.- X V." do. ?2 6? 70 67 N 1 i*. E E do. '3 68 66 70 s> : s clor.dv ' n> i * 14 72 50 "ol .80 s | do.' 15 75 50 85 50 «2-5o" 3 V.'f s do. char .; ': 76 87 '')-s SJ ■ cr. CO. * ; r;a 50 79 75 :* 50' 1 do. do. 1 o 77 7.8 S i ch~r It. TCI!—' 19 ,rQ' r-\ 50 *4 * h:V.< r?:'n J JO 60 . 68 50 r'S J W ; S W clear j rain .., ^ 1 53 5-o 61 , _ 1 ■' ' i \" ■ i i do. I:?, wind 1 4' . ■78 | 57 .. JNW do. dc. -J 53 (;.\ \ f.'", V" j d( . hVhi ■-'.-. 54 j 57 66 50 j 5A W '' i do. l.iVhdc ^ ! ;8 '3 j 72 ' V. 1 r',"»_ 0" *-v 26 : 1 ?; ro 72 i !';5 ■ w Ni : SE j cloud". ■27 | " (i) 75 | AN ACCOUNT OF THE cf the ftrcets they fronted, whence from our regular rains, they very generally became ftagnant, putrid mud puddles. I can hardly think it poflible, was it not for the oLftruction of the houfes preventing a free obfcrvation of thefe grounds, that any candid perfon acquainted with the common canfes of fevers, could harbor the leaft doubt after walking through this part of the town, but that the epidemic originated from this fource, rendered active by the con- tinued exceftlve heat of the fun during the laft fum- mer. It raged with peculiar violence in the parts that were near the docks; this is what might fj expected from the additional vapor of the dock mud. as above-inentioned. It alfo was very fa- tal in a part-of George-ftreet, " not lefs than fixty '•' perfons were buried out of it within the fmall com- " pa.Cs of twenty houfes." This was probably owing to the poifonous ftcan\s difcharged.from large quan- tities of ftreet dirt and manure, collected durino- the fummcr and depofited near the head of it, fubjoined to the common caufes above-mentioned. Its fatality to the Weft of Peck-flip was induced, no doubt, by the noxious vapors from the putrid fink there. The reafon of its prevalence about the Fly-market, can feem no ways ihange to any one acquainted with the iituatjon of that place, the market being built over an ofrenfive. fewer, whofe exhalations were confined only by an hmpL-rfect board floor, to which may be aade ci, the ehlIuvia conflantiy arifing from the putre- fying animal and vegetable matter all around, as well as from the flip that puts in at it. Skinner-ftreet is lowly fituated, unpaved and very imperfectly drain- ed. That putrefactive effluvia will give rife to,andare the common cauie of fuch diee^, is clearlv proved by ine accurate obfervations of the moft judicious wri- EPIDEMIC YELLOW FEVER. *J ters on the difeafes of hot climates. Lmd's valuable book of interesting facts (Effay on the Difeafes of hot climates) abounds with proofs of this difeafe be- ing caufed by the air from the low lands in the Weft Indies; he particularly mentions, that it often raged in the Greenwich Hofpital at Jamaica; which, as he obferves, was unfortunately built near a marfh, and that it could not proceed from any fource of infec- tion in the hofpital. , Dr. Hunter fays (Difeafes of the army in Jamaica) fnips lying at Port Royal in Jamaica, on moving and taking their ftation higher up the harbor, have in a few days become ficklv. 44 The men, fays he, have been feized with fevers Ci owing to the low fwampy lands along more, and 44 at the head of the harbor, from which laft the ex- 44 halations are carried every morning towards the 44 fhips, when the regular fea breeze fets in, as is 44 perceived by the bad fmell which accompanies it." He fays that there are examples, where out of fixiy or feventy men, employed in filling the water ca&a, not one has efcaped a fever, from the watering place being wet and fwampy. The fame author obferves, that Fort Augufta, which was at other times a falubri- ous fituation, became fickly in 1783, the fea that year having rifen higher than ufual, ib that it 44 overflowed the whole of the ground on which the 44 fort ftands, near a foot above the furface in fome 4C places, and on ebbing left much flime and ouze. 44 A few days after this, many of the men were taken 44 with fevers." Dr. Jackfon (Treatife on the Dif- eafes of Jamaica) as well as a holt of other authors, might be brought if neceffary, to prove that putrid exhalations are the common caufes of epidemics. The above facts, together with the many others ad- duced by Dr. Rufh (Account of the Yellow Fever &c.) in their fupport, appear to me to be fufficient «3 #iN ACCOUNT OF THE »> to eftablifh that opinion with every unprejudiced per- foii—which if allowed, no one acquainted v/ith the fituation of the part of this city where the yellow fever raged as above ftated, can' have the leaft doubt but that it was owing to like caufes, without the ne- ceility of ranfacking Weft India veffeis or innocent hags of cotton, for that which is within ourfelves, and whofe very effence perhaps, is fuch as proves it not to be of a tranfportable nature*. Manv of the ftrenuous fupporters of the-conta- gious nature of this difeafe, compelled by the force of the foregoing circumftances, acknowledge, that the difeafe may be earned by other means, however they cannot entirely, give up this favorite opinion, hut.perfift in afferting that contagion often does in- duce the difeafe, when the foregoing ftate of the air favors- its operations ; and they defy any one to prove that it does not. To prove a negative is al- ways difhcult, fuch a one, perhaps impouible. But fince the only proof we can have of the exiftence of ?,. caufe, is the neceffity of it for producing known effects, and fince we are to admit, (according to Newton's firft philofophic precept) no more caufes than are fufficient to explain the appearances, and, as has been obferved, (Pemherton's view of Newton's philofophy) " When one caufe is fufficient, if there fi really mould in nature, be two, which is in the 4,5 laft itcp'ee improbable, we can have no poflible 44 means of knowing it, and confequently ought not " to take the liberty of imagining, that there are ; It has been c >!>!",. nwl by Dr. Ruth, hi Vol. I. of his Med. Ob- ferva'.ioiiP, as well as by IV. iJnd, that mufquetoes generally rUead a fichly fea fan—the fame was obferved here durhig-thelaft futilizer: the caufe is very clear, fur cireuiratances favoring the life of putrid mi.ihnata, equally favor the qeneratirn of thefe in- feels. I EPIDEMIC YELLOW FEVER. $$ "■ more than one." Now, therefore, as the above fuggefted caufe of our epidemic feems fully fufficient of itfelf to produce it, nothing can be more unphilo- fophic or imprudent than to fuppofe, that contagion ever had any thing to do with it. The moft probable means of preventing a like ca- lamity in future will be—ift, To have all the lots, particularly in the low parts of the town, filled up, fo as to afford a fufficient defcent to carry off the water into the. ftreets, and not permit any of it to ftagnate in them. 2d, To have the dirt and filth in the ftreets and yards more carefully and frequently cleared away. 3d, To have the docks repaired and'regu- lated in fuch a maimer, as not to permit the mud to gather and be expofed to the fun at the ebb of the tide. 4th, To have the fpaces under the granaries and ftore- heufes on the decks, properly filled up or walled in. 5th, To prevent great quantities of ftreet-dirt and,ma- nure from being collected in heaps, and left for any time on the vacant lots, in and about the city. 6th, To have the ftreets properly paved with a fufficient de- fcent to prevent any water from Handing in them; and 7th, To have the common fewers, in good or- der and well covered. An attention to thefe cir- cumftances, no doubt, will prevent the return of a, like epidemic in this city; for, as I fuggefted fome time fmce to the corporation, 4C whether the difeafe 44 is contagious3 or whether it was imported or 44 not; this one fact feems to be pretty firmly eftab- 44 lifhed, that it never h^fpread, but by the influence 44 of putrefactive effluvia." If, either from a neglect of the foregoing precau- tions or from any other caufes, the yellow fever fhould again become prevalent in any part of this G 4° AN ACCOUNT OF THE city, it certainly would be moft prudent for fuch as have it in their power, to remove from it; or if unavoidable circumftances, or the calls of humanity mould render it neceflary for fome to continue there for a part of the time, let them if poffible, lhun the night air, as the harbinger of death, and efpecially to avoid fleeping in that neighborhood, as they value their lives; for perhaps in the relaxed hours of reft, the epidemic miafmata may act with redoubled force. Dr. Lind's inftances clearly fhews the particular dan- ger of fleeping within the limits of the contaminated air; many perfons having been taken with the com- plaint, after having, flept a night on fhore in the low ground, while others, who had paffed a confiderable time there during the day, and always returned to the veffels at night, generally efcaped it. Befides, keeping from the night air of the epide- mic neighborhood, and the fleeping in a healthy part of the town: all perfons who are forced to pafs fome of their time in the contaminated atmofphere, mould avoid with the moft fcrupulous attention, excenes of every kind; not only of eating and drinking, but alfo of heat, exercife and watching. But I wifh to be underftood, not to mean a rigid abftinence from, or a reftriction with refpect to thefe things ; but only to advife moderation and regularity in the ufe of them, becaufe it is likely that a very low diet and the entire neglect of wine, with them who have been ac- cuftomed to it, as well as cold, inactivity, too much fleep, fear, &c. may as effectually predifpofe to this complaint, as their oppofite extremes: I believe the more regularly we fupport the natural healthy tone of our bodies, the more powerful they will refill the caufes of difeafes applied to them. EPIDEMIC YELLOW FEVER. 41 The obfervation of Dr. Lining muft be a great fa- tisfaction to thofe who have once fuffered with this difeafe. He fays (Effays and Obfervations, Phyfical and Literary, vol. 2.) 44 It is a great happinefs that 64 our conftitutions undergo fuch alterations in it, as 44 forever afterwards fecures us from a fecond at- 44 tack." He certainly had a good opportunity of knowing whether it did or not, as it raged four times in Charleftown, South-Carolina (the place ofhisre- fidence) within fixteen years. In the Weft-India Ifl- lands an attack of this difeafe, which feems almoft entirely confined to perfons from more northern cli- mates, is called zfeafoning, and after which, if the patient recovers, he is fuppofed to be pretty fecure. I never have known of any perfon having had it twice decidedly ; perhaps fome inftances fuppofed to have been that fever, were only common remittents. Dr. Rufh fays, (Medical Obfervations, Vol. 2.) that 44 during the prevalence of the meazles, he as well 44 as Dr. Quier, obferved feveral perfons (who had 44 had that difeafe, and who were clofely confined to 44 the rooms of perfons ill with it) to be affected with 44 a flight cough, fore throat, and even fores in the 44 mouth." And what are called nurfe pocks, are no rare things with perfons (who have previoufly had the fmall pox) that have much to do with pati- ents in that difeafe: fo alfo is it poffible that fome people may fuffer a flight indifpofition from the caufe of this difeafe, after having had it once, which per- haps ought not to be confidered as a full attack of it. It may be that the great debility, remaining after a complete removal of this difeafe, may predifpofe to an attack of fome other, perhaps of a fever of a dif- ferent nature, that might even prove fatal, fo like eon- fequences might follow a fevere attack of the fmall pox and no one would confider this as a return of the difeafe. Notwithftanding thefe remarks are not en- 42 AN ACCOUNT OF THE tirdy conclufive with me, yet they have fo much in- fluenced me, in the opinion of the impoffibility of taldng this difeafe more than once, that fhould it agc'In become epidemic here, although I could not ar/ain venture among it with lefs hefitation than here- tofore, I certainly fhould with much lefs apprehenfion. METHOD of CURE. In the treatment of this, as of all other difeafes^ *'^e firth object fhould be to remove their caufe ; for although in fome inftanees, the human body by habit may be enabled to refill the effects of injurious im- prciiionSj and even by proper means to recover itfelf after morbid effects are inducted, while the caufe ftill continues ; yet that phyfician would be confidered very deficient, who would undertake to cure an oph- thalmia caufed by refiding in a fmoky apartment, or the chckra infantum, originating from the impurity and heat of the city air, without firft adviling his pa- tient.; to remove from fuch an obnoxious fituation, for although he might fomecimes fucceed in his at- tempts, yet it certainly would be attended with more difficulty and uncertainty ; fo alfo is it in the yellow fever ; hence in this difeafe it is of the higheft impor- tance to have the patient removed, as foon as poffible, out cf the reach of the original caufe of his com- phints, into a more faiubrious atmofphere ; a neglect of this perhaps was one main reafon of the great fatal.':y of this epidemic ; therefore, fhould it again prevail, it would be of the utmoft confequence, for thofe whofe'circumftances would admit of it, to fe- cure a proper af) lum in cafe of an attack, and the poor ought to be induftrioufly fought after and ear- neftly advifed, early in their complaints, to remove to fuch places as the police may prepare for their re- ception, -It may be rc^izr^td, that but a fmall pro- EPIDEMIC YELLOW FEVER. 4$ portion died at Belle-vue who went there in the early ftages of their difeafes. Whether the original caufe be removed or not, the next indications are, i. To obviate the reftricted ftate of the bowels, and clear the alimentary canal of the fuper abundant bile that feems to attend the difeafe. 2. To ufe all means in our power to obtain a re- million of the fever; and ?. Durino- the remiffion, to reftore the tone of the JO J fyftern fo as to prevent a return. Whether the feat and throne of this difeafe is in the flomach and bowels, according to E)r. Warren, or not, it muft be acknowledged that it is in a great degree Upon a particular attention to them, that the hopes of a cure depend, as it is upon a particular morbid affection of them that the greateft danger is to be apprehended. To fulfil the firft indication, a fufficient dofe, viz. ten or twelve grains of calomel, with as much jalap or rheubarb, fhould be exhibited immediately and repeated every fix or eight hours, till it purges freely ; its operations fhould be favored by the plentiful drinking of warm chicken or barley water or gruel, and keeping warm inched ; by thefe means oftentimes a free perfpiration is brought on, and the fecoud indication is accomplifhed at the fame time ; an almoft complete remiffion being the con- fiquence. Let no one fear the largenefs of the dofe of the purgative, or its early repetition as above recom- mended, for in no difeafe perhaps is it of mofe^con- feeuence to obtain the fpeedy operation of medicine AN ACCOUNT OF THE. than in this; it is probable many rives have been loft from the cautious timidity of Phyficians, in giv- ing but | fmall and repeated dofes of cathartics, till the difeafe ftole on to that ftage wherein the great irritability of the flomach utterly refufed to retain any more of it, before they have given a fufficiency effectually to evacuate the interlines. If a remiffion dees not fucceed to the operation of this medicine, but fymptoms of great excitement, with violent pain in the head, &c. particularly in perfons of a full habit of body, with a plenitude in the vafcular fyftem, bleeding undoubtedly promifed and proved of the moft effential fervice, and ought by no means to be neglected; but I do not wifh to be underftood to recommend the indifcrimmate ufe of the lancet by any means, for there are innumera- ble circumftances, both as they relate to the previous ftate of the patient, as well as to the exifting fymp- toms, that fhould ahvavs govern the judicious phy- fician in the ufe of this moft powerful remedy. After the operation of the purgative, if the degree of excitement or tone in the vafcular fyftem, fhould not juftify the loofimg of blood, or if as much has been drawn as the ftate of the patient may render advifeable, and ftill there remain a degree of tenfion in the pulfe, a drynefs on the furface, &c. a fudorific draught of half an ounce of fpt. minderer with twen- ty drops of tincl. thebaic has often been exhibited with the happieft effects; a fweat generally fucceed- ing with a confidereble remiffion of all the fymptoms; in conjunction with the fudorinc'portion, the patient fhould have his feet and legs fomented with flannels wrung out of warm water, for as long as half an hour at leaft; he fhould alfo favor its operation by a plen- tiful dilution with the beforementioned drinks. EPIDEMIC YELLOW FEVER. 45 The ufe of antimonial medicines have been greatly recommended in this ftate of the difeafe, to bring on a remiffion; but I confefs, in the few inftances where- in I made trial of them, they did not anfwer my ex- pectations, the ftate of the ftomach generally being fuch as would not bear even the fmalleft dofes of them. For the violent pain in the head attending this firft: ftage, nothing feemed more effectual than the con- ftant application of linen cloths, wetted with cold vinegar and water to the forehead and temples, and changed as foon as they became warm. I know not whether Dr. Jackfon's method of ufing the warm and cold bath alternately, has been practifed by any phyficians of this city; but the dafh- ing of cold water over the body, and afterwards drink- ing plentifully of a ftrong infufion of rad.ferpentar. has been much cried up by fome; I ufed it in but a fingle cafe, and although the patient was particularly attended to, yet the looked for fweat and remiffion did not fucceed; this was neverthelefs, accomplished afterwards by the partial application of cold vinegar and water to his forehead. f After the bowels were properly evacuated and a remiffion obtained, I loft not a moment's time, but immediately applied to the ufe of the bark, in dofes* apportioned to the ftate of the ftomach, half a drachm, if it would retain fo much, was given every two hours, otherwife half that quantity was given and increafed as the ftomach would bear it; it was exhi- bited in milk and water or fome of the drinks before- mentioned, which ever was moft agreeable; a few drops of the acid elix. vitriol "with each dofe of the bark, fometimes would make it more agreeable to 46 AN ACCOUNT OF THE the ftomach; it feems hardly neceffary to mention that in this cafe it muft not be given in milk. When the bark in fubftance could not be retained, the cold infufion was fubftituted in dofes from half an ounce to an ounce, according to circumftances, and repeated every two hours or oftener if it fat well on the ftomach. At the exacerbations of the fever, the ufe of thefe remedies was often fufpended, and the means beforementiohed were applied to, till a degree of remiffion was again obtained, when the ufe of the bark, &c. was again returned. When the patient was coftive, he had a few grains of rheubarb united with each dofe of his bark, till that ftate was obviated. The acid elix. vitr. was ufed with advantage during the remiffion of this difeafe, particularly if hemorrhages attended it. I have already mentioned it, as ufeful in making the bark fit eafy on the fto- mach ; but in cafe the bark fhould* be retained well without it, it then would perhaps be better to admi- nifter it between the times of taking that medicine; it may be that this acid, while it covers the bitter tafte, may likewife tend to leffen the tonic effects of the barlfc. Generally, if the abovementioned means were not ufed, and frequently notwithftanding our greateft at- tention, about the third or fourth day, the fecond ftage of the difeafe would be ufhered in with pain and conftant ficknefs at ftomach, particularly upon fwallowing any thing; an epifpaftic was often ap- plied to the fcrobicuhs cordis in this fituation, and fometimes with advantage; fome others received be- nefit from unng warm fomentations to the part. Laudanum was rejected; but in fome inftances I thought a grain cf folid opium was, adminiftered EPIDEMIC YELLOW FEVER. £2| with good effects, and fmall bleedings feemed fome-, times ufeful; this, however, as well as all other means, often failed, the ftomach throwing up every thing that was taken into it. In this defperate ftate, our laft refuge was to the bowels, and our only de- pendence appeared to be upon the plentiful exhibi- tion of our remedies per anum, half an ounce of pow- dered bark, with a gill of milk, chicken foup or beef tea, and twenty-five or thirty drops of lauda- num, make a proper injection for this purpofe; it fhould be repeated at leaft twice a day. This means no doubt has preferved the lives of many; fhould the bark be retained in the bowels till the period of ad- miniftering the third dofe, it would be advifeable to bring it away by a common injection of warm water, before that is given. From obferving that none died who were affected with a falivation, I attempted in feveral inftances to induce that affection, by rubbing the gums with calo- mel and ufmg mercurial frictions; but as thefe at- tempts were made only in the latter ftages of def- perate cafes, I never fucceeded. May not mercurial frictions be advantageoufly ufed from the commence- ment cf the difeafe to produce this affection? The diet of the patient in this difeafe, fhould be of the mildeft nature; panado, chicken foup, beef tea, roaft apples and milk, tapioca, &c. appeared to agree bell with the delicate fituation of the ftomach, and perhaps were the moft proper food that could be taken. In the convalefcence, a continuance of the bark and elixir of vitriol, a more nourishing diet of roaft- ed oyfters, beef-fteakes, porter, &c. together with H ■£*%. £3f EPIDEMIC YELLOW FEVER, &C. moderate exercife in the country air, were the mofl effectual means of reftoring the loft tone to the de- bilitated fyftems of thofe who happily furvived the effects of this moil dreadful difeafe. FINIS. LETT E R S TO' WILLIAM B U E L, Physician, ON THE FEVER WHICH PREVAILED IN NEW- YORK, IN 179;. B T E. H. S M I T H TO 'WHICH 13 PREFIXED, AK ACCOUNT OF THE FEBRILE DISEASES OF SHEFFIELD3 (MASSACHUSETTS) IN THE YEARS 1793, x 794 AND 1795. BY W. B U E L. -^r; ■■'^..''vt.**'. A N ACCOUNT OF THE FEBRILE DISORDERS WHICH PREVAILED IN SHEEFIELD, IN THE STATE OF MASSACHUSETTS, IN THE YEARS J793> 1794 and 1795. EXTRACTED FROM A LETTER OF WILLIAM BUEL, PHYSICIAN AT SHEFFIELD, TO E. H. SMITH, PHYSICIAN, OF NEW-YORK. JDEFORE entering directly on the fubject of the diforders, which prevailed here in 1793, 1794 and 1795, I fhall mention fome circumftances relative to the face of the country in the Town of Sheffield. The river Houfatcnak runs in a ferpentine courfe through this town, from North to South. Upon the banks of the river, on each fide, is an extent of intervale, or meadow land, averaging on both fides at about a mile in breadth. The greateft part of this intervale is overflowed at the time of the thawing away of the fnow, in the fpring ; and fometimes, by large and hidden frefhets, at other feafons. The na- ture of the foil, in general, is fuch, that, very foon after the water is off, the land is dry and fit for tillage. It is, however, much interfperfed with coves and marfhes ; in the former of which the water re- mains ftagnant a confiderable part of fhe fummer, and in many of them perpetually ; of the latter there are not many upon this river, but there are fome which remain fuch through the feafon. fL. $£* LETTER FROM D.R- W~. BUEL, Beftde the Houfatonak, there are two other conn- derable ftreams, running through part of this town,. which unite and empty into that river. Upon each of thefe ftreams are large tracts of low, marfhy lands j great part of which is overflowed by frefhets, and is- never perfectly dry.—There is (which is very mate- rial) a mill-dam, on each of thefe ftreams ; and the two dams occafion the overflowing of feveral hund- red acres of the low lands.. As fummer advances, and the ponds fall, corrfiderable parts of thefe lands are left uncovered by the water ; more or lefs, ac- cording to the drought of the fummer. In both of thefe ponds are large quantities of timber and other vegetable matters, which, in hot weather, are al- ways in a ftate of putrefaction. This ftate exifts in an increafed degree as the fubftances become more expofed to the action of the fun. The fcetor occa- fioned by this putrifying mafs is fuch, in hot weather and when the water is low, as to be extremely often- five to the fmell, at the diftance of many rods. The inhabitants of this town, who live in the vi- cinity of thefe marfhy and drowned lands, have, as would naturally be expected, been always fubject to remittent and intermittent fevers, from its firft fet- tlernent. It is, however, generally remarked by the old people, that thefe difiorders have of late years— until the three l:\ft~-drcreafcd : owing, probably, to the clearing, or partial draining, of the lands. Although the difordcrs which have prevailed in this town, for two or three years paft, are owing un- doubtedly, principally to thefe local caufes ; yet it is not imp^bable that fome predifpofition to them was occasioned by a. general conftitution of the air. To afcertain this point, with any degree of precifion, we ought to have before us an accurate hiftory of the TO DR. E. H. SMITH. $$ weather, for feveral years paft. Even then it would, perhaps, be impoffible ; as it has ever been found a difficult matter to trace any connection between the manifeft qualities of the air, and the effects of a ge- neral conftitution of it, favorable to difeafe. As I . \ am unable, either from minutes, or memory, to give any account of the weather, I fhall leave the mat- ter unattempted. In the year 1793, during the feafon in which fuch complaints ufually appear, intermittent^ and their concomitants were more frequent than they had been for many years before. In September and October, there were a few fcattering inftances of bilious fevers. Early in the fpring of 1794, inflammatory com- plaints, chiefly of the pneumonic kind, were unufu- ally prevalent. They were foon fucceeded by inter- mittents ; which were more frequent than they had been the year before. Nothing peculiar attended them ; and they continued to occur pretty often through the fummer. Towards the laft of July, the bilious, or, as it is • called here, the pond-fever, began to make its ap- pearance ; principally about the South Pond, one of the mill-ponds beibreinentioned, and near the Canaan line. There v/ere fome fcattered inftances about the North Pond : and a few, which were at fuch a dis- tance from both, that they v/ere, probably, occaiioned by the ftagnant water about the great river, the Houfatonak. But the diforder was chiefly confined to the vicinity of the South Pond. The influence of this pond appeared to extend about one mile and a half from its borders. Within this place there are about 150 inhabitants; and about 80 of this number i% LETTER FROM DR. W. BUEL, were affected with the fever : part of them inhabit- ants of Sheffield, and a part of Canaan. ^ Among thofe who were fick, there were five or fix inftances of mortality. There were not more than ten or twelve perfons who had the diforder in other parts of this. town. From thefe there was but one death ; and that in a cafe complicated with pregnancy, and eventually with phthifis pulmonalis. People con- tinued to be attacked with this fever through the months of Auguft, September and a part of October. The diforder was, probably, in all refpects, what is termed a bilious remitting fever. It began with an ague fit; intenfe pains in the back, head and limbs, foon fucceeded by thirft, drynefs of the fkin, &c. continuing without much variation 18 or 20 hours: a flight moifture then broke out upon the fkin—feldom a profufe fweat; a degree of remiffion of the fever, and abatement of the pains, then enfued, and continued till about the time of day of the firft attack, when another exacerbation of fever com- menced, with fymptoms fimilar'to the firft. If the difeafe was left to itfelf, the remiffions would fome- times become fhorter and more imperfect, as the pa- roxyfms were repeated, until it grew to be nearly or quite a continued fever. A diarrhea, and fometimes dyfenteric fymptoms were added to the reft. Moft of thofe who died were attended with a preternaturally lax ftate of the bowels ; which, in feveral inftances, might properly be called dyfenteric. The tongue was, from the firft, covered with a white fur. After three or four days, a black ftripe began to appear ; extending from the root, towards the extremity ; and gradually fpreading, as the diforder advanced, till the whole tongue affumed a black appearance. Even the teeth and gums were fometimes covered by this black fur; and in fome patients who afterwards re- covered. TO DR. E. H. SMITH. $$ In the treatment of this diforder, evacuation of fome kind, is undoubtedly neceffary in the early ftage of it. Venefection generally produced a temporary relief from the violence of the pain, and was, proba- bly, when the conftitution was firm and robuft, and the habit plethoric, frequently ufeful; but it did not appear to me to be important as a curative remedy. Emetics fometimes did well; and where there was a great degree of naufea, I thought them ufeful. But purging, with calomel and jalap, was the mode of evacuation I preferred, and generally practifed ; and the remedy which of all others appeared to me moft advantageous in the early ftage of the difeafe. It is unneceffary for me to fay any thing more, in this place, than that affiduous purging, in the begin- ning, and a plentiful ufe of the Bark, after the remif- fions had become fuch as to make it admiffible, were the effential parts of the management of this diforder. So ftrong was the tendency to diforders of this kind, that people continued in fome inftances to be affected with intermittents, or fever and ague, thro" the winter. Thefe were very frequent in the fpring, but with no peculiarities, and yielding to the common remedy with the ufual facility. During the month of Auguft 1795, I was in the county of Ontario, in the weftern part of the ftate of New-York. There was, at that time, a diforder prevalent there, of the fame nature with that which I found rife in Sheffield, on my return, and which I am about to defcribe. It was chiefly exiftent in the neighborhood of flagnant waters, and in fituations fimilar to thofe places, in this town, to which the dif- eafe was moftly confined. The treatment required was, of courfe, the fame. I 56 , LETTER FROM DR. W. BUEL, On my return to Sheffield, which was the 5th of September, I found a number of the inhabitants, about the North Pond, afflicted with a fever, which began to appear about three weeks before. The people firft attacked were thofe who lived neareft to the pond; whole families of whom were down at once. Numbers continued to be taken, daily, chiefly within the vicinity of this Pond, or within three quar- ters of a mile of its borders, till about the middle of October ; after which time there were few inftances of new attacks. In this time, i, e. from the 1 oth of Auguft to the 20th of October, of about 200 (which is not far from the number of perfons living within three quarters of a mile of fome of the borders of this pond) not lefs than 150 were affected with more or lefs of this difeafe ; out of which number, but one perfon died, and that an aged man, previoufly debili- tated and difordered.—The number affected with this fever, in all other parts of this town, did not,T believe, exceed thirty. Of thefe, three died : one, an aged woman : the other two, pregnant women ; of whom, one died in the fever, the other fuffered an abortion, and died fome months after, dropfical. The difeafe, this year, put on a different form to what it did the laft. It might, with more propriety be called an intermittent, than a remittent fever ; though it was very different from a common fever and ague. It began, like other fevers, with an ague fit, attended with pains in the head, back and limbs. The duration of this part of the paroxyfm was uncer- tain. It was fucceeded by a hot fit, whcfe duration was, in different perfons, from fix to forty-eight hours. A remiffion, and, fometimes, nearly or quite, a perfect intermiffion, then came on ; but whofe du- ration was as irregular and uncertain as was that of the paroxyfm before. After the firft, the paroxyfms TO DR. E. H. SMITH. 57 were not generally ufhered in by a regular ague fit; only fome flight chills were felt; and thefe were ir- regular, both in degree and continuance. The length of the next fucceeding paroxyfms and intervals could, by no means, be calculated for, from the preceding : fo completely irregular was this diforder. The fever evidently tended to an intermittent form; but ft could neither be called quotidian, tertian, quartan, nor by any other name ufed by authors to diftinguifh the different fpecies of intermitting fevers. The pains in the head, limbs and back, were very fevere, parti- cularly in the latter, which were fo univerfally in- tenfe, that the fymptom might almoft be confidered as criaractereftic of the diforder. In the primse viae, flatulency was nearly a conftantly-attendant and very troublefome fymptom. Evidences of an increafed fecretion and excretion of bile, were generally pre- fent through the difeafe, but were particularly ob- fervable in the convalefcence. Some degree of yel- lownefs of the fkin, which was almoft univerfal, indi- cated a reabforption of this fluid, and a depofition of it upon the fkin. This yellownefs was in two in- ftances, which I faw, very intenfe. A flight degree of delirium was very common, during the height of the fever. The appearance of the tongue was much the fame that it was laft year. My method of treating the fever of this year, was fimilar to that which I employed the laft year.— Purging, in the beginning, and afterwards a plentiful ufe of the Bark, appeared to me to be the moft n\c- cefsful way of managing it. In extreme cafes, parti- cularly, a free and full exhibition of bark, wine and laudanum, feemed the only means of falvation. It was abfolutely neceffary that the patient fhould be thoroughly purged, previous to the ufe of ftimulants, ptherwife the bark, wine or laudanum, would have _g LETTER FROM DR. W. BUEL, very pernicious effeas. I faw feveral inftances, at the weftward, where, by too early a ufe of thefe me- dicines, the fever was changed into a continued form, attended with a conftantly dry and yellow fkin, com- atofe fymptoms, &c. One of the inftances of extreme yellownefs, which I have mentioned, was of this kind, and at the weftward. I removed this fymptom, and recovered the patient, by giving repeated dofes of calomel and jalap, fome perfpirative medicines, and afterwards the bark, wine, &c. Each purge, in this cafe, leffened the degree of yellownefs, very appa- rently. The other inftance of intenfe yellownefs, which I faw, was in this town, in the cafe of the pregnant woman, whom I have mentioned to have died in the fever. This woman's fever never had diftinct intermiffions. Several flight attempts were made to adminifter the bark;' but it would not do. Perhaps my timidity in the ufe of evacuants, on ac- count of her fituation, was injurious to her. The Bark did not fufpend the paroxyfms, in this diforder, in as fhort a time as it does in common in- termittents; but, if the patient was properly pre- pared, and the uie of it was perfevered in, it never failed to have the effect. Purging was probably ufeful in a twofold way: Firft, by carrying off the fuperfluous bile ; which was, evidently, fecreted and excreted in a preternatu- ral quantity : Secondly, by reducing the fthenic dia- thefis, which was, perhaps, always prefent, in the early ftage of the diforder. It is true, that thofe whofe fever was fufpended by ' the bark, were fubject to frequent relapfes, and to a long and lingering ftate of convalefcence. This drew an odium upon that medicine; and many were TO DR. E. H. SMITH. 59 induced to believe that it was owing to the ufe of it that people were fo long in recovering, and, of courfe, that it was improper. I am convinced, how- ever, from very attentive obfervation, that thofe who did not take the bark, but fuffered the fever gradually to wear away, as it fometimes would, were equally fubject to thofe inconveniences. Indeed, this feems to be the nature of the difeafe. The old people in this town, who recollea the times when diforders of this kind have prevailed here before, and when the bark was not at all ufed, inform me that thofe who were afflicted with them, were a long time in recover- ing. It feems that, in all cafes, when patients have got rid of the fever, either by means of the bark, or otherwife, there remains an increafed difpofition to the formation and excretion of bile, and that this humor accumulates in the prima? vlx, till it firft de- ftroys the appetite and occafions naufea, and then excites a fpontaneous difcharge by ftool or vomiting, or a relapie of fever, or both. A continuance in the ufe of fome laxative medicine, after a recovery, has a tendency to prevent thefe effeas ; and, if ftrictly at- tended to, would probably prevent them, and per- haps obviate the difpofition to relapfe entirely. In refkaing on phenomena of this kind, the hu- man mind is anxious to fix on fomething fatisfactory as their caufes. Specific contagion, I am convinced, was in no inftance, which came u nder my obferva- tion, either here or at the weftward, the caufe of the propagation of the diforder. That marfh effluvia, to whofe aaion the inhabitants of fome parts of this town are fubject, is the exciting caufe, and is necef- fary to the produaionof the diforders inqueftion, is beyond any manner of doubt. This is evident from 6a • LETTER FROM DR. W. BUEL- their exifting only where this influence extends. But fomething more is wanting ; otherwife we cannot account for their prevailing in fome years, and not in others. Every circumftance relat^e to the ponds* and marfhes in this town has, apparently, been the fame, for many years paft; and yet very little of this form of difeafe has appeared, for ten or twelve years back, until the two laft. We muft either fuppofe a peculiar conftitution of the atmofphere, occafioning a predifpofition to thefe diforders, and coinciding with the local caufe, or marfh effluvia ; or that the marfh effluvia itfelf is, by fome peculiarity of the atmof- phere, wrought up to a higher pitch of virulence,and thus produces a higher degree of difeafe. I am in- clined to admit the latter fuppofition, as I am con- vinced that the fevers which have prevailed here, for two or three years paft, and the common intermittent fever, are the fame, only differing in degree. I have feen all degrees, from the miideft form of intermit- tents, to the moft extreme of bilious remitting fever. It is impoffible to fay where the line of divifion fhall be drawn. The difeafe this year feems to have formed a conneaing link between intermittent and bilious fever ; and, were I to name it, I would call it a bil- ious intermittent. 'Should the intermittent fever, in its ufual form, prevail next year, the diforder may be faid, in the three years, to have been in regular gra- dations run through. SHEFFIELD, NOV. 30, 1795. * I have endeavored to difcover the caufe why the ficknefs in 170/;, was confined almoft-entirely to the South,'and in 1795, to the North-Pcnd ; but I can find no local circumftances to have cxiiU-d which fiiouid prodr.ee ficknefs about one, and not about the other, in either of thefe years. LETTERS TO WILLIAM BUEL, Physician, SHEFFIELD, MASSACHUSETTS, ON THE FEVER WHICH PREVAILED IN NEW- YORK, IN 1795. B T E. H. SMITH. Stotoertitement 1 HE following letters were written at the requeft, and for the information, of a medical friend, with whom the writer has long been accuftomed to cor- refpond, both on profeffional and general topics. Being compofed originally without any view to the prefs, and nearly finifhed before the idea of publica- tion was fuggefted, they will need much indulgence for many defeas of expreffion and method, which the writer has not leifure to correa. Much, too, muft be pardoned to that pruriency of ftyie. and po- fitivenefs of decifion, into which perfons in habits of fraternal intimacy are apt to tail, and which the laws of epiftolary intercourfe do not forbid. A careful revifion, would, doubtlefs, have rendered thefe let- ters more acceptable, in thefe refpeas, and have chaftifed them of thofe repetitions of fentiment and expreffion, which, though partially avoided in tranf- cribing for the prefs, ftill occur too frequently. But this was impoffible. A further, and more fatisfaao* ry, apology may be expeaed, for the opinions which they contain ;—confidering the youth, and fuppofed inexperience, of the writer. It is hot improbable that hafty and unfounded opinions have crept into the following pages; opinions unfupported by faa, and which informed reafon would difclaim. If fuch there are, no perfon can be more defirous, than he who has delivered, to difcover them, or more ready to relinquifh them. But a conclufion againft an opinion mould reft on fome better foundation than the age of him who maintains it. To thofe who think otherwife, the words of the learned Van Swieten mav not impertinently be addreffed, " Honor and refpea are due to phyficians, emi- " nent from their long and extenfive praaice of this " falutary art; but they, on their fide, ought not to " be fupercilious, nor defpife the advice of younger " profeffors. If even a gardener may fometimes " fpeak to the purpofe, how much more may not " this be expeaed from phyficians, though young, " when regularly educated and diligent in their " profeffion: they have an opportunity of obferv- " ing the whole courfe of a difeafe and its fuc- " ceffive changes, while the others, overwhelmed " with bufinefs, view in hafte fome of thofe circum- " fiances only which happen in the time of the " difeafe, and are obliged to collea the reft from *s ignorant nurfes, who do not always tell the truth. " The public good will be moft promoted, if the fire " of the young phyfician be moderated by the ma- '" ture difcretion and experience of the old praai- *' tioner ; nor let thefe, while they inftruct, be " afhamed to learn."* * Comment: jm tfce 1413 aphorifm of Boerhauve, NEW-YOiRK, MAY, 1796. LETTERS ON THE FEVER OF 1795. LETTER FIRST. INTRODUCTORY. IN compliance with your wifhes, and in return for the communication with which you lately favored me, relative to the difeafes which prevailed in the neighborhood where you refide, for the laft three years, I have put together all the fcanty information I poffefs, refpeaing the fever which was the occafion of fo much diftrefs to this City, in the laft fummer and autumn.—I regret my inability to communicate a more minute and fpocifk ftatement of faas ; and the more, as there feems little probability, at prefent, that any perfon, qualified for the tafk, will undertake it. Various circumftances confpired to narrow the fphere of my obfervation ; and this may have led me into erroneous conclufions, which more extenfive praaice and wider obfervation would have correaed in me, and may have correaed in others. But, how faulty foever my reafonings may be thought, I muft demand abfolute and entire credit for my faas. In thefe, I cannot well have been deceived: for the very circumftances which rendered them few, made me more attentive, and gave me leifure to be accu- rate. There is but one poflible way in which any falfity can be chargeable on them; and this might be, were I to pretend to decide that the courfe of the difeafe was always fuch, as when it came beneath my notice. But you will underftand me ftriaiy. I 6§ LETTERS FROM DR. E. H. SMITH, defcribe what I faw ; and mean only then to make-It remark general, when I fo exprefs it, and when I find a concurrent opinion on the part of many. In my reafonings on faas, you will not blame me for taking a range fomewhat wider ; for, fhould I, in my way, light on fome truth, interefting and important, it will well repay you for the fatigue of accompanying me ; and, fhould I not, your friendfhip will excufe me, in this inftance, as it has often done before. Of one thing further you ought to be forwarned : That, con- cerning every thing conneaed with the fever of I795? wnere opinion may be exercifed, there fs Va- riety of opinion. And as, in this conteft of jarring'and hoftile opinions, but one can have juftice on its fide, I would have you follow mine, with diffidence, into the field of controverfy. Viaory does not always incline the balance on the fide of right; but even fhould minedeferve defeat, it will fuffer in the com- pany of myriads. LETTER SECOND. An account ofthefituation and peculiarities of that part of the City in which the Fever mofl prevailed, in 1795« Though the fever continued to extend itfelf, to the laft, yet it never became general over the city ; and, for a long time, it was moftly confined to a par- ticular diftria. As the feafon advanced, the pecu- liarities of this diftria may be fuppofed to have be- come common to a larger portion of the city ; and their extenfion to the whole only prevented by the letting in of winter. To the diftrict alluded to', the Eaft river, from Long-Ifland ferry to Mr. Rutgers's. TO DR. W. BUEL, 67 forms the eaftern boundary ; the northern reaches from thence to Divifion-ftreet; thence wefterly, down Divifion-ftreet, Chatham-ftreet, the extremity of Pearl-ftreet, into William-ftreet, to Franckfort-ftreet, down this laft to Gold-ftreet, through that to Beek- man-ftreet, along which the line proceeds to Pearl- ftreet, as far as the Market, down which it fhould be continued to the river.—The fpace included in thefe bounds, is all over which the fever, according to the beft of my remembrance, exerted any power, till after it had reached its height; when it extended down Water-ftreet, a little below Wall-ftreet, and proved very mortal. It is true that there were a few perfons affeaed in various other parts of the town ; but, during the greater part of the prevalence of the fever, it was principally aaive in the north-eaftern and middle parts of the diftria comprehended as above : and, as a thorough knowledge of the peculiarities of this portion of our city is, in my opinion, indifpenfa- ble to the hiftory of the difeafe which affliaed it, I cannot doubt your patience with the minute defcrip- tion I think it neceffary to give. The firft and moft obvious remark, on the greater part of the diftria, juft pointed out, is, that it is the loweft, flatteft, and moft funken part of the whole city. Some places are much more funken than others ; but the whole fpace is evidently fo, compared with the adjacent ground ; and appears to have an in- clination, more or lefs obfervable, in different ftreets, to the Eaft river. This inclination is very confider- able in Dover-ftreet; a ftreet which is faid always to have fuffered from fevers of this kind, during the hot feafon. From the divifion of Pearl and Cherry- ftreets, down the latter, the defcent is rapid, to forne where near James's-ftreet; about which is tht loweft part of the ftreet, and from whence it is nearly level 68 LETTERS FROM DR. E. H. SMITH, to the northern boundary. Beyond this bound, the ground rifes again ; and the made ground, by the river fide, is alfo fomewhat elevated : fo likewife, is the whole of the ground over which the wefterly line paffes through Divifion, Chatham, &c. ftreets. Thus you will perceive, that the part of the city where the fever was moft active, for the longeft period, forms, as it were, a bafon, having its fide, neareft the water, a little inclined. "Within this bafon, there are feveral fmaller cavities ; one of which, in particular, will re- quire a further defcription. Thofe ftreets, alfo, which are not included in this hollow, but which lie along the river, will require fome attention; which fhall be given them. The extreme irregularity in the difpofition of the ftreets, and the narrownefs of the greater number of them, are great obftacles to a free ventilation of this city. This misfortune, common to every part of it, falls with peculiar heavinefs on that diftria which has juft been fpoken of. The comparatively high and neighboring lands ofMorriffania andLong-Ifland, receive almoft folely the benefit of breezes from the north-eaft and eaft : The Sound, which divides them from the city, being too narrow to add much force and frefhnefs to a breeze nearly fpent on their heights. North, the iiland rifes into little hills, from which the wind paffes on to the high parts of the city ; rarely vifiting the low and intervening fpace ; unlets it may be the topmoft rooms of the houfes: and, as the houfes are generally low, the effeas of a wind from this quarter muft be inconfiderable.— North-wefterly, there is fomewhat more of an open- ing ; but even this is fmall. Weft, fouth weft, and fouth, the other parts of the town, which are higher, and thickly fettled, break the force of the gales from thefe points. So that, thus fituated, this quarter of TO DR. W. BUEL. 69 the city, though it were perfeaiy well laid out, would have but little chance for a free ventilation: irregu- larly difpofed and narrow as the ftreets are, we muft be convinced of the impoffibility of its receiving the neceffary fupply of frefh air. You will underftand me as fpeaking of a thorough ventilation, and in the fultry feafon, when it is moft neceffary: a partial fupply of air, equal to the fupport of a feverifh exif- tence, it undoubtedly obtains. Much of the ground, in the northern part of this •diftria, is fwampy, and abounds with little pools and puddles of ftagnant water. This was efpecially true laft fummer and autumn ; there being great rains, and no adequate means for conduaing off the water. Indeed, fo flat are fome of the paved ftreets, in this quarter, that the rains did not run down the gutters, but continued in little puddles, and were evaporated from the places whereon they fell. In the new ftreets, which are unpaved, and without any gutters, numer- ous imperfect ditches aflifted the difpofition of the water to ftagnate. Thefe places were often mud- dy, when the fouthern part of the town was dry; and the fleams from them very offenfive, when the dry ftreets, towards the North river, were perfeaiy fweet. Several of the paved ftreets, and indeed the greater number, in the diftria of which I am fpeaking, are narrow and crooked ; fome with neither fide walks nor gutters , and by far the largeft portion of them, miferably built. Mofl of thofe which are unpaved, are, in all refpeas, ftill worfe ; the buildings chiefly wooden, and placed on the ground; the old ones falling to decay; the new, but imperfeaiy finifhed. Of them all, it may be remarked, that they are much expofed, fome' of them more than others, to the full J® LETTERS FROM DR. E. H. SMITH. influence of the docks, whatever that may be, and it cannot be falutary ; or to that of a broiling fun, from early in the morning, till the middle of the afternoon j and fome of them, to both. So much for the ftreets, generally : a few particu- lars, concerning fome of them, are neceffary to the formation of a perfea idea of this diftria. A line, drawn from the corner of Ferry and Pearl- ftreets, up the latter, tc where William ftreet enters it; then down William to Franckfort, and through that, a part of Gold and Ferry-fireets, to Pearl-ftreet again, will form the ridge of a new cavity (included in the principal boundaries above mentioned) which feems contrived, by art, for the dwelling place of fever. This court-yard of the palace of death, is di- vided by feveral difmal lanes, courteoufly denomi- nated ftreets; fuch as Vandewater, Rofe and Jacob- ftreets, &c. which form the borders to innumerable tan-vats. The whole is one vaft tan-yard, the firm parts of which feem to have been conftruaed by art in the midft of an extenfive quagmire. To this place, as far as I can difcover, there is no outlet. Think what muft be the condition of it, in the months of Auguit and September!—Yet human beings live here ; and habit renders its noxious exhalations, in fome fort, harmlefs to them. It is remarkable that few perfons, regularly inhabiting this hollow, died of the fever laft year. To thofe, whofe evil deftiny led them to feek a new dwelling place there, it proved highly peftilential. Dover-ftreet is a fhort, narrow ftreet, running from the beginning of' Cherry-ftreet, down to the Eaft river ; and contains near twenty buildings.— The defcent, from Cherry into Water-ftreet, is very TO DR. W.TJUEL, 71 rapid. As the expofure is nearly to the eaft, it re- ceives1 the whole effea of the fun, from 6 a. m. to 3 p. m. in the fummer. The defcent makes it eafy to keep the furface of the ftreet clean ; though it pre- vents a free ventilation. But it has been raifed, fe- veral feet, fince the buildings, which are moftly low, were ereaed ; k> that the road is, in many in- ftances, up to the middle of the lower ftory windows; leaving the cellars to the houfes, and cellar kitchens, without a communication with the ftreet. The yards remaining as before, are, of confequence, much lower than the ftreet; without vent; and, of necef- fity, all the water, and filth of every kind, which gathers in them, muft there ftagnate, ferment and putrify. Add to this, fome of thefe yards are capa- cious, and contain little, decayed, wooden huts; fometimes built direaiy-on the ground ; and contain- ing, oftentimes, feveral families. Water-ftreet, above - Dover-ftreet, is chiefly-com- pofed of low, decayed and dirty wooden buildings.- This ftreet being either made-ground entirely, or raifed like Dover-ftreet, the fame is true of the fili- ation of the houfes and yards. And, left any of the filth, or water, fhould drain off, from any of the yards, the weftern fide of Water-ftreet has been kindly converted, by the enlighiened zeal of the direaors of thefe affairs, into a perfea dyke ; which anfwers its defign, moft completely, by preventing even the flighteft leakage. Befide, as this ftreet lies direaiy on the water, it has the benefit of the whole force of the fun, the greater part of the day ; and of the exhalations from the docks; which are here in great number, and in the higheft ftate of their per- feaion. There is, however, a better opportunity for frefh air, in this, than in fome other ftreets. Yet even this -is an advantage which the rage for im- L Jb LETTERS FROM DR. E. H. SMITH, provement threatens to transfer to a new ftreet, ftill further out in the river ; which, if completed, may form another dyke, to the increafed pleafantnefs and health of this quarter of the town. Of Roofevelt, Catharine, James, Oliver, &c. ftreets, nearly the fame remarks are true as of Dover and the upper part of Water-ftreet: for though they are fomewhat wider, ftraighter, and have more good and new buildings in them, yet they are raifed in the fame manner, have funken yards, and under-ground apartments ; and Roofevelt ftreet has an open fink, where the drippings of the tea-water pump, after having gently collected ell the filth in their way, are received ; and being juft enough to keep up a con- ftant dropping, and not enough to wafh the gutter, or the fewer, the ftench is moft intolerable, during the fultry months. To many other of thefe ftreets the fame remarks will apply ; and to fome with aggravated force : but what has been faid, will, perhaps, be fufficient to aid vour imagination in the conception of a juft idea of their condition : I mean of their neceffary and una- voidable condition. Of the Docks, it may be enough to mention, ge- nerally, that they are badly contrived in every part of the town ; and worft of all, in this part; being broken up into numerous little wharves, thus form- ing narrow flips, where the ground is left bare at ebb tide ; and where vegetable, animal, and excremen- titious matters, being thrown in, at all times, inftead cf being eaft into the ftream, ferment, putrify, and render the ftench truly peftiferous. Indeed, this is fo much the cafe, with all of them, in the fummer, that, except to perfons habituated to their exhala- TO DR. W. BUEL. 73 tions, they are abfolutely intolerable; exciting, in perfons of a delicate make, immediate vomiting ; and in others naufea, indigeftion, head-ach, or fome tem- porary illnefs, when expofed to them but a fhort time. In addition to the above-related faas,concerning the condition of the ftreets, in that part of the city where care was moft needed, it may be remarked that, at no time, was there ever fo great an apparent inat- tention to preferving them clean. Befides the impe- diments which the level nature of the ftreets, in many parts of the town, prefented to the draining off of the filth which is conftantly accumulating in large towns like this, artificial impediments were permitted ; as if death were not fufficiently aaive, and needed the aid of the magiftrate. In all the ftreets where buildings were going forward, the workmen were allowed to reftrain the courfe of the water, in the gutters, by forming little dams, for their convenience in making their morter. The effea of this ftoppage of water was fo great, that even in Broadway, one of the ftreets the beft calculated of any in the city for free ventilation, in that part of it where the new Tontine Tavern was building, the ftench was exceed- ingly offenfive. And in this condition was it allowed to remain for near two months ; though it was al- moft under the windows of the principal magiftrate of the city. If this were true of the wideft, and one of the beft aired and cleaneft ftreets, of New-York, what think you was the ftate of thofe narrow, crook- ed, flat, unpaved, muddy alleys, mentioned above ? No, one can form even a faint idea who has not walked through them, in the middle of fome one of thofe deadly, fuffocative days, which we experienced in September laft. 74 LETTERS FROM DR. E. H. SMITH, But this is not all: befide thofe maffes of ferni- putrid vegetable and animal matters—cabbage, tur- nips, the heads and entrails of fifh, &c. which, at all times of the year, out of compaffion to men who might be ufefully employed as fcavengers to the city, are allowed to complete the putrefaaive procefs, un- difturbed, in the middle of the ftreets,—-the fight and the fmell were fhocked, at every turn, by dead rats, fowls, cats, dogs and pigs. So remarkably was this the cafe, that I queftion whether there could have been found a fingle ftreet, alley, or even bye-lane, of any tolerable length, which did not lend its ^aid to render this exhibition' full and frequent. The preceding ftatement, melancholy as it may appear, will convey a very inadequate idea of our misfortune, in refpea to fituation, without fpecial information concerning the feafon, as it appeared here, during the reign of the fever ; and a knowledge of the people who moftly inhabited, thefe parts of the city, and,on whom the feverity of the diforder was infliaed. V/ith this knowledge I fhall en- deavor to furni fn you; but the length which this letter has already acquired will excufe me, to you, for poftponing the attempt, to a future opportunity. LETTER THIRD. Some Account cf the Seafon of 1795. Physicians, from the earlieft ages of medical re- cord,_have remarked that great peculiarities and irre- gularities of feafon, have exerciied an unfriendly influ- ence on human health: And Hippocrates, himfelfi, takes TO DR. W. BUEL. IS notice of the difficulty, which hence arifes, of forming a proper judgment, and adopting a fuitable method of cure, in thofe difeafes which occur under fuch cir- cumftances. The importance of this divifion of my fubjea, makes me regret that it is in my power to fur- nifh you with no other than general information. You will be the more ready to overlook this defea, when you recollea that I do not pretend to deliver a hiftory of the fever, and are informed that there is fome probability that this particular defea will be fupplied by another hand. Generally, then—every one knows that the fum- mer and autumn of 1795 were exceffively fultry and exceffively wet. Every article of houfehold furni- ture, or in ufe about a houfe, fufceptible of mould, was fpeedily and deeply covered with it. It feemed to penetrate places where we fhould have "deemed its appearance impoffible. A friend of mine found a pocket-book of Morocco leather quite mouldy ; though it was in the drawer of a private defic, inclofed within a large defk—both of which were ufually locked—and covered by papers. Boots and fhoes hung up by a wall, near a fire-place, heated every day, contraaed mould within twenty-four hours. Meats fpoiled in the market-place uncommonly quick ; and thofe which were brought home, appa- ( rently frefh and good, in the morning, were often found unfit to be eaten, when cooked and brought upon table. Efculent vegetables, in general, and efpecially fruits, were unufually poor, tough and taftelefs. The peach, particularly that called the cling-ftone, was fcarcely digeftible; and often occafioned temporary 76 LETTERS FROM DR. E. H. SMITH, illneffes, quite fevere, while it doubtlefs aided in the produaion, or aggravation, of the fever.* Flies were very numerous and troublefome, in every part of the city, in the beginning of fummer ; but they fuddenly difappeared, about the middle of July, from the more airy parts of the town, colleaing in (warms, in the lefs healthy parts, and fucceeded, every where, by clouds of mufketoes, incredibly large and diftreffing : and thefe continued to afflict us, long after the time when they commonly depart. Almoft every perfon fuffered exceedingly from the bites of thefe infeas ; and foreigners efpecially. In fome they occafioned univerfal fwellings, and erup- tions, fomewhat like Pemphigus ; and in others nu- merous little ulcers. Thefe laft, a phyfician of my acquaintance, faw even in a native American. The irritation, reftleffnefs, and confequent watchfulnefs and fatigue, occafioned by thefe animals, no doubt predifpofed the well to be affeaed by the fever; while they extremely harraffed the fick, and retarded their recovery. During the whole of this feafon, I remember but one thunder-ftorm ; and this was very gentle. There was but a fingle hard clap of thunder, for more than four months, that I remember ; and very little thun- der and lightning, at any time. * Vegetable growth was uncommonly rapid 3nd abundant, in the fummer of 1795. I mention this that no miftake may arife from the above remark concerning efculent vegetables. The more rank they grow, beyond a certain degree, the more taftelefs they are ; and the influence of a wet feafon, in rendering roots and fruits tough, as well as infipid, is well known. It is worthy of remark, that many fruit-trees, plumb-trees in particular, blofTomed a fecond time, laft year, and producedau imperfect and fecond crop of fruit. TO DR. W. BUEL. 77 Our rains, exceffive in quantity and frequency as they were, feemed to have loft their wonted power of cooling the air. In thofe ftreets, moft unhealthy, and leaft ventilated, this effea was, in a degree, ob- fervable ; but, in the airy and healthy parts of the town, on the contrary, they never failed to render the heat more intolerable ; and the fleams from the hot pavement were like thofe of a vapor bath. The clouds, too, feemed to fhut out every kind of breeze. —One of thefe heavy rains, which continued two or three days, feemed to poffefs all the qualities of fleam. It pervaded every recefs of the houfes, and diffolved the beft glue—fo that furniture, in many inftances, which had been long Handing, fell in pieces. Fogs, which Dr. Lind enumerates among the figns of an unhealthy climate, and caufes of difeafes—page 134 of his Effay on hot climates, &c.—prevailed in the city, and fpread over all the moft unhealthy parts, in particular, in a remarkable manner,—in the even- ings—for a confiderable part of September and Oc- tober. The oppreffion, thicknefs, ftench, and un- comfortablenefs in every refpea, of thefe fogs, was very uncommon. In a phyfician, who, in the per- formance of his profeffional duty, was expofed to their influence feveral hours, one night, they pro- duced bleeding from the gums and fauces, and black and fetid flools.—On the city watchmen, however, they had no fuch effeas. About the firft Q Oao- ber but one perfon had died out of their number ; and he was a man who returned to the city, a little before, and refumed this occupation, after having been fome time abfent in the country.—Whether this fecurity of the watchmen is to be attributed-—as it is by Dr. Rufh, to the influence of the cool night- 78 LETTERS FROM DR. E. H. SMITH, air*, or to that of habit, I leave others to decide. It is not impoffible but that both may concur in pro- ducing this infenfibility to the caufe of difeafe in others. To this imperfea account of the feafon, which, de- feaive as it is, appeared to me too important to be omitted, I have one faa to add," on the authority of a gentleman diftinguifhed for his attention to meteo- rological phenomena. He informs me, that no Aurora Borealis has been feen, of any magnitude, in our country, north of Pennfylvania (as far as he can learn) for near four years, till the latter end of Sep- tember 1795 ; and adds, that his father, a refpeaable clergyman, now about 70 years of age, who noticed the fame abfence of thefe appearances, remarks, that, according to his uniform obfervation, fome uncom- mon ficknefs has never failed to follow a long conti- nued difappearance of thefe phenomena. How far the experMKce of other obfervers will tend to con- firm this ftatement, I have had neither time nor op- portunity to inquire. And, if it be admitted as in- difputable, it may ftill be queftionable, whether this is to be regarded as a caufe of difeafe, or whether this difappearance and difeafe, be not co-ordinate effeas of a common caufe. * Page 35 of his account of the Fever of Philadelphia : " I " afctibe it to the habitual impreffion of the cool night air upon " the bodies of the city watchmen," &c. By habit, as ufed above, is'njeant that condition of the body which is produced by cuftorhary expofure to any particular imprefiion ; and I defign only to fuggeft a probability that the watchmen efcaped the fever, as much from their having been rendered by habit hneni'blr to the influence of the effluvia, &c. of the unhealthy parts of the city, as from the influence cf cold. TO DR. W. BUEL. 7 LETTER FOURTH. Some circumftances relative to the principalfufferers by the Fever of 1795. It is a faa, generally admitted, I believe, that, of thofe who were fick and v/ho died of the Fever of 1795, the greater number were foreigners : perfons, either juft arrived from other States, from the Weft- Indies, and from Europe ; or who had not been many months, or years, fettled in this city. It is probable that the proportion of citizens, who died, to ftrangers, did net exceed one to feven. Of thefe ftrangers, it is thought, a large number werelrifh ; and there are fome reafons why this fhould be true ; but I cannot pretend to know it to be fo, from my own obferva- tion. The caufes produaive of difeafe in foreign- ers, in thofe of this nation in particular, are numer- ous, and fome of them deferve particullr attention. This I defign to bellow upon them, after remarking, that, both among natives and foreigners, the feverity of the difeafe was experienced by the poor. L Dr. Blane, in his obfsrvations on the difeafes of feamen, remarks, " that it fometimes happens, that a " fhip, with a long eftablifhed crew, fhall be very " healthy ; yet, if ftrungerg are introduced among "them, who are alfo healthy, ficknefs will be mu- " tually produced;" and Dr. Rum, in tfe firft vo- lume of his " Medical Obfervations and Inquiries" takes notice of this remark of Dr. Blanc's, and con- firms it, by a reference to the experience of our coun- try, during the late war. Thefe are his words-™ " The hiftory of difeafes furnifhes many proofs of " the truth of this afiertion.-—It was very remarkable, (i that, while the American army at Cambridge, in M GO LETTERS FROM DR. E. II. t,MITH, " the year 1775, confided only of New-England " men (whofe habits and manners were the fame) " there was fcarcely any ficknefs among them. It " was not till the troops of the eaftern, middle and " fouthern ftates, met at New-York and Ticonderoga, li in tiie year 1776, that the Typhus became univer- " fal, and fpread with fuch peculiar mortality in the "'armies of the United States." It is ur?neceffary to enlarge, in this place, on the oppreffions and diftreffes of what are called the lower eider of the people in Europe. War, which doubles the burthens upon every rank in fociety, exercifes an aggravated violence upon the poor. This violence, feverely felt by all, in England, chiefly falls upon the manufacturing poor ; who are, at the fame time, the moft ignorant, abject and depraved: in Ireland, its ehedts are more general, including in its circle of wretchednefs, the cultivator, as well as the mechanic. The prefenPwar in Europe, unparalelled as it is for the number of men involved in it, has given, birth to oppreffions and calamities equally new and deftru&- ive. Under thefe circumftances, and when men of fortune and refpedability, difgufted and difheartened at the enormous mafsof mifery which every day and every hour prefented to their view, turned their thoughts towards another h-mifphere, it is not to be wondered at, that the wretched and depreffed poor ihouki pant for a fettlement in a country, where li- berty is tile portion of every man, and independence the fure crown of alt his honeft labors ; and which had been, fdlacioujly, reprefented as courting their ac- ceptance, and loading their untoiling hands with every gift of fortune.—The real bleffings of our go- vernment and country are precious and ineftimable; but they are of a nature not to be felt and enjoyed by minds depraved by ignorance and debated by flavery. TO DR. W. BUEL. 8 I That temperate enjoyment of the goods of life, and moderate exercife of the bleffings of independence, which, alone,enlightened liberty ianaicnp,,can neither be conceived of, nor relifnecl, by thofe who have been accuftomedto crouchbeneath theironrodof defpotifm. Liberty, according to their ideas, was the reverfe of all they felt; and independence, the unlimited gratifica- tion of all their appetites. The mifreprefentations, too, of fpeculating and unprincipled men, who v/ere inte- refted in the fale of large traas of unfettled territory, had foftered and extended thefe erroneous concep- tions. Hence, when the poor and miferabie emi- grants, on their arrival here, found that neither gold, nor farms, folicited their acceptance; that, in Ame- rica, as well as in Europe, their life was alike deftined to be a life of toil; when they perceived that licen- tioufnefs, the only liberty of which they had any no- tion, brought punifhmentalong with it; thedifappoint- ment, new and unexpeaed, became a powerful ag- gravation to every other caufe of difeafe. You will not underftand me as extending thefe laft remarks to all emigrants to this country, nor fuppofe that de- ceived hope was prefent, or active, in every cafe. On fome, even of the better fort, it undoubtedly had a very pernicious influence ; on the poor and friendlefs, effeas ftill more melancholy.—But to return:—Two motives, then, poverty and oppreffion at honje, and the hope of independence and wealth abroad, con- curred to draw to the United States, an aftonifhing number of the inhabitants of Europe; and as thefe motives were moftly aaive among the very poor and very wretched, people of this description emigrated in the greateft number. Of thefe, the largeft portions fell to the fhare of the States of Fennfylvania and New- York ; and the moft worthlefs and profligate, proba- ' bly, refted in the capitals of thofe States. 82 LETTERS FROM DR. E. H. SMITH, The diftreffes in the Weft-Indies, efpecially thofe occafioned by the deftru&ion of Cape Francaife, obliged numbers of the iflanders, white, mulatto aiufblack, to take refuge here. This circumftance, harmlefs, in great meafure, to the people them- felves, can fcarcely be confidered as fo, in relation to the whole. Whatever effect it may have had, all things confidered, it feems irrational to fuppofe it to have been good. This colleaion of ftrangers, from various parts of Europe and America, which had been rapidly form- ing for two or three years, was greatly increafed by repeated arrivals of large importations from Great- Eritain and Ireland, during the fall of 1794, and the forinp-and fummer of 1795. One or two fhips came into this port, after the commencement of the fever, filled v/ith emigrants. If, then, the opinion of Dr. Blane, corroborated by the teftimony of Dr. Rufh, be founded in truth ; that the iudden intermingling of people of various and difcordant habits, climates and nations, be a circum- ftance favoring the produaion of difeafe ; this caufe of ic\er v/as certainly prefent, in New-York, in the year 1795. II. " Men who exchange their native, for a difknt " climate, may be confidered"—fays Dr. Lhid, page 2d, of his Elfay on the difeafes incidental to Euro- p.;ns in hot climates—"as aiicaed in a manner 4i fomewhat analogous to plants removed into a " foreign foil; where the utmoft care and attention " are required to keep them in health, and to inure " them to their new fituation ; fmce, thus tranf- " planted, fome change muft happen in the confix *' anions of both. TO DR. W. BUEL. 8? " Some climates"—he^continucs—"are healthy and " favorable to European conftitutions, as fome foils " are favorable to the produaion of European plants. " But moft of the countries beyond the limits cf " Europe, which are frequented by Europeans, un- " fortunately, prove very unhealthy to them." The healthincfs and unhealthinefs of a climate, or the effea wrought on the human conftitution by a change of climate, muft be more or lefs confiderable, according to the extent of its conneaion with other circumftances. How far fuch a conneaion was ob- fervable in this city, in refpea to the Fever of 1795, will appear by and bye. Two remarks may be made, concerning the emi- grants from the Weft-Indies. The firft is, that they p-enerally bear the firft winter, after their arrival in the middle and northern flates, better than the na- tives, while they are lefs incommoded by the fum- mer heats. The fecond is, that they fuffer lefs from Fevers, during the fultry feafon, than Emigrants from Europe. It feems difficult to explain the firft men- tioned faa; the fecond I fhall attempt to account for, hereafter. The climate of this part of America differs from that of Great-Britain and Ireland in the intenfer cold of its winters; more extreme and longer continued heat of its fummers; and the greater variablenefs of its temperature. The great body of emigrants come over to Ame- rica in large companies, crouded together in one fhip, and ill-accommodated in every refpea. After a long voyage, under fuch circumftances, they muft be feniible, in an uncommon degree, to the influence of a nev/ climate, and to every fudden variation of H LETTERS FROM DR. E. H. SMITH, temperature. If they arrive,, as is often the cafe,, in the fultry feafon, the effeas of a change of climate muft be felt in all their force. The heats of the fummer muft render them lefs able to cope with the ruggednefs of the following winter ; as the feverity of the winter makes them more unfit to endure the fcorching fun of the fucceeding fummer. This will account for the fuffering of many who had paffed a feafon in the country before. To this it may be added, that, in 1795, the cli- mate muft have been particularly bad ; fmce it may be fuppofed to have preternaturally affeaed the na- tives of the country. This being admitted, it is not difficult to conceive of its having had a pernicious. influence on ftrangers; and being, therefore, fairly enumerable among the caufes predifpofing to the fever of this feafon. III. An animal diet, or a great ufe of animal food, efpecially in fummer, and when there is general dif- pofition to fevers, is thought by many phyficians, of our own and other countries, to favor their produc- tion ; and a vegetable diet, on the contrary*, to be a preventative, or prefervative, againft them. This, alfo, was the opinion of the humane and celebrated Howard, who is known to have abftained from the ufe of flefh, for many years previous to his death.— Both theory and fact feem to concur in eftablifhing the truth of this doctrine ; for a fatisfaaory illuftra- tion of which I may faieiy refer you to the publica- tions of Drs. Rufli and Mitchill. The proportion of animal, to vegetable food, eaten at the beft provided tables in America, is fo great as to aftonifh a European. This may be faid of the country generally—but is efpecially true TO DR. W. BUEL. 8$ of the cities of New-York and Philadelphia. An objeaion, too, has been made by Europeans, particu- larly by the French, to our mode of cooking meats. They complain, and with apparent juftice, of the im- perfea aaion which fire is allowed to exert upon them ; and reprefent us as little better than the Aby- fmians, who devour a part of the ox, while he is yet expiring.—It is certain that a great change is obferv- able in the appearance and kind of difeafes, in the United States, fmce our citizens have fubftituted frefh meats, for faked, in fummer.—Some reafons may be affigned for this effea, which would countenance the opinion of the French ; but they will fuggeft themfelves to your own mind, and would require more room than I can allow them, in this place.— But, finely, if meats be prejudicial to health, in our hot feafons; if they expofe us, by their ufe, to difeafes of the kind, which prevailed here, laft year ; how pe- culiarly muft this evil have been felt by us, when they were in a condition fo uncommonly bad as the year 1795—If the wealthy often had meats brought upon their tables, in a ftate of incipient putrefcency, what muft have been the ftate of thofe which were confirmed by the poor ?—Add to this, that the vege- tables principally ufed among us, are not diftinguifhed for their afcefcency.—Thefe remarks apply to all ranks of our inhabitants ; and plainly fhew that the fituation of our city, the laft year, was unufually bad, in this relpea, for natives, as well as foreigners. Other circumftances affifted to heighten the evil, in relation to thefe laft. The poor of Europe, and efpecially of Ireland, are but.fparingly accuftomedto the ufe of meat. In that ifland, it is not uncommon for people to pafs through life, without ever having tailed it, except by ftealth, accident, or on holydays.— In this country, the great 86 LETTERS FROM DR. E. H. SMITH, ufe of meat produces a comparative fcantinefs in the fupply of vegetables ; and a proportionate poornefs and dearnefs of them. This is fufficient to determine the choice of the poor towards the ufe of meat; and produce, in the emigrant poor, an almoft total, and hidden change, in their aliment. When, too, we re- ccllea that animal food is more gratifying to a de- praved tafte ; that it provokes to greater repletion, than vegetable food ; that it is more neceffary to hard laborers ; and that it is moft craved by thofe who in- dulge in the habitual ufe of ardent ipirits; we are alive, at once, to the full perception of the mifchiev- ous effeas arifing from fuch a fubftitute, to their for- mer bland and fcanty meals. In thofe, with whom this change of diet took place the laft year, for the firft, the confequences muft have been ftill more per- nicious. For we ought to confider that if the poor always confume the worft provifions, thofe who were ftrangers, as well as poor, were leaft likely to procure thofe which were good ; and the flighteft obfervation is fufficient to convince us, that their bad qualities could not have been much obviated by the prepara- tion common among the confumers. May we not, then, conclude—that the aliment ufed by the citizens, generally, was favorable to the production of difeafe—and that the great and fudden change of diet, among the emigrants, confidering the nature of their food in 1795, muft have difpofed them, in a particular manner, to be affeaed bv the fever of the countrv ? IV. If unwholefome aliment affifted in the produc- tion, or aggravation, of the fever of 1795, improper drinks were fcarcely lefs adive, to the fame ench— The ufe of ardent fpirits, among all claffes of citi- zens, and efpecially among the laboring claffes, is af- TO DR. W. BUEL. 87 tonifhingly great and general, throughout the United States. No country in the world, in all probability, confumes an equal quantity, in proportion to its po- pulation. In vain has the eloquence of the moft en- lightened phyficians and moralifts been exerted againft them, for centuries : governments conftitute it the intereft of individuals to prepare and circulate them ; they withhold from men that knowledge which would teach them to fhun, or elevate them above the ufe of, intoxicating liquors ; and prejudices are excited and foftered in their favor, that the igno- rant and depraved, to whom they form a congenial gratification, may continue to confume them ; to the deftruaion of morals, the emolument of diftillers, and the augmentation of the revenue. As they are more eafily and cheaply obtained in America, than in Eu- rope ; as the wages of laborers are more confiderable here, than there, and therefore permit them greater indulgences ; as there is every encouragement from example ; and as a fiercer fun, according to common notions, juftifies a more prodigal ufe of them ; it is naturally fuppofeable that the emigrants of the la- boring clafs indulged in them, to an unufual degree. Unqueftionably, the ufe of intoxicating liquors was highly pernicious to thofe moft accuftomed to them ; to thofe not fo habituated, it was, as unqueftionably, ftill more pernicious. In Philadelphia in 1793, when the fever was prevalent, Eh". Rufh remarks that—" a " plentiful meal, and a few extra glajfes of wine, fel- " dom failed of exciting the fever." With us the difeafe \va*. lefs ferocious and lefs aaive ; but, as if no means of caufing it to become more fo were t% be negleaed, an idea was, moft unhappily circulated —and, it fhould feem, was countenanced by perfons bearing the title of phyficians,—that free living, the plentiful ufe of vinous and ardent liquors, was a pow- N 88 LETTERS TROM DR. E. It. SMITH, erful preventative of the fever. The dreadful cori- fjqumces which a belief of this fort produced, were numerous, and mocking to the laft degree. The feai of death, fo adive in ignorant minds, when once aroufed ; idienefs, the parent of every vice, and lift— Icmiels, the confequence of want of employment; all com'pired, with this pernicious doarine, to effea the ruin of numbers. Never, I believe, was drunkenefsfo common. Not a day paffed that I did not meet per- fons reeling through the ftreets, or ftretched on the pavement—fometimes in the noon-day fun, unfhel- iered, and fometimes expofed to the heavieft rains. I have feen three men, lying in this condition, in one little ftreet. Thefe were all, as ycu may fuppofe, among the moft depraved of our poor; and moft of them were foreigners. Is it poflible that condua fuch as this fhould fail of giving nev/ activity to every other caufe of difeafe ? V. I have, in a former letter, given you fome ac- count of the condition of that part of the town, where the Fever moft prevailed ; it is now to be no- ticed that it is in that diftria that the greateft num- ber of the poor, efpecially the emigrant poor, refide. In thofe numerous miferable dwellings, were thefe wretched people crowded together; many families in one ho ufe ; and not infrequently many families of different nations. In fome inftances, a fingle room in one of thofe half-under-ground huts, ferved as bed- room, kitchen and fhop, to a whole family; while underneath them, a cellar, half filled with mud and water, fent up i:s peftiiential fleams; and under their window, a yard in the fame condition, was rendered ftill more-noxious, by receiving the offals eaft out from every pari of the houfe. TO DR. W. LUEL. &9 VI. But, if the fordid and almoft unavoidable fil- tiiinefs of their dwellings were promotive of the-dif- eafe, under which the wretched inhabitants lam guifhed or fuffered, ftill more fo, in fome inftances, muft have been their inattention to perfonal cleanli- nefs. It was well remarked, formerly, by a foreigner, of the Englifh ladies, and is applicable, v/ith but little de- duaion to our own fair country-women*—That they were whitedfepulchres; beauteous and clean, without; but within-----You know the reft.----■ Were our country-women difciples of Zoroafter, they could not more ftudioufly hold, facred the ele- ment of water.—How many of thofe houfe-v/ives, how many of thofe maidens, the cleanlinefs of whofe houfes, and the"neatnefs of whofe apparel, we often have occafion to admire and commend, think you, have applied to any other parts of their perfons, than their hands and faces, this purifying element ?*-—-The infrequency of bathing among both fexes^ and all conditions, efpecially among females and the poor, in America, is furprizing.—In this refpea, the emi- grant poor are in no wife more commendable ; and,. m every other kind of cleanlinefs, ftill more back- ward. The French, alone, exhibit a laudable^con- duct, in every grade of life, as pcrfnai1 ablution is re- garded. * " Who can come in, and fay, that I mean her ; « When fuch a one as the, fuch is her neigh mv ? "___.--- Let me fee wherein «' My tongue hath wrong'd her ; if it do her right, " Then the hath wrong'd herfelf ; if uhe be free, " Why then, my ta:c;:ig, like a wiid-goofe, fiiesX " Unclaim'd of any one." As You Like Irv 90 LETTERS FROM DR. E. H. SMITH, To every phyfician, who knows the importance of cleanlinefs to health, and how rigid an attention to it is neceffary, in Fevers, efpecially in thofe which are called malignant, it is ufelefs to infill on the con- fequences of negligence in this particular. I fhall conclude this letter with a few remarks, which the fubjea naturally infpires. .the preceding flatement is ftriaiy applicable, in all its extent, to great numbers of thofe who were fick of the Fever of 1795. Your own mind will fug- geft to you that there muft have been many excep- tions ; and, likewife, among whom thofe exceptions were to be found. You will learn, from it, that circumftances un- friendly to foreigners were more numerous and for- cible, in more inftances, than to natives ; and will perceive, at the fame time, what is appropriate to each, and what common to all. It will, further, be evident, that, though fome of thefe caufes may have been fufficient, fingly, to create a predifpofition to difeafe,—and probably did, in fome inftances, create it; yet, that predifpofition muft have been more confiderable, and the difeafe which followed more fevere, in proportion to the combination of two, or more, of them. It now remains to take a comprehenfive view of the refults furnifhed to us by this letter, in conneaion with the two immediately preceding it; but this I fhall defer to another opportunity. TO DR. W. BUEL. 9 J LETTER. FIFTH.^' Recapitulation of Fails, and an Opinion' Cjnc:rr.h:g the Origin of the Fever of 1795. From the ftatements contained in the preceedmg letters it appears, that the Fever of 1795 was moft aaivein Situations--—whe^e— There was the leaft chance for free ventilation ; Where the fun exerted the greateft and Iongeft influ- ence ; there was the leaft drain for water and filth ; the rains which fell ftagnated ; there were, conftantly, ftagnant pools ; the ftreets narrow, crooked, unpaved ; , the houfes partly under-ground, wooden, de- cayed or flight; there were confiderable collections of vegeta- ble and animal matters fullered to re- main and putrify; and where the exhalations from the fewers and docks extended :— The fever firft appeared and continued to be mor- tal in a Season— which was unufually fultry and wet; throughout which efculent vegetables were fcanty and poor; 92 LETTERS from dr. e. h. SMITH,- meats tended rapidly to putrefaaion, and were often confumed in a ftate of inci- pient putrefcency;— , During which— Infeas were very numerous and nox- ious ; there was fcarcely any thunder and lightning; there were feveral violent and fudden alternations of heat and cold ; and the city was, in the evening, often im- merfed in a very peculiar and per- nicious fog:— The Fever proved moft fatal-^ to the poor ; to emigrants more than natives ; to the emigrant poor moft of all;—and they— lived in fituations, moftly, fuch as above-men- tioned ; were, often, crowded together, in fuch houfes ; mingled, without diftinaion of nation, climate and habits; changed a mild vegetable, for an animal diet;— perhaps a femi-putrid animal diet; were chiefly laborers in the open fun ; were unufually intemperate ; and were inexcufably inattentive to the cleanlinefs of their houfes and perfons. Such are the faas:—-what inferences would rea- fon, unperveited by prejudice, intereftednefs, or ig- norance, deduce from them ? How would fhe decide "TO DR. W. BUEL, 93 on the fo-much-agitated queftion of donwftic, or fo- reign, origin ?—Were a rational being to fee hundreds of men, women and children, removed from a tem- perate and equable climate, to a climate fubjea to the extremes of heat and cold, and to fudden and ex- •ceffive alternations of temperature; were he to obferve this removal to take place in crowded, ill-provided, fhips, which were a long time at fea, and whofe ar- rival was at fuch a time as to fubjea them to the ri- gors of a v/inter, fevere beyond their knowledge, and under all the inconveniences attendant on poverty, ignorance, and vice in a flrange land—or to the terrors of a fummer equally intolerable to them, from its inexperienced fultrinefs; were he to view them, af- ter fuftaining, one, or mere, fuch feafons, or immedi- ately, expofed to the influence of a feafon fultry and moift beyond the common courfe,in this new climate; fhould he learn that they exchanged oppreffion for li- centioufnefs, and, in fome cafes, found all their hopes illufory ; that they fubftituted a fcanty fupply of wretched vegetables and a gluttonous ufe of femi- putrid, ill-cooked, meats, for a fparing confumption of mild and healthy vegetable food ; that they were often perfecuted by fwarms of infects, whofe bites raifed fwellings or caufed ulcers, when, till now, they had been unaccuftomed to any ; fhould he fee them indulging, habitually, in the ufe of intoxicat- ing liquors, to which many of them had hitherto been ftrangers ; were he to find them dwelling in narrow, unpaved, funken, and illy-ventilated ftreets, in which large colleaions of putrid matter were allowed to remain, where there were puddles of ftagnant water, or open fewers, and in the neighborhoods of pools or docks, whofe noxious qualities were heigh- tened by the admixture of putrefying vegetable and animal fubftances;—were he to difcover the houfes in which they dwelt, to be decayed or flight, and LETTERS FROM DR. E. H. SMITH, fometimes pervious to fun and rain,—in part, below the furface of the earth, and with yards equally low, and in the condition of the pools and docks above-mentioned ; fnould he, on entering thefe habi- tations, find them mingled with emigrants from va- rious other climates, or with natives of that to which they had removed, equally debafed, and perhaps ftill more fo, than themfelves—with people of difcordant habits, colours, languages and countries,—'-and all, alike, inattentive to perfonal and houfehold cleanli- nefs ;—I fay, were a rational being to obferve all this, and perceive all the circumftances, juft enume- rated, to be concurrent, in refpea to time, would he, think you, find it neceffary to recur to the Eaft or to the Weft-Indies, for caufes of difeafe ? Would he deem it of much importance whether a fingle man died on board this,' or that, veffel ? Or whether con- tagion might, or might not, be imported ?—Would not thefe circumftances^ of themfelves, when viewed in conneaion with each other, and compared with the known and eftablifned laws of health and difeafe, imprefs on his mind, with all the force of intuition, a conviaion of the domeftic origin of the Fever of 1795 ? Is it poflible that he fhould have any other opinion than that the caufes, cure, and prevention, are equally local, and difconneaed with the preva- lence or abfence of fimilar difeafes in other countries ? But, certain as I feel that this muft be the inevitable conclufion from a candid attention to the faas above- difplayed, I am pleafed to be able to declare that it is unneceffary to truft to their teftimony, alone, for iupport to the opinion derived from their confidera- tion.—No direcl, no clear, evidence, ever has been, or can be, produced, in favor of the opinion that the Fever was imported.—I fhall defer the attempt fcsi fubftan- tiate this affertion, to a future opporterutv ; in the meantime, permit me once more to remark—That, TO DR. W. BUEL. 9S though all the circumftances, enumerated in this let- ter, as concurring to produce the Fever, did, often- times, in reality concur, it is not to be fuppofed that they did fo. uniformly. So much is true, beyond difpute—A concurrence of the greater number of fome, or other, of them, was obfervable in a vaft majority of the cafes of fickneft* More than this was not neceffary :—for, expofe the moft temperate and cleanly native, to the full influence of all the caufes predifpofmg to this fever, befide thofe which his birth, cleanlinefs, and temperance, would difarm, and his chance for continued health muft have been fmall; efpecially, after the additional aid which they, queflionlefs, derived from great numbers of fick and dead, and from the reign of terror. The number of na- tives, of this description, who died, was very inconfi- derable; and, of thofe few, perhaps there was not an individual whofe iituation, conftitution, or office, did not peculiarly expofe him to the attacks of the Fever. To which may be added, the chance of his falling a facrifice to an inert, or deftruaive praaice. LETTER SIXTH. On-the Evidence of the Importation of the Fever ofijg$* " No direa, no clear evidence ever has been, or " can be produced, in favor of the opinion that the " Fever was imported." The authority on which the advocates of importa- tion chiefly reft, for the fupport of their doarine, is, as far as I can difcover, the letter of the Health Com- mittee to the Governor, of the 8th of September O <)G LETTEE.S FROM DR. E. H. SMITH, 1795 > or> more properly, on what is there reported to be the faa.—I fhall quote, from this letter, the paffage referred to. . " On the 2othdayof July, DoaorMalachi Treat, " the late Health-Officer of this port, vifited the brig " Zephyr, from Port-au-Prince; on board of which " he found three perfons ill of fever, and the corpfe "■ of one who died that morning. The Doaor calls, " the Fever, in his report, a Bilious-remitting Fever. " The brig was ordered to ride quarantine. On the "■ 2 2d day of July, Dr. Treat was taken ill, and died "on the 30th, of a fever marked by a yellow fkin, " hemorrhages, vomiting of black matter, refembling 41 coffee-grounds, and all fuch fymptoms as charac- " terize bilious fevers of the malignant kind.—On " the 2 r;h day of July, four perfons, from on board " the fkip William, from Liverpool, which arrived " here feveral weeks before (all the crew having,- " previous to that day, and during the voyage, been " perfectly healthy) were taken ill of Fever, attended " with iimilar fymptoms; and all died within feven <: days. "This imp lay at a wharf at the foot of Dover- " ftreet, in the fouih-eajlerly* part of this city, which "lies exceedingly low, is much of it made-ground* " has an eaftern expofure, and (from the ftreets hav- " ing been raifed, about three years ago, which threw " the lots and yards into hollows of confiderable " depth) is almoft unavoidably liable to great collec- " tions of offal, ana filth of all kinds; is a part of the " town very much crowded by poor inhabitants, and G' contains a great number of lodging-houfes, in " which feamen and ftrangers of the poorer clafs, com- * A jr.iftahc of the Prefs fox^-narth-eajerly. a ti3v»woi:i md alalia > . tot i ytdBill TO DR. V,\ BUEL. 9/ " monly refide ; and ever has fuffered moft from the " regular autumnal difeafes, as well as from any new " and uncommon complaint. From all which cir- " cumflances, we entertain no doubt but that the " feamen of the fhip William contraaed the difeafe, " of which they died, here, and did not introduce it "into the city. " A little before, and immediately after, the attack " of the feamen of the fhip "William, which firft " called the attention of this Committee, feveral other " perfons, in Water and Front-ftreets, and in the " neighborhood of Dover-ftreet, were feized with " fever, which, efpecially in thofe cafes which proved " mortal, was marked by fevere vomitings, a yellow " fkin. herrtorrhagy, and, in fome cafes, a vomiting a " black matter, refembling coffee-grounds,—and " which generally terminated within feven days, and " proved fatal to more, in proportion to the number " feized, than is ufual in the ordinary complaints of " the feafon, in this city." Two remarks of confiderable importance are natu- rally fuggefted by a careful examination of the above quotation : Firft, that the Committee appear to have fuppofed Dr. Treat, alone, to have received the dif- eafe of which he died, from the Zephyr; and, fe- condly, that they have, in fome fort, admitted the poffibility of fuch a difeafe as the Fever of 1795, originating here, in their flatement of the circum- ftances relative to the fhip William. It is true that they are inexplicit, in both inftances ; and the only abfolute conclufion which we are juftified in deduc- ing from what they fay is, that the difeafe was not introduced into this city by the fhip William. This, however, narrows the ground of controverfy, confi- derabiy j for no veffels befide the William and the 98 LETTERS FROM DR. E. Hi SMITH, Zephyr, as far as I can learn, have ever been fufpeaed of introducing any difeafe, of this kind, into this city. It is neceffary, therefore, only to difprove the affer- tion, in refpea to the Zephyr, and the whole founda- tion of the doarine of importation is deflroyed;— But, even were we to admit that Dr. Treat did aau- ally derive the fever of which he died, from the Ze- phyr, as no other perfon is known to have been in- feaed by that veffel, and as the doaor communi- cated it to no perfon, the advocates for importation would not be greatly benefited by our conceffion. But no fuch conceffion is neceffary. The following papers, copies of which lam kindly permitted to tranfmit to you, appear to me, to eftablifh it, beyond contradiaion, that neither Dr. Treat, nor any other perfon, contraaed a Fever, fuch as prevailed in New- Yoik, in 1795, from any fick, or dead, man, or any- thing elfe, connVaed with the veffel in queftion. no 1. m Letter from the Captain of the brig Zephyr, to Dr. Dingley. .",: New-Tork, Sept. 8, 1795. jIi Sir, Having been informed that many people have re- ported that the late Health-Officer, of this port, caught the difeafe with which he died, on board the brig Zephyr,; I have thought it a duty which I owed to the public, to, eontradia the report.. This, I truft, will he fatisfactorily done, to the minds of all reafon- able men/ by my depofition, taken before C. Dunn, TO DR. W..BUEL. 99 l^11' x116 °f the 5uftices for the city and county of New-York; which I defire you to publifh, for the information of the citizens, as foon as you may think proper.—-My departure from this city is the occafiori of giving you this trouble. I am, fif, your friend & humble fervant, COMFORT BIRLV Dr. Dingley. NO II. Captain Bird's Depofition. Captain Comfort Bird, commander of the brig Ze- phyr, of Bofton, failed from Port-au-Prince on the ift of July, and arrived at New-York on the 20th of the fame month. The mate and one mariner had the Fe- ver and Ague feventeen days on fhore, and came on board with the fame difeafe ; and the captain himfelf had a Dyfentery on his arrival in New-York ;—and John Wheeler, aged 16 years, died on the day of the arrival of the brig at New-:York, by worms crawling up into his throat and choaking him. He was fewed up in a piece of canvafs, and ready to be committed to the deep, when the late Health-Officer came on board, who defired the captain to have the canvafs opened, that he might infpea the body—and he:onIy cut the canvafs open over the face, and viewed the countenance, but did not make any other examina- tion of the body,—which was, foon after, carried to Governor's Ifland, and there interred.—The young IOO LETTERS FROM DR* £. |£ SMITH, man who died as above-mentioned, had fuffered chro- nic complaints, but no fever of a dangerous nature.— Eighteen paffengers came in the above brig, ail m good health,—who have continued in this ftate to the prefent day.—Three days after the above event, the ; Health-Officer vifited the fame brig, in as good health " as ufual. • : •; Signed COMFORT BIRD. Sworn before me, this feventh day of Septem- ber, one thoufand feven hundred and ninety- five, in the City of New-York.. C. DUNN, Jun. Of the undoubted veracity of Captain Bird I am affured by Dr. Dingley, who is perfonally acquainted with him, and attended him, at the time, for the dyfentery mentioned in the depofition. The opinion, therefore, that the Yellow Fevei, or a contagious difeafe, was brought into the city, laft year, by the " brig Zephyr, feems wholly unfupported by evidence. Neither is it neceffary that any imputation mould reft onthememoryofDr. Treat: He faw the mariners after they had been long affiled by the Fever and ague, and perhaps with fome fever upon them at the time ; and from the yellownefs of the fkin, common to the ad- vanced ftate cf that dife^e, efpecially in hot climates might be eafily induced to fuppofe it a remittent. 1 his, however, is mere conjecture, and not neceffary to be admitted, fince the fact of the men having been nek leventeen days, previous to their embarking for ourcoaft, is ample proof that they could not have keen affeaed by the fever which prevailed ^nJ wa- TO DR. W. BUEL. 101 fo mortal, here.—Indeed, the whole teftimony in favor of the idea of importation, is too loofe and flight to build any rational opinion upon. The very words of the Committee are calculated to ftrengthen a con- trary opinion, if rightly confidered; for they not only countenance the idea that the people of the fhip Wil- liam became fick from the unhealthinefs of the place where they dwelt, but, alfo, that the Fever had made its appearance, in various other of the neighboring houfes and ftreets, previous to their being feized with it. And what confirms the truth of this opinion is, that perfons were taken with the diftemper, about this time, in other parts of the city, who had no conneaion with the brig Zephyr, nor with any other veffel, and whofe illnefs may be fatisfaaorily ac- counted for from their fituation, in other refpeas- An inftance of this kind fell under my own obferva- tion, the laft of July ; feveral fimilar cafes have been related to me ; and one, if I am not mifinformed, occurred in the New-York Alms-houfe, where the difeafe was diftinaiy marked, before Dr. Treat's ill- nefs.—^-The following ftatement of faas, too, will convince every candid mind, that we ought to look at home, for the caufe of this Fever. The fhip Conneaicut came to Fitch's wharf, about the 20th of July—I think it v/as on the 21ft : flie" had juft arrived from fome part of England, and the people v/ere perfeaiy healthy. No veffel fufpected of being infeaed, came to this wharf, during the feafon 5 though the fhip William lay at the next wharf, at the diftance of about two hundred feet,—and Mr. Fitch gives the moft pofitive affuran- ces that all the articles in his ftore, at this time, were in good condition. At this wharf the fhip Connec- ticut continued till after trie middle of Auguft. The owner was- employed about the fhip, great part of LETTERS FROM DR. E. H. SMITH, the day; but ate and flept in an airy part of the town* The people of the fhip either flayed on board, or at public houfes near by.—On the evening of the 25th of July, the owner was feized with the fever; I faw him the 27th ; he had good accommodations, was in a favorable part of the town, in the third itory of the houfe, and recovered after an illnefs of about ten days, which was never very dangerous, though the attack was fevere.-—About this time, one of the mates, the fl eward, and two of the mariners, of the fhip Con- neakut, were feized in the fame way, and with the fame fymptoms, as the owner. They continued in the fhip, or its neighborhood, and all died. I did not fee them, but was informed, by the owner, that the mate, in particular, vomited large quantities of blood, and expired delirious.. Three perfons, who were in Mr. Fitch's ftorer were taken fick, and two died, of the Fever. One fickened on the 26th of July, one on the 6th, and the other on the 9th of Auguit. It was common for all thefe perfons to fit " feveral hours, in the mom- " ing, in the ftore, with empty ftomachs,—inhaling " the effluvia of the night.". One of the firft perfons, who died of the Fever, was one " v. ho lived at the head of the wharf, and " had been confined for feveral months with a rheu- " matic complaint." For the faas contained in the two laft paragraphs. I am indebted to a communication from Mr. Fitch to Dr. Dingley, which that gentleman has allowed me to make ufe of en this cccafion. The account which it contains of the condition of the wharves in his neighborhood, adds new force to the other teftimony in iavor of the opinion: that the Fever originated here ; and is too much to the purpofe to be omitted. Thefe are his words:— TO DR. W. BUEL. I03 "■:1am pofitive that the diforder has originated ** feom local caufes—becaufe^ it has appeared in this " quarter, at the fame feafon, for feveral years; paft; *'the caufe why it has is, to ine, rnyfterious; but *' what appears to me moft probable is, the central " fituation, and the motion of the tides. The " tide of flood fets dire&ly into thefe wharves ; cot* " kaing all the vapors and effluvia of the city.-— *6 The fituation of the ground, between Water and " Cherry-ftreets, is rendered noxious by raifing " Water-ftreet, and confining the ftagnant waters,—> " The emptying of tubs into the head of the docks, " infteadof the fend of the wharves, although not " peculiar to this part of the city, is a horrible nui- " fance ; particularly in time of ficknefs.—The pon- r?atb of all oftbrm," TO DR. W. BUEL. I I I afeout words. Perhaps, the following ftatement of my opinions, will lead us to the formation or attain- ment of fome more accurate notions on this point. » Owing to a variety of caufes, which have been enumerated in the courfe of thefe letters, I fuppofe the atmofphere of New-York to have become vi- tiated, in 1795, to an uncommon degree: that there was either an unufual abfence of that principle necef- fary to fupport healthy life, or an extraordinary con- centration, diffufion, or quantity, cf fome other, un- friendly to healthy life. From the operation of one, or other, of thefe ftates of the atmofphere, and of the caufes above-mentioned, on the bodies of the refidents in this city, I fuppofe a predifpofition, greater or lefs, according to the fituation and other circumftances of individuals, was formed, in the citi- zens, generally, to the Fever which prevailed here that year. With fome perfons, this condition of the atmofphere, of itfelf, might be fufficient to produce in them difeafe. But, ordinarily, I believe, the aid of fome caufe, which fhould difturb the regularity of the diftributions, or funaions, of the body, was re- quired to bring the fyftem into a ftate of febrile ac- tion. Such, for inftance, as intemperance in eating or drinking, fudden fright, fatigue, or indeed, any confiderable irregularity in what Syftematics call the Non-Naturals. This condition of the atmofphere, I fuppofe, ac- quired flrength, daily, as the feafon advanced ; or, in other words, the power of the atmofphere, &c. to predifpofe to the Fever, was increafed, as the feafon progreffed. I fay to predifpofe,—for I fufpea it fel- dom, of itfelf, produced the difeafe, after that had at- tained its height, in thofe who remained here con- LETTERS PROM DR. E. H. SMITH, ftantfy. Though, on perfons coming into the city, from abroad, it doubtlefsoperated with much greater jforce, in many cafes, than on the citizens, at any time. This is eafily accounted for, from the known effeas of cuftom. For " The monfter Cuftom, who doth, &c. «„...---- is angel yet in this." The fyftems of thofe who continued here became habituated to the atmofphere ; and while thofe who ~ came here from the country, with ruddy faces, funk down in death, the pale and yellow beings who flalked through our ftreets, derided difeafe, and purfued their cuftomary occupations.—But, to return from this di- greffion. Not only am I convinced of the accuracy of the preceding ideas, but I have no doubt that this vice of ;theatmofphere was rendered ftill greater by exhala- tions from the bodies of the fick—It is a point welKeftablifhed in medicine, that the air of a room is rendered unfuitable for refpiration, if a num- ber of healthy perfons are obliged to breathe ft over feveral times, without the admiffion of frefh air from abroad. So injurious is fuch a confinement, in re- fpea to air,To the human body, that it has, in nume- rous inftances, produced terrible febrile difeafes. And if fuch effeas arife from the repeated breathing over the fame, or nearly the fame, air, by healthy perfons, v/e fhould naturally conclude, as is the faa, that fuch repeated refpiration (efpecially when united with the conftant exhalation from their bodies) by the fick, muft be ftill more pernicious to health.—You will pardon me for the introduaion of remarks fo trite and familiar, for the fake of the ufe I wifh to make of them; which is no other than this—I have mention- TO DR. W. BUEL. I I 3 td it as my belief that the ftate of the atmofphere was fuch, in this city, the laft year, as, in conjunaion with the general influence of the caufes producing that ftate, to predifpofe to, and, in fome inftances, pro- duce, the Fever ; and that this ill-conditioned atmof- phere was rendered ftill more noxious by means of the numbers who became fick, in the courfe of the feafon ; and to this I would add, for the reafons con- tained in the remarks above, that I think it not im- probable that fome were affeaed with the Fever, in confequence of the further vitiation of the atmofphere by the fick, who, without that circumftance, would have remained free from difeafe. So, likewife, there may be perfons, the balance of whofe health is fo tre- muloufly fenfible to every external influence, as to preponderate to the fide of difeafe, on the flighteft impulfe of its caufes. With fuch, the mere contaa of a fick perfon, or a tranfitory expofure to the efflu- via arifing from a fick body, may be fufficient to pro- duce Fever ; and inftances of this kind may have hap- pened, in the courfe of the Fever in queftion. Such cafes, however, muft have been extremely rare, if there were any ; and no one has ever come to my knowledge.—But, with regard to Fevers produced by fuch a ftate of the air, as above-defcribed, even when aided by the mixture of human effluvia, arifing from fick bodies,—if thefe are to be called Contagious dif- eafes, and the caufe which excited them Contagion, fo, likewife, may all other Fevers on the fame principle, continued, remitting, intermitting, Fevers,—be called Contagious, and their caufes, as marfh miafmata, &c, Contagion.—Now, to fuch a ufe of terms I have not the leaft objeaion, provided the perfon who employs them, be uniform and explicit in his application of them, 114 LETTERS FROM DR. E. H. S"MITH, To conclude,—-If, in fpeaking of the Fever of 1795, the epithet Contagious is meant to exprefs that it was communicated by contaa, &c. like the Small- pox, Meazles and Plague, I muft repeat it, I find no good reafon for admitting this to have been the faa^ but, for the reafons before alledged, I think there is juft ground for a belief that the Fever was never ex- cited in this way. But if, on the other hand, the term Contagion be meant to convey an idea of the in- fluence of the atmofphere to predifpofe to, or pro- duce, difeafe,—whether that influence arife from the abflradion, or addition, of a principle. or be diflina from human effluvia,, or combined with them—there appears no reafon for denying the Fever of 1795 t0 have been Contagious.—Still, as the term Contagion is not generally ufed in a fenfe fo rcftriaed, as in this fecond inftance, but is often employed by the fame writer, to exprefs both the caufe of the difeafe com- municated by contad,&c. and of that produced by the influence of the atmofphere, there feems to be a pro- priety in rejeaing it altogether,in theprefent inftance, or at leaft in confining the ufe of it, to defignate a fingle-mode of producing difeafe; and, according as it is applied in the former or latter inftance, the Fe- ver of 1.795 maY De denominated Contagious, or the reverfe. I have now gone through with the confideration of all the fubjeas, preliminary to an account of the dif- eafe itfelf. In my next letter, I fhall lay before you, the refult of thofe fcantv obfervations which I had opportunity to make.--Knowing the caufes of their imperfections, you will not fail of extending your charitable indulgence to their author. TO DR. W. BUEL. J 15 LETTER EIGHTH. Some Account af the Symptoms of the Fever of 1795. After the frequent confeffions, which occur in the preceding letters, of the circumfcribed fphere of my obfervation, it were prefumptuous in me to pre- tend to deliver a regular hiltory of the fymptoms of the Fever of 1795. You will obferve, from the ac- count which I fhall tranfmit to you, that the appear- ances it exhibited were too various to authorize fuch an attempt in any one who had not opportunity to ex- amine them, in relation to numbers of the fick. It is proper, therefore, that I warn you, once more, to confider what is here delivered as the refule of my own obfervation only—except where it is exprefsly mentioned to be otherwife. The Fever of 1795 was, generally, fudden in its accefs ; fo much fo, in fome inftances,- as to refemble convulfions. In a lefs^number of cafes, it came on gradually, and after a flowly-increafing illnefs of feveral days. It began with great pain of the head, heat and rednefs of the face, and fullnefs and rednefs of the eyes, accompanied by a ltrong, full, tenfe, pulfe, and an almoft univerfal coftivenefs. Pains in the back and limbs were common ; but not as much fo as of the head. A great inquietude, or anxiety, of the ftomach and breaft, was common; approaching, fometimes, to fyneope, and fometimes a vomiting, which foon ceafed, or continued, at in- tervals, through the diforder.—The Fever which now commenced was rarely ufheredin by a chill, and con- Ilfj LETTERS FROM DR. E. H. SMITH, tinued for a greater or leffer period, according to circumftances, with fo many varieties and combina- tions of fymptoms, as to render it impoffible to purfue a regular defcription. I fhall, therefore, difpofe my remarks under feveral heads; preferving as much conneaion as circumftances will permit. I. Though the pulfe was generally full, ftrong, and tenfe, in the beginning of the Fever, it was not always fo. It was fometimes weak and low, but ftill tenfe—if it be proper to ufe this term, to point out a condition of the pulfe, as it appears to me, wholly peculiar to this Fever. I well remember that, in a youth of 12, or 13, years of age, the pulfe became much fuller after a plentiful bleeding ; though he was of a feeble conftitution, and had been flightly affeaed with the Fever once before.—In two gentlemen, who were confiderably affeaed by the Fever, for ieve^al- weeks, but not to fuch a degree as to be confined to their beds, this peculiar pulfe was very diftinguifhable; as much fo, I think, as in any other perfons. whofe pulfe I examined. Hemorrhages, from various parts of the body, were frequent, efpecially in the advanced ftage of the difeafe, and where it had been violent from the firft. Thefe were from the nofe, fauces, efpecially the gums, from punaures made in bloodletting, and from the ftomach : I faw no other. Bleeding from the nofe and fauces often occurred in the beginning of the difeafe, and was removable by the general reme- dies. Bleedings from the punaures made in blood- letting, were feen in the clofe of the difeafe, and were reftrained with the greateft difficulty. I recolka to have been conftantly engaged in an attempt to re- ftrain fuch a hemorrhage, in company with another phvfician, two cf the moft melancholy hours I ever ,JV ,(i TO DR. W. BUEL. 117 experienced. Heniorrhagy from the ftomach I fhall mention more particularly hereafter. '"L II. Symptoms of pulmonic affeaion were not un- common ; though I do not recollea to have obferved them tiH the laft of September, or beginning of Oc- tober. They fometimes rofe nearly to the height of pneumonia. Hiccough was a troublefome fymptom, and often accompanied vomiting ; and there was fometimes, as it appeared to me, a mingled hiccoughing and belch- ing. III. The marks of congeftion in the brain were too numerous and unequivocal to be miftaken.—A vio- lent pain in the head was one of the earlieft, moft conftant, and moft diftreffmg, fymptoms of this dif- eafe---Coma was a very frequent fymptom ; and, as I thought, in proportion to the feverity of the difor- der. Towards the clofea it amounted almoft to total ftupefaaion; it being fcarcely poffible to route the patient. Some degree of delirium was common ; par- ticularly at the commencement of an exacerbation of the Fever ; manifefting itfelf in the hurried manner in which the patient performed any aaion, and in the rambling manner in which he converted. That kind of delirium which fome have called light-headednefs, was remarkably prefent, in one perfon, at the clofe of his diforder. He often ftarted up, wildly, without any apparent objea, then lay down, and commenced finging, in an interrupted, incoherent manner ; but without any violence. And the day before his death, he continued to fing, with flight interval, more than an hour.—At other times, he would fix on fome par- ticular words, and repeat them over and over ; fome- times, with no appearance of emotion; at others, IlB LETTERS FROM DR. E. H. SMITH, with fome glimmering of confeioufhefs.—In another perfon, a patient cf a phyfician of my acquaintance, the affeaion of the brain was like that in Phrenitis. A bliftering-plafter applied, if I remember accurately, for 24 hours, to the head, which had been fhaven, excited no veffication, and fcarcely any rednefs, -though twice the ufual quantity of cantharides was incorporated, and the patient was of a delicate ha- bit. In this cafe the affeaion of the brain took place on the third day, and the patient died on the fifth or fixth.—On examination and diffeaion of the contents of the cranium, all the membranes, and the very fub- ftance of the brain, were difcovered to be in a remark- able and uncommon ftate of inflammation.—I have been the more particular in relating this cafe, as it feems to contradia, in a degree, the ideas of Dr. Rufh, p. 50, of his Hiftory of the Philadelphia Fever: our feafon having been unufually wet. As conneaed with the ftate of the brain, it may be proper to mention here, that the eyes were often fuf- fufed, the whites of them tinged with yellow, and the fmall vefiels turgid with blood. In fome patients they had an expreflion' of fingular wildnefs ; while, in others, there was a remarkable vacuity, or abfence of expreflion.—I faw no inftance of fquinting ; nor ob- ferved any uncommon ftate of the pupil: but I ought to acknowledge that my attention was not particularly directed to the condition of the eyes, in this refpea. The ftate of the mind was very variable. Some were exceedingly impatient and irafcible ; others, aflomfhingly obftinate ; and this particularly, when, as was often the cafe, there was a lofs of memory, or fome degree of mania. A ftrong appeal to their good- fenfe, calling them by name, feemed to effea a tem- porary reftoraeom <-?f their docility and recohectien.— TO DR» W. BUEL. Il8 which were foon loft.—Many were very confident, at firft, fuppofing their illnefs not be the Fever ; but gave themfelves up to defpair, immediately on being convinced that it was the Fever. Many were full of dreadful apprehenfions, from the firft ; and often- times, exceedingly aggravated what would have been, otherwife, a flight difeafe. A few^ were calm, col- leaed, undaunted, throughout their ficknefs. And here it may not be unfeafonable to remark, that thefe fame varieties were, in a degree, obfervable in thofe who continued well. Some phyficians thought they could difcern a tendency, among the citizens, gene- rally, to mania. It is certain that fear was a terrible evil, and frequently proved the exciting caufe of the Fever. IV. I have remarked that a great anxiety at the/o- machwas fometimes felt, on the patient's being firft feiz- ed with the Fever. This anxiety, it may now be added, in fome cafes, extended through the complaint; but was moft diftreffing when the Fever was moft violent. A great fenfe of forenefs was often complained of, when any thing was taken into the ftomach, as if it were ratiV;—to ufe the words of one in whom it wa^ob- ferved. £ fome, the fenfibility of this organ, xfas fo exceffive, £ to make it almoft impoffible to adminifter, either food or medicine, by the mouth. Patients were often affliaed-with extreme pain in the bowels; but more refembling that in dyfentery, than in cholic. , A difcharge, generally, afforded a prefent relief. Flatulency, both of the ftomach arid bowels, was almoft univerfal, and to an extraordinary degree.— Th<- abdomen was fcrr.erimes diftended with wind ; R 119 LETTERS FROM DR. E. rf. SMITH, but the diftenfion fubfided after a condefable dif- charge of wind, downwards. This was often the cafe in one of my patients. Several diffeaions, as I am informed by the gen- tleman principally concerned in them, fhew the flo- mach to have been in a remarkable ftate of inflamma- tion and excoriation. It appears to me that this dif> eafe of the ftomach, or inflammation—(if it be pro* per to call it fo) extended through the whole length of the Alimentary Canal; as it is known to do in Apthae and fome other diforders ; for one cafe of excoriation and partial mortification of the Reaum came within my. knowlege, and I have heard of feveral others. - I have menticmetl, above, that Coftivenefs was al- moft univerfal -at the commencement of the Fever j but it was not always prefent. For though it was obfervable in the greater number of patients, fb much fo as to deferve to be ranked amoftg the cha- raaeriftic figns of the difeafe; and though a conftant tendency to a coftive ftate, was general in thofe fick with the diforder ; yet, in fome, the Fever was at- tended from the firft, or for a while, by a Diarrhea; and in one inftance, the whole of the I'feafe ap- peared to me to be turned upon the bowels, and to be converted into, or affume the form of a Diar- rhea. Some were feized with vomiting at the firft, which was foon flopped, or ceafed fpontaneoufly, and ne- ver returned. One cafe of this kind, proved favora- ble—the patient recovering ; another unfavorable, the patient dying.—In others, vomiting commenced the difeafe, and continued through it: while in others, again, it came on in the courfe, or at the TO DR. \V. BUEL- 120 clofe of the diforder ; and this both in fuccefsful and unfuccefsfui cafes. V. The matters vomited up varied in colour and confiftence, in different perfons, and in different pe- riods of the difeafe. The moft common was of a yellowifh, greenifh, or a muddy green and yellow,. appearance, and very fluid. Vomitings of this kind, were feen both in thofe who recovered, and who died ; and were both temporary and continued.— Next, in frequency, was that of a blackifh appearance, commonly defcribed as refembling coffee-grounds, but bearing a nearer refemblance to blopd partly burnt, and diluted with muddy water. Several who had'this vomiting recovered.—I never faw an inftance of that tar-like vomit, which has been noticed by fome writers. But, of all others, that which ftruck me as evidential of the greateft derangement of the ftomach, was the vomiting up of, what appeared to be, thin blood, in which floated a flaky, filmy fub- ftance, which I fuppofe to have been the villous coat of the ftomach.—This I faw but in a fingle inftance, a few hours before death. This difcharge was fre- quent, though fmall; and accompanied by a large worm. I cannot help thinking that the matters vomited up, except it be thofe of the yellowifh or greenifh eaft, have all a portion of blood mingled with them; and that their various appearances depend—afide from their mixture with the contents of. the fto- mach—in great meafure, on the quantity of blood mingled with them. It appears to me that, in this difeafe, the fecretion of the Bile is greatly affeaed \ and that, in many inftances, the blood itfelf paffes into the biliary veffels, charged with the Bile, de- firmed to have been feparated, and being poured in- 121 LETTERS I ROM DR. E. H. SMITH, to the duodenum, and difcharged by ftool or vomit- ing, communicates the blacknefs obferved in thofe evacuations. Befide this, as appears from diffeaion, and from the cafe juft mentioned, the coats of the ftomach itfelf are deftroyed; and the numerous little veflels, which, in a healthy ftate, diftill into it a limpid and colourlefs fluid, now are preternaturally diftended, receive the blood, inftead of lymph, and pour it, by their numerous orifices, into this organ. This effulion of blood may be fuppofed to increafe, as the diieafe increafes in violence, till, at length, the tender coats of the ftomach are feparated, and thrown up,- mingled with pure blood.—-If thefe ideas be juft, it is clear that no vomiting can be more evidential - of a fatal termination of the difeafe, than this; none ' can afford a more unequivocal fign to the phyficianr that his attention is no longer ufeful*. The difcharges from the bowels were very dark," in general, even where no preparation of mercury was ufed. They were, likewife, in moft cafes, re- i markably fluid, where the bowels had been once. J * If the ideas contained in the above paragraph are accurate, they will tend to confirm both the general notions of the difeafe, and of the proper mode of cure, advanced in thefe letters. Tor— I ft. The effect- of Blood-letting, in flopping the black-vomit, may be explained on the fame principle as in Hemoptoe—by -.veakening the circulation, and allowing time for coagulation. ' 2d. The reafon why ail ftimulating fubftances increafe the particular difcharges from the ftomach, is evident; and, alfo, why cold drinks, ice, Sec. reftrain thorn. 3d. The aftonilhing fluidity, ordifiblution, as it is called, of the blood is accounted for, and feen fairly to correfpond with the preceding circumftances: all of which__ 4th. DemoorVrate the nature of this difeafe; that it is not a difeafe of vafcular debility:—and eftabliftx the propriety of em- ploying evacuations, and whatever may leffen the activity of the circulations, to effect a cure,! ..',.. TO DR. W. BUEL. 122 thoroughly, opened ; and, where the purgatives were brifk, and in all fevere cafes, exceffively offenfive.— They were, fometimes, of a dark, fhining appearance, fomewhat like molaffes, melted pitch, or black-lead. But I have feen ftools of this colour, in other dif- eafes—particularly once in the Croup—where calo- mel was frequently ufed as a purge.—I mention this, as it may fometimes happen, that phyficians deceive themfelves, in fuch cafes, afcribing that to the difor- der, which depends on medicines. Some were troubled, with a retention of urine; but, more generally, with an unufual flow ; and this in one inftance, I diftinaiy recollea, where the quan- tity of fluids taken into the body, was very fmall. In refpea to fweating, I difcovered nothing unci- form. In one cafe, the patient always had a profufe, clammy, fweat, when he fell into a reftlefs fieep, with a rife of fever. This was often obfervable. likewife, in that, ftate of remarkable anxiety ivhich frequently preceded an evacuation by ftool. - Blood drawn in this Fever, was remarkably want-- ing in floridity ; and this was efpecially true of that which was evacuated in the clofe of the difeafe— whether by art, or fpontaneous effufion. In one in- ftance it feemed endowed with a cauftic quahty, and affeaed a lancet fo as to leave a permanent inequality and difcolouration of its furface. VI. Sleep, for the moft part, appeared unnatural and unrefrefhing; attended, by great reftleffnefs; and fometimes by great mobility of the mufcles, twitch- ing of the tendons, and frequent flarting up.'; One of mv patients often raifed himfelf up, fuddenly, out of bed, with every appearance of extraordinary ter. 12% LETT: Kb FROM PR. E. H. SMITH, ror ; tnit with no evident or clear confcioufnefs of the aa. In one perfon, I faw rexmrk-Me fubfultus tcndi* num. There was great variety in mufcular power, in dif- ferent perfons. A man who died v/ith the very worft fymptoms of the Fever, the evening before his death, rofe from his bed, ran down two flights of flairs, re- turned, and was only prevented from going down a fecond time by his nurfe's having locked him in his chamber.—In another cafe,, where the difeafe was mild, the patient fek perfectly eafy and compofed, and in full pofieflion of mental and corporeal ftrength, while he lay on his bed ; but, when he rofe, and at- tempted to walk, a fenfe of univerfal anxiety was felt, his ideas became confuted, his ftrength feemed to de- fer! him, a fudden faintnefs came over him, and twice he funk down, unable to proceed. An evacuation, by (tool, often fuddenly reftored the patient, who v/as lifted from bed, to fuch a degree of ftrength, that he continued for fome time after, to walk about the room, or fit up. VII. I noticed no uncommon femtbility to light but in a Angle cafe; and that was not of long dura- tion. Hearing, in or* inftance, I obferved to be unufually acute; but generally, it was much impaired ; and, ijometimes, feemed to be entirely loft. Perhaps this may account for the apparent lofs of memory in fome perions. The tafte was either exceedingly impaired, or very fickle. The farm may be faid of the appetite. When the appetite began to return, and food to be relifhed, TO DR. W. BUEL. 124 the fick were Very voracious, but not eafily fuited. They difcovered no partiality for animal food. Thirft was moderate, in a few inftances; but oftener excef- five. I have feen Porter defired; but it was not often relifhed, when allowed. The fame is true of coffee. Water was, univerfally, the moft agreeable drink; and I allowed its free ufe. One of my patients fre- quently drank, in one night, when very feverifh and reftlefs, three quarts of water. The appearance of the tongue varied, according to the violence and du- ration of the difeafe, from white, to yellow, darkifh, and black, like burnt blood ; and the gums often af- fumed this laft appearance, when there had been bleeding from them. An aftonifhing infenfibility to cold was nearly univerfal.—I remember, in one of thofj| cold turns which we had in September, a remarkarjle inftance of this. One of my patients occupied a chamber in the fecond ftory : the room was very large, extending the whole width of the houfe, and having a chimney,a large door, and two windows at either end. The bed was hard, in the middle of the room, the door and all the windows open, and he covered with a fingle fheet, frequently thrown off in his reftleffnefs, yet he complained of no cold, while I was chilled through, though fheltered from the draught of air, with my ufual cloaths on, and the addition of a fur- tout and double cloak. VIII. Yellownefs of the fkin was not conftantly prefent in this difeafe ; at leaft, not in any remarkable degree. A tinge of it was common in the eyes and on the fkin ; but ftot ftronger, in numerous inftances, than in ordinary Fevers. Some were exceedingly yellow, even to being tawny—fo that the bed and body linen were ftained, both by the fveat :mi urine. 125 LETTERS FROM DR. E. H. SMITH, I faw eruptions but in a fingle inftance. They re- fembled mufketo bites fo nearly, that, had I not been forewarned of this fimilarity by Dr. Rufh, in his ac- count of the Philadelphia Fever, I fhould have mifta- ken them, efpecially confidering the numbers of thefe animals.—In this inftance, the eruptions were on every part of the body ; which had not been expofed to their ravages. I have fometimes obferved a coldnefs of the fkin, on the body, generally, but efpecially of the feet, of which the patient was unconfcious, while the face and breaft were red and communicated a burning fenfation to the touch. IX. I have, hitherto, faid nothing of the type of the Fever of 1795 ; and, in truth, it is a point on which I cbuJ&wiih to be iilent, as, of all others, con- neaed with the Fever, it is the one where my obferva- tion is the leaft fatisfaaory. In its mildeft form, the Fe- ver or pyrexia, appeared to me to be moderate and conftant; without any evident or ftrongly-marked exacerbation : when fevere, it fell in with Dr. Cul- len's idea of a Continued Fever, as ftated in his Firjl Lines § 27, more than with any other: but, in both cafes, I could not determine that there was any regu- larity in the rife, or diminution of pyrexia ; on the contrary, the remiffion (if it be proper to term it fo) was more or lefs protraaed, and the exacerbation fooner or later, moderate or fevere, in proportion as the patient preferved a regular ftate of body and mind, or was irregular in thefe refpeas. For exam- ple—any fudden agitation of mind, as anger, pertur- bation, &c. and any irregularity of body, fuch as eat- ing improper food ■"■or too much food, drinking any ftimulating drink, reftleffnefs, too long detention of the faeces, he. appeared to "hurry on a'return cf all TO DR. W. BUEL. 127 the violent fymptoms; while, on the other hand, the fick never failed to get through the day with more eafeto themfelves, when no fuch excefs, or irregula- rity, happened. In one cafe which came under my care, and which various caufes contributed to render the, moft inte- refting of any I attended, there were complete inter- miffions, during a part of the diforder ; but there was no kind of regularity, either in their commencement, or duration ; and a flight excefs, in any of the parti- culars mentioned in the preceeding paragraph, was fufficient to bring on a fpeedy and violent turn of Fever. X. The period of convalefccnce, as well as of Fe- ver, was variable. In the former part of the time, and before the weather began to grow cool, patients fel- dom died after the tenth day—as far as I can learn ; but their deaths took place on the 3d, 4th, 5th, 6th, 7th, rarely on the 8th, and ftill more rarely on the 9th day. After the cold weather appeared, they fometimes dropped off fuddenly, and after having ex- hibited all the marks of convalefcence, three weeks from the time of their feizure.—So, of thofe who re- covered, fome regained their health with an elaftic quicknefs ; while others, were very flow in the ac- quifition of ftrength; were a long time troubled with great weaknefs in fome of their joints, and ofteneft the knees ; and were affliaed by cedematous fwellings of the feet, ancles, and legs. You have now before you the refult of my obfer- vations, on the appearances of the Fever of 1795 ; and I fhall conclude this letter by the fimple men- S 128 LETTERS FROM DR. E. H. SMITH, tion of two faas, which will ferve to confirm the doarine of the great Sydenham, concerning the defpotic nature of the reigning ficknefs. The Meazles had begun to appear, when the Fe- ver came, and they difappeared; but no fooner was the Fever vanquished, than they returned more generally than ever, and have continued in this city ever fince.* I cannot learn that any febrile difeafe was obferv- ed in the city, while the Yellow-Fever was prefent. I faw only one inftance of Intermitting-Fever in a lady, who contraaed it in the country. It was flight, and was foon cured on her coming to town, by the ufuai remedies. Her refidence in town, like- wife, was in a part to which the Yellow Fever never came. Befide this, I heard of one other inftance, of a gentleman coming hither, from fome other place, with the Fever and Ague j which was, alfo, cured by the ufual means. I fhall proceed, in my next letter, to bring you ac- quainted with thofe means which were moft fucceff- ful in the removal of that difeafe which I have juft defcribed. LETTER NINTH. Method of Cure, in the Fever of 1795. It was obvious, to the flighted obfervation, that the mildnefs, or feverity, of the Fever of 1795, de- pended, in no fmall degree, on the fituation. of the :* April. TO DR. W. EUEL. I 29 patient. That thofe who lived in the higher, drier, cleaner, and more airy parts of the town, were more lightly affeaed; and that a removal, from the other quarters, into fuch as were fo circumflanced, was al- ways followed by beneficial effeas to the perfon re- moved. In confequenee, a milder treatment, in every refpea, efpecially a more fparing ufe of evacuations, was warrantable in fome cafes, than in others; and as fome praaitioners were chiefly employed among thofe whofe favorable fituations protected them from the moft malignant attacks of the difeafe, you will readily conceive why there fhould prevail, in the minds of fome, an opinion that vej-y aaive remedies were unneceffary, and a recurrence to the lancet in- expedient, at leaft, if not pernicious. It is true that I did not always ufe it myfelf; but it is alfo true, that I never failed to regret the omiffion. And though I loft no patient by the neglea, yet I am convinced that, in every fuch cafe, however flight the difeafe might appear, the cure was protraaed. But, if the remedies were not always the fame, the principle on which they were adminiftered, was uniform; and their operation the fame in kind, if not in degree.— And, after the Fever became more general, and the feafon confiderably advanced, there was but little choice left in the ufe of means. Pofitive and fpeedy relief was required ; for to temporize, was to kill.— You will fufficiently comprehend, from thefe re- marks, how far the praaice recommended below admitted of variety in the application ; and I fhall de- tain you no longer from the confideration of the par- ticular remedies, which are meant to be arranged nearly in the order of their comparative importance. I. Blood-letting.—This was indicated by the fevere pain, heat, and rednefs, of the head and countenance j by the rednefs, turgefcence, ,I?0 LETTERS FROM DR. E. H. SMITH, and heavinefs, of the eyes ; by the opprcffion, pain, and anxiety, often obfervable at the breaft; by the fullnefs, hardnefs, tenfity, or oppreffednefs of the pulfe—and equally by that flender, wiry, vermicular feeling which it fometimes had—commu- nicating an idea of approaching numbnefsto the finger which felt it.* The effeas of bleeding were, in every inftance where I had an opportunity of obferving them, mofl falutary. The fick feldom failed of finding immedi- ate relief from it, and of perceiving that relief in- creafed as the blood continued to flow. It dimmifhed the pains in the head, breaft, and ftomach: oppref- fion, anxiety, faintnefs, and heat, were moderated : the eyes rarely failed to affume a clearer and more natural appearance : and it feemed to communicate a new energy to the fyftem.—I remember an inftance where a patient was fo unable to affift himfelf, on the fecond day of the difeafe, that, when I wanted to bleed him, it required'two perfons to fupport him, in paffmg a few fteps from his bed, into the open air.— There, he was feated and fupported in a chair. He grew eafier, in every refpea, as the blood flowed.— After taking away about twenty ounces, and tying up his arm, he rofe without affillance ; walked feve- ral rods, to a Neceffary ; took care of himfelf; had a profufe evacuation, by which he feemed to gain addi- tional ftrength ; and returned to his bed, without any aid, and with a firm ftep. Such were the immediate effeas of bleeding early in the difeafe. The importance of this remedy was not diminifhed by the duration of the diforder, nor * It is fcarcely poffible to convev an idea, by words, of minute peculiarities m the pulfe. You will lecoilect this, and pardon rr.ty if I have failed in this inita.^cc. TO DR. Wi BUEL. I 3.I the neceffity for it leffened, while the fymptoms con- tinued which made it ufeful in the commencement.— On the contrary, it was oftentimes as requifite, and as beneficial, the fifth and the fixth days, as on the firft. But this neceffity for its ufe, at fo late a period, did not often occur, where it had beem vigoroufly em- ployed, in conneaion with other remedies, at the firft. The following cafe, which I ftate briefly, is one among numbers, in evidence of the advantage of early, free, and repeated bleeding. A phyfician was called to a young man, with all the fymptoms of the difeafe—as it generally appeared at the firft—in the evening. He bled him 16 or 18 ounces ; direaed purges, &c. in the manner hereaf- ter to be mentioned; and though the weather was then cool, ordered the windows to be removed, both day and night. The fymptoms were relieved ; but the next morning it was thought neceffary to repeat the bleeding ; which v/as done, to an equal quantity. The purges, &c. were alfo continued. In the even- ing, a third bleeding was performed, and a like quan- tity of blood was taken away ; and the other reme- dies were continued. On the ninth day, from the feizure, the man was well, and able to purfue his bu- finefs; though his ftrength was not perfeaiy ref- tored. In one inftance which came to my knowledge, bleeding removed an obftinate vomiting, of many days continuance, which threatened the life of the pa- tient, and which had refifted all other remedies. It feems hardly neceffary to add any thing more, in favor of this remedy, after its beneficial effects have I32 LETTERS FROM DR. E. H. SMITH, been ftated, with fo much eloquence and perfpicuity, by Dr. Rufh, in his various publications, refpeaing the Yellow Fever. II. Purging. No cafe occurred, in my particular praaice, where, notwithftanding the vomiting, ca- thartics could not be adminiftered. When this fymp- tom was very troublefome, they were required to be given in a folid form, at more confiderable intervals, and of as fmall a fize as poffible. The aaivity of the purge was always to be proportioned to the vio- lence of the fymptoms; and it was important that all medicines of this kind fhould be given in divided dofes—fo as to promote a gradual and continued dif- charge.—The operation was often very much affifted by clyfters; for which water alone was neceffary. The good effeas of cathartics were not lefs obvi- ous than thofe of veneefeaion. They were indicated by the conftipation, fo generally prefent; by pain in the bowels, flatulency, and tumefaction of the abdo- men ; by pains of the head, heat and flufliings of the face, and of the whole body ; and finally, by the vo- mitings : and all thefe fymptoms they rarely failed to obviate, or relieve. This relief^ too, v/as oftentimes fo fudden, as to feem like enchantment.—Frequently have I feen a patient, after an hour or more of fevere pain, reftleffnciS, heat, thirft, and inquietude of every kind—feeble, exhaufted, and as it were, ready to ex- pire—rife with the greateft difficulty, and with the aid of others, to the chair, and after his evacuation, feel his pains removed, his heat and reftleffnefs va- nished, his ftrength renewed, and himfelf able to fit up, or walk about, and breathe the air with freedom: and fometimes, the difcharge was followed by a re- frefiiing lleep, and gentle perforation. TO DR. W. BUEL. " 133 Thefe benefits were neither fo certainly, nor fo fre- quently, obtained, where the evacuations were violent and fudden. Indeed, it appears queftionable to me, wmether it be ever proper to excite fuch difcharges, in Fevers. Patients, when much reduced, are apt to fink under fuch immediate and abundant evacua- tions. III. Cool Air.—It was of the utmoft importance to procure a conftant application of cool air to the body of the patient, from the commencement of the Fever. The advantages which refulted, were univer- fal and wonderful.—To this end, the fick were or- dered to be placed on a hard bed, with very little covering, in the middle of the room ; and the doors and windows were, as much as poffible, kept open day and night.—The good effeas of this practice were exceedingly increafed, where the application of the cool air could be made to the patient in an erea pofture. For, not only was it more equable, but the head was alfo relieved, thereby, from that fenfe of fullnefs and oppreffion which was invariably experi- enced in a recumbent pofture. The fick, therefore, were direaed to fit up, in the courfe of the day, with the affiftance of their attendants, as long as their ftrength would permit, without their becoming ex- haufted. While in this fituation, their feet and legs were covered more warmly than any other part of the body: and if cloths, dipped in cold water, or vinegar, were often applied to the temples, the relief obtained was ftill greater. IV. Cool Drinks.—The great thirft, which was nearly univerfal in this Fever, from the firft, made the drinks, of neceffity, an article of early attention. It was obfervable, that they never could be too cold. Pa- 134 LETTERS FROM DR. E. H. SMITH, tients complained of the warmth of water which had been ftanding but a fhort time ; and feemed to languifh for a fupply of frefh water, with an anxiety which became truly painful, when the ufual hour of its diftribution approached.* ■ The good effeas of a plentiful ufe of cool, dilut- ing drinks, were obvious. They tempered the pre- ternatural heat and anxiety of the ftomach ; often re- ftrained vomiting, and the faucial hemorrhage ; ferv- ed to dilute, and carry off, the offenfive contents of the interlines; and difpofed to a more equable and aqueous fweat.—Of all other drinks, Water was moft relifhed—and on many accounts, was the moft pro- per. A pleafant and fuitable drink was made, by pouring warm water on frefh apples, and fuffering it to cool; and likewife, by the addition of a piece of toafted bread to water. Milk, much diluted with water, was relifhed by fome ; fome were fond of but- ter-milk ; and as ail thefe poffeffed bland and nutriti- ous, qualities, they were advantageoufly ufed, where a variety of drinks was required by the capricious tafte of the patient. I had no opportunity of trying the effcacy of ice, but the teftimony of a Phvfician, in whofe judgement and veracity 1 place great confidence, is ftrongly in its favor, and inclines me to believe that it may be ufed with high expeaations of advantage. Under h;s dircaion, it anfwered, better than any thing elfe, ..'-i relieving heat and fever; reftraining hemorrhagy; * The water which is ufed for drinking, in this city, is moftly drawn from a fmgle pump, calk d the Tea-Water Pump; and it is ditlributcd, by means of large cafes, which are carted to every part cf the town ; ouce a day, ;:: v.ir.tcr ; and every morning and afternoon, in fummer. TO DR. W. BUEL, x35 and obviating, partially, or entirely, the vomiting—^ even the black vomiting. V. Cleanliness.—This is of the utmoft impor- tance, and, in a meafure, indifpenfable.—The bed and body linen fhould be often changed ; the cloaths neceffary about the bed, well aired, feveral times a day : there fhould be two beds, one of which may be aired, while the other is in ufe: all unne- ceffary furniture—particularly woollen, filk and cot- ton—every thing which may abforb and retain efflu- via and moifture-—fhould be removed: all utenfils employed about the patient, frequently changed and rinfed: the room fhould be often fprinkled and dufted : the face, mouth, eyes whole head, hands— and, where it can be done, body of the patient, waffied with cool water, feveral times in the day. The more exaaiy—other circumftances being regarded—thefe direaions can be put in execution, the better for the patient; and, as my own experience convinces me, the more certain and fpeedy will be his recovery.— You will obferve that I fay cool water ; for I cannot believe that the fhock which would follow from the application of cold water to the body, would be be- neficial.—It is not here, as in the ufe of air ; for water is fo much more perfea a conduaor of heat, that the abftraaion would be univerfal and fudden, were it applied cold. And, befide, as much is effeaed per- haps, by the ablution, a by the coldnefs, confequent upon bathing. It was not in my power, in any cafe, to carry this praaice to the extent I wifhed ; but, ceteris paribus, the relief of the patient was proportioned to the de- gree in which it was purfued. T LETTERS FROM DR. E. H. SMITH, VI. Blisters.—The advantages ufually derived from the ufe of blifters, were not evident. It was fometimes doubtful whether they were any way ferviceable. Yet there were inftances in which they afforded relief; though moftly temporarily.— I have feen them, applied to the breaft, relieve the oppreflion at the lungs ; and applied to the back of the neck, relieve the head : in both cafes, when the difeafe had been of fome days continuance. A phyfician, to whom I mentioned thefe remarks, in- formed me that his experience juftified them, except when, as was often obferved by him, a hemorrhage enfued from the vefication, and continued for fome days. Perhaps it was neceffary to the efficacy of blif- ters, that they fhould have been, always, preceded by copious blood-letting. VII. The Tinclura Sacra, given in fmall quantities, at intervals, in water, was found by one Phyfician, to have the happieft effeas, in relieving naufea, and obviating the tendency to vomit, in all cafes where a deftruaion of the coats of the ftomach had not taken place. The fame gentleman derived much advantage over the difeafe, where, from long-continued vo- miting and effort to vomit, the ftomach appeared to have fuftained confiderable injury, or abrafion, from the ufe of 01. Oliv. vel amygdal. dulc.—The oil co- vered the inflamed, or abraded, part, and proteaed it from mechanical ftimulus, while it allayed the forenefs and irritation produced by the aaion of the difeafed fluids it contained. VIII, Food.—I have before remarked that the fick ftiewed no preference for animal food ; on the con- trary, they very generally refuted it. Some, who requefted it to he prepared for them,found themfelves TO DR. W. BUEL. 137 unable to eat it, when prefented to them.—Fruits, milk, bifcuit rjoiled in milk or water, fago, falep, hafty-pudding, and vegetable food, generally, were mofl relifhed .by them, both during their illnefs and their convalefcence.-—This was peculiarly fortunate, as any indulgence in a contrary courfe, was fure to be followed by diftreffing effeas. The more rigidly attentive patients were to preferving a fimplicity of diet, the more certain and pleafant was their recovery. And, in all cafes that I had opportunity to obferve, their convalefcence was always extended or fhortened, tedious or fatisfaaory, in proportion as they returned fuddenly to the ufe of meats and ftimulating drinks, or adhered to vegetable food and water. * # * * # # * * # # ### I have now, my dear friend, made you acquainted with that courfe which I generally purfued, in regard to thofe who came under my care. The number was not great, nor the fuccefs always complete—for I had not always the liberty of employing the means I wifhed to, as fully and freely as was neceflary to com- plete fuccefs. But, I can truly fay, that I never faw them do injury ; and that they appeared to me to do good, in every cafe, where they were employed, and in the proportion of their trial and application.-— More than this no man can truly declare ; more than this ought never to be expeaed from any remedies. The moft able praaitioners are deftined to fee their patients frequently expire, in ipite of all their care, through the obftinacy of the patients themfelves, and the prejudices of their friends, the careleffnefs of at- tendants, or the intervention of unforefeen and una- voidable accidents. The confciofunefs of having done their duty, of having acquitted themfelves, under cir- I38 LETTERS FROM DR. E. H. SMITH, cumitances fo diftrefsful and embaraffing, to the beft of their knowledge, and with purity of intention, will prove a never-failing confolation, though the execra- tions of ignorance, and the calumnies of hatred, may purfue and perfecute them.—Happy,—at leaft in this refpea,—are thofe, "' the peacefultenor of'whofe way," while it excites neither oppofition nor malice, and neither elevates to opulence nor fame, fecures them from mifreprefehtation and injuftice. LETTER TENTH. Mifcellaneous remarks on Medicines ufed as Remedies in the Fever, and general conclufions. You with to obtain every poffible information, refpeaing the Fever of 1795 ; you are not fatisfied with knowing what remedies I employed, nor which were moft fuccefsful; but you would learn all that were ufed; the fuccefs, or failure of each. I ap- plaud your curiofity, my friend, for I am not ignorant of the benevolent motives which excite it; but I fear that there is little with which it is in my power fur- ther to gratify it. The praaice which I faw, was that which I have recommended: other remedies I know were ufed ; but, not having had opportunity, but in few inftances, to mark their effects, I ought not, from my own conviaions, how well-founded foeyer they may appear to me, precipitately to con- demn either the prefcriptions, or their authors. In the variety of cafes, conftitntions, and circumftances, it might happen that fome of thofe very things, which TO DR. W. BUEL. 139 appeared pernicious when I faw them ufed, were fometimes proper and falutary. It would be pre- fumptuous, therefore, in me, to decide without more information ; but I may be allowed an opinion; and that opinion need not be with-held from a friend.—I confefs, then, that from the fuccefs which attended the antiphlogiftic plan of cure, I am perfuaded that no other can be falutary, or fafe; and the few in- ftances in which the effeas of a different mode of treating the Fever were obferved by me, ftrengthened my previous conviaions of its inutility and dan- ger. The medicines chiefly trufted to, by thofe who purfued a different courfe from that laid down in the preceding letter, were, as I am informed, Calomel, to promote, or effea a Salivation,—Bark—Lauda- num—Wine, and other ftimulating drinks—with an Animal diet. Of the effeas of Salivation, not having feen it take place, by nature nor art, in the Fever of 1795,1 can fay nothing. Dr. Rufli countenances the praaice, in his Treatife on the Fever of Philadelphia, and adds the teftimony of many refpeaable authorities to his own.—As a Cathartic, Calomel, combined with other purgative fubftances, was unqueftionably ufe- ful. Some, I know, thought otherwife; and that other purgatives might be more fafely and efficaciouf- ly employed; and, I confefs, I faw fome cafes in which it appeared to affea the ftomach very painful- ly. But a Phyfician on whofe judgment I have great reliance, informs me, that he faw reafon to re- jea a fimilar opinion, which he had haftily adopted; repeated obfervation having convinced him, that all the fymptoms of gaftric affeaion were worfe in thofe I40 LETTERS FROM DR. E. H. SMITH, who had not been purged with Calomel,'than in thofe who had been evacuated by its affiftance. I gave Bark, in no form, but in three cafes. Two were in the early part of the reign of the Fever, the two firft patients that I had; and I am convinced it retarded the cure in both. In the other inftance, it was adminiftered after the Fever had left the Patient,. and he was convalefcent. Here it was given as anv other Bitter, and as much in compliance with his opinions, as from any expeaation of its doing good; and, as far as I can judge, with very little effea of any kind.—In the following cafe, its exhibition was not fo harmlefs. A medical friend was called to vifit the patient of another Phyfician, who had quitted town, on account of his health. The fick man was oppreft by the moft alarming fymptoms; of the number of which, were hemorrhagy and the black vomit. The ftimu- lating fyftem had been fleadily purfued, and was con- tinued, under the direaion of a pupil of the phyfician firft employed. In particular, large quantities of Bark were exhibited, throughout the day.—On the entrance of the fecond phyfician, the Bark and all other medicines of the kind, were laid afide; cool air was freely admitted; and the antiphlogiftic plan of cure ftriaiy adhered to. The confequence was, that all the fymptoms were relieved, and a profpea opened on the patient of a recovery. The vomiting and hemorrhagy had totally ceafed. In this fitua- tion, and while the Phyfician was attending to fome perfons whofe condition was more alarming, the perfon who had the immediate charge of the fick man, began, again, to adminifter the Bark.—The next day —or the very ftmie, at night—all the bad fymptoms TO DR.W. BUEL. I4I recurred; the Bark was, neverthelefs, perfifted in \ and the man died. Several fimilar cafes have been reported to me ; but none fo minutely as to authorize an attempt to ftate them to you. The extreme reftleffnefs of a patient, in whom I had the ftrongeft intereft, and for whofe fate the deepeft anxiety, induced me, in violation of my more fober judgement, to adminifter Laudanum.— This I did not do, till he had fpent three nearly fleep- lefs nights.—In every inftance, it undoubtedly, in- creafed the reftleffnefs, clammy fweats, thirft and Fever. I was obliged to difcontihue it. Wine, brandy and water, and efpecially porter, when taken by any of my patients, had the moft per- nicious effeas. I had occafion to fee an accefs of Fever, repeatedly brought on by the one, and a re- lapfe by the other; where they were ufed without my knowlege, and contrary to my direaion. Of the effeas of Animal Diet, I have already fpoken, and have nothing new to add. On the whole, it appears inconteftible to me, that what is called the antiphlogiftic treatment is to be adopted in Fevers like that which prevailed in New- York, in 1795, in all its ftrianefs, and adhered to with pertinacious refolution. Both the fymptoms of the difeafe, and the fuccefs attendant on the praaice recommended, concur in eftabliihing the propriety of employing it.—It is alfo to be remembered that, in this difeafe, not a moment is to be loft : a day, an hour, nay almoft an inftant of delay, may fometimes be fatal j and the means prattifed muft be powerful in proportion to the violence of the fymptoms. Nei- 142 LETTERS FROM DR. E. H. SMITH, ther muft we be deceived by the apparent mildnefs of the feizure—for a few hours may. entirely change the face of things, and we may be left to lament that credulity which led us to temporize, and prevented the ufe of thofe remedies, which delay alone rendered ineffeaual. But, while the Phyfician ftrenuoufly direas his ef- forts to the removal of the fymptoms of this difeafe, let him not overlook a paffion which never fails to aggravate them. Fear, the exciting caufe, in many in- ftances, of the Fever; the fomenter of all its evils j and fometimes, as it were, the fole difeafe; is a fre- quent and dreadful calamity, and one of the direft adverfaries with which medicine has to contend.—In numerous inftances, during the continuance of the Fever of 1795, apprehenfion touched upon infanity; deftroying all confidence in the Phyfician and in re- medies, or exciting an abfurd and enthufiaftic reliance on pretenders and madmen : and utterly difqualfying the patient for a proper attention to himfelf.—In the well, the evil was fcarcely lefs. The name, alone, of Yellow Fever, feemed fufficient to induce difeafe, to banifh discretion, to fever the bonds of focial connec- tion, rend afuiider the ties of parental, filial, and con- nubial affeaion, and put reafon to flight.—It was in vain to point out the folly of this terror; to declare the difeafe not infeaious, and eafy of prevention ; to offer mathematical demonftration that other diforders were often more mortal, without exciting any alarm ; it was ftill the Yellow Fever, and that was an irrefi- ftable reply to every argument.—The city of New- Haven, fummer before laft, loft about 50 of its inha- bitants, with the Yellow Fever. Univerfal confter- nation prevailed throughout the place ; all bufinefs was at an end ; and molt of the principal inhabitants fed.—Laft fummer, the Dyfentery raged there : more TO DR. W. BUEL. H3 than 70 perfons died of it: but nobody fled; nobody was frightened ; and the Magiftrates, very gravely, put a flop to all communication with New-York, for fear of the Yellow Fever; made veffels ride qua- rantine, and confined ftage-coach paffengers, that no contagion might be diffufed, through the city, from their trunks and their garments.—But, it is time to put an end to this feries of letters ; and feek, by no- velty, to give new intereft to our correfpondence. I fhall take my leave of the prefent fubjea, with an enumeration of the inferences I have drawn from having viewed it, in the light here exhibited to you. 1.. The Fever of 1795 was Endemic :—i. e. gene- rated by local caufes, producing a Fever every year, in this city. 1. The peculiar ferocity of the Endemic of New- York, in 1795, is afcribable to the peculiarity of the feafon, together with a greater accumulation, than ufual, of the ordinary caufes. 3. It was not Contagious : i. e. communicated by contaa of difeafed perfons, by cloaths, nor by vifiting the fick, &c. 4. As it originated here, its prevention will depend on a change of the local and individual circumftances which promote it. 5. The Fever in 1795, exhibited fuch appearances as charaaerize what are cuftomarily denominated In- flammatory Difeafes. 6. It is cured by the remedies fuited to remove In- flammatory Difeafes. , LETTERS FROM DR. E. H. SMITH. 7. The fame caufes which converted the ordinary Fever of New-York into the Yellow Fever, would change the Fever which prevails around our Wef- tern Lakes into the Yellow Fever; and, as certainly, the Intermitting Fever of Sheffield : while the efta- biifhment of a free ventilation, the filling up of all pools, yards, &c. and a fcrupulous attention to clean- lirfefs and fimple diet, would reduce our Fever to a ftmple Remittent or Intermittent, or remove it alto- gether ; as the filling up and cultivation of your ponds and marfhes, would forever banifh all Fevers of the kind—as general difeafes—from Sheffield. fc# *###*##***■* I have now, my dear friend, performed the tafk demanded of me, in the beft manner I am able con- fiftent with my leifure, and my duty towards others. I cannot conclude without once more foliciting yout indulgence, and requefting you to recollea with what expeaations and confeffions I entered on the compo- fttion of thefe letters.—I have taken the words of Cicero for my motto— " Rationem, quo ea vie curnque dueetfequar—" And if I have erred in my conceptions of what is reafon, and what was faa, let my intentions prove my apology. an-n.n^-.li. i.— . |..... II I .Ji ._|---n-----|r LETTER FROM DOCTORS TAYLOR AND HANSFORD, TO THE PUBLISHER, LETTER FROM DOCTORS TAYLOR AND HANSFORD. TO THE PUBLISHER. NORFOLK, VIRGINIA, DECEMBER, 1795 SIR, If, in our attempts to add to your information reflecting the fever, which prevailed here in Auguft laft, we fhould draw upon us the illiberal farcafms, which we have obferved to attend all who endeavor to ferve their fellow creatures in this way; we muft leave it to you to juftify our intentions, at leaft, be- ing ourfelves unprepared to anfwer any thing which may be objeaed to what we fhall advance. We mean to ftate faas, or what we believe to be fuch, and willing to admit that there are feveral ways or. curing the fame difeafe. It will not be underftood, that we reprobate the praaice of others who follow a different mode of treatment. Our obfervations have been drawn from thirty years experience with the advantage of records relating to fimilar diieales for a muchlonger period. We do not know of a more regular mode of treating the fubjea than by anfwering your inquiries in the order they occur, which will perhaps comprehend every thing required at prefent. I48 ACCOUNT OF THE FEVER IN NORFOLK. The Fever we believe has its origin in the feafon,, and exifts every year in various grades, beginning generally in the month of Auguft, and difappearing about the middle of Oaober. The precife time of its commencement and termi- nation, and its degree of malignancy, depending upon contingent caufes. We have been accuftomed to call it a Bilious Remittent, with a tendency to putrefac- tion ; whenever it proves uncommonly fatal, it is aggravated, according to the beft of cur obfervation, by the prevalence of fome unufual weather for a long time together—Thus we have feen this difeafe equally malignant after a dry hot feafon, and after a very rainy period. The approach of frofty weather being uniformly the cure for the effeas of either.— The Fever of the laft autumnal feafonj appeared firft on the river, then on the ftreets adjoining ; was foon after diffufed through the town and fuburbs, and finally the neighboring country ; though in this laft not generally : as ufual it declined on the approach of cold weather.—The month of June had been very cool, and at the change of the moon, or a little be- fore, it began to rain in torrents, and fo continued to do, with fhort intervals of clofe fultry weather, till Auguft, when a violent hurricane, attended with a flood of rain, laid wafte the whole vegetable king- dom—afterwards the weather was as before, fultry and moift, with profufe fhowcrs till the end of Sep- tember.—The firft appearance of the Fever was about the 1 oth of Auguft ; it increafed in violence and in extenfion during all that month ; it was per- ceived then to abate, and continued to do fo till the laft day of September, when a few frofty nights fu- pervening, it difappeared almoft fuddenly and en- tirely. ACCOUNT OF THE FEVER IN NORFOLK. I49 There were perhaps more deaths, than for many years before ; but whether greater in number to the proportion of the fick, than is ufual from autumnal difeafes, which prove as univeifai as that in queftion, we cannot undertake to determine. The fame mode of treatment generally fucceeded^—as in other fea- fons. Our method was plentiful depletion in the be- ginning, not by bleeding, but by purging with Jalap, Calomel, Scammony, Aloes, or by the milder purges, the Neutral Salts—Sennae, Rhubarb, Manna, &c. as the age, fex and conftitution of the patient pointed out,-—taking care that the evacuation of the firft paffages was complete) by whatever means procured. As foon as we judged that to be fufficient—which we always endeavored to make fo with as little delay as pofnble-^-the bark was adminiftered in all and every form that it could be made to remain, without re- gard to quantity, or to the period, or heigln of the fever, with wine, porter, and even brandy, if wine was rejeaed by the inclination, habit, or ftomach of the patient. We can affure you, we have no reafon to alter our mode of praaice in future. In a multitude of inftances, fome will occur in all difeafes, when a change, and fometimes a material change of reme- dies may be neceffary--fuch cafes we found, and in thofe we ufed Blifters, Emetics, Camphor, Opium, and often ventured upon Cupping—but never upon vengefeaion.—This laft, a long courfe of praaice has taught us to be at leaft, not advantageous. In diffe- rent climates, and under other circumftances—when the difeafe may have appeared in other grades than thofe we have experienced—that operation is perhaps found Ufeful. We wifh not to impofe our opinion, as a rule for any perfon ; fenfible of the fallability of all human judgment. We ever thought it our duty to give up our own theories, when contradi&ed by events. We only mean "to recommend that plan, I50 ACCOUNT OF THE FEVER IN NORFOLK. which long experience has taught us to be moft fuc- cefsful. There is no proof that this difeafe poffeffed any fpecific infeaion. It was rarely fatal to the na- tive inhabitants or the old fettlers, fpeaking of. the town only ; but we have been told that many of the traders from the Rivers and diftant part of the State, died immediately after leaving the port. The terror which pervaded all parts of the country, and deprived thofe viaims of the common attentions of humanity, will eafily account for this without applying to the malignancy of the difeafe. All, or moft of thofe born in, or who" had been accuftomed to a fouthern cli- mate, efcaped death, and when attacked, had the dif- eafe in its milder,form. A large number of the inhabitants enjoyed unin- terrupted health ; moft of the deaths happened in confined ftreets and buildings, and in thofe. neareft the river.—Thofe who were accuftomed to live well, (as it is termed) did not fuffer fo much as the poorer clafs—But the intemperate of every defcription be- came viaims when attacked-—The fmall pox imme- diately preceded this fever. We, did not obferve that thofe who had been the fubjeas of it were par- ticularly fufferers.—There had been no malignant complaint in the preceding winter. A particular defcription of the fever, and its fymp- toms, does not feem to be here neceffary, becaufe, it differed from the ordinary Bilious Remittent, only in the rapidity with which it paffed through the feveral ftages, and in its malignancy.-—This laft circumftance we are of opinion was occafioned by the long conti- nued and univerfal heat' and inoifture of the atmof- phere.—The air was evidently impregnated with pu- trid effluvia, arifing from decayed fubftances of every fort, brought down upon the creeks and rivers by the •• • ?■+ r • • ,.\S ' a • • •'#;^ <—* --^ imp1. • . V/ • fc^: s r» .. x,^ T * '•- <*£