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                       AN-



                 ON THE DISEASE CALLED


  YELLOW  FEYER;

            WITH OBSERVATIONS  CONCERNING

FEBRILE CONTAGION, TYPHUS FEVER,
      DYSENTERY, AND THE PLAGUE,

              PARTLY DELIVERED AS THE

          4K ulstoman 3Uctm*0,

                    BEFORE THE



           IN THE YEARS 1806 AND 1807.
4i
    BT EDWARD NATHANIEL BAJV&ROFT, M. D.
FELLOW OF THE ROTAL COLLEGE OF PHYSICIAHS, PHISICIAW TO THE AKMT, ASI) LATJS
              PHYSICIAH TO ST. GEORGE'S HOSPITAL.

            AND REPUBLISHED, WITH NOTES,

     BY JOHN B. DJljkl)GE, A. M. M. D.
   AND PROFESSOR OF ANATOMY LN THE UNIVERSITY OF MARYLAND.
 " V ignorance d'une verite en physique peut nous cacher la cause d'un phenomene
naturel;  mais Perreur etablie au lieu de la verit6 arrete les progres de la science, et
substitue des songes et des chimeres aux faite et a la nature.—II est des crreurs et des
verites qui touchent les hommes des plus pres que les autres, et ce sont surtout celles
qui regardent la conservation de son individu.—F<ontana sur les Poisons et sur les
Corps Animal, tome i. page 97, 4to
              Baltimore: A, 3 tHr *-~   i
PUBLISHED BY  CUSMNG AND JEWETT.
             J. Robinson, printer.
                 1821.
* 
     District of Mart/land, Set.
     BE IT REMEMBERED, That on the tenth day of February, in the Forty -
          fifth year of the Independence of the United States  of America, Joseph
 iiiM'H'WWi CcsHiNGand Joseph Jewett, of the said District, have deposited in this
fSEAL.f Office the title of a Book, the right whereof  they claim as proprietors,  in
 *********** the words following, to wit:
   "An Essay on the disease  called Yellow  Fever;  with observations concerning
 " Febrile Contagion, Typhus Fever, Dysentery, and the Plague, partly  delivered
 "as the Gulstonian Lectures, before the  College of Physicians, in the yea^s 1806
 "and 1807.   By Edward Nathaniel Bancroft, M. D.  Fellow of the Royal College
 "of Physicians, Physician to the Army, and late Physician to St. George's  Hospital;
 "and republished, with Notes, by John B. Davidge, A.  M. M. D. and Professor
 "of Anatomy in the University  of Maryland.
  "L'ignoranced'une verite en Physique peut nous cacher la  cause  d'une pheno-
 " mene naturel; mais I'erreur etablie au lieu dc la vc-i-ke arrftte les progres  de la
 " science, et substitue des songes et des chimeresaux faits, et a la nature.—II est des
 " erreurs et des verites qui touchent les hommes des plus presque les  autres,  et ce
 "sont surtout celles qui regardent la conservation de son individu.   Fontana sur les
 *' poisons et sur les Corps Animal, tome i,  page 97, 4to.
     In conformity to an act of the Congress  of the United States, entitled,  " An
 act  for the encouragement of learning, by  securing the  copies of maps, charts,
 and books, to  the authors Imd proprietors  of such copies during the times therein
 mentioned." And also to the act, entitled,  " An act supplementary to and to amend
 the act entitled, " An act for  the  encouragement of learning, by securing the copies
 of maps, charts, and books, to the authors and proprietors of such copies during
 the  times therein  mentioned,  and  extending the benefits thereof to the arts  of
 designing, engraving, and etching historical and other prints."
                                                    PHILIP MOORE,
                                        •   Clerk  of the District of Maryland.
4 
INTRODUCTION,
  Whatever obstructs the progress of science, or
throws a shade over  the research of philosophy, is a
subject of fair and legitimate  criticism.  Truth, phy-
sical, moral, or political, is tfie  common property of so-
ciety ; and every member of the literary whole, may, ac-
cording to taste and ability, enlarge its bounds, or pro-
mote its interests.   Where motive  is ingenuous, it is
commendable; and manner, though awkward, may be
pardonable.   But  before we  write,  we should  think;
and  before we publish,  we should at least understand
the nature, if not  the extent of  the subject, on which
we are about to  admonish  the  world.   The  publick,
however ready to learn,  is impatient of unprofitable in-
trusion.  Vanity may invite  derision, but knowledge
alone communicates information.
   The man  who conceives that  the use of writing con-
sists in the multiplication of books, mistakes the adula-
tion of private vanity for the approval of publick senti-
ment.  It is the pleasure or the  caprice of the many to
write, the good fortune of the few to convey knowledge. 
IV                  INTRODUCTION.
 In the reiteration of what has been said, is not always to
 be found the illustration of what is valuable.
   The promotion of science, the encouragement of arts,
 the amusement of the curious, or the polish of the social,
 appears  to be the chief, if not only object for which the
 pen is properly used.   And every writer who undertakes
 to maintain, with success and understanding,  a discus-
 sion,  or to arrive at any satisfactory conclusion, through
 a process of reasoning, must in the first place  settle his
 principle and define his object.
   Dr. IIosack,by undertaking to write a nosology, prac-
 tical  he  terms it, necessarily pledges himself  to throw
 additional light on what is 'already befoie  the profession,
 or to  give something new.   Merely to repeat  what has
 been  uttered, were  to  fatigue  himself, and disappoint
 his reader.
  The learned author, in his preface, offers  the  most
ample opportunity  for us to believe that  nosology, the
science of disease, is not a branch of natural history;
that it is  a thing indeterminate in form, and  mutable in
principle,  t or he says,  that " in the details,  however,
of the synopsis now to be submitted, it will be readily
perceived, that I  have been more solicitous  to  convey a
distinct enumeration of the characteristick or pathogno-
monick symptoms of diseases, and to form those associa-
tions  which are connected with their cure, than to ob-
serve  the rigid rules exacted by the the naturalist in the
formation of the genera and species."
* See Pref. p. viii. 
INTRODUCTION.
V
  The rigid rules exacted by the naturalist, in the forma-
tion  of genera  and species, can only be  such as an
honest and  faithful history of the distinctive characters
may suggest, by which animals, vegetables, and mine-
rals, can be  formed into genera and species.  Any other
rules would be absurd and beside  the subject.   And
these rules  can be derived  from  no other source  than
nature herself, in her varied forms.
  The  formation  of genera and  species, pre-supposes
distinctive characters; and to be distinctive, the charac-
ters  must be regular, otherwise they could not consti-
tute rules to the naturalist,  nor would  the naturalist be
intelligible to his  reader, when he might speak on his
genera and  species.
   The writer says, " that I have been more  solicitous
to convey a distinct enumeration of the  characteristick
or pathognomonick symptoms of diseases"  &c.
   The writer's object clearly appears to be a distinct
enumeration of those symptoms  which are  character-
istick of diseases,  and such  as will enable him to " form
those  associations1'' which   are  connected  with  their
cure; and no doubt to be intelligible to his readers, was
a part of his purpose.   And yet he tells us,  that  he  is
not to be expected to observe the rigid rules exacted by
the naturalist.
   To the naturalist  there  is  no other rule than that
which is derived from characteristick or distinctive phe-
nomena, nor indeed can there be.  The ingenious no-
sologist assures  us, that his object is to  convey a distinct 
VI                  INTRODUCTION.
enumeration of the  characteristick or pathognomonick
symptoms of diseases, tyc.  Then by what rule does the
author attempt to convey a distinct enumeration  of pa-
thognomonick  symptoms?  If not by the rigid rule  ex-
acted by the naturalist, by what other rule does he at-
tempt  to form  a distinct enumeration  or association of
symptoms ?
   As the author admits that  diseases have their distinc-
tive or pathognomonick signs, and indeed such a conces-
sion is implied in the very attempt distinctly  to enume-
rate the symptoms,  in what  does the nosologist differ
from the naturalist?  Each is bound, by the ordinary rules
of history and narrative, to give an ingenuous statement
of those characters that are indicative of the genera and
species, or, in other words, proper to their subjects.
   If a distinct enumeration (what is not essentially regu-
lar,  cannot  be  distinctly enumerated,)  can be given  of
patlwgnomonick symptoms of diseases, in the very  ad-
mission itself, disease is allowed to be fixed and deter-
minate in its nature; and of necessity,  disease is a  part
of natural history.   It is not presumed that disease is the
production  and intention of art, although it may be, at
times, the result of casualty.
   By what  the writer admits, it is conceded, that  no-
sology is a  science;  and that there are  other sciences,
denominated natural sciences,  or branches  of natural
history.  It  is also suggested  by  the necessary import of
the  assumption, that the sciences of nature, in  object 
INTRODUCTION.
Vll
and principle, are fixed; but that the science of nosology
or disease, is variable and indeterminate.
  The end  of the following pages  is to show that no-
sology is a science;  that it is, radically and  fundamen-
tally,  fixed and immutable in its nature and character;
and that it is a physical or natural science, attended by
as few marked or sensible variations as any other branch
of natural history equally extensive.
  Were disease  mutable  in  its fundamental laws, it
could exhibit no  general or uniform phenomena.   The
doctrine  of  disease  would become a  mere  object of
speculation.  In  it there would be nothing regular or
formal on which the understanding could exercise  its
powers, much less could any gentleman, possessed of in-
tellectual sanity, undertake to give to the world a distinct
enumeration of those signs which should be  pathogno-
monick,  and by which future generations are to distin-
guish one kind of disease from another.
  " It is not, indeed, to be contended," says Mr. Good,
" that the distinctive signs of diseases are as constant and
determinate as many of the distinctive signs that occur in
zoology and botany; and so complicated is the animal
machinery,  so perpetually alterable and altered  by cli-
mate, idiosyncrasies, and the many accidental circum-
stances by which life is diversified, that the general rule
must admit  of a variety of exceptions, and is here, per-
haps, rather than any where else,  established by such
exceptions."

                Dr.  Hosack's pref. p. viii.
*% • 
Vlll
INTRODUCTION.
   With the opinion, certainly not argument, of this clas-
sical writer before his eye,  the  author of the nosology
undertakes to  convey a distinct enumeration of the cha-
racteristick  or pathognomonick symptoms of diseases;
constant or determinate signs.
   If the signs  be not constant or determinate, will inge-
nuity itself explain now a distinct enumeration of symp-
toms  characteristick  and pathognomonick of diseases
can be given?
   To say that signs  are not determinate, and yet are
characteristick of  diseases,  is to lay  the  rational mind
under a serious contribution, and awaken sentiments of
compassion.
   " That the distinctive signs of diseases are not  as con-
stant as the distinctive  signs that occur in zoology and
botany; and so complicated  is the animal machinery,  so
perpetually alterable  and altered by habit, climate,  &c.
&c." is one of those bold and gratuitous assertions which
forces  us  to appeal to the observations and records of
naturalists, in  regard to animal life.   Alterations in ani-
mal life, to be entitled to consideration,  must mem funda-
mental and radical.  If animal machinery be fundamen-
tally alterable  and  altered,  what preserves the races of
animals distinct?  How is it that the  horse has not de*
generated into the monkey,  and man  into  the  ass ?
   Upon what principle will learned  gentlemen  explain
how the signs in  zoology are constant and distinctive,
and yet the animal machinery so alterable and so altered
as to call for exceptions  to general rules? 
                   INTRODUCTION.                  iX

  Either the animal  machinery is not  alterable or  al-
tered,  radically, or the signs of the animal  economy
cannot be  distinctive.  What is not constant, is-not
distinctive.  And what is altered, is not constant.  Does
animal machinery refer to the human animal only?  Is
the brute  an animal?  Or does zoology treat of, ani-
mals?  And if the reference, by the  learned writer,  be
to man only,  is the human more alterable than the brute
animal? Or either,  than vegetables?
   It is below the dignity of science, and insulting to  the
human understanding,  to  bring such follies before  the
publick eye.   Mr  Good may be very classical, in  the
opinion of the gentlemen of New-York, but  certainly,
he is neither very intelligible, nor philosophical.
   " It is true," says Dr. Young, " that we  must not  ex-
pect the same  rigid accuracy in medicine, that may be
obtained in  some  of the  departments  of natural  his-
tory, since, in fact, many of the distinctions which  are
required in a nosological method, are rather established
for the sake  of practical convenience," &c. &c.
   Nothing can be  more unintelligible and inexcusable,
than this  confusion of  nosology and general  medicine.
The subject before  the reader, and that  to  which his
attention is called by Dr. Hosack, is the science of  no-
 sology—the  science of disease.  The  science of medi-
 cine involves more extensive considerations.
   Nosology  is a discourse on disease, as it is cdgnizable
 by its diagnosticks or  more  characteristick  signs.   In
 other words,  it is  the  science  of pathognomonicks.
 This  appears  to be  the acceptation and import of the
                           2 
X                 INTRODUCTION.

term,  by all  medical philosophers, from the  earliest
periods in which the science has been cultivated.
   Human nosology, then, is that discourse which treats
of the diseases, in  their sensible characters,  to which
the human body is liable.
   Disease  is,  essentially, in nature, in laws  and  phe-
nomena, the same,  whether art interfere  or not.  The
intention of art is  not to produce,  but remove disease.
Hence  it follows,  that the  science of disease must be
viewed  apart from that art which human  ingenuity and
skill employ for the removal of disease.   No two things
can be  more distinct.   The small-pox occurring in the
savage,  at the  most remote distance from professional
aid, is the same in  signs and nature, as that which takes
place in civilized life.   In the eye of science, the dis-
ease, and the art resorted to for the removal of the dis-
ease, are mutually opposed in fact and nature, however
intimately,  in  the views and practice of the profession,
they may be associated.
  The  science of medicine is general, that of nosology
particular.   Nosology refers to nature, incumbered and
disordered  in  her  functions;  art  to human  skill, ad-
dressing itself  as well as  it may to the  removal of dis-
ease and restoration of health.
  Art,  in its  address to  the  removal of disease, may
vary; and vary it will, according to experience, to ed-
ucation, to  intellectual  ability.     Different   intellects,
viewing the same  phenomena, will make  different de-
ductions, as those  intellects may be vigorous or feeble;
educated or ignorant; liberal or  prejudiced.  But te 
                   INTRODUCTION.                 XI
                                     s
detain the reader longer in pointing out the  incongruity
and absurdity  of extending our views  to general prac-
tical medicine, in a discourse professedly on  nosology,
were  to offend his good sense.   What the writer  can
mean by a practical nosology, I  must leave to his own
interpretation.
  That nosology  furnishes the signs  from which the
rules  of practice are deduced is true, for it  furnishes
the only means by which the professional man can form
any idea whatever of  the particular  condition of the
bodv  against  which art directs  its  force.   But yet  it
constitutes no part of  the therapeutrick scheme,  and
hence can never be,  to  my understanding,  practical.
But I leave the  solution to the ingenuity of the author.
  Nosology,  or  the science of  disease, implies three
things:   1st.   There  necessarily must be  a subject, a
body  to be diseased:  2dly.  There must  be an agent
or a cause:  And 3dly, there must be  diagnostick signs,
or disease could not be  recognised.
  Although nosology  has chiefly for  its object a con-
sideration of the phenomena, yet the subject and the
agent are involved  in the general idea of disease.  And
either the human body cannot be a subject of nature,
or the agents are not productions  of nature,  or the phe-
nomena can  take place without a subject or an agent;
otherwise I expect to show  that the science of disease
is a science of nature.
  That  science is said to be a natural  science, the
scope, object,  and tendency of which are, to treat of those
subjects and  agencies  that strictly are physical.  The 
Xll                 INTRODUCTION.

business of natural history, is to record  the things and
operations of nature.
  A science is termed a natural science, in contradis-
tinction to the science of the mind; to the science of
general or particular  state polity;  to the. mathematical
or demonstrative  science;  to the tactical or maritimal
science.   Tacticks and navigation, however, are rather
arts  than sciences.  To the above  enumeration might
be added the forensick and  medical sciences;  as far
as the latter has  a practical interpretation,  however, it
is generally styled the " art  of healing "   Although in
a more general acceptation,  the medical science  is de-
nominated the science of healing;  but not so properly.
For  assuredly, as relates to practice, medicine is an art,
purely tentative;  a matter of experiment solely.
  It is  conceded  on  all hands, that if  it can  be  esta-
blished that the science of disease is a branch of natu-
ral history,  it  follows, of course, that in character and
diagnostick, it is fixed and determinate.
  The laws of animal iife, on which depend the struc-
ture and  economy of the animal  body; by which, at
first, the whole organization  was laid out, and by which
it is reproduced and  sustained, are natural  objects; ob-
jects of which the science  of nature   delights to dis-
course.  And it  is in these  principles  of life that the
susceptibilities reside, on which the morbid agents act.
Can natural history treat more properly of  any subject
than of the structure, the life, in  its  sensible pheno-
mena, and of the susceptibilities of the human body? 
INTRODUCTION.
Xlll
  This structure, this life, and these susceptibilities, are
intimately  concerned in  disease.   And surely,  so  far,
disease is  a subject of  a brancii of natural  history.
And, so far, must be as unchangeable as the principles
of life themselves.
  But  the principles of  life  on which morbid  agents
exert their forces and  powers, are not more the sub-
jects of nature  than the agents  to  the operation of
which are finally to be traced the disease.  Nor  can
those agents exert their influence,  except through pro-
perties natural and  intrinsick to themselves  as  agents.
We cannot conceive a fundamental change in the pro-
perties of an agent, but with  a radical alteration of the
thing  itself.   And upon such alteration it ceases to be
an agent.
  Granting that  the  subject  and agent are the  objects
of natural history, I propound the question, what  can
the  result or  disease be?  Can a  subject be acted  on
otherwise than through its own capacities? Or an agent
act  by other  instruments than  qualities  intrinsick to
itself?  Is  not  the  disease immediately and necessarily
consequential on such operation?  But still we are  told
that the science  of disease is not a science of nature;
that the phenomena of disease are not the  proper ob-
jects of natural  history!  If not the legitimate  objects
of natural history,  of what history are they the  proper
objects?  Diseases have existed from time immemorial,
and we have histories  of diseases.   Shall we denomi-
nate such histories medical histories ? 
XIV
INTRODUCTION.
  Medical histories  are complex,  not  simple; and in
strict propriety, are more annals of the efforts of human
skill and art for the removal of disease, than  of disease
itself.  Had there been no medical profession, the pen
of the historian would have transmitted down to us the
narrative of disease.
  Nature, in her  general scheme, is uniform; otherwise
ruin would invade the universe.  But one part of nature
may fall into collision with another part, and the regu-
larity and uniformity of particular laws be disturbed. In
lifeless nature, we style such disturbance and irregu-
larity disorder, or disarray. In enlivened nature, we de-
nominate such disturbance of function, or alteration of
structure, disease.  And although disease be not a  part
of the natural  healthy functions of the body, yet it must
be viewed as the natural result of agents acting on these
functions.
  A  column  of electrick fluid passes  from  a cloud
electrified plus, to one  electrified  minus;  or a column
descends  from a  cloud to the earth;  the atmosphere is
greatly  rarified;  a sudden evaporation from the cloud
is produced;  and by this sudden evaporation, the tem-
perature of the cloud is depressed, and a portion of the
water of the cloud is rapidly changed, by the sudden
and great loss of heat,  from a vaporous to a solid state.
Irregular masses  of ice are formed, which, partly from
the resistance of the air down through which they are
preoipitated, and  partly  from laws proper to themselves,
constitute hail, or congealed bodies.   These,  by their
own superior  gravity, and the  impulse received from 
                   INTRODUCTION.                 XV

the violence of the wind,, in their  descent, injure and
destroy trees, brutes, and men.
   Here, from a simple exchange between the clouds, and
a descent to the earth, of an electrick column, we per-
ceive the most  disastrous  consequences.   The  contu-
sions in  some,  and the deaths of other  animals,  are
equally with the prostration of the forest, subjects of
natural history'.   And it is  natural science, that by its
lamp,  conducts  curious  inquiry  from the last effect to
the  first cause,  explaining  to the eye  of enlightened
intelligence, this awful  but grand  phenomenon.   How
simple the philosophy of the formation of hail,  during
the days of the highest temperature—a sudden evapora-
tion*
   The marsh effluvium, wherever found, and however
produced, never from animal matter, is an agent brought
into existence by a certain combination of natural atoms
by laws proper  to these  atoms.   Or it is an agent from
some simple source and indecomposable.   Its nature is
inscrutable.  But,  compound or simple,  it is furnished
from nature's stores.
   This effluvium is poisonous to human life, and pro-
duces  disease.   And to whatever period of the  history
of its  operations the eye of observation is directed, the

 * I wrote an essay on this  interesting phenomenon  between ten
and  fifteen years  ago, for the Maryland Society; in which I at-
tempted to prove  that the  formation of  hail in hot  weather was
wholU attributahle to a sudden passage of electrick fluid from cloud,
to cloud, or to some other body. 
XVI                INTRODUCTION.

same effects will be perceived under the same circum-
stances.   Nor in the opinion of the medical philosopher
is there any fact  more certain,  or  better established,
than  that men living within its range, will be effected
with  diseases  of the  spleen and liver; with diarrhea,
intermittent, remittent, and yellow fevers.
   How is this fact established, so as to be made a thing
of uniform belief?   Is it from individual "observation, or
the general history of the effects of this poison?  Surely,
from  general and acknowledged history.
   This effluvium,  whether in  the East Indies or  West
Indies,  in Greece  or  Italy,  France or America, is  the
same; the human body  and economy are in principle
and general attribute  the same.   Thus it occurs, that
wherever the poison  is evolved in given quantities,  we
see the swollen spleen, diseased liver, bilious colick,
morbid secretions of  bile, with all their consequences;
sick stomach, diarrhea, dysenterick phenomena; inter-
mittent, remittent,  and yellow fever; and these  modifi-
cations under various  incidental circumstances.
  The variety in the effects of this effluvium on the hu-
man body, is not greater than in the conditions  under
which water is found; sometimes of ice, or snow,  or
frost,  or fluid, or vapour, the productions of incident or
circumstance.   But yet water modified, as it may be, is
the same, and an object of natural history.  The- effects
of the marsh poison are equally uniform.  In the same
intensity, and under the same circumstance, and on the
same  excitability,  the phenomena will be without va-
riety, and is equally a subject of natural science. 
                -  INTRODUCTION.                XVU

  For a physician  to say that disease, in principle and
nature, is alterable, is to inform the world that he is to-
tally ignorant of the science and history of disease, and
of what he undertakes to speak.
  We at times,  it  is true, have a new disease to come
in upon us.   And  what is this, but a discovery that out
previous scheme of science  did not embrace a know-
ledge of all the  possible morbid effects, or causes ade-
quate to the production of disease ?  Or indeed, that
some new  agent or combination had come  into opera-
tion.   But such would be from the  store-house of na-
ture, or her plastick, creative power.   But this is not
change; it is only  an addition  to the old stock, nume-
rous enough already!
  That one and the same disease can  arise from this
cause  to-day, and that cause to-morrow, is unphiloso-
phick  and  absurd  in the extreme, and in the face of all
the facts of history, and analogies of nature.  As I have
advanced,  I believe, somewhere  else, there is nothing
better settled in science, than that no simple effect can
be produced by any two or more causes distinct in their
nature.  Every simple  effect must be referred to some
simple cause, aided as it may be, by incident and casu-
alty.
   What I have said of marsh effluvium, I might, with
equal propriety, repeat of the various animal, vegetable,
and mineral poisons.  They are all from the great work-
shop of nature,  and all their  effects on the human body,
necessarily consecutive of their attributes.
                        8 
XV111
INTRODUCTION.
   I might here  refer to other irregularities and disor-
ders in the physical world; the tornado, the earthquake,
the water-spout, &c.  &c.  and ask the question—are
they more the productions of natural changes and com-
binations than the  plague, the small-pox, the influenza,
the canine madness, the mumps, &c. ?  Or are the for-
mer better known  than the latter, in their sensible phe-
nomena or ruinous effects?  But the one is said to be a
branch of natural history; the other is a branch of what
science?   Is  the tornado, the  earth-quake, the water-
spout, more  constant  and  distinctive in their effects,
than the small-pox, siphilis, the canine madness,  &c.
&c, in their diagnostick symptoms? The  former and
the latter both vary in degree.
  The learned professor has given to the  world a no-
sology;  but to what  end or purpose, if disease be not
regular  in its sensible signs, the professor has, in so
laboured a manner, spread himself before the world, I
cannot conceive.   If the animal machinery, the human
structure, be so alterable and altered, and the symptoms
of disease so irregular and inconstant as to make the sci-
ence of disease a matter of speculation,  what benefit or
advantage can accrue  to the profession from any efforts
at distinct enumerations of character?
  The diseases of the subsequent year may  not  be
known by the phenomena of the precedent, and those
of New-York may never appear in  Baltimore, Philadel-
phia,  or Lexington.   Where, and what then  are the
advantages derived from spending a great deal of money,
and wasting much more valuable time, by attendance on 
INTRODUCTION.
XIX
lectures in New-York, for two or three seasons? If dis-
eases do appear, and they will  not fail to  annoy the
world, they may manifest themselves under new forms*
How unavailing our  knowledge and  our reading!  For-
mer realities have become unreal, and our science va-
nishes  like the  dream of a feverous  moment.  Of all
men in the world, the nosologist should be  the last to
utter a word  against uniformity  and regularity of diag-
nostick and pathognomonick in disease.
  The able and ingenious professor offers to the world
a nosology, and in the very prefaee  assures his reader,
that the literary performance to which his attention is
invited, is entitled to but little consideration.   For if di-
agnosticks are not constant and determinate, it may be
insisted that the most laboured writing is vain, and the
most sedulous perusal equally vain.  But the Doctor de-
clares his to be a " practical nosology."  I  would much
rather see a scientifick nosology;  a nosology founded on
nature  and accurate observation.   In my estimation,
those distinctions, in any nosological method, which are
established for the  sake  of practical convenience, are
slightly to be valued.  Nosology cannot be supposed to
take its character and form from practical convenience.
On the other hand, practice must always derive its les-
sons from that  order of sensible characteristick  signs
which nature presents, and, by the aid of which alone,
we can form any rational idea of the condition of parts
or the whole body.
  Were a physician inadequate  to  discriminate  a re-
mittent fever from a small-pox, or a  condition of mea- 
XX
INTRODUCTION.
sles from a pleurisy, or an apoplexy from an hydropho-
bia ;  or were a surgeon unable to distinguish a wen from
a cancer, or a varix from an aneurism,  he would pro-
voke the contempt of every man who had ever looked
into a medical book.   But yet diagnosticks are not de-
terminate!
  I ask again, if the science of disease or nosology be
not a branch of which natural  history treats,  will the
learning of  Dr. Young,  or Mr.  Good,  or any other
learned gentleman, inform  the profession to what his-
tory it may be referred ? 
ADVERTISEMENT.
In me year 1806, I was appointed to deliver the Lec-
tures  founded  by Dr. Theodore Gulston ; and  having
chosen the Yellow Fever as my subject, and prepared
myself to discharge this duty, I found it would be  im-
possible to  read what I had written, within the time
allowed for these lectures  ; and considerable parts of
it were, therefore,  separated,  and  laid aside.   These
have  been  since restored, and some facts  have been
added, which  had not  then  occurred.  I have, more-
over, subjoined three chapters on Typhus,  Dysentery,
and the Plague, which  seemed fit  to be connected or
contrasted with the Yellow Fever, or with each other.
I have also added eight Appendices, to confirm or illus-
trate particular  positions,  contained  in the Essay on 
XXii               ADVERTISEMENT.
Yellow Fever:  and as  only the first two parts of this
Essay were printed, when I determined to embark for
Jamaica, I requested my father to superintend the re-
mainder of the volume.

  There are- no diseases which  affect mankind so ex«-
tensively, or produce so much  mortality,  as  some of
those which occupy this volume  ; and as very opposite
opinions  are  entertained,  respecting  their origin  and
contagious power, real or supposed ; and as this opposi-
tion  of opinions is disreputable both to the science-and
professors of medicine, and incompatible with the best
interests of mankind, I have endeavoured to remove all
doubt and  obscurity from these important questions,
and place them beyond the reach of future controversy.
How far this endeavour  will prove successful,  time
must discover.   But in regard to the Yellow  Fever, I
am persuaded that I shall have done more than enough
to convince every candid and judicious reader, that it
possesses no contagious power ; and that a considerable
part of the facts and arguments which I have employed
for this purpose, might have been spared, had I not
been also anxious to convince, even the most prejudiced^
on this subject. 
                  ADVERTISEMENT.             XXU1
  I know, indeed, that many of these facts, and argu-
ments, have been already noticed ; some by one, and   ^
others by different writers ; but  as in these ways, they
have failed to produce that general conviction, which is
most  desirable, I have thought I might render an im-
portant service to mankind, by so collecting and arrang-
ing the proofs, and reasons connected with this question,
as would best fit them to elucidate, and  support each
other, even if I had not been able to  add any thing
new,  and valuable from my own stock.

   I know, also, that I have been anticipated in several
of my most important conclusions ; but as I was led to
them, rather by own train of reasoning, than  by defer-
ence  for the opinion of  others,  however respectable, I
may in  regard to these,  say with Montaigne,  " Que la
verite, et la raison sont communes a un  chacun, et  ne
sont pas plus a qui les a  dites premierement,  qu'a celui
qui les a dites apres."   I have, however, commonly
mentioned those writers, by whom conclusions similar
to mine were first advanced,  (so far, at least, as  they
are known  to  me) for the purpose of giving them  all
due  credit, and also to  confirm my  own opinions,  by
their authority ; and, in my quotations, I have, with
two  or three unavoidable exceptions, always referred 
       XXiv              ADVERTISEMENT.
       to the particular pages of the several works whence my
^  ,   extracts were taken ;  so  that my readers  may be able
       to ascertain the accuracy with which they have  been
       made. 
AN ESSAY
                       ON THE

DISEASE  CALLED YELLOW FEVER,  $c,
PART  I.
          APPELLATIONS OF THE TEIXOtV FEVERi

The Fever which is to form the chief subject of my inquiry,
has been called Typhus icterodes, by Sauvages, and Typhus
cum flavedine cutis, by Cullen; it is generally known, in this
country, by the name of Yellow Fever; among the French,
by the names of Maladie de Siam, and Fievre Matelotte; and
among the Spaniards, by those of Vomito Prieto, and, accord-
ing to Coreal and Ulloa, Chapetonada.
  The title bestowed by Sauvages is improper, because  the
Fever in question (independently of any discolouration of the
skin) does not accord with his own definition of Typhus, and
also because, as will be proved hereafter, it is not connected,
at least not generally, with any morbid state either of the liver
or of the bile, nor with any permanent obstruction to the pas-*
sage of that fluid  into the duodenum,—causes to which icterus,
or jaundice, is commonly  referred.  Dr. Cullen may have
been, in some degree, aware of the latter objection j and  he
may, on that  account, have been induced to  lay  aside  the
epithet of " Icterodes," used by Sauvages, and to substitute
for it the words  " cum flavedine cutis," in his designation of
                           4  - 
26
  the disorder: but even these, as well as the English epithet of
  " Yellow" Fever, are objectionable,  because  they  draw tin-
  character of the  Fever from a symptom  which is very often
  wanting, even m the most severe cases  of the disease,  and
  which certainly is not always of high importance when it does
  occur, very  many persons having recovered  after  heing re-
  markably yellow.
    The term of " Vomito prieto," or "black vomit," is likewise
  objectionable, because this  symptom does not occur in  a  very
  large proportion of the persons who are attacked by the Fever
  now spoken  of;  it is, moreover, certain,  that neither* the
  yellowness of the skin, nor the discharge! of a dark-coloured
  matter by vomiting, nor even the existence of both these symp-
  tom s\ in the  same patient, is peculiar to that disease.

   * Dr Lind mentions (at pages 188, 198, &c. of his Essay on the health of
 Seamen) the existence of a fever at Portsmouth, on board of several ships of
 war lately returned from Louisbourg and Quebec, " which went commonly
 under the denomination of  the Yellow Fever, from the sick often becoming
 yellow "  This was clearly a different disease from the Yellow Fever of hot
 climates.
   f See page 30, of "  Surgical Observations on the constitutional origin and
 treatment of local Diseases," by John Abernethy, Esq for an instance of black
 vomit in another disorder.
   t One instance will  suffice to show, that those two symptoms are some-
 times combined  in other diseases.  Dr. William Stark, respectable for his
 accuracy, and zealous pursuit of knowledge,  in his valuable Clinical and
 Anatomical Observations, (" the materials of which," as he tells us, " were
 collected at a great hospital," which it is wtll known was St. George's Hos-
 pital, London, where it will not be suspected  that cases of Yellow Fever
 wen- to be found) relates, at ch. 1, §. 2, the case of a  man who died from
 " inflammation of the smaller intestines, with effusion of blood," and whose
 body he examined after death.  From  this case the following lines are ex-
 tracted: " A man ag^d thirty, unknowing of any cause, was one evening
 suddenly seized with retching and vomiting,  which were  frequent, day and
night, ever after."  " His skin became  yellow on the fourth day, and  what
he vomited was observei'., on the eighth, to  be of a coffee-colour." " He
died on the thirteenth  day." 
                             87

  Several writers on the Yellow Fever, who have been sensi-
ble of the impropriety of the above appellations, have adopted
others, taken from among the names given to fevers by the
ancient Greek physicians.  In the works attributed to Hippo-
crates,  mention  is made of  violent febrile disorders, which
sometimes proved fatal  on the fourth  day, and  even sooner,
and were attended with incessant vomiting, sometimes of black
matters, yellowness of skin, and other affections so similar to
those which are frequently observed in the Yellow Fever, that
I am disposed to believe that they could  be no other disease.
These fevers are  described under various names, such as
* xaLvtro?. xacwsvwJW Tu0a$, tKTepoi Xeisrvpit] QpeiHTtr vi<r»if*A zret%u  &C.
but as the descriptions are either very loose or very brief, and
as each of these  names is also applied to other very different
diseases, it is evident that no precise meaning can be affixed to
them, and that  confusion would result from  employing any
one  of them  to designate the  Yellow Fever.
   It is unquestionably of great moment, both for the advance-
ment of science,  and the prevention of dangerous errors in
practice, that disorders should not be arranged under impro-
per  titles: and of all titles, none  can be  more improper, or
tend more to embarrass inexperienced practitioners, than such
as are borrowed from certain symptoms, which, like the yel-
lowness of  skin, and the black vomit, besides being wanting
in the great majority of patients,  do not, in general, make
their appearance, when present, till towards the close of the
disease.  I hope, therefore, that the disorder,  of which I  am

  ♦ For KKvrai, see Lib. de judicat  page 54, line 54 of Fcesius's Hippocrates,
Geneva, 1657; and Lib. 1, de Morb. Vuig. Sect. 7, p. 954. D : for kxvtu^,
Lib.  de Affect, p. 519, 1; 21: for Tttyas Lib- de intern. Affect p 553, 1 6.:
for »*7«f««, Lib. de Morbis, p. 49 », 1. 6; and Lib. de intern. Affect, p. 551,
1. 8: for totirvgi?). Lib de Vforb. p. 467,  1. 10 : for  <P?tnti^ Lib. de Affect.
p. 518, 1. 21. and for vim/toi ^*x», Lib. de intern. Aflfcct. p. 559,1. 14. 
28
to treat, will, ere long, receive a more appropriate name than
any yet bestowed upon  it; but I must leave  to  others the
task of proposing one, and content myself with that of Yellow
Fever, since it is, at present, in general use.   I  beg, however,
to observe, that if it be allowable to apply to a disease, affect-
ing the whole system, a name which designates only one of its
symptoms, the terms of causus, or of ardent Fever, seem to be
the most eligible of all the appellations that  have been bor-
rowed from the ancients, and given to the Fever here treated
of; because the excessive heat of the skin, and indeed of the
whole body, is a symptom which occurs not only very gene-
rally, but also very early in the disease, and requires particu-
lar notice for the successful treatment of the malady:  so that
either of the above names, especially the latter, is well adapted
to direct the  attention of the practitioner, however inexperi-
enced, to an important point of practice, arid is not liable to
mislead him  in other respects, or to occasion uncertainty or
delay as to the management of the  patient in the first stages
of the Fever. It appears to have been upon  similar grounds
that Dr. Towne,  M. Poissonnier Desperrieres, Dr. Moseley,
and Dr. Fowle, have applied the one or the other, or both, of
those  names to the Yellow Fever.
  Before I proceed to describe the appearance of this disease,
I shall  briefly notice the  indiscriminate mode in  which the
term Yellow Fever has been employed; a subject  not unim-
portant in  itself, since- it is probably owing to a want of pre-
cision in the use of that term, that so  much ambiguity has
prevailed, even  to the present time, concerning the nature of
the disease.  The  truth is, that in those countries in which
the temperature of the atmosphere is usually heated, during
certain seasons, to 85°, or more of Fahrenheit's thermometer,
in the day time, all febrile affections, however produced, have
a tendency, in consequence of the action of heat on the human
body, to assume  the violent and  dangerous form which is 
                            29
generally considered as characteristic of the  Yellow Fever.
Thus, the fevers which sometimes originate from intoxication,
and other excesses, from taking cold, or from fatiguing exer-
tions  of body, while exposed to the sun, or strong agitations
of mind, are, in  those  hot seasons liable to be accompanied
with the same severe and fatal symptoms which occur in the
terrible Fever that occasionally  attacks  a great  part of the
population  of certain  towns  situated  in warm  latitudes  ;
and from this resemblance, the term Yellow Fever has  been
equally applied to Fevers, which are strictly sporadic,  and
comparatively rare, and to Fevers  truly Epidemic*  But,
although the same symptoms be observed in the Sporadic, and
the Epidemic Yellow Fever, the course of these is not exactly
similar, and their causes are totally different.  The Sporadic
Fevers are always, I believe, of the  continued type, and are
brought on by certain affections of the body and mind, operat-
ing only upon a few individuals;  whereas the Epidemic Fever
almost  always manifests  a disposition to remit, unless the
speedy  death  or  recovery of the patient precludes a second
paroxysm;  and  it arises from causes of a generaknature,
such as are  capable of operating on  a considerable number of
persons at the same time.  The causes of the Sporadic Yellow
Fever are so well known, that it is in the power of almost
every  individual  to preserve  himself from its  attack;  but
those of the Epidemic Fever  are  still  involved  in so much
obscurity, and placed so little within our power, that neither
■human  ingenuity, nor patriotick  zeal, with their  most perse-
vering efforts, have as yet been able to hinder its appearance,
or perhaps materially to check its  ravages.   Tliis is, there-
fore, the most formidable and interesting to mankind; and it
will, for this reason, form the  chief object of  my present in-
  *  By the term Epidemic, I understand simply a disease prevailing in an
extraordinary degree, without any reference  to contagion^ which I do not
consider  as being essential to an Epidemic. 
30
quiry.   A great part of the subsequent observations, however,
concerning the symptoms  and the treatment of the  Yellow
Fever, wilf, I think, be found  equally applicable to the Spo-
radic and to the Epidemic disease.  Both  have,  kideed, been
described by so many writers  of great eminence, that it will,
I hope, not be deemed improper in me to abstain from giving
a minute account of all the various symptoms of this Fever in
its several  forms, and to confine myself to those only which
are of most importance, as indicating  the nature of the dis-
ease, and the parts principally affected by it, together with the
proper means of obviating, or removing those affections.

                       SYMPTOMS.

The progress and violence of the Yellow Fever differ great-
ly,  according to the force of its cause, the vigour and excita-
bility of the  patient,  and  the season of the  year.   When it
prevails epidemically  in hot climates,  and attacks young and
robust men, lately arrived  from temperate regions,  the disor-
der commonly  appears in  its  most aggravated form.  In this
the patient first complains of lassitude,  restlessness, slight
sensations of cold and nausea, which symptoms  are soon suc-
ceeded by strong arterial action, intense heat, flushing of  the
face, redness of the eyes, great pain and throbbing in the head
and in the eye-balls, uneasiness and pain in the stomach,  op-
pression of the prsecordia, a white fur on the tongue, and a
dry, parched skin, with a quick, full, tense,  and generally
strong pulse, though  it is sometimes oppressed and irregular.
These symptoms are speedily  accompanied by frequent efforts
to vomit,  especially  after swallowing food or  drink,  with
discharges, first of such matters as the  stomach happens to
contain, and  afterwards  of  considerable quantities of  b.ile 
31
 appearing first  yellow, and then green,* sometimes  tinged
 with blood, but, in the progress of the disorder,  w ith matters
 of darker colours ; an increase of  pain, heat, and soreness at
 the prsecordia, also occurs, with constant wakefulness, and, fre-
 quently, with delirium, more or less violent.   This paroxysm,
 or  exacerbation,  which has  been   called  the  inflammatory,
 or the febrile stage, generally lasts thirty-six  hours,  but is
 sometimes protracted for  seventy-two hours, and even longer,
 probably in consequence  of either general or local inflamma-
 tion, (particularly in the brain or stomach) or of irregularity
•in the circulation, which are known to prolong the paroxysms
 in Fevers of Type.
   A remission then occurs,  in which many of  the symptoms


   * The green colour of the bile, wh ich is very frequently brought up by vomit-
 ing,  has been attributed,  by some writers,  to a morbid  condition, or action
 of the liver, or gall-bladder   It would probably, however, be more just to
 attribute it to a spontaneous, and, as it may be called, chemical change-, which
 the bile itself undergoes in the  duodenum and stomach, while these viscera,
 being debilitated by disease, or by the  operation of certain medicines, and
 particularly of emetics, no longer possess the power of preventing the matter
 which they contain from acting chemically on  each other, and forming de-
 compositions and new combinations.  This power of the stomach, which has
 been called by Dr. Fordyce its governing power, will be particularly noticed,
 at page 13, &c. in treating of the symptoms which denote a putrescent state
 of tht fluids  It is well known, that the fsces  of infants,  although yellow
when voided, (which is the proper colour of the bile mixed with them) fre-
quently become green after some time ; and, in addition to this, I may ad-
duce the following fact from page 206,  of Dr-  Heberden's Commentarii  de
morborum  historia & curatione.  " Cujusdam icterici urina saturrime fusca,
paucas horas servata, viridem colorem induit;  quemadmodum mterdum fit
in vomitu*bilis flavae,  cujus color  post  aliquam moram in viridem mutari
solet."  As acids, when added to bile,  change its  colour from yellow to
green, it is, probably, from a mixture with acescent matters that  the bile
becomes green within the intestines : and this is the opinion which the late
Dr. John Hunter also entertained on the subject—See page 129 of bis Ob
servations on the diseases of the Army in Jamaica. 
32
subside, ;m> as often to induce a belief that the Fever is at an
end, and recovery about to, take place.   Frequently, however,
the foundations of  irreparable injury to the brain or stomach
have already been laid in the former paroxysm, and in such
cases the remission is short and imperfect.  During these re-
missions the pulse often returns apparently to the condition of
health, the skin feels qooI and moist, and the intellect, if pre-
viously disturbed, sometimes becomes clear; sometimes, how-
ever, the patient remains in a quiet and stupid state, a symp-
tom generally denoting great danger.   Another sign of dan-
ger, as denoting a very morbid condition of the stomach, is
the renewal of the efforts to  vomit when pressure is made on
that organ, or food is swallowed.  After  a certain interval,
this remitting stage is succeeded by another, which may be
called the second paroxysm, and which probably would appear
as a renewed exacerbation, if the  violent effects of the first
had  not almost  exhausted the  patient's excitability, and in
conjunction with the  extreme depression of strength  which
usually attends inflammation of the brain or stomach, rendered
him nearly  unsusceptible of those morbid actions  which are
necessary for that purpose.  In this latter stage, then, instead
of great febrile heat, and strong arterial action, the warmth of
the body, and the frequency  and strength of the pulse,  are
often  less than when the patient  was in health ;  but frequent-
ly the pain  and heat in the stomach become excruciating, with
incessant strainings to vomit, which, in most of the fatal ca-
ses,  are followed  by  hiccough,  and repeated discharges of
matters resembling turbid coffee,  more or less diluted, or the
grounds of  coffee,  and also  by evacuations of  similar dark
matters from the bowels.  Here it is to be observed, that when
these symptoms occur, (indicating a violent affection  of the
stomach and bowels,)  the patient is, in-general, sufficiently in
possession of his intellects to know those about him,  and to
give distinct answers to questions made to him,  although his 
33
 excessive weakness often renders him incapable of mental ex-
 ertion, and his inability even to raise his head, may induce the
 appearance of coma.  In those cases,  however,   in which the
 brain has suffered greater injury than the stomach,  the retch-
 ing and the black vomit,  just described, do not so commonly
 occur,  but instead of them,  low  muttering,  or coma,  with
 convulsions of the muscles  of the  face, and the other parts
 of the body, supervene.  About this time, also, the tongue and
 teeth are covered with a dark brown fur;  yellowness of  skm
 and petechias make their appearance;  the urine,   when passed
 has a putrid smell  and dark colour ;# the  fseces likewise be-

   * Of the many authors who have treated of putrefaction in fever, the late
 Dr. George Fordyce seems, in his investigation of that subject, to have ap.
 proached most nearly to the truth.   His reasoning thereupon, which will be
 found at length at page 71 of the first part  of his third Dissertation  on
 Fever, and at page 151 of his Treatise on Digestion, may be summed up as
 follows :
   The Creator, as one  of the means of destroying and removing the remains
 of the successive races  of animals  and vegetables as  they become extinct,
 which otherwise must have accumulated on the surface of  the globe so  as
 to afford no space for new  generations, has ordained that dead animal and
 vegetable matter should be subject to certain processes called fermenta-
 tions, and terminating in putrefaction. Now every circumstance which would
 cause a rapid putrefaction to  take place in the dead body of a man, is con-
 stantly applied to the living body;  viz. a warmth of nearly 100 degrees of
 Fahrenheit's thermometer, thecontactof atmospheric air, and motion; and
 although no  chemical circumstance  has been discovered in the body of a
 living man that is capable of hindering such putrefaction from taking place,
 nevertheless the body of a  living man has  no  appearance of putrefaction :
 and hence he concludes, necessarily, that there is in  the life, independently
 of all other  circumstances, a power of preventing putrefaction.  Thus en-
dowed, the living body is able to preserve, from the fermentations  above-
mentioned, not only its own solids and flu'ds, but also,  when in health, the
extraneous matters, as aliment, which it contains ; and thus, when the living
power of the stomach  is strong, 'the food thrown into that viscus will be
perfectly digested; but, when the organs of digestion are weak or disordered,
or when food is given to an animal which is not adapted to its organs of  d;
                                 5 
34
 come most  offensively putrid ;  haemorrhages sometimes tak«
 place from the nostrils,  gums, and various other internal sur-
 faces ;  there is,  in some patients, a suppression of  urine,  in
 others an involuntary discharge of  it,  and of the faeces :  the
 pulse becomes feeble and intermits; the breathing is laborious,
 portions of the skin assume  a  livid colour, the  extremities
 grow cold ; and life is gradually extinguished.
   This is a general outline of the Yellow Fever,  when it  ap-

gestion, a greater or less portion of that food is not governed by the stomach,
but runs  into the fermentations which would arise, if it had been in the same
 chemical circumstances, out of* the body.  It seems to  be upon the  same
principle (viz the defect of the governing power, as  Dr. Fordyce has not
inaptly styled it, of the organs, or vessels,  of the body over the substances
the}' contain) that we are to explain why, in certain  morbid conditions, the
faeces, the discharges from tht vagina, *and from wounds or ulcers, and  also
pus, in the lungs, or other parts, the urine, and even the  blood, which has
been itself supposed to possess a living power, become putrescent.  ••  The
putrescency of the blood," (says Dr. Fordyce, at page 285  of the 1st volume
of the Transactions of a Society for the improvement of Medical and Chirurgi-
cal knowledge) "is ihe effectof the depression of strength ; for it happens  only
when there is great depression of strength;  and when such depression arises
in any other case the same progress  towards putrefaction is always ob-
 served."  It is a confirmation of the above  opinion, that,  in most of those
cases of injury to the spine, or disease of the bladder, in which this viscus
loses the power of contraction, it also soon  loses  its governing power, and
the urine is voided in a putrescent state, like that voided  in severe  cases
of fever.
  Two distinguished modern physiologists have stated it as their belief, that
the stomach and intestines had,  under certain circumstances,  a  power  of
■secreting air; but even their authority has not removed  the objections  to
that opinion which appeared to me to exist; and the generation of the air
in question will, perhaps, be more satisfictorily explained by supposing that,
under such circumstances, the governing power of those viscera is, in a cer-
tain dtgree, impaired,  in consequence of which chemical decompositions of
the matters contained m them begin to take place, and air is thereby evolved.
 It is not necessary to remind the reader' of the volumes of various gazes
which can bt extricatvd by chemical agencies, from even small masses  of
 most of the substances usually existing in the alimentary canal. 
35
pears in its most violent form ; and in this form  it some?
times proceeds  with so  much  rapidity  as to destroy  the
patient  on  the third or fourth  day, or  even sooner.   But
the disorder frequently appears  in  a milder form at first;
the course being protracted into several paroxysms,  shor-
ter at first, and  followed by  more  distinct remissions,  but
afterwards increasing in violence and in duration, when  the
disease terminates fatally.  In these  cases, death usually hap-
pens between the seventh day and the fifteenth.
  The features,  which  are the most remarkable in this dis-
ease,  are the affections of the head, of the stomach, and of the
skin ; and I therefore propose to offer  some observations  on
each of them.  There is great  reason  to believe, both from
the symptoms,  and  from  the frequent examinations which
have been made after death,  that most of  those,  who die of
the Yellow Fever, are destroyed in consequence of some irre-
parable injury having occurred either in the brain, or  in the
stomach.  It seldom happens, however,  that these organs are
both  mortally injured in the same subject ;  more  commonly,
one of them only is dangerously  affected.  I do not here mean
to aflirm, that there have been cases of  the  Yellow Fever, in
which a fatal affection of the head  had supervened,  without
any disorder of the stomach ;  or cases  in which the stomach
was much diseased,  while the. brain  continued  in  a sound or
healthy state ;—for I believe,  on the Contrary, that these or-
gans  jointly suffer more or less in every case and species of
Fever ; but,  according to my experience, and that of several
very respectable practitioners, with whom I  have conversed on
the subject,  those patients in the Yellow Fever,  who die from
an affection of the head, generally perish early in the disease,
and with less vomiting, especially of  blackish, or dark-colour-
ed matters ;  whereas, on the other hand, those in whom  this
last symptom greatly predominates,'  are usually found to have
their  mental faculties clear, though often  much  weakened > 
36
 and they  seldom expire before the end of the fourth, or the
 beginning of the fifth day.

                       DISSECTIONS.

 When the bodies of patients, in  whom the affection of the
 head formed the principal feature of the disorder, have been
 inspected after death, the integuments of the brain have gene-
 rally been found more or less inflamed,  especially near the
 temporal bones ; the vessels of the dura mater,  and of the pia
 mater,  were not unfrequently observed  to be very turgid w ith
 blood, which moreover was sometimes  extravasated.  Effu-
 sions of a watei-y fluid also have occasionally  been seen over
 the surface of the brain, or in vesicles between the pia mater
 and the tunica  arachnoidea.   In some cases, the integuments
 have been  so firmly  attached to each other, and to the brain,
 that, in attempting to raise, or separate them, a part of the
 substance of the brain  has been torn up.  The  volume of the
 brain is often increased, and  the substance of  it is, in some
 instances,  more firm than usual;  when cut,  the vessels distri-
 buted through it, have been so distended w ith blood,  that the
 medullai'y part has immediately become thickly spotted  with
 red points,  owing to the oozing of blood from the divided ves-
 sels ; and it was not rare to find that some of those vessels had
been ruptured,  and that blood had escaped into the substance
of the  brain.   The ventricles  have usually  contained water,
frequently of a  yellow colour,  and were, in  some cases, quite
filled with  it.  The plexus choroides has often been loaded
with blood.
  Such is  the disorganization which careful dissectors have
uniformly detected, in  a greater or  less  degree, in those ca-
ses of the Yellow Fever in  which the predominant symptoms
indicated a severe affection of  the head.   It accounts  suffici-
ently for the occurrence of those symptoms, and for  the fatali- 
37
 ty which so often attends them,  as well as for the derange-
 ment of mind, the loss of memory, the impaired state of the
 Bight, and  other  senses,  and the extreme  feebleness of the
 limbs, which are the frequent consequences of this disorder in
 those who escape with life;  and from which they sometimes
 recover Aery slowly.
   Those cases of the Yellow Fever, in which the stomach is
 principally affected, are next to be considered.  This organ
 appears to be the most universal and important of all the vis-
 cera, and that which is the most indispensably necessary to
 animal life.   Some  animals are organised with so much sim-
 plicity as to have no visible brain, heart, or lungs; other ani-
 mals, with cold blood, which are endowed with these organs,
 will live, and even  move, for a considerable time after being
 deprived of them : but no animal is formed without a stomach,
 nor would any one  be capable of  supporting life, perhaps for
 even a very short time, after  that viscus was destroyed.—
 There is, indeed, no other animating viscus discoverable in
 Zoophytes, Hydatides, Polypi, &c. though they are all capa-
 ble of muscular motion  and self-propagation.  In the more
 perfect warm-blooded animals,  which possess other vital or-
 gans besides the stomach, this last always sustains a distin-
 guished part in the general system,  by its important functions
 and associations.  When it is in its healthy state, every other
 part of the  body feels its salutary and invigorating influence;
 and when, on the other hand, it languishes or suffers,  they all
 participate   in  its  derangement.  Ardent  spirits,   Opium,
 JEther, &c. when  swallowed, produce powerful effects in eve-
 ry part of the body, long before they can have passed beyond
 the stomach; and a few ounces of strong Laurel-Water* occa-

  * Fontana, sur les  poisons,  vol. ii.  p  125.  "Si on donne cette eau (de
 Laurier-Cerise) en  grande quantite aux animaux,  ils meurent presque dans
I'instant sans convulsions, toutes les parties de kurs corps e"tant relachees,
& dans 'laffaisement. 
                              38

sion almost instant death,  upon reaching that viscus,  without
any struggle or appearance  of re-action.   But this intimate
and extensive  connexion of the stomach w ith other parts  of
the body,- and its great irritability,  subject it also to be injur-
ed and disorder by every thing  which occasions injury and dis-
order to them.   Thus it exhibits marks of inflammation in an-
imals  killed by the bites of venomous serpents, and of rabid
animals, and by other poisons externally applied ; and it is al-
ways, in some degree, affected by attacks of Fever, in which
loss of appetite, aversion from  food,  and inability to digest it,
occur  with not  less certainty than any other  febrile symptom.
But the Yellow Fever is almost invariably  attended by marks
of disorder in the stomach, much more decided than these,—I
mean nausea, followed by frequent vomiting, even in the early
part of the disease, and by the discharge of considerable quan-
tities of bile,—a discharge which appears, in these cases,  to
be  caused solely by the  efforts  to vomit, in the same  manner
as in  sea-sickness, and  other affections,  in which the evacua-
tion of bile, and  even the increased secretion of that fluid,
(which violent vomitings are believed  to occasion) are  merely
a consequence,* and not a cause, of the disorder.  These indi-

  * Dr. G. Fordyce has properly noticed, in his valuable Dissertation on
Simple  Fever,  (page 94.) the error of a common opinion, viz —that " re-
dundancy of bile constitutes an essential part of the  attack of Fever," which
opinion has been formed, because bile is " conspicuous from its colour, taste,
and smell;  while the gastric, pancreatic, and other juices, as  they are  not
very conspicuous for their sensible qualities, have not been taken into  the
account."  " If the pancreatic juice had been blue, (continues he,) and had
any particular taste or smell, and the bile had been colourless, insipid, and
inodorous, or as much  so as the pancreatic juice now is ; in that case, what-
ever has been said of the redundancy of bile, as  being an essential part of
the attack of Fever, would have been said of the pancreatic juice.—See also
the JSote, at page 467, of Dr. Clarke's Observations  on the Diseases of Long
Voyages. The idea of an increased secretion of bile in the Yellow Fever, or 
$9
cations of a morbid affection of the stomach in the Yellow Fe-
ver, are accompanied with others, affording similar evidence
of the state of that organ,  particularly excessive thirst, acute
pain, and burning heat in the stomach, with so great a degree
of tension and  soreness over the epigastric region, that exter-
nal pressure cannot  be  endured.   As the disease advances,
these symptoms become  more violent, the strainings to vomit
are incessant; and when  the termination is fatal, hiccough and
the black vomit usually supervene.
   When the bodies of those who have died with the preceding
symptoms have been dissected, the stomach has, in every in-
stance, as far as either my knowledge or my  information ex-
tends, exhibited very evident signs of inflammation.   In some
cases, almost the whole inner surface was inflamed; very often
portions of the  villous coat were abraded, and not unfrequently
observed floating among the contents of that viscus.   Marks
of inflammation, but less violent  than these, have also been
often seen  in the small intestines,  especially near the pylorus.
The inflammation observed on these viscera, seems to be  of
the kind denominated erythematic, which is found to affect
the villous coat of the intestines more  frequently than  any
other.  This kind of inflammation is apt to spread wherever
there is a continuity of membrane or of structure;  and as
-such continuity exists through the alimentary canal,  the vis-
cera, nearest to the stomach, must be  liable to participate in
the inflammatory affection of the latter.

                    THE BLACK VOMIT.

As erroneous opinions have been entertained concerning both
•flic origin  and  nature of what is  called the Black Vomit,  it

in persons living in warm climates, is opposed by Dr John Hunter, upon
ground- which appear to be just, at page 128 and 316, of his Observations
on the Diseases of the  Army in Jamaica. 
40
may be proper to state, in this place, some facts and observa-
tions relating to it.
   From the time of Galen, bile was supposed to be the prin-
cipal agent in producing  intermittents;  and as soon as we
became acquainted with  the  Remitting Fever of the West
Indies,  it was generally ascribed to that cause.   Dr. Towne,
who, in 1726, published an account of the Yellow Fever, under
the name  of " Febris Ardens Biliosa," considered it  as a
truly bilious  disorder;  so did Hillary, who called it a " Pu-
trid Bilious Fever."  This idea has been since very generally
adopted, and the  matters which constitute what  is termed
Black Vomit have, accordingly, been deemed, by many per-
sons, to be the product of a morbid secretion of the Liver, or
else of a morbid change in the bile.   That neither of these,
however,  is  the case, has been clearly ascertained, by  late
examinations made upon the bodies of great numbers of per-
sons who have died of the  Yellow Fever,  particularly by Dr.
P. S. Physick,* in Philadelphia.   In these dissections,  the
Liver was very rarely found diseased, and even when in that
state, the disease seems  almost always to have  been  of a
chronic nature.   The alteration  from the  usual appearance
of this organ most frequently observed, was a greater or  less
degree of paleness.  The stomach, however,  was  constantly
diseased, if the  symptoms, which I have  lately mentioned as
denoting inflammation in that organ, had previously existed.
The matter of Black vomit (which is commonly found in the
stomach, but is  also found in the intestines when they have
partaken of  the inflammation) was  never  discovered in the
Gall-Bladder, the  Liver, or any other viscus or cavity.  The
stomach has  sometimes been loaded with this  black matter,
  * For rtiore satisfactory information to the reader, the paper of Dr  Phy-
sick, which is alluded  to,  is given in the Appendix, (No  1.) and there is
also added the  substance of another memoir concerning the Black Vomit,
written by Dr. Isaac Cathrall, of Philadelphia. 
41
while, in the same subject, not only the Liver was free from
disease, hut the  bile in the Gall-Bladder was  in  its natural
healthy state; and  this has been seen  in  several cases,  in
which a contraction of the pylorus had completely obstructed
the passage from the duodenum into the stomach.  The matter
of Black Vomit is, besides, essentially different from bile; it,
differs from it in colour; for, however dark the bile may ap-
pear in its  most concentrated state, it always displays a yel-
lowish, or greenish yellow tinge, when spread  on a  white
surface, or when diluted; and this is never observed with the
matter of Black Vomit.   It has also been found that an addi-
tion of bile to the latter altered its nature so much as to give
it an appearance different from that  which it had before; nor
could the Black Vomit be imitated by any mixture of various
proportions of dark-coloured bile, with the fluids found in the
stomach.   It  differs likewise, most decidedly, in  taste; the
Black Vomit being always insipid, when  freed  from  other
foreign matters, whereas bile can never, by any means,  be
deprived of its intense biterness.  In many cases, portions of
the inner  surface of the  stomach have  been covered with a
coat of thick  blackish matter, and upon removing this coat,
the parts beneath it, and no other, were found inflamed.  The
substance thus obtained, was exactly similar to  that of Black*
Vomit, and, like it, incapable  of being made to adhere again,
when applied to the same or to any other parts.   Hence there
is reason to believe, that the matter forming this black cover-
ing, must.have been derived from the vessels of the inflamed
part,  especially as  it could  not of itself have produced the
inflammation, since it  is  so perfectly bland, that it has been
frequently  dropped  into the eye  without exciting any greater
sensation than pure water.  Neither  can it be supposed, that
it could have come  from the gall-bladder, or from the biliary
ducts, (in which, as I have remarked, nothing like it has ever
been found) or from any part of the alimentary  canal, and
                            6 
42
 have attached itself afterwards  to the stomach, in the man-
 ner in which it is seen adhering,—first, because it has no
 adhesive  quality when  it has been  once  detached from the
 surface on which it was  found;—and,  secondly,  because,
 in some  subjects, no  such matter  was  found  loose in the
 stomach or  intestines,  although a very  great  part of the
 inner  surface of the stomach was, at the same time, covered
 with a coat of it.   At those  spots,  moreover,  where the
 villous coat  had  been  abraded, the extremities of arteries
 have been frequently seen filled with this dark-coloured  mat-
 ter ; and collections  of the same matter have even been  dis-
 covered immediately under the  villous coat,—a situation to
 which  it  is impossible that any  foreign matters, which  had
 passed into the stomach, could have found access.   To these
 facts, which render it incredible  that the liver has any share
 in producing the matter of  Black Vomit, I may add that this
 vomiting of dark matters never accompanies  Hepatitis, or any
 other affection of the liver; and that it  has seldom appeared,
 so far as I can learn, in any case of the Yellow Fever, in which
 there was not reason to believe that the stomach  was, or  had
 been inflamed. It may, therefore, be concluded, that when this
 symptom occurs in the above disorder,  it is  usually a conse-
quence of inflammation in that viscus.
    Some authors, who had adopted a similar  conclusion, were
 inclined to consider the matter of Black Vomit as a particular
 morbid secretion,  by the inflamed vessels or glands of the
 stomach; but this opinion, if I understand their meaning, does
 not accord with fact; for it is to  be  supposed that the villous
 coat, and  the glands beneath it, are the only parts of the
 stomach by which secretion  can be performed; and proofs
 have have just been adduced, that the matter in question may
 be formed without  the co-operation of that membrane, or the
 glands connected with it, since it has been found  in the extre-
 mities of arteries, and lying beneath the villous coat itself. 
43
   The least  objectionable, and,  in all probability, the  true
 explanation of  the  most common formation  of  this  sub-
 stance, and of the phenomena  attending it, seems to be, that
 it is  merely blood which  has been effused from some  of the
 small arteries, ruptured in consequence of the separation of
 certain portions of the villous coat, and has coagulated within
 the general cavity of the stomach, or on the surface over which
 it  was effused; and having been  afterwards  detached,  and
 triturated  by  the violent  and  frequent contractions  of  that
 organ, in  the efforts  to vomit, has had its appearance  as a
 coagulum  of blood  altered, and  its colour* darkened by the
 gastric  juice,  or  by some  chemical decomposition, either

  * Dr. Henry Warren, at page 39, of his Treatise concerning the Malignant
 Fever in Barbadoes, (1740 ) says, " I ought here to observe, that the fatal
 black stools and vomitings are vulgarly supposed to be only large quantities
 of black bile, or choler; which false notion seems to be owing to that fixed
 unhappy prejudice  that the fever is  purely bilious.  But let any one only
 dip in a bit of white linen clotb, he will soon be undeceived, and convinced
 that scarce any thing but mort.fied blood is then voided, for the cloth will
appear tinged of a deep  bloody red, or purple, of which I have made  many
experiments."
  Dr- Cullen, treating  of Hxmatemesis, (See Art. 1017 of his first lines of
the Practice of Physic,) mentions the  " black  and grumous appearance " of
the blood thrown out from the mouth, as one of the signs by which  " the
blood may be certainly known to proceed from the stomach ;" and in Art
1029, Treating of Melana,  or Morbus niger, which consists " in an evacua-
tion either by vomiting or by stool, and sometimes in both ways, of a bLck
and grumous blood," he says, " it is highly probable that what gave occasion
to the notion of an  atrabilis among  the ancients, was« truly the appearance
of the blood poured into  the alimentary canal in the manner I have men-
tioned ; which appearance we know the blood  always puts on, when it  has
stagnated there for any length of time"  Blood acquires a dark colour also,
though in general more slowly, when it happens to be effused in other parts
of the body ; and the  brownish  tinge, which the fluid in Hydothorax and
ascites frequently exhibits, seems to  be  derived from a similar change of
colour induced in the red globules of blood that had been effused into  the
thorax and abdomen, together with serum and coagulable lymph. 
44
 spontaneous, or produced by the action  of the air,  or other
 matters contained in the stomach.
   That blood  is really  poured  out into the stomach in the
 manner just stated," will scarcely be doubted, many respect-
 able* authors  having affirmed, from their  own observation,
 that  blood,  sometimes red,  as if  very recently effused,  and
 often grumous, is frequently vomited in the Yellow Fever.   It
 seems, indeed,  impossible that any portion  of the villous coat
 could be destroyed, or separated from the other coats, without
 occasioning a rupture of the  arteries which conveyed blood  to
 it, or that an effusion of blood should not immediately take
 place from the  ruptured arteries, and continue until some  of
 the blood thus poured out  had coagulated, either within their
 cavities, or  over the  adjoining surface, so  as  to  prevent the
 effusion of more blood.   This is the usual operation of nature
 in all other  haemorrhages, and, we may presume, that it must
 unavoidably be performed in the case before us.

  * Thus Dr. Bush, at p. 4C, Edinb. edit, of his account of the bilious Yel-
low Fever in Philadelphia, in 1793, says, «« there was frequently discharged
from the  stomach, in the close of the disease, a large quantity  of grumous
blood, which exhibited  a  dark colour on its outside, and which, I believe,
was frequently mistaken for what is commonly known by the name of the
black vomiting j"  which last Dr. Rush had conceived to be " bile in a highly
acrid state."
  On the same subject, one of the latest of the authors alluded to, M. I  N,
Berthe, Professor in the School of Medicine, at Montpellier, (who was'joined
with two other Medical Professors of that University, Mess P. Lafabrie and
V. Broussonet, in  a commission sent by the French Government into Spain,
 in 1800, to observe and report  upon the  Yellow  Fever, then prevalent in
many parts of that country,  and who has since published the result of the
information collected by that commission, under the title of " Precis Histori-
qur de la Maladie  qui a r£gn6 dans I'Andalousie in 1800," printed at Paris
in 1802)  has stated at  p. 67, as follows, viz.:  " On observait egalement a
 ceite epoque le hoquet, le vomissement noir :  les malades rejetaient tantdt
 du sang, et tantot de 1'atrabile; et plus souvent ces deux matieres melees et
en me me temps fetides." 
45
  There is another mode by which the vomiting of black mat-
ters in the Yellow Fever has been explained. Sir John Pringle,
treating of this symptom, at page 197, of his Observations on
the diseases  of the  Army, states his belief that the  blood,
" by oozing into the stomach, gives that blackish cast to what
is then  thrown up;"  and he  attributes  this oozing  to  the
blood's  being " here so much resolved."  Dr. John  Hunter
entertained a similar opinion ;  " the blood," says he, " being
frequently in a dissolved state, is forced into the stomach and
thrown  up, forming, what is  called by  the  Spaniards,  the
black vomit." See page 64 of his Observations on the diseases
of the Army in Jamaica.  Dr. Blane, however,  apparently
with greater justice, thinks that " this happens, more probably,
from a  relaxation of the vessels  on the surface of the alimentary
atrial, than from a dissolved state of the blood."  " The black
matter," adds he, " that is vomited, and  the black colour of
the fteces and urine  in the last  and hopeless state of this  dis-
ease, seem to be owing  to the propensity to  haemorrhage in
the internal surfaces."   See page 410-1, of his  Observations
on the Diseases of Seamen.  It has been ascertained by Sau-
vages, and other physicians, that in  Meloena, blood in  various
gradations of change, from a red fluid to a matter resembling
the grounds of coffee, has been  sometimes vomited by patients,
 whose  stomachs were found,  on dissection, free from  any
 abrasion or rupture of the blood-vessels ; and it is also  known,
that a vomiting of similar dark-coloured matters has occasion-
 ally happened suddenly to women in  labour, especially in cases
 of rupture of the uterus, without being preceded by a vomiting of
 any other matters, and in patients, the coats of whose stomachs
 were observed to be perfectly  sound upon examination after
 death.   A relaxation of the  vessels on the surface of the
 stomach,  (which may be, and perhaps often is, accompanied
 with some degree of inflammation)  appears to be the cause  to
 which the effusion  of blood in such instances ought to be re- 
46
 ferred:  and if such relaxation may take place in the affections
 just  mentioned, it is to be presumed, that it may also take
 place in a disease of so debilitating a nature as the Yellow
 Fever, which is sometimes seen to occasion haemorrhages from
 many other internal surfaces.   On these grounds, therefore, it
 seems not improbable, that .a relaxation of the vessels of the
 stomach had existed in most, or all of those cases of this fever,
 in which the black vomit occurred with little or  no previous
 v omiting, or in which the coats of the stomach were entire.  1
 must, however, remark, that in the accounts  of dissections of
 patients  dead  of the Yellow Fever,  which have come to my
 knowledge, I have found the cases just described, to bear only
 a very small proportion to the number of those in which injury
 had been done to that viscus; and I am, therefore, inclined to
 believe, that the black vomit is much less  frequently the conse-
 quence of a relaxation of vessels, than of a separation of some
 portions  of the  internal coats of the stomach.
   I must not omit to mention among the  appearances on dis-
 section, that the lungs and pleura have sometimes been found
 to have undergone some degree of inflammation during the
 course of the Yellow Fever; but, although the sufferings of
 the patient  must have  been greatly increased  from such an
 affection, it does not appear that the inflammation was often so
 considerable as to warrant the supposition that it had caused
 his death.

                AFFECTIONS OF THE SKIN.

 The  connexion between the skin and the alimentary canal is
 well known, and, perhaps, results, in a  considerable  degree,
 from  the identity of  their membranes.  This connexion  may
contribute to  some of the appearances observed on the surface
of the body in Yellow Fever, which generally begins with more
moderate sensations  of  cold than other Fevers, but soon pro- 
47
duces strong arterial action,  during which the skin becomes
excessively dry and parched, with  an  intensely burning or
pungent  heat.  Sweats are in this stage a very rare  occur-
rence, and when they do appear, no relief is afforded by them.
A feeling of general soreness of the skin also takes place in
many patients.   But the most remarkable symptom affecting
the skin  in this Fever, is  a yellow suffusion; which, though
far from  being  a constant  symptom, occurs often enough to
have given occasion for the name by wjiich the disorder is now
commonly distinguished.   The  yellowness begins  in  a few
cases, within the first forty-eight hours;  sometimes on the
third day, and frequently not  until the fourth or fifth.   It is,
indeed,  sometimes observed but a few minutes before, or a
little after death.  I believe that in  many  instances it might,
with attention,  be first discovered on the eyes; but it is com-
monly first  observed on the  cheeks, extending towards the
temples,  and about the angles  of the nose  and mouth; about
the lower jaw and on the neck, along the course of the jugu-
lar veins, whence it afterwards spreads in stripes and patches
along the breast and back downwards, so as at last to become
universal in some patients, though in others it remains partial.
The yellowness is sometimes of a dingy or brownish hue, some-
times of  a pale  lemon, and  at others  of a full orange colour.
When the yellowness appears only in patches or spots, and of
a dingy or brownish hue, these are frequently intermixed with
other spots of a florid red, or a purple, or livid colour.
  A considerable difference of opinion has subsisted respecting
the cause of this symptom ; some physicians having ascribed
it to serum, which has been rendered yellow either by a colli-
quation,  or dissolution  of the  red globules, or by a peculiar
action of the vessels, and afterwards effused under the cuticle :
and some to  an error loci of the globular  part of the blood,
which, as they conceive, might occasion yellowness, by getting
into the smaller order of vessels, in consequence of their great 
48
 debility and relaxation, or into the cellular membrane : as
 happens after Ecchymosis, from external contusion ; in which
 the skin, though at first livid, becomes yellow, when a part of
 the red globules is removed by absorption or otherwise.   The
 late Dr. George Fordyce, in his fourth dissertation on Fever,
 (page 74) attributes the yellowness in question to the sebaceous
 matter, which he supposes to be then secreted more copiously
 by the sebaceous glands  of the skin; he contends that, " the
 colour is very different from that which takes place in Jaun-
 dice," supposing,  erroneously, that  " the secretion  Tom the
 kidneys has not  that deep yellowish brown, nor that thick
 sediment, which have almost always been seen in those per-
 sons, in whom bile has got into the blood."  Another author
 again, the late Dr. John Hunter, (whose authority on this sub-
ject is entitled to  greater weight,  from his experience  in the
 Yellow Fever, and who  had found, as every other person must
 have done, who has really made the trial, that in this disease,
 " the urine is of a very deep colour, and stains  linen rags
 yellow, like that of a person in the Jaundice," See page 72 of
 his Observations on the  diseases of the Army in Jamaica) be-
 lieved it " probable that the inflammation in the coats  of the
 duodenum and stomach, and the violent contractions they suffer
 from repeated vomiting  and straining, may produce a spasm
 of the gall ducts, sufficient to interrupt the course of the bile;"
 (See page 157 of the same work) the consequence of which
 was, as he  states at pages 135 and 137, that the bile was
 " absorbed and carried  by the lymphatic vessels into the ge-
 neral mass of circulating fluids," and thus became " the cause
 of the yellowness."  And lastly, Dr. William Saunders thinks
 that, in the more aggravated species of the Yellow Fever, this
 symptom " depends rather upon a particular state of the lymph
 in the cellular substance of the parts, than upon the absorption
 of bile into the circulating mass:"  (See page 104, of his valu-
 able treatise on the structure, oeconomy, and diseases  of the 
49
liver,  3d edition); but that in "the ordinary," i.e. "the
Endemic Fever of the West Indies," " the Jaundice stems to
depend upon a redundant secretion," the quantity of bile being,
perhaps, so very  considerable in this  disorder, as  he states
farther at page 233,  " that though the greatest part of it
escapes into the primse viae, the whole may not readily find a
passage; and the surcharge thus occasioned, may give rise to
regurgitation and  absorption."
   I was once inclined to adopt one of the  latter opinions, be-
cause it seemed difficult to  conceive by what other means, or
from what other cause bile should be introduced into  the blood
vessels in this Fever so as to render the skin yellow.  That
fluid is naturally intended to perform  all its offices in the ali-
mentary canal, and to  be all conveyed thither:  and  it is only
when  its passage  through the ductus communis choledochus
into the duodenum is obstructed, that nature is believed to have
provided means for its escape into the blood vessels, in order
to obviate the mischief which  might result from an excessive
accumulation of bile in the gall-bladder,  and  biliary ducts.
But no such obstruction appears to exist in the Yellow Fever;
the alvine faeces being commonly dark-coloured, so as to de-
monstrate the admixture of bile; and the quantities of that
fluid which are discharged from the stomach during the whole
course of the disease, being  such as to  obviate all suspicion of
an obstruction in the duct, and  all probability of an accumula-
tion of bile in the liver, or gall-bladder.   These, however, and
other objections against the existence of bile in the blood, as a
cause of the yellowness in question, were overcome in my mind
by further consideration and inquiries ; and I am now disposed
to think that, with perhaps one partial exception to be here-
after mentioned, the yellowness of the skin, which is frequent
in this Fever, is derived from the bile.£
   In the action of vomiting, the abdominal  muscles  contract
strongly, while the diaphragm is forcibly drawn downwards :
by these  motions the liver, from its situation immediately be-
neath the diaphragm, and its large bulk and  inelasticity, suf- 
50
  iers a certain degree of compression.  When this compression
  is moderate and gradual, as it appears to be  in most cases of
  ordinary vomiting,  it is probable that some portion of the bile
  contained in the biliary ducts is thereby propelled into the du-
  odenum,  whence it passes into  the  stomach, and is thence
  throw up with other matters.   When, however, there has been
  very frequent  and  violent vomiting for some length of time,
  the stomach, diaphragm, and  abdominal muscles, are apt  to
  become irritable to  an extreme degree, so that, at each  effort
  of the former to discharge its contents, the latter (whose pow-
  er, as Mr. John Hunter has observed, at page  158 of his  work
  on the Animal OSconomy,  is " often capable of  forcing the
 bowels themselves out of the abdomen, producing rupture")
 will frequently be thrown instantaneously into strong spasmo-
 dic contractions, and the liver together with the gall-bladder,
 will be, as it were,  suddenly caught and tightly squeezed in a
 powerful press, the  necessary  consequence of which pressure
 seems to he, that  all the fluids contained in that viscus will be
 driven towards both extremeties, backwards  as  well as for-
 wards, in those vessels which are not provided with valves to
 prevent their retrograde motion.  Under such  circumstance it
 can scarcely be doubted, (after the experiments of* Haller, con-
 firmed by others,  demonstrating the facility  with which fluids
 may pass  from the biliary ducts through the pori biliarii into
 the hepatic veins)  that the bile will be forced to regurgitate in
 this manner, and pass from those  ducts into the vena cava, at

  * '« Altera certissima anastomosis est ex ductibus biliariis in venam cavam,
quam  cl« ante me vin viderunt, &  mea experimenta conformant.  Elem.
Phisiolog. Corporis humani.  Tom  6. p.  509. 4to.
  " Baron Haller observes, that a subtile  injection thrown in by the hepatic
duct' will escape readily  by  the hepatic veins.  This is a fact; and I know
from experiment, that  wate% injected  in  the same direction, will return by
thv veins in a full stream, though very little force is used.  From the facility
with which water takes this retrograde course, a probability arises that, if
from any cause the  natural direct on of the bile be obstructed, it will readily
obey the same (retrograde) direction "  Dr. Wm. Saunders, Treatise on the
Structure, &c of the Liver, page 108. 
51
each violent compression  of the liver;  and that  by continued
and  strong spasmodic  contractions of the before-mentioned
muscles  in vomiting,  a considerable  quantity  of bile may be
carried into the circulation,  and a yellow suffusion,* exactly
resembling Jaundice,  be, even very speedily, produced.   It is
in this manner that we must account for the universal yellow-
ness of the skin which even in the time of Galen, has been ob-
served to follow the bite of the viper,f when the poison w as of

  ♦ As the  liability of the liver to such compression depends on circum-
stances  varying in different  individuals, and principally on its situation,
form, and size, and also on the suddenness and force by which the surround-
ing muscles happen to contract upon it,  we can hence understand why
Jaundice may be  more readily produced in one  person than in another, al-
though the  symptoms might  seem to be equally violent in both.  We may
likewise hence understand why infants, in whom the liver is, proportionably,
much larger than in adults, and who are subject to numerous indispositions
inducing strong  convulsive contractions of the  diaphragm  and abdominal
muscles, should be so frequently affected by Jaundice ; the cause of which
affection, however, appears to have been overlooked, and mistaken by Haller,
(Elementa Phisiologisc corporis humani.  Tom. 6. page 590) for curdy mat-
ters obstructing  the common duct,  and  by others for viscid bile imparted
therein, or other gratuitous  suppositions.  The only  authors within my
knowledge who have expressed a  belief* that the bile might be driven into
the blood vessels by the violent action of the diaphragm and  abdominal  mus-
cles, and thus occasion Jaundice, are, Haller (in his work  entitled, " Her.
manni Boerhaave Praelectiones academics," § 348,) and Van Swieten (in his
" Commentaria in H. Boerhaave Aphorismos Sect. 631 and 950) ; these very
learned Physicians, however, do not appear to have thought, that the violent
action of those muscles simply could produce a Jaundice, for they suppose
the pre-existence of gall-stones, or of some other obstruction in the cystic
or common  duct, by which the excessive vomiting that precedes the Jaun-
dice  in such cases, is  always produced as  a  salutary effort of nature  : but
this supposition does not accord with the well-ascertained  facts, that gall-
stones may obstruct the common duct, and produce Jaundice, without ex-
citing any vomiting, even when  they are attended with excruciating  pain,
and that Jaundice frequently occurs, although a free passage of the bile into
the duodenum exists.
  f Fontana was led to suppose, that the yellowness of the  skin in persons
bitten by vipers is derived from the bile, which is carried into the circulation
in consequence of the common duct being closed by some crisping or irrita-
tion in the duodenum,  arising from convulsive vomitings; but he offered no 
52
 sufficient force to produce the usual symptom  of convulsive
 vomiting,  and  for the similar effects  that have likewise been
 observed to ensue  from the bites of some other venomous ani-
 mals.   In these cases  a deep yellow colour of the skin has been
 observed within  even a  single  hour  after the accident,  (as
 Dr.  Mead affirms, at page 9 of his mechanical account of poi-
 sons, 3d edition) and  consequently too soon to have been the
 result of any tiling but a regurgitation of bile as before explain-
 ed : for in regard to absorption, it is scarcely credible that the
 lymphatick vessels of  the liver could ever, under  any circum-
 stances, take up and convey into the circulation such a quanti-
 ty of bile as would suffice to produce Jaundice in that short pe-
 riod  of time : neither is it readily to be perceived why, or how,
 in persons bitten by  vipers, or in those labouring under certain
 affections to be presently  mentioned, in whom a yellowness of

opinion concerning the means hy which the bile is conveyed thither.  *' Con-
venous done." says he, at page 68, vol- 1, of his work sur les poisons, " que
si les  sujets attaques par le venin deviennent jaunes, il faut que  la cause
qui produit cet effet ait intercepve'  le cours de la bile, apres qu'elle est se-
p <ree  dans le foie, sans avoir auparavant nui en rien a  cette secretion  Je
croirois volontiers qu'elle ne se repand ainsi dans la masse des humeurs, que
paro que  son cours est intercept^ dans le canal choledoque avant qu'elle se
degorge dans le duodenum  Les convulsions de  I'estomac et des  intestins,
qu'eprouvent ceux  qui oui £te mordus par la vipere, peuvent tres  bien irri-
ter, et cr>sper le duodenum, et boucher ainsi cet orifice.  Ne nous etonnons
pas non plus de voir la meme jaunisse se mamfester chez ceux qui ont pris
d'autres poisons, puisqu'ils eprouvent aussi  de semblables convulsions, un
tiraillement douleureux dans le creux de I'estomac, des vomissemens bilieux et
convulsifs, une contraction autour de I'ombilic el d'autres accidens dans le bas
ventre."  Fontana  probably borrowed his gratuitous notion of a crisping of
the duodenum from Morgagni, (de Sedibus and Causis morborum.  Epist. 37.
 n. 35.) -, and Dr John Hunter appears to have taken his idea of " a spasm of
the gall-ducts," as mentioned at page 36, from Fontana, combining with it,
that of the bile being  absorbed by the lymphatic vessels of the liver, and
employing both to explain the occurrence of Jaundice in the Yellow Fever.
The bite of the rattle-snake does not cause excessive and convulsive vomit-
 ing, as that of the viper ; and it seems reasonable to suppose that the poisons
of different snuk s  may be endowed, each with peculiar properties, and pro-
 duce different effects. 
                                 53

the skin is speedily induced, a particular system of vessels in a
particular viscus, i. e. the lymphatics in the liver,  should have
their functions at once changed, and should on a sudden be ex-
cited to absord bile copiously,  and this while there is a ready
exit for the passage of  that fluid into the intestine, as is mani-
fested hy the matters discharged in such  cases from the stom-
ach and rectum.*   In the same way yellowness of the skin, to

  ♦ It may yet be doubted whether Jaundice be produced  by abaqrptvm of
the bile in any instance, even in a complete obstruction of the common duct
by a gall-stone, although this  is  the mode in which it is now by most per-
sons supposed to be always produced in that case-  A justly eminent physi-
cian relates an experiment made  by himself, which, as he thinks, " evinces
that the absorbents take  up the  bile from the interior part of the liver, and
convey it by the thoracic  duct into the mass of blood."  He tied the hepatic
duct in a living dog, and two hours  after, the animal being strangled, he
 examined the parts.  " On inspection," says he, " it appeared that the ab-
 sorbents had been very  active,  for  they were very much distended with a
 fluid of a bilious colour, and their course, which was very conspicuous, could
 be traced with the greatest ease to the thoracic duct, the contents of which
 seemed  only moderately  bilious.  The bilious colour  was, in a great  mea-
 sure, concealed by the red particles of blood, which  had been extravasated
 by the injury, taken up by the absorbents, and conveyed into that canal.  It
 is probable, however,  that the bile was only just entering the blood vessels,
 as on a very  careful inspection of the eye, the tunica conjunctiva did not
. betray  th% slightest  appearance  of  Jaundice."  From this experiment the
 author draws the  following conclusion.  " It seems then,  that, during the
 space of two hours, the secretion of the liver had been sufficient in quantity
 to distend its ducts,—to stimulate the absorbents to relieve that distension,
 and to allow of  a  small portion of their contents to be conveyed into the
 blood vessels "
    This conclusion, however,  notwithstanding my great deference  for the
 opinions of this author,  does not appear to me sufficiently supported by the
 preceding facts.  It is, indeed, mentioned that the contents of the thoracic
 duct were " bilious ;" but they are admitted to have been ««only moderately"
 so;  it  is moreover acknowledged, that " the  bilious  colour was, in a great
  measure, concealed by the red particles of blood •» and as it was by the eye
  slone, that  the result of this  experiment was determined, I  think  that a
  slight yellow  tinge, which confessedly was almost « concealed by red," is
  not of .tself of'.uffic.ent evidence to decide a doubtful point of great physio-
  logical, as well as pathological, importance.  The  presence of bile in  the 
54
  a remarkable degree, attended with yellow sweats (which,  as
  well  as the urine, gave  to linen a yellow tinge, have been
  sometimes  produced  by  the excessive vomitings,  and  violent
  spasms, which ensue from eating some species of mushrooms in
  Europe, and  certain poisonous  fishes* in the East  and West


 thoracic duct, would probably have been determined with greater certainty
 by tasting the irtatters contained therein.
   When the circumstances attending an obstruction  of the common  duct,
 by a gall-stone or other cause, are fairly considered, it seems highly probable
 thit some regurgitation of the bile must happen, which, if continued  for a
 sufficient length of time, may produce Jaundice : for, in such a case  of ob-
 struction, the bile will still be secreted as copiously as before, and must accu-
 mulate in the ducts, and distend the liver considerably beyond its usual size;
 and it does not seem possible, that in this state the latter can avoid suffering
 almost perpetually some degree  of compression by the mere actions of the
 muscles  in respiration ; nor probable that, when thus turgid,  it could be
 compressed without some  portion of the  redundant  bile bting each time
 driven into the hepatic veins.  Besides  these,  other stronger actions of the
 thoracic  and abdominal muscles are  likely to  be very frequently excited by
the general uneasiness, or  local pains, accompanying this morbid condition
 of the liver, as in  sighing,  coughing, &c. which may also force bile  into the
 hepatic  veins   In these ways regurgitation  appears to be  of itself ade-
 quate to  the production of Jaundice; and if it be so, to recur to the doc-
 trine of absorption, as another source of that  disease, without any decisive
 proof that the bile is really absorbed,  would  only multiply caus%s without
 necessity.
  * Several authors of  undoubted credit,  as Kaempfer, Frezier, Sloane,
Catesby,  Ulloa, Osbeck, Forster, &c have giveo accounts of various species
 of fishes found in the seas of warm climates, which frequently act as poisons
 upon those who have eaten them. The morbid effects produced by  such
food have been described by Dr Robert Thomas,  now of Salisbury, but who
formerly  resided nine years in the West Indies, (at page 586 of his " Modern
Practice of Physic, 3d edition) ;  and among these, besides " severe vomiting
and purging,"  he  stage s the following  "  In the advanced state  of the dis-
ease, I observed that the whole surface of the  body acquired  a deep yellow
hue as in Jaundice, and that the urine was  likewise tinged of the same
colour   Even the perspiration gave a deep yellow tinge to the linen  These
appearances took  place,  in a very high  degree,  in one or two  cases, but
more particularly  in my own, as  I was so unfortunate as once to experience
the deleterious effects of a  poisonous rock fish,"  (perca marina)
  As the fishes in  question are poisonous at some times and situations  and 
55
Indies, and also from swallowing a violent dose of arsenic, or
other poisonous substances. And if the vomitings and spasms,
arising from these causes, are found in a multitude of instan-
ces, to produce general yellowness  of skin, with such excre-
tions,  by urine and sweat,  as manifest  the presence of bile,  we
may surely infer that the severe vomitings, which occur in the
Yellow Fever, may produce the like  effects, and that they also
may cause the introduction of bile into the blood-vessels, and
thus induce the yellow suffusion of the skin under our consid-
eration.   In  like manner, temporary jaundice  is  sometimes
found  to arise from Spasmodic colic,*  Hysterics, and, as Hal-
ler,!  Lind,  and other highly respectable physicians have  de-
clared, strong passions of the mind.
   The exception to the yellow suffusion being generally deriv-
ed from the bile, to which I lately alluded, refers  to those cases
in which the yellowness of skin occurs partially, i. e. in patch-
es or spiSts, previously to,  or shortly after, death, or in which
the patches are of an  obscure or dingy hue, and  intermixed

not at others, it is not improbable that their poison is acquired by, feeding
on certain noxious submarine plants  or other  substances.  They are  said to
be rendered innocent by being laid for some hours in salt-
  * Dr  William Saunders, whose opinions concerning  the origin  of the
yellowness of the skin in the two supposed  species of  Yellow Fever have
been lately  stated, attributes  the  Jaundice,  that sometimes follows the
affections here mentioned, to the same cause which Fontana believed  to pro-
duce the yellow suffusion in  persons bitten by vipers.  "  When Jaundice
has arisen  from very  acrid emetics  or griping purgatives,  or colic, or
hysteria, the resistance to the free passage of the bile, is  either at the very
extremity of the ductus communis, or during its oblique course through the
substance of the duodenum, at  which  part it is liable to compression from
the muscular action of that intestine."—See  page 243, of his Treatise on
the Liver.
  • Nascitur enim icterus, et bilis adeo retrograda in sanguinem refluit plu-
rimas ob causas, quarum aliqux vix corporea sunt, ut ex  ira.'   " Hue
msror  profundior, terror," fcc—Haller Elem.  Physiol. Corp. Human- Tom
vi. p- 592.
  "A violent fit of anger or grief will immediately produce a Jaundice"—
Lind- page 177, on his Essay on the Diseases of Europeans in Hot Climates- 
56
 with petechia ;  the yellowness may, perhaps, in these instan-
 ces,  be produced by a cause similar to  that which produces
 the  yellowness that follows Ecchymosis;  and  this cause is
 probably connected with that particular state of the blood,  and
 of the vessels, which occurs in  the worst cases of the disorder,
 and gives rise to Haemorrhages from various parts of the body,
 external and internal.   It seems admitted by all  practitioners,
 that these yellowr patches on the skin indicate extreme danger $
 but a general yellow suffusion, such as I suppose to arise from
 bile, which  is forced into the blood  vessel  by the  temporary
 compression of the liver, is,  according to my own experience,
 and that of many practitioners with whom I have conversed, a
 symptom of little real importance in the Yellow Fever; the  bile
 so introduced being in all probability,  incapable of doing  any
 more  considerable mischief than it is observed  to do in those
 cases  of  Jaundice, wiiich have  succeeded  to a* colic, or  a
 strong hysteric fit, &c.  It has,  indeed, been associafed with
 extreme danger in the Yellow  Fever, by  most writers on that
 disease, but only, as I  believe,  because the excessive vomiting,
 w7hich had produced it,  had also  produced other more destruc-
 tive effects.

                         DIAGNOSIS.

 Having thus stated, and endeavoured to account for, the prin-
 cipal symptoms of the Yellow Fever, I shall conclude this part
  * When a Jaundice is produced by the affections here mentioned, it  will
gradually disappear without any aid from medicine ;  if the  suffusion be
slight, it will vanish in a few days ; but if deep,  and approaching to an or-
ange colour, it will generally require from four to six weeks for its removal.
The kidneys seem to be the principal  means by which the bile, and most
other unnecessary ingredients, are extracted from the circulating mass, a
portion of bile, corresponding with  the  quantity thereof existing in  the
bloodvessels, being voided in every discharge of urine.  An infinite number
of remedies are recorded, by which the  Jaundice is stated, and was believed,
to have been cured;  and  the above explanation may serve to point out the
real degree  of their respective virtues,  as well as their  modes of operatiou
in such cases. 
57
of my subject with noticing some of the diagnostics, by which
it may he distinguished from the distemper properly called the
Plague, and from that fever which is now known, in this coun-
try, by the name of Typhus,—two diseases with which it has,
by some writers, been, even lately, assimilated and confounded.
  The Yellow Fever- prevails only in those countries, and in
those seasons,  in which the heat is,  or  has recently been so
great as would destroy,  or stop the progress of,  the Plague;
and it is for this reason that the latter disease has never been
known to exist  in intertropical countries, the temperature of
which, however,  is eminently suited to the  existence  of the
Yellow Fever.   The latter disease is not accompanied with the
glandular and cutaneous affections, called Buboes and Carbun-
cles ; some of which, especially the former, always accompany
the Plague ; for although, patients are sometimes cut off by the
latter disease, before Buboes appear above the surface  of the
adjoining parts, their germs may nevertheless, as I believe, be
always felt, after death, in the glands near the groin or axilla-.
It is true,  indeed, that the parotid glands are occasionally af-
fected in Yellow  Fever; but this is not a  common affection,
and it differs greatly from the glandular tumours which occur
in the Plague.   The  Yellow7 Fever is moreover, always atten-
ded by  a  violent febrile paroxysm:—this is essential to its
 character; but it is admitted  by several writers on the  Plague
 and I have myself witnessed the fact, that persons have been
 attacked by the latter disease without having the least febrile
 affection,—an occurrence which has also been observed in the
 Small-Pox, in the Scarlet-Fever, and in the Measles.  Final-
 ly,  Blacks are  very rarely  seized with the yellow  Fever,
 and  when  seized, they are  much less violently  affected  by it
 than Whites living  under the same circumstances; but I had
 occasion to observe,  in Egypt, that Blacks were not at  all less
susceptible  of the Plague than Whites, and that they died of it
 in a far greater proportion.
   Yellow Fever differs  from Typhus in the following circum-
 stances, viz. it  prevails,  as I have already mentioned, only
                              8 
58
during, or immediately after, very hot seasons, in which Ty-
phus is soon extinguished;  and it is, in its turn, completely
extinguished upon the accession of cold weather, in which Ty-
phus is commonly most prevalent; it attacks most readily and
most violently the young and  robust, over whom Typhus is
allowed to have the least power;—it begins with much greater
exertions of the living power than Typhus,—is attended with
many different symptoms, and terminates much sooner;—it is,
besides, disposed to  remit, and  it frequently changes into a
regular remittent, and  sometimes even into an  intermittent
fever, which true Typhus is never observed to do.   There are
some other very important  circumstances in which the three
diseases differ from  each  other, but these  are reserved for
another place.
                       prognosis.

Having already stated all that I had to submit in regard to
the prognosis in the Yellow Fever, I must beg permission to
refer the reader, who desires  farther information  upon that
subject, to the treatises of former authors.

                       TREATMENT.

In offering some observations concerning the cure of the Yel-
low Fever, it is not my intention to recommend any particular
indiscriminating mode of treating the  disease, in  its several
forms and varieties, being persuaded that none which I could
devise would be found adequate to all cases of the disorder;
but my sole aim will be to point out the general principles by
which, as  I conceive, the most urgent  symptoms may be  re-
relieved, and the violence and fatality of the fever lessened.

                       BLEEDING.

The  remedy which first  presents  itself  to our notice is
bleeding, as being proper only in an early stage of the disease* 
59
Concerning this evacuation, the most opposite opinions have
been delivered, some considering it as an indispensable remedy,
and others alleging that nearly all who were  bled had died.
The number of persons  who  have  survived, after copious
bleeding, in this disease, among whom I may be included, are
a sufficient proof that this evacuation is not necessarily fatal 5
and, therefore,  we can  only account for  this contrariety of
opinion,  by supposing that, where bleeding has proved hurt-
ful, some important mistake must  have been made  as  to the
necessity of that evacuation, or as to the quantity of blood re*-
quired to be drawn.
  It has already been observed, that the Yellow Fever, espe-
cially the violent forms of it, seldom occur among any other
persons than strangers recently arrived from temperate cli-
mates, the greater part of whom will commonly be found to
be young, robust,  and vigorous.—Hence we might  be  led, a
priori, to believe, that these persons would be most liable to
that inflammatory disposition, which is well  known to be a
very frequent concomitant of the intermittent and remittent
fevers common in Europe; but we can have no hesitation in
regarding the Yellow Fever as  a disorder frequently, in its
first stage, accompanied  with a very considerable  degree  of
general inflammation, (a degree which is,  perhaps,  greater
-than occurs in  any other kind of fever) if  we attend  to the
leading symptoms which are visible  at the commencement  of
the disease,—I mean the hard, full, and strong pulse,—the
distressing sense of universal  distension, the red, starting,
watery eye, and the parched skin.  Dissections, moreover, of
persons, who wTere victims of this disease, have very generally
exhibited signs of considerable inflammation in various organs,
and especially in the head and stomach.  Now experience has
clearly demonstrated that general inflammation always  in-
creases the duration of the paroxysm, whenever it supervenes
in a fever of an intermittent or a remittent type, (as the Yel-
low Fever is) without being removed, and that it likewise
augments the severity of all the febrile symptoms; the conse- 
                              60

 quence of which is  either that the patient is often destroyed
 during the paroxysm, though  he might  otherwise have sur-
 vived ; or, at least,  that extreme weakness, with  all those
 symptoms called putrid,* which arc its usual effects, is more
 speedily induced.  To avoid, therefore, the mischiefs  arising
 from such superadded violence, no  means  appear  to me so
 certain or beneficial  as bleeding; but, that it  may prove ad-
 vantageous, it ought to be performed copiously; and  from a
 large orifice,  as early as possible after general  inflammatory
 action is perceived ;  it being sufficiently ascertained that such
 action is more speedily and completely  subdued  by taking
 away a large quantity of blood at once, in this  manner, than
 by a larger evacuation at two  or more bleedings;  and  that,
 although the  patient may be much  debilitated at first by the
 former, his strength will, in the end,  be less exhausted than
 by the latter.   Those physicians, who have found the greatest
 benefit  from  this  remedy in the Yellow Fever,  insist  most
 strongly upon the necessity of bleeding early, (as within twen-
 ty-four hours, and even twelve if possible, from the attack) to
 the amount of twenty-four or thirty ounces in the more violent
 cases ; hut in mentioning these quantities, it is not my inten-
 tion to recommend that all patients should indiscriminately be
 bled to such an extent: the  necessity of this evacuation, and
 the quantity in which it is to be performed, can only be  indi-
 cated by the vigour of the patient's constitution, and the pre-
 sence of inflammatory symptoms, and their degrees of violence
 and previous duration ;—and doubtless, in  some patients,
 bleeding may be superfluous, or detrimental.
  * It is not uncommon, in hot climates, for the  symptoms denoting putri-
dity, to supervene within  two or  three days after the commencement of
fever; and this has led several systematic medical writers, the greater part
of whom have never been out of this island, to believe, and assert, that the
fevers of hot climates are usually putrid, and very seldom inflammatory. These
 writers, however, seem either not  to  have been aware of the violence, and
exhausting nature of the symptoms, which precede the appearances of pu-
 tridity, or not to have been acquainted with the true causes of those ap-
 pearances. 
61
COID WATER.
One  of the least tolerable among the  earlier sufferings  o£
the patient in  this disorder, is a sensation of burning heat
through the whole body, which is  far  from being imaginary,
as his general temperature frequently rises four degrees,  or
more, of Farenheit's thermometer, above the natural standard.
Happily we have a remedy for this most uneasy and formidable
symptom,  in  the external use  of cold water,~the safe and
efficacious operation of which has been very ably explained  by
the late Dr. Currie.  The modesty and  generous delicacy of
this estimable man, have led  him to  do  injustice to himself,
that he might perform what he thought an act of justice to the
supposed discovery of a contemporary writer, from whose prac-
tice,  in a distant country, as reported  to  him, he had first de-
rived the idea of employing cold bathing in fevers.  In doing
this,  however, he could  not have been fully acquainted with
the claims which several physicians,  ancient as well as mo-
dern, had to  acknowledgments of the  same nature, for  having
recommended, or mentioned, the external application of cold,
by bathing, or otherwise, in febrile  disorders;  and especially
Hippocrates,* who, in several parts  of  his works, has given

  * A multitude of instances  might be cited  from the works of this great
physician, shewing the extensive use which he made of cold and of warmth,
especially in external applications, towards the cure or relief of general or
local affections ; but I shall content myself with referring to only a few such
instances, observing that his practice appears to have been grounded upon the
general principle of restoring the due temperature of parts,  by cooling those
which he conceived to be too much heated, and of comforting, by warmth,
those  which were either too cold or debilitated ;-a principle which, after
some experience, I am inclined to consider as the best practical rule upon
this subject that he  could have followed.  And Hippocrates had, in this re-
spect, so judiciously adapted his practice to the suggestions of nature, as
to have  discovered that heating and cooling  applications might be usefully
employed, at  he same time, with the same patient, for the purpose of cor-
recting the deficiencies and excesses, of heat  in different parts.  Some pas- 
62
particular directions for the employment of cold water, which
are almost as judicious as Dr. Currie's.  If, however, as Mal-
pighi says concerning Harvey, " in  arts and  sciences he is
properly to be deemed  the discoverer, who, by a proper inves-
tigation, unravels nature's perplexities,  and calls in  reason

sages, it is true, may be found which seem to contradict the above-mentioned
principle; but these are comparatively few, and might justly, perhaps, be
included  among the interpolations with which the writings, commonly as-
cribed to Hippocrates, are, on good grounds, believed to abound.—See the
treatment directed in the disorder termed Distension  of the Lungs from
Inflammation, in the third book de Morbis, (page 489, line 29 to 53. of the
edition of the Works of Hippocrates, by Fcesius's, printed at Geneva, in 1657;)
in Ilei, also in the third book de Morbis, (page 491, line 34 to 46;)  in Cau-
sus, in the book de Affectionibus,  (page 518, line 4 Mo 50;) in Tertians
and Quartans, (page 520, line 48 ;) in Typhus, in the book de Internis Aflec-
tionibus,  (page 553, line 25 to 38 j) in Ulcers,  in the book de Liquidorum
Usu, (page 426, line 45 to 4:7.) - See also the Cases, in the fifth book of Epi-
demics, of the woman in Larissa, ill of Puerperal Fever, cured by water very
cold, (page 1144. F.) and of another woman, who, being in appearance dead,
was  recovered by throwing thirty amphorae of cold water over her, (page
1153. B. C)  Hippocrates  had likewise successfully employed effusions of
cold water in Tetanus  and  Opisthotonus,—(See the third book de Morbis,
page 491, line 30 to 33, and the book de Liquidorum Usu, page 427, line 34,
the latter of which two passages is  repeated  in the fifth book of his Apho-
risms, 21.) and even in the Gout, as appears from the twenty-fifth Aphorism
of the last-mentioned book,  and from the book de Affectionibus, (page 524,
line 23, 24.)
  It is net improbable that Hippocrates borrowed his modes of using cold
water from similar uses, which he might have observed in the course of his
travels through rude nations, among whom that natural and simple remedy
for excess of heat was likely to be  much employed, especially in Fevers.
The two following passages will prove the existence of a like practice among
very unenlightened people in other and opposite parts of the world.
  The first is taken from a manuscript letter, (preserved in the  library of
the British Museum, and marked in  Ascough's catalogue, 4432. 71.) which
was written by Dr. Oliver Coult, at Calcutta, to Dr. Mead, and is dated the
25th of November, 1718.  '* 1 am credibly told, (says Dr  Coult) that, upon
the coast of Sumatra,  Pegu, and Siam, the natives, in fevers of  all kinds,
whether continued, intermitting, or  eruptive, also in diarrhceas  and slow
dysenteries, wash frequently in the rivers, which are very cool, in the seaspn
of rains," (from June to November.) 
65
 and experience to support, and facts to confirm, what he as-
 serts," then will Dr. Currie doubtless be esteemed the dis-
 coverer of this remedy.
    It is only when the heat of the body is  above the  healthy
 standard, that cold water should be applied externally; and
 the patient's feelings will sometimes best direct  how long and
 how frequently the application should be made; but we ought
 always to recollect that, if he should become chilled by it, not
 only mischief may be caused by driving a considerable quan-
 tity of blood from the surface to  the internal parts, especially
 the brain, but also a violent re-action of the system might be
 produced, which could scarcely fail of protracting and aggra-
 vating the paroxysm.
    As the usual modes of applying cold  water to the surface of
 the  body, viz. by placing  the patient in a bathing-tub, filled
 with water, or pouring  water over  him, or washing him with
 wet sponges, while  sitting on a stool, may sometimes cause
 serious disturbance and fatigue to him, and are  often attended
 with difficulty or inconvenience enough to  deter both patient
 and attendants  from persisting in their use  for a sufficient

   The second will be found in a well-written tract, composed by a Mr. Bour-
 geois, Secretary of the Board of Agriculture at the Cape in St. Domingo, in
 1755, entitled  " Memoire sur les maladies les  plus communes a Saint Do-
 mingue; leurs remedes," &c. and  contained in a volume  of "Voyages in-
**teressans dans differentes colonies Franchises, Espagnoles, Anglaises, &c. a
 Paris, chez Jean-Francoise Bastien, 1788."  " L'habitude des Negres qui
 veulent  guerir des fievres est de se jeter dans l'eau la plus froide, de s'y
 baigner, & de se mettre sur la tete des herbes fraiches qu'ils arrachent au
 fond des ravines ou des rivieres.  J'en ai vu l'essai sur des blancs, qui con'-
 venaient que cela leur otait l'ardeur de la fievre, que le mal de tete cessait
 presque aussi-tot, &. qu'ils se sentaient  soulages.  Plusieurs m'ont meme
 dit en avoir et£ gugris. Ces herbes  se changent d'instant  en instant, and se
 retirent toujours aussi chaudes que si on les  eut fait bouillir: elles procu-
 red de  fortes transpirations,  & d£barassent surtout la tete. J'ai eprouv£ c©
 remede sur moi-meme. Mais pourquoi douterait-on de son efncacite'} q'i'on
 se r. ppelle ce que rapporte Chardin, de la mamer<- dont la fievre se guerit
 en qm'ques lieux de  1'Orient, <>u. I'on ne connuit d'autre cure, que de se
 fbire jeter sur le corps des seaux de l'eau la plus fratche."—P. 488. 
64
 length of time, a safe and useful substitute may be procured,
 by covering the patient, as he  lies in bed, with a single sheet
 wetted* with cold water, which, by evaporation, will gradually
 reduce the temperature of his body to a proper standard.
   The addition proposed by two or three writers  of  distilled
 spirit,—as rum,—to the water which is employed as a bath,
 would, indeed, contribute to cool the  patient more speedily;
 but it may be disagreeable,  if not injurious, to the patient, to
 inhale the spirituous vapours;  and it is probable that  the pro-
 cess of cooling by water only in the management just mention-
 ed will be sufficiently quick and effectual in most cases.
   Besides the external application of cold water, there is  an-
 other use of it, I mean the  drinking of it in small quantities
 frequently, which, as I have good reason to  believe from per-
 sonal observation, will be found of great efficacy, in  moderating
 the excessive heat of the body, as well as the violence of general
 febrile action; also in disposing the skin to perspire gently j
 and in preventing inflammation of the stomach, or diminishing
 and removing it after it has been excited.  The utility of fre-
 quent draughts of the coldest water in the cure of ardent fevers,
 and likewise in various other inflammatory disorders, was very
 generally known among the ancientf physicians, as is evident
  * The mode here proposed of carrying off the superabundant heat of the
body in fever, may be used in this country during warm weather ; but, during
cold weather, if the patient's room be not too much heated, he may, in ge-
neral, be sufficiently cooled, by merely diminishing the quantity of his  bed-
covering.
  ■j- It is true  that these ancients differed among themselves about the proper
time of administering cold drinks in fevers ;—Celcus, Galen, and most of the
other Roman and Greek physicians, deeming it dangerous to administer them
before the fourth day, or before those appearances, which they regarded as
the signs of concoction, had taken place ;  while the Arabian Physicians gave
cold drinks in the beginning,  without waiting  for  such  signs ;  tht latter
practice, however, has been proved by more modern experience, to be safe
as well as advantageous ; we cannot, therefore, wonder that some sanguine
physicians should have pushed it to an extreme, and employed it alone in
the treatment of febrile disorders, as in the diaeta aquea of  certain Italian
Physicians. 
65
from  the writings of most of those whose works have been
handed down to us; and it has been so fully established by the
experience  of many of the most considerable medical writers
on the Continent during  the last two or three centuries, espe-
cially in Italy and Spain, that it is a matter of no less sur-
prise than regret, that this beneficial remedy should have been
so little employed by British*  and American physicians in the
cure of the Yellow Fever.   It is scarcely necessary to add,
that in places where ice or snow- is  preserved during  the  hot
season, water-ices, made with acidulous fruits, will be found a
 safe and very pleasant mode of diminishing febrile heat.
PURGATIVES.
The state of the primse vise likewise demands early attention.
Costiveness frequently precedes, and generally accompanies,
the Yellow Fever; and as an  accumulation of faecal matters
usually  produces  morbid irritability  in the whole intestinal
canal, but more especially  in the stomach,  and  aggravates
other  symptoms, it is highly expedient to employ a cathartic
without  delay.   The medicine,  which should be given for this
end, ought,  for  reasons which I shall immediately explain, to
be such  as will not offend  or irritate the stomach hy its bulk or
quality ; and unless there be considerable determination to the
head,  the dose ought not to be very powerful,  lest the patient
should be too  much reduced by excessive evacuations, and a

  * Dr. John Williams, of Jamaica, and Dr. Rush, are two of the few  exceptions I
have met with to this remark —" Lare;e draughts of cold water, (says Dr Williams)
or other cool liquors, have occasioned  profuse sweats, when all the sudorificks in the
shop would not have had the same effect" He adds, « I have often observed that
those persons who had this (the Bilious or Yellow) Fever on board  of the vessels in
the harbour, who seldom drank any thing but cold water, no beds to lie on, or clothes
to cover them, with a free admission of air, frequently recovered "—See pages 16 and
27 of " Essays on the  Hi funis Fever, containing the different opinions  of those eminent
physicians, John Williams, and Parker Bennet, of Jamaica " London, 1752.
  Dr. Currie has made some useful observations on cold drinks in the 11th chapter of
vol. i. of his Medical Reports on the Effects of Cold Water.
                              9 
b6
prolongation of  the paroxysm,  or a diarrhcea be  the conse-
quence.   Calomel,  with  Scammony,  Jalap,  Gamboge,  and
similar purgatives,  will best answer the above purpose ; and
it will be proper to  repeat them as may be  requisite, in order
to  procure  two  evacuations  daily during  the  continuance of
the fever.

                             EMETICS.


Emetics have  been recommended in the begining of this dis-
ease by some,  but reprobated, and as I think, very justly,  by
other writers, in no respect  inferior to the former, either in
discernment or  experience.   My  reasons  for condemning the
use of emetics are,—first,  that they  commonly  fail in their
principal object  of removing nausea, which is very  apt to con-
tinue,  and  even in a  greater  degree than before; for this
symptom rarely proceeds from  any load of undigested food,*

  * It is, perhaps, only for the purpose of removing such undigested food, and thereby
preventing the injurious effects  which its continuance in the stomach would occasion,
that vomiting can be beneficially employed  in the Yellow Fever; and, in cases of this
description, the  above purpose may be sufficiently attaineu, if not by draughts of tepid
water  alone, to  aid the stomach in discharging its offending contents, at least by a
moderate dose of Ipecacuanha, which is a more  certain emetic than any of the prepara-
tions of Antimony in use, and is also preferable to the  latter for other reasons presently
to be explained.
  The practice of giving emetics in the beginning of fevers, has probably been rendered
more  general by the opinion first advanced, as I believe, by Sir John  Pringle, (See
page '290, of his Observations on the Diseases of the Army) and afterwards adopted
and maintained by Dr  James Lind, who, in his Dissertation on Fevers and infection,
chap 2, says, that  " if a person be seized with chills or sickness, after examining a
prisoner, visiting a prison, or being in a crowded Court of Judicature, where prisoners,
suspected of infection, have been tried, a vomit taken immediately seldom or never
fails to prevent the future  mischief;"—(See page 346 and also 248  and 257, of his
Essay on Preserving the Health  of Seamen, second edition ;) but I am  persuaded, by
numerous facts which  have fallen under my observation, to be stated in another part,
that in all the instances adduced  hy Dr. Lind to support his opinion, no one of the per-
sons, whom he supposed to have been  infected, and  to have been  preserved  in tliis
mode from fever, was  really infected ;  and 1 am likewise persuaded by other facts, also
to be stated, that when a person has imbibed a dose of contagion sufficient to produce
fever, a vomit will not only not prevent, but, on the contrary, assist  its production. 
67
or bile,  or phlegm in the stomach, but seems rather to proceed
from other causes, such as  sympathy with the  morbid state
of the brain, or of the surface of the body, or else from an in-
flammatory affection of the  coats of the  stomach itself; and
these are causes which emetics have but little  power to re-
move.   Secondly, the patient  cannot vomit  without making
violent  efforts, which  will exhaust his strength,  increase the
circulation, and propel a large quantity of blood into the head
where it may occasion the  most serious  mischief.  Thirdly,
there is a peculiar tendency in a warm temperature, to render
the stomach  and intestines relaxed,  irritable, and liable to
inflammation ;  hence the great prevalence of Cholera Morbus
and Dysentery, in all countries, towards the end of Summer
and  in  Autumn ; and this natural effect of heat is,  in  no dis-
ease, more perceptible than in  the Yellow Fever,  in which a
disposition to vomit is usually a very early symptom,  and one
of the most difficult to allay, as well as one of the most fatal
if not allayed ;  for  what  is properly understood by the term
of the Black Vomit, rarely occurs except as  the sequel to fre-
quent vomitings,  nor can we be surprised at the remarkable
frequency of this  disposition to vomit,  since we learn, from
very numerous dissections, that the stomach is more or less
 inflamed in  most of those who have died of the Yellow Fe-
ver.  Instead, therefore,  ,of prescribing  emetics in this disor-
der, it soon became my chief anxiety, while attending the sick
in military hospitals,  in  the West Indies, to calm the irrita-
tion of  the stomach by every possible means;  and I had full
employment  in this occupation; for  the  greater part of my
patients,  in the Yellow Fever,  were persons to whom emetics
had already been administered before they were  sent into the
hospitals. The mode which proved most successful towards
effecting this intention, when patients, with constant vomiting,
came under  my care, was to  give small doses of Opium, as
half a grain,  at intervals, at first of half an hour, and after-
wards of one or two hours; to procure  sufficient alvine eva-
cuations, where the bowels had been torpid, by clysters, and 
68
  also by combining moderate doses of the more powerful purga^
  tives,  as Calomel, Scammony,  Jalap, &c. with  the Opium,
  such  evacuations being highly  useful  towards checking the
  vomiting, by promoting the natural propulsory action of the
  stomach and intestines ;  to apply a large blister or  sinapism
  over the epigastric region, and to forbid the patient from swal-
  lowing food of any kind, liquid or solid,  as the  presence of
  even a very small quantity in the stomach always renewed the
  strainings to vomit.  The patient was, however, directed to
  rinse  his  mouth  frequently  with  lemonade,  or  some  other
  pleasant and acidulated liquid.
    When  this treatment had  been  persisted in for eight, ten,
  or twelve hours, I generally found that the vomiting had sub-
  sided,  and that the patient was able to retain a little food,
 which I then allowed him to take, at first in small  portions, as
 a tea spoonful or two, and gradually* in larger:  and I have
 the satisfaction of knowing, that very many persons were en-
 abled to take sufficient nourishment, and in the quantity of half
 a pint or more at once, within a day or two after  this simple
 plan of treatment had been adopted, and that they finally re-
 covered ;  when  it  seemed  highly  probable that they  would
 have been carried off in the same space of time, if, according
 to the mode which some authors have advised, and many prac-
 titioners have pursued, I had kept the stomach in a perpetual
 state of irritation, by forcing the patient, who had  rejected
 one potion, immediately to swallow another, perhaps  possess-
 ing even a more stimulating quality  than the former.f

  * I have very often found that patients, in the condition here described, were able to
retain, and relished, small quantities of spruce beer, cooled as much as possible, when
almost every thing else disgusted them, or was rejected by the stomach.
  ■j- Although Dr. Cullen  and Dr. George Fordyce, two of our greatest modern teach-
ers of medicine, have been partial to the use of emetics, and have recommended them
in the commencement of  Fevers, the weight of their recommendation, so far as it re
gards the treatment of the Yellow Fever, is considerably lessened by recollecting, that
neither of them was personally acquainted with any but the Fevers of this country,
wl ih a«e much less vioh- t in their  symptoms, and less rapid  or dangerous in their
egiirse, than the Fevers of hot climates, and in which it is certain, that emetics are 
69
     Though opium, as I have found, given in the manner above-
  mentioned, may be of great  service towards  putting a  stop to


 given with greater safety than in the latter: yet the following  passages from  their
 works will  show, that both these experienced physicians were aware of the bad effects
 which emetics are capable of producing.
   Cullen.   First lines of the  Practice of Physic, paragraph CLXXVIII.  " It is sel-    „
 dom that vomiting is found to produce a fi >al solution of Fevers ;  and, after they are
 once formed, it is commonly  necessary to repeat the vomiting several times; but this
 is attended  with inconvenience, and  sometimes with disadvantage.—The exercise  of
 vomiting is  often a debilitating power; and therefore, when the vomiting does not re-
 move the atony and  spasm very entirely, it may give occasion to their recurring with
 greater force."
   Fordyce.   Third Dissertation on Fever, second  part, page  73.  " It happens some-
 times, when an emetic is employed, that,  with every precaution, the sickness will con-
 tinue, and the patient shall pass a restless and distressing night, more so than would
 probably happen if no emetic had been exhibited."
   Id  Fourth Dissertation on  Fever,  page 80. " Preparations of antimony, ipeca-
 cuanha, and other medicines, which produce symptoms similar  to those which  take
 place in the ordinary crisis of Fever, and especially Dr. James's powder, have frequent-
 ly been employed in this very violent disease  (the Yellow  Fever).   The patient's
 stomach very soon becomes so  extremely irritable, that any dose of sueh medicines
 which might be  expected to be at all efficacious, has produced vomiting; which, when
 it takes place in  any great degree, has hardly ever been got over,  but has destroyed
 the patient."
   Sir John  Pringle was also aware of the disadvantages of emetics in the  advanced state
 of Fever.  See page 308 of his Observations on the  diseases of the Army.
   Some useful instruction concerning  the injuries that may be caused by emetics, and
 particularly by antimouial ones, in the treatment of Fevers,  is to be derived from the
 account given by VI. Le Cat, M. D. (and published in the 49th vol. of the Philosophical
 Transactions, part 1, page 49) of a " malignant Fever that raged  at  Rouen, in the
 winter of 1753-4," where  " the havock it made  gave them the reputation throughout
 Europe  of having the plague."  This was the contagious Fiver  to which L'r. Cullen
 has  applied  the  name of  T. |;hus; a disorder,  in  a great  measure,  peculiar to the
 British Isles, and but little known to French physicians;  for which reason it appea. s to
 have been very unsuccessfully treated by them whenever it has been introduced into
 Brest, or other ports or towns in  France by English prisoners of war.  The treatment
pursued by M. Le Cat on the above occasion  was, " after a bleeding or two," a vomit,
 the formula  of which was " four grains of emetic tartar dissolved in a quart of water,
 the fourth part  of which is given at a time ;  after tins had worked either by vomit or
Stool, another fourth was taken, and so on, till the patient was supposed to have vomited
or purged enough."   This remedy sometimes  produced " a small flux of five or six
stools a day  " and is the reby said to have effected a cure, &s it might do in slight cases;
'* bin ■.. -    tins success (lid i oi follow, the  p ti< nt » as aga:ti bled, first in the arm, then
 ifl the foot, and every two or three days there was given some cassia, quickened by an 
70
 excessive vomiting, much caution is nevertheless required  in
 the use of it; for if it be given freely, and in a larger quantity
 than is necessary for quieting the stomach, delirium and coma
 may be brought on, affections not less to be dreaded than that
 which the opium was intended  to  remove.   And,  indeed, it
 will be found of the greatest consequence, throughout the dis-
 ease,  to pay unremitting attention to the state of the brain, and
 to moderate, as far as possible,  every  action which threatens
 mischief to that most important organ.
   If, therefore, the patient should,  after having been suffici-
 ently   bled,  complain of very severe pain  in the head,  or
 be  delirious,  or comatose, it would  be  proper to support him
 in bed, so that his head may be raised, to apply a blister at
 the nape of  the  neck,  or between his shoulders, and to keep
 cloths wetted  with  cold  water  wrapped  round  his  head:
 and if these should not have  procured the desired  relief, to
have the head shaved, and fix a large blister over it, by which


emetic,  in a decoction of tamarinds." From vomitings and purgings thus reiterated,
the reader will not be surprised at the following appearances having been discovered
in the stomach and intestines on examining the bodies of " many" of those who died,
viz.  " In some, part of the villous coat of the stomach, and of the small guts was in-
flamed,  and the rest of these organs were filled with an eruption of the miliary crystal-
line  kind, except  that it was larger." " In others, a strong inflammation had seized
the whole stomach, and a small portion of the oesophagus, but the intestines were free.''
" In those cases where the delirium had continued long  and violent, we found either
ulceration on the stomach, or its villous coat separated, together with a great inflamma-
tion, and even some gangrenous spots on the other coats of that organ."
  " The manner of recovery from this disease, adds M. le Cat, deserves a place in the
history of it.  There were but few who recovered of it in the usual way, that is to say,
 who only wanted the restoration of their strength, exhausted as well by sickness as by
 the  medicines. Almost all of them, even those who had it in the first and second de-
gree, (the-mildest degrees) still  felt some remains of the symptoms of the disease ;"
" others who escaped the mortality of this dangerous poison, carried about with them
for several months and still feel, its terrible effects."
  M.Le Cat appears to have had no suspicion  that the  above appearances, and slow
or imperfect recoveries, were the consequences of his mode of treatment; for, in men-
tioning that treatment, he styles it " the most successful," which it might have been,
 compared with other modes then in use;  but to have (erroneously) considered them
 as characteristics of au unusual and peculiar distemper. 
71
sleep is frequently soon  induced, and severe pain in the kead
greatly mitigated or removed, after other usual means hava
failed.

                       sudorific s.

Sudorifics have, as well as emetics, been frequently com-
mended, and employed in the treatment of the Yellow Fever:
I cannot, however," join in this commendation, for the follow-
ing reasons; 1st. They do not seem to be at all necessary,
because a natural perspiration will readily ensue as soon  as
the excess of heat above the standard of health has been re-
moved, which  can be  accomplished with certainty by  the
proper application of cold water to the surface of the  body.
2dly.  The  means by which a perspiration is to be excited  are
not altogether innocent.  Small doses of such  sudorific  medi-
cines  as,  when given in large quantities, prove emetic, tend to
increase that disposition to vomit,  from which, as I have just
mentioned, the greatest danger is  always to be apprehended;
and of this class of sudorifics none are so detrimental in  the
Fevers of hot climates as preparations of antimony, because,
aided by the natural operation of heat, they usually leave be-
hind them  an extreme degree of irritability in the primse viae,
which but  too often resists all our endeavours to appease it.
Again, if the sudorifics be composed of medicines of the above
class,  combined with opium,  as Pulvis Ipecacuanha composi-
tus, some  share of that irritability will still be  produced,
though less, Indeed, than  in the  former case;  and the first
effects of this combination will generally be a  morbid increase
in the heat of the body, and a greater determination of blood
to the head, which may soon be followed by delirium or coma.
 Moreover, medicines of this description do not always succeed
 in causing perspiration ; and if they fail in this respect, they
 will probably produce other effects very injurious to $he  pa-
tient, such as aggravating the existing symptoms, and length-
ening the paroxysm. 
72
               PERUVIAN BARK AND CORDIAXS.

By the means above-mentioned, joined  with  mild febrifuge
remedies, as saline draughts in an  effervescent state,  and  by
such others as wrill mitigate the sufferings  of the patient,  we
may confidently hope, either that the termination of the first
paroxysm will also terminate the disease, or at least, that  the
brain and the  stomach will have been so far  protected as to
obviate the  dangerous consequences of the succeeding stages;
and in this  expectation we  may begin, as  soon as the febrile
commotion  subsides, to administer the Peruvian Bark, in s-ich
form  of preparation, and  in such  quantity,  as will best suit
the state of the stomach,  in  order* to restore that organ to
its proper functions, to strengthen the system, and to prevent
any return  of the  Fever.   It  should, however,  be a rule  not
to give bark in this disorder till the  period just mentioned;
for if it be given when there is a parched skin, a hard pulse, a
dry tongue, great  heat  and pain at the stomach, or delirium,
it will generally be found to increase and prolong these symp-
toms.
   When the patient begins to sink in strength,  he should be
supported by combining aromatics with the bark, and also by
wine more  or  less  diluted, or even brandy, which is often more
palatable and more easily retained by the stomach than wine;
and these cordials should afterwards be continued, or increas-
ed according to the state of his stomach,  and the degree of his

  * Dr. John Clarke, after a review of the practice in Fevers, as contained in the
journals of the Surgeons of the different ships in the service of the East India Compnn},
between the years  1770 and 1785, has given the result thereof in the following words,
at page 468 of his valuable work on the diseases of long voyages.  " Upon the whole of
the evidence it appears that, when Fevers of any consequence prevailed in the  ships,
either at sea, or at the different stations in India, mortality was almost invariably the
consequence of bleeding, and the continued use of purgatives and a-.itimoniuls.  That
under a cordial regimen, and moderate evacuations, succeeded  even hy a late use of
the bark, many recovered; and that  under the early, liberal, and continued use  of this
medicine, not one instance of death is recorded." 
73
 debility.  If the extremities grow cold, they should be warmed
 by artificial means.

                         MERCURY.

 It will  doubtless be expected that I should  speak of saliva-
 tion  hy  Mercury in the Yellow Fever,  which some writers
 have so highly extolled; and, indeed, I  should  have done it
 earlier, if the results of my  former experience, or a satisfac-
 tory explanation  of its mode of operation, had  relieved me
 from the doubts  and difficulties which  I have felt  on this
 subject.
   Dr. Henry Warren, in his  " treatise concerning the Malig-
 nant fever in Barbadoes,"(for so lie called the Yellow Fever)
 first printed in 1740, after condemning what he designates as
 " a very odd, and unwarrantable practice which had obtained
 for many years among several of the plantation practitioners
 in that island, of giving calomel  in  Inflammatory  Fevers,"
 says, (at page 36) " I have yet never heard  of mercury being
 given in this malady, (Yellow Fever) and I hope I never shall j
 as,  no  doubt, it  would here act an  uncommon  mischievous
 part."   It was  not then foreseen that, in the  year  1793, a
 medical  practitioner in Grenada would  be  found boldly ad-
 ministering mercury in this very disease, even so as to excite
 copious  salivation,  because he supposed, erroneously,* that
 " the liver was the most diseased part," and had heard of two
 Surgeons of the army who, some years before, gave calomel with
 success in the Yellow Remittent Fever, not indeed to salivate, but
 to produce evacuations by stool;  and also, because he thought
 that " it was, at all events, better to try a doubtful one, than
 remedies of no efficacy."  Although I should not have thought
 these motives sufficient to warrant an innovation so extraordi-
 nary, yet if it has  really preserved even a few of the lives said

  * See pages 351 and 423 of Vol. 1, of Dr. Chisholm's Essay on the Malignant Pesti-
lential Fever, &c.
                            10 
74
  to have been saved thereby, I shall most readily excuse the
  acknow ledged " temerity" of that new practice, and sincerely
  rejoice at the practitioner's good fortune in thus stumbling
  upon an efficacious remedy for a disease commonly productive
  of so much mortality.  I must, however, acknowledge, that I am
  not yet convinced of the supposed benefits of this new practice;
  for,  should it even be true, as is pretended, that the patients
 labouring under Yellow Fever, in whom a  salivation can be
 excited, generally recover, I  do not perceive that we could
 thence fairly infer, that their recovery was effected by the sali-
 vation. It is well known that, in many cases of that disorder,
 more than 500, and, in some, more than  1000, grains of calo-
 mel  have been given  internally  to  a single patient w ithout
 producing any sensible effect on the salivary glands, or even
 on the  intestines; and although, te explain this inactivity of
 the mercury, it has been supposed, that in such cases the ab-
 sorbents alone were in fault by not taking up the mercury,
 this  explanation cannot be  admitted,  because the intestines
 have commonly been as little excited by the calomel  thus in-
 troduced as the salivary glands; and it seems, therefore, pro-
 bable that a general torpor, or defect  of excitability, and of
 vital energy, existed in such patients,* and that the mercury
 proved  inefficacious in them only, because they had already
 made considerable approaches towards the condition of a dead
 body, in which it is obvious that no quantity of that medicine,
 however large, could exercise a stimulant power.   If this rea-
 soning be just, there will be room to  suspect at least, if not to
 conclude,.that, when patients  die of Yellow Fever, after all
 attempts to excite salivation in them have failed, their deaths

  * Dr. Chisholm, after mentioning (at page 429 of Vol. 1, of his Essay) that there are
some habits which, under the influence of disease, resist the action of mercury even
when more than 2000 grains have been given, while there are others in which-saliva-
tion is excited by less than ten grains, adds, " hence it may not be irrational to conclude,
that the susceptibility of, or resistance to, the action of mercury in habits, in which the
morbid action of the cause of the Malignant Pestilential, and Yellow Remittent Fevers
has already taken place, are in the direct ratio of their excitability ,•" a conclusion tha
is in conformity with the explanation which I have above given. 
75
have resulted, not from the want of any good effect which sali-
vation may he thought capable of producing, but because the
condition of their living, or sensorial power, and of the func-
tions depending thereon, had already become so morbid  as to
render their recovery impossible;  and, on the other hand, that
where persons have recovered from  the  Yellow Fever, after
having been salivated, their recovery was not occasioned by
the salivation, but was the consequence of such a condition Of
the powers of life, and of the functions connected therewith,
as induced a mitigation of the disorder, for the  same reason,
and perhaps, ceteris paribus, in the same degree, as it favour*
ed the operation of mercury upon such persons ;  and therefore
that, although recovery has not unfrequently followed, or ac-
companied salivation, the latter was not a cause of the former.
There is, indeed, no source of error more common  or produc-
tive, than  that of supposing  an  event which closely follows
another to have been occasioned by it; and it may be doubted,
whether a great number of the advocates for mercurial saliva-
tion in the Yellow Fever have any other, or better,  foundation
for their conviction of its efficacy.
  Besides the uncertainties in the operation of mercury, which
depend on the different conditions, or degrees of the general
excitability,  there are others,  arising from certain constitu-
tional peculiarities not well understood, which give  occasion
to excessive salivations hy the taking of only a few grains of
calomel; and this effect constitutes a serious objection to the
use of mercury, in a disease so rapid and dangerous, without
manifest necessity.
  In order, however, to attain  the truth upon this important
subject, it is not sufficient for us  to  discover,  that recovery
generally follows salivation in Yellow Fever, though even this
is contradicted by many very respectable authorities; but we
must ascertain whether those  practitioners who  excite saliva-
tion in as many of their  patients as  may be susceptible of it,
under that disorder, do  in fact lose a  smaller proportion of
them, than those who purposely abstain from all endeavours to 
76
 produce that discharge : and on this point I must declare that,
 after some experience,  assisted by no ordinary portion of in-
 quiry and information, I have not been able to  discover that
 the salivators were  more successful than the others.   And, if
 not more successful,  their practice has certainly been hurtful;
 because,  in most of  the persons who  have recovered, the (per-
 haps useless) salivation  had retarded the convalescence, and
 produced  very troublesome affections of the tongue,  mouth,
 and throat, with other ill consequences ; as is well known and
 acknowledged, even by its advocates.   Dr. Chisholm (at page
 357, of vol. i. of  his Essay,) warmly acknowledges his "obli-
 gations  to Dr. Rush for supporting  in a  masterly manner,"
 and "pursuing the mercurial mode of treatment," and express-
 es both " admiration  and respect" for  his " fortitude" in doing
 so.  But Dr. Rush, notwithstanding this support and this for-
 titude,  has candidly stated, that " in  the City Hospital, (of
 Philadelphia)  where  bleeding  wras sparingly used and where
 the physicians depended  chiefly upon salivation, more than one-
 half died  of all the patients who were admitted."—(See page
 128, of vol. v. of his Medical  Inquiries and Observations.)—
 But great  as this mortality was,  it fell vastly short  of that
 which occurred in a detachment of the Royal Artillery, placed
 under the  care  of Dr.  Chisholm, when of twenty-seven re-
 cruits for that corps, who arrived in Grenada,  in July, 1793,
 twenty-six were seized with the Fever, and of these,* twenty-
 one died before the middle  of  August ensuing, that is, in six
 weeks.  (See page 133, of vol. i. of Dr. Chisholm's Essay.)—
 Upon the subject of  this occurrence, Dr. John  Hunter has ob-

  * Among the cases given by Dr. Chisholm, in his first Appendix, the four which are
 numbered 9, 13, 14, and 15,  (See pages 371, 383, 386, and 387, of vol. ii.) seem to be
 the cases of four out of the five survivors of the twenty-six men in question ; and it is
 remarkable that in the two  first of those  cases very little mercury was administered,
but the Peruvian Bark,  with some opium, wine, &c was chiefly relied upon for the
cure; and that in the two last, no mercury whatever was given. The twenty-five
cases, therefore, before us, and th  ir results, appear by no means to correspond with
 D, Chisholm's high commendation of, or professed confidence in, the mercurial treat-
 ment. 
77
 served, (at page 328, of his work on the Diseases of the Army
 in Jamaica,) that although  "Dr. Chisholm had satisfied him-
 self of the great virtues of Mercury, at least four months be-
 fore, yet this is a mortality never exceeded in any Fever."*
   To one who is sincerely desirous of discovering and adher-
 ing to the truth, it is extremely  difficult to reconcile,  or ac-
 count for, the very opposite testimonies given on this subject;
 and the doing it would moreover be too invidious for me to atr
 tempt  it.   This,  however,  appears certain, that the good ef-
 fects of the  mercurial treatment have been greatly exaggera-
ted  by persons who either  were deceived,  or were willing to
deceive others ; that  many persons have died of the Fever in
question,  although mercury, administered externally or inter-
nally,  had produced a copious salivary discharge ;  and that,
 in  very many  others who have recovered,  this discharge did
 not beginf until after a solution, or a great  mitigation, of  the
disease had evidently  taken place, which solution, or mitiga-
tion, therefore,  could not have been the  effect of salivation.—
 I  cannot,  with an eminent  aiid  respectable  physician4 who
treats of this practice, " aver that, although I have been called
 in to attend  many under such  circumstances, not one survived,

  • Dr. Chisholm, who was likewise attacked by the same Fever in the same year, was
himself more fortunate ;  for though he had recourse, at first, to the same remedy, he
became convinced of its inefficacr, in his own case, early enough to call for the advice
of Dr. William Vlunro, then of Grenada, and now of Demerarv, under whose care he
recovered, but, as I have been well informed, by a very different mode of treatment.
  Dr. Chisholm, at page 237-9, of his second volume, mentions the great success of the
mercurial treatment in the hands of his former partner in Grenada, Mr. W. Campbell j
yet, as 1 have been assured from respectable quarters, this gentleman refused to take
Calomel, when he was afterwards attacked by the Yellow Fi'ver, of which he died.
  ■J- " Mercury seldom salivated until the fever intermitted or declined.  I saw several
cases in which the salivation came on during the intermission, and went off during its
exacerbation; and many  n which there was no salivation until the  morbid action had
ceased altogether in the blood-vessels, by the solution of  the fever."—See Dr. Hush's
Account  of the Bilious Yellow Fever of Philadelphia, in 1794, in the 4th vol. of his
Medical Inquiries and Observations, page 94.
  * See  the " Essay o» the  Yellow Fever  of Jamaica, by David Grant, M.D"
page 51. 
78
and that they became more victims to the mercury than even
to the Fever;" but I can aver, that I had not a few opportuni-
ties of observing the effects of mercury given  in this disease,
while I served, in 1796 and  1797,  as physician to the army,
under Sir Ralph Abercrombie, in the West Indies; and that
I saw nothing, which, to my understanding,  could afford a
proper encouragement to continue the mercurial practice; and
this, I have great reason to believe, may be said of  most of
the other physicians and medical officers,  who were then, or
have  been subsequently, employed  with the British forces in
the West Indies ;  and therefore, though  I have adopted no in-
vincible, nor, as I hope, unreasonable,  prejudice on the sub-
ject, I cannot venture to recommend the  use of  mercury to
excite salivation in  Yellow Fever, without farther evidence of
its utility.   At the same time, I consider the use of it, in this
disorder, as a purgative, to be highly beneficial.
  Of mercurial frictions, which  have been largely employed
in the Yellow-  Fever, it may also be observed, that  they do
not seem likely to prove altogether  innocent in those cases in
which they  may happen to do no good;  for,  besides the sali-
vation which they may produce, when  the patient lives long
enough, and which is to he added to the number of his suffer-
ings, already sufficiently abundant, the very act of rubbing-in
the mercury tends greatly to disturb his body and mind, when
his  only wish is to remain unmolested;  while the covering a
large portion of the skin with a greasy ointment produces a
considerable accumulation of heat therein, by which the gen-
eral heat of the body,  and with it many of the other febrile
symptoms, will be increased.
KND OF PART FIRST. 
PART  SECOND.
 Having given some account of the symptoms and  treatment
 of the Yellow Fever, it seems expedient, as far as possible, to
 ascertain its cause: but in attempting to do this, I find the
 natural course and progress of my inquiry obstructed by cer-
 tain  doctrines, taught by authorities highly respectable, and
 almost generally adopted, though, as I think, without sufficient
 evidence', and I am, therefore, induced to  enter upon  a pre-
 vious examination  of these doctrines, in order to remove the
 obstruction occasioned  by them, and clear a path which will,
 I  hope, lead towards the truth.
   To render this examination the more methodical  and satis-
 factory, I beg leave to propose, for discussion, two  problems,
 to which the doctrines in question seem to be referable, viz.—
 First, Are all fevers naturally contagious, or  capable  of ex-
 citing fever in other persons not predisposed thereto ?
   Secondly, Can a fever, strictly contagious, be generated by
 an accumulation of filth,  or  of  putrifying, or putrid matters,
 or by the crow ding of healthy persons into confined,  or ill-
 ventilated, and unclean places ?
   The affirmative of the first of these problems has been as-
 serted  by Dr. Cleghorn,* Dr.  Robert Hamilton,!  Dr. John
 Clarke,:}: and more especially by the late Dr. George Fordyce.
 The last of these authors, in his Dissertation on Simple Fever,

 * Observations on the Epidemical diseases of Minorca, third edition, page 132, &c.
 j Observations on Marsh Remittent Fever, page 39, &c.
 + Observations on the Diseases which prevail in Long Voyages to Hot Countries,
vol. i. page 151, &c. 
80
(page 113 and 114, second edit.) endeavours to maintain, that
" by repeated experience, it is  now known that, although it
very frequently happens that  a man  coming  near another
afflicted with fever, is not afterwards affected with the disease,
yet of any number* of men, one-half of whom go  near a person
ill of this disease, and the other half do not go  near a person
so diseased, a greater number of the former will be affected
with fever, than of the latter, in a short period afterwards. In
some instances, the proportion is not very different;  in others,
the author has known seven out of nine, who went near a per-
son afflicted with fever, seized with the disease, in  the  space
of three weeks afterwards.  There is,  therefore, (adds he)  a
perfect ground, from experience,  for believing, that coming
near a person afflicted with fever is a cause of the disease."
  This  general indiscriminating  assertion, if  it were true,
could only prove that some fevers are contagious,—not that
all are so.—But the assertion  is  manifestly  founded upon  a
supposed probability, or presumption, that such effects would
result from the  causes here described ; for no one can believe,
that an actual experiment was ever made by selecting a cer-
tain number of persons, and sending one-half of them into
close  communication with  a febrile patient, and afterwards
contrasting what happened to these, with the condition of those
who were not allowed to approach any person labouring under
fever.  Nor would a single experiment afford any conviction
on this subject, for reasons too obvious to require explanation.
Much also would depend on the species of fever to which the
individuals in question  are supposed to  have  been exposed,
which is  not mentioned by Dr. Fordyce.  Few persons, if
any, doubt of the contagious quality of what  is called Jail
Fever, and  few believe that intermittent fevers possess that
quality.
  The same author,  at page 116, inculcates that " a peculiar
matter is  probably generated in the body of a  man in  fever,
which, being carried by the atmosphere,  and  applied to some
part of the body of a person in health, causes a fever to 4ake 
81
 place in him."  This matter having no sensible properties,
 " its existence (says he) is  only known by its effect in pro-
 ducing the disease."   And  in  the  next page he asserts, that
 " this infectious matter is produced by all fevers whatever ,•"
 but immediately adds, that, "  as far as he  knows,  no person
 has been  seized with fever, in consequence of coming near
 another person afflicted with it, where the fever consisted  of
 one paroxysm only ;" and he thereby, in effect, admits that he
 has gone  beyond  his knowledge,  and contradicted  his own
 uniform experience, in asserting that  " this infectious matter
 is  produced by all fevers whatever."  And probably,  if he
 had examined facts with  sufficient  accuracy and caution, he
 would have discovered that other fevers, beside those of one
 paroxysm, had occurred, which were not known to have ever
 re-produced fever  in any other person.
   In the same page, Dr. Fordyce declares,  " that Intermittent
 Fevers produce this matter, or, in other words, are infectious;"
 and that he " knows this from  his own observation, as well as
 that of others."
   Here again the author seems to have hazarded an assertion,
 for which it is hardly possible that he could have had  any
 certain foundation, because it is now known, as will  be  more
 fully  stated hereafter,  that the  ordinary, and  perhaps  sole
 cause of intermittents, i. c. Marsh* miasmata,  may remain
 inactive for several months after having  been imbibed by a
 person in health, and, finally, produce fever, notwithstanding
 such long inactivity; and therefore, although  Dr. Fordyce
 may have known persons to be  attacked by intermittents, after
 having communicated with others labouring under that disor-
 der, he could never have been certain that they had not, with-
 in  the preceding  six or eight ihonths been exposed to these

  • I beg to state, in this place, that, in joining the epithet marsh, or marshy, to the
terms miasmata, exhalationF, efiluvia, &c. and in considering these as a cause of fever,
I do not mean to intimate that such miasmata, &c. are emitted solely by marshes, (it
being certain that they frequently arise from soils in a different state,) but only to desig-
nate the quality of those vapours, which are eminently the product of marshy ground*.
                             11 
                            82
miasmasta,  existing,  as they do, in  a variety of unsuspected
places..  He  seems, indeed, to have been less confident in re-
gard to these than in regard to other fevers, for he immedi-
ately subjoins the following concession, viz.—" But intermit-
ting fevers are not nearly  so apt to produce it, (the conta-
gious matter,) or at least, to propagate it, as continued fevers;
and the more violent the continued fever is in its febrile symp-
toms, the greater quantity of infectious matter is produced."
  This general assertion of the contagious nature of all fevers
without exception,  is so important in the conclusions  deduci-
ble from  it,  and so much at variance with the general experi-
ence of  mankind, more especially in regard to those fevers,
which  so frequently follow any considerable exposure to the
exhalations of marshy, or damp, soils during, or soon after,
very hot seasons, that I feel it incumbent on me to contest this
assertion; and in doing so, I beg leave to observe, that the
kinds of evidence, which would be sufficient to produce convic-
tion in a Court of Judicature respecting the ordinary transac-
tions of  our lives, would often prove fallacious in regard to
medical  facts,  and especially those  which relate to the exist-
ence and effects of contagion;—the former being cognizable
by some  of our senses, we are enabled to ascertain and testify
the truth concerning them ; but this rarely happens in regard
to the latter ; of which our belief frequently depends upon sup-
posed  causes and effects, whose existence  and relations are
not capable of being either seen, heard, or felt; and  yet men
will frequently  imagine they have seen, heard, or felt, all that
is necessary to warrant their belief; and will, in such eases,
even assert what appears to them to he  true as confidently as
if their judgment had not been, in any degree liable to  error.
   Hence the works of medical writers  abound with supposed
facts,  which are now known to have been more or less falla-
cious ; and  to this source of error,  all proofs of the existence
of  contagion are particularly  liable; because the matter,  of
which it consists, is not distinguishable by any of our senses;
 and we can, therefore, only presume its existence and agency 
83
by certain effects or events, which may be suspected, but can
hardly ever be absolutely proved, to -have resulted from it.—
Aware of this difficulty, Dr. Haygarth has very properly made
adistinction between facts  adduced to shew the existence of
contagion, from the circumstance  of  certain persons having
been attacked by a particular disease, which last he names af-
firmative proofs; and other facts shewing the non-existence of
contagion, from a number of persons having escaped the disor-
der, who had been fully exposed to the action of effluvia,  sup-
posed to he infected; these he calls negative proofs.  " Obser-
vation,  or experiment," says he, " can  determine with much
greater  certainty what aloes not,  than what daes, give infec-
tion ;" wrhence  he  justly concludes, that the negative proof is
 capable  of being  established by incomparably stronger  evi-
 dence than the affirmative, and is therefore, in  all cases, much
 better entitled to credit."*
   Indeed, Dr. Fordyce maintains, page 110, of his first Dis-
 sertation, that, " in treating  of Fevers,  nothing is to be ad-
 mitted as a cause, the knowledge of the action of which does
 not depend upon experiment;" and he observes, at page 112,
 that, " of the number of causes to which  fever has been ascri-
 bed by the practitioners  who have treated of this  disease, few
 will bear the  test of  any strict  inquiry:"—an observation
 which will I think, hereafter appear applicable to more than
 one of the causes of fever, which  have been supposed by Dr.
 Fordyce himself,  notwithstanding the great merit of his wri-
 tings in many other respects.  If contagion be a quality natu-
 rally belonging to all sorts of fevers, without distinction, they
 ought all to manifest this property in circumstances favourable
 to, and upon persons susceptible of, its action.   That there are
 fevers, however, which do not manifest this property, or qua-
  lity, in circumstances highly favourable to its operation, and
  upon individuals who  must have been fully exposed  to, as

   * See his letter to Professor Waterhouse, at pnge 296, of bis " Plan for exterminate
 ing the Small Pox." 
                            84
well as susceptible of, its impressions, if such contagion had
exsted, may be  demonstrated by hundreds,  and probably by
thousands, of well-authenticated facts, capable of infinitely
overbalancing the supposed evidence derived from occurren-
ces, in most of which it was easy to mistake, for the effects of
personal contagion, those produced by morbid causes existing
in the atmosphere, and derived from very different sources.
  It will,  however, be sufficient to adduce a few only of these
facts at present,  especially  as I shall have occasion hereafter
to mention a variety of others, of similar import, though for a
different purpose.
  Dr. James Lind, in his Essay on the Diseases incidental to
Europeans in Hot Climates, (p. 27,  fifth edition,) states the
following fact,—viz.
  " In the month of August, 1758, Admiral Broderick, in the
Prince ship of wrar, anchored in the Bay of Oristane, (in Sar-
dinia)  where  twenty-seven of  his men, sent ashore on  duty,
were  seized  with the  epidemical distemper of this  island;
twelve of them  in particular, who had slept on shore, were
brought on board delirious; all of them laboured under a low
fever,  attended with great  oppression on the breast,  and at
the pit of the stomach,—a constant retching, and sometimes a
vomiting of bile, upon which a delirium often ensued.   Those
fevers changed into Double Tertians, and afterwards termina-
ted in obstinate Quartan Agues.   It is worthy of remark, that
in this ship,  which lay only two miles distant from the land,
none  were taken ill but such  as had  been on shore, of whom
seven died."
  The same  respectable author, at page 221,  mentions ano-
ther similar fact in the following terms,—viz.
  " In  a  voyage to the Coast of  Guinea, performed  in  the
year  1766, by the Phoenix ship of war, of forty guns, the offi-
cers and ship's company were perfectly healthy, till, on their
return home, they touched at  the Island of  St. Thomas.—
Here the  captain, unfortunately,  went on shore,  to spend a
few days in a house belonging to the  Portuguese governor of 
85
that island.   This happened during the rainy, or sickly, sea-
son.  In the same house were lodged the captain's brother,
the surgeon,  some midshipmen, and the captain's servants.—
But in a few days after their being on shore, the captain, his bro-
ther the surgeon, and every one, to the number of seven, who had
slept in that house, were taken ill; and all of them died except
one, who returned to England in  a very ill state of health.—
The ship lay at anchor there twenty-seven days, during which
time three  midshipmen, five men, and  a boy,  remained on
shore, for twelve nights, to guard  the water casks, under pre-
tence  that the islanders would steal them ; all of wrhom were
likewise taken ill,  and two of them only escaped with life.—
At that island, only those who slept on shore were taken ill; no
other  man of the ship's company was seized with any distem-
per during their stay there.  Even during  the  whole voyage,
if we except these unfortunate persons, only one man died,
and he was  killed by an accidental  blow upon the head.—
None of those who slept  on shore escaped the sickness,  and
of them only  three survived it."   And, at page 225, he adds,
"In the year following, the Phoenix made another voyage to
the Coast of Guinea, and  happened again to touch  at this isl-
and in the sickly season, where she lost eight men out of ten,
who had imprudently  remained all night on shore.  At the
same  time, the rest of the  ship's company continued in perfect
health, who, after spending the  greatest  part of the day on
shore, always returned to their ship before night.   On board
the Hound sloop,  then  in company with  her, only one man
died during the whole voyage; the officers having been  parti-
cularly careful not to permit any  of the people  to continue all
night on shore in that place.   This man was cut  off by an ob-
stinate intermitting fever,  with which he had been first seized
at Sheerness."
   The  same  author,  in  his  " Essay on the most  effectual
means of preserving the health of Seamen,"  had previously
observed, at page 57, "that the  fever  of the Island of St.
Thomas, is, to a proverb, in that part of the world, deemed 
86
the most malignant and fatal species of  any African or Ame-
rican Fever ;*'* and consequently,  if Dr. Fordyce's doctrine
were true, that all fevers  are more contagious  according as
their symptoms are more violent, this fever ought to have
been communicated to great numbers on board  the Phoenix,
whose intercourse with  the  sick in that ship must have been
sufficiently near and frequent.  The same want  of contagion
has, however,  attended this fever on other, and,  so far as I
know, on all other occasions.
  Dr. Trotter,  late physician to the Royal  Navy says, (See
Medicina Nautica, vol.  i.  page 456,) " In a voyage down the
Coast of Guinea, in  the Assistance, in the year 1762, we had
scarcely a man indisposed.  We wooded and  watered  at the
Island of St. Thomas, and with a view to expedition,  a tent
was erected on shore, in which the people employed on these
services w ere  lodged during the night.   On the  middle pas-
sage, every man who slept on shore died, and the rest of the
ship's company remained remarkably healthy."
  Of a similar  nature are the facts which occurred in regard to
the Ponsborne  and Nottingham East Indiamen,  at the Como-
ra Islands; (See Medical Observations and Inquiries,  vol. iv.
page 156,) atone of these islands,  viz.  Mohilla, a great part
of the crew of the  former ship, after sleeping on  shore in Au-
gust, 1765, were attacked  by a  violent  fever, which, in a few
weeks, proved fatal to more than seventy of them; and, on the
16th of July of the following year, the Nottingham  having an-
chored to the leeward of Johanna, (another of the Comora Isl-
ands,)  and a considerable part of her crew having been sent,
and allowed to sleep, on shore, they were attacked, soon after
the ship had put to sea,  by a severe remitting fever, of which

  * Of the Island of St. Thomas, Dr. Robertson, Physician to Greenwich Hospital,
observes, page 32, of his Meteorological and Physical Observations,  &c. 4to. that « the
town is built on the leeward-most part of the island, which is not at all cleared of the
woods, nor the marsh drained; the consequence of which is, it is generally peopled
fro.  I'ortugal every second year, it proves so fatal to Europeans "  For another proof
of the danger of sleeping on shore on that island, see pages 33 and 98 of the same work. 
87
- several died.  Of this fever,  Dr. Badenoch, then surgeon of
 the Nottingham, observes, ** it infected only those that slept on
 shore, and having gone through them, the fever ceased."   And
 this  he adds,  " wras likewise the case  with those on board the
 Ponsborne, in regard to the Bilious Fever, which prevailed in
 that ship, at the island of Mohilla."
   A similar occurrence  is related by Dr. John Clark, in the
 first volume of his Observations on the  Diseases which prevail
 in Long Voyages to Hot Countries, page 124; after descri-
 bing the  low place,  " covered with impenetrable mangroves,"
 at North Island,  near the Streights of  Sunda, where most of
 the East India ships take in wood and water for their home-
 ward voyage, he adds, that " a Danish ship, in 1768, anchor-
 ed at this Island, and sent twelve of her people on shore to fill
 water, where  they  only remained two nights.  Every one of
 them were seized with  a fever, of which none recovered ,* but
 although the ship wrent out to sea, none, except the twelve who
 slept on shore, were attacked with the complaint."  Here
 again was a fever so violent as to kill every one in whom it
 was excited, and from a cause so powerful as to affect every
 one who  was exposed to it, which,  notwithstanding, did not
 reproduce itself in a single instance.
   Many facts  and occurrences, of  a similar nature, might ea-
  sily be added to the preceding; but they are all rendered su-
 perfluous by the notorious and unfortunate events, which have
 recently  happened among the British officers and soldiers em-
 ployed in Zealand,  among whom, though near tliirty thousand
 of them were attacked by fever, which  proved  fatal to nearly
 one-sixth of the whole number of sick, I have not been able,
 after much inquiry,  to discover a single case,  in which there
 has been reason to  suppose, that any  one person caught the
 fever from  another.  But,  on the contrary,  it appears to be
 the  unanimous  opinion of the army physicians employed on
 that service, (with most of whom I have conversed on the sub-
 ject,) and also of the other medical officers, best qualified to
 judge of such matters, that no contagious quality accompanied 
88
 the fever in question, either upon  the  island of Walchereu,
 or among the sick removed to this country.  And  I  shall
 hereafter  adduce the  most convincing  evidence, that in fact,
 these  fevers were  not of a contagious  nature; and we may,
 therefore, consider ourselves  as  abundantly  warranted  in
 concluding, that all fevers are not endowed with a  contagious
' quality, which conclusion is all that I propose to establish at
 present.
   Problem II.  Can a Fever, strictly contagious be generated
 by an accumulation of filth, or of putrefying, or putrid,  mat-
 ters, or by the crowding of healthy persons into confined,  or
 ill-ventilated, and unclean places ?
   Most writers on the subject  of Contagious Fever have ei-
 ther inculcated or believed, that it might be generated,—first by
 an accumulation of  those  disgusting matters, cemmonly de-
 nominated filth ;—secondly, by the offensive vapours  emitted
 by corrupting dead bodies, or by other matters in a putrid
 state;—and, thirdly,  by crowding persons, even when heal-
 thy, in ill-ventilated and unclean places.
   I have no desire to weaken any of the prejudices which tend
 to promote cleanliness in  civilized nations,  any further than
 is  absolutely necessary for the manifestation of truth, on a
 question of great importance to mankind ;  and I flatter my-
 self that we shall all  find within ourselves  sufficient motives
 to  remove or avoid filthiness,  even when  convinced that it
 does not produce contagious fever.  Whence the belief of its
 doing so was derived,  I am unable to explain ; but  it has pro-
 bably been confirmed by the frequent co-incidence of such fe-
 ver, with  nastiness and offensive smells in the dwellings of
 indigent people.  There is, however, no necessary, or  natural
 connexion between the former and the latter.
   Dr. Fordyce asserts, (first Dissertation, page 115,) that he
 has known persons to  be ill of  the most infectious fevers, and
 to communicate fevers to others by infection,  when there was
 no peculiar smell nor taste, nor any thing  perceptible to the
 senses  in the atmosphere  surrounding them; an/1 similar .a*- 
89
Bertions have been made by Dr. Lind, and others, which I be-
lieve, are in conformity with the experience of all physicians.
I know, indeed, that masses of animal and vegetable matters,
and  especially the former,  while undergoing putrefaction, or
other modes of decomposition, as in privies, &c.  may give out
vapours  so condensed and noxious as to cause asphyxia, and
sometimes almost  immediate  death, to those by whom they
are inspired.  But such mischiefs  have  no relation to fever;
nor are those who  recover from them, afterwards affected,  in
consequence thereof, by any  febrile disorder.  This is also
true of the dangerous, and often fatal, effects produced by the
fumes of charcoal, and the mephitism of mines, long-neglect-
ed wells, &c. which are not known to have ever produced fe-
ver ; these do not  however, properly relate to our present in-
 quiry.
   Every thing which I have been  able to  discover, or  ascer-
 tain, respecting the nature and' properties of contagion, in-
 duces me to  consider each of its several species as a  peculiar
 morbid quality, or power, imparted to certain  animal  secre-
 tions, in consequence of some particular, though unknown, ac-
 tions excited in the living body, when actually disordered, by
 the  very same species of contagion previously,  and  in like
 manner, elaborated in another body, whilst labouring under a
 smiilar disorder from a similar cause; ^nd therefore, though
 we  are unacquainted with the origin of any one species of con-
 tagion,  yet,  considering the properties  manifested by all,
 ever since they have been known to exist, we may conclude,
 that being thus produced, exclusively by,  and within, the liv-
 ing body, each  is capable of exciting,  in other living  bodies,
 the  same morbid action, or disease, which occasioned its own
 production, and of thus maintaining and propagating itself in-
 definitely; and consequently, that though contagion be a mor-
 bid and morbific secretion  or production, it is also a natural
 one, wholly,  inimitable, either by accident or art.   If  this be
 true, it must follow that, though noxious vapours should result
 from those fortuitous, and ever varying, collections of unclean
                             12 
96
 or putrefying matters commonly denominated filth,  which, as
 in the instance of marsh effluvia, may produce diseases, inclu-
 ding  fever, yet the diseases  so produced will be incapable of
 exciting similar diseases in other persons, and will, therefore
 be destitute of  the most  essential property of contagion.
   Indeed,  if it were true that vegetable or animal matters,
 while decomposing or putrefying, could de novo generate con-
 tagion properly so called, the species or varieties of contagion
 ought necessarily to have  become as numerous and various as
 the matters so decomposing,  and also as various as their re-
 lative proportions;—every dunghill, every  collection of rub-
 bish and filth, ought to be  capable of generating the cause of
 a new disease, and that disease ought to be  capable of repro-
 ducing itself in other persons ; and human existence, w ith such
 additions  to the other dangers  which surround us, ought to
 have become the most precarious,  transient, and deplorable,
 of all the w7orks of creation.
   No person, who is even  moderately acquainted with the
 subject,  can believe  that  a disorder  resembling  Small Pox,
 (for instance,) and possessed of the same properties,  could be
 created by any accidental collection, or even by the most ar-
 tificial and scientific combination, of either organic or inor-
 ganic  matters,  not impregnated by the  specific contagion of
 that disease.  On the" contrary, we have the strongest reason
 to believe that neither human ingenuity, nor  any co-operation
 of natural means, could even alter the  nature of variolous con-
 tagion ;  and that, in fact,  it has continued,  without any last-
 ing change in its properties, ever  since that unknown sera
 when  its morbid action  was first exerted upon mankind;
 though,  having been successively transmitted through the bo-
 dies of, perhaps, several hundred thousands  of individuals of
 different colours and temperaments,  many of  them probably
 contaminated at the same time by scrophula,  syphilis,  cancer,
 or  other morbid taints, or infections, (and this, during the
 prevalence  of numerous epidemical  or pestilent  diseases,)
these  ought, if any tiling  could, to have produced every de- 
91
 gree of deterioration, of which the original virus was suscepti-
 ble, and some permanent varieties,  at least in  this species of
 contagion.* We  know,  however, that its specific  properties
 are invariably the same, and that the differences which are ob-
 served in its effects, depend  upon causes  connected with the
 individuals to whom it is  respectively applied;  the  disease,
 cseteris paribus,  proving  no worse, when  communicated by
 one  dying  of  it  in ike most  confluent and malignant form
 than it  would have been,f if  communicated by one  recovering
 from the mildest product of inoculation.   And  we have simi-
 lar  reasons for  believing  that  Measles,  Chicken  Pox,  and
 other specific contagions, are equally permanent and unaltera-
 ble.  If then  the powers  of  life, and the organs by  which


   * Dr. Adams, physician to the Small Pox Hospital, observes, at page 21 of his work
 on morbid poisons, in 4to. that, from the great affinity, or analogy between the vario*
 lous and vaccine contagions, " we might even expect that the characters ol the two
 might be altered, by applying both at the same time, and also that the phenomena of
 one might imitate  the phenomena of the other, in such a manner as to render the dis-
 tinction between them doubtful.  It is, therefore, a matter of surprise, that the distinc-
 tion should be so regularly observed, and the laws  which separate other morbid poisons
 be so rarely infringed."
  He also remarks, at page 398, that " Small Pox  and Cow Pox, contrary to the law of
 all morbid poisons, which are different  in their nature, will proceed together in the
 same person without the smallest interruption of each  other's  course.  If inserted
 nearly at the same time in the same person, each proceeds in the same course as it'
 they were in two distinct subjects; if inserted nearly in the same spot, the two form
 one common areola, but the vesications are distinct, and each preserves its own charac*
 ter, till that of Small Pox becomes purulent from suppuration," Sec.  In this case, he
 adds, " you may take Small Pox matter from the pustule, which,  by the adhesive in-
 flammation, will remain distinct from, though seated in part of the Vaccine Vesicle;
 and from the other parts of the Vesicle you may take vaccine matter, and each will
 perpetuate its respective morbid poison."
  Thus we find that, by the simultaneous association of two infections, so nearly alike,
 that the action of the one renders the body insusceptible to the action of the other, the
 energies of the constitution cannot produce even an intermediate, or hybrid contagion.
  f At page 10, vol. i. of the Transactions of a Society for improving Medical and Chi-
rurgical knowledge, Dr. G. Fordyce says, " I have the greatest reason to believe, that
it is not of the smallest consequence, (in inoculation) whether the matter be of the mild
or the confluent  kind. I never knew of an instance of any other disease being commu-
 ■icated by inoculation of the Small Pox." 
92
 these contagions are successively renewed  and perpetuated,
 cannot even alter the qualities or effects of the latter, by any
 of the changes which may be supposed to have taken place in
 their actions and in the fluids of the human body, from a va-
 riety of morbid, and other,  causes excited in so many  differ-
 ent individuals,  it is credible, that putrefaction,  which is but
 a natural separation of organised matters,  previously  held
 together only by animal or vegetable life, should be capable of
 generating a new contagion ? Such matters spontaneously de-
 composing,  and returning  to  their  natural  inorganic and
 harmless combinations, necessarily obey their respective  che-
 mical attractions; and the products resulting from this sort of
 obedience are as certain and  constant as the formation of Sea-
 salt,  by combining soda with  muriatic acid.  There is no
 chance, therefore, nor even possibility, of thus generating any
 thing so wonderful,  and so immutable,  as contagion, which,
 resembling animals and vegetables in the faculty of propaga-
 ting itself, must, like them, have been  the original work of
 our common Creator, and must  have been continued  in exist-
 enceby the energies of a living principle, exerted successively
 in the different bodies, through which it has been  transmitted
 from one generation to another.   As well might wre revive the
 for-ever exploded doctrine of equivocal generation, and be-
 lieve, as formerly, that insects, reptiles, &c. are the offsprings
 of mere corruption, as to believe that a substance so analo-
 gous to them,  in that  most mysterious and essential function
 of self-propagation, could originate from that cause, or form
 any operation of chemical agencies alone.
  As this reasoning, however, may not of itself produce gene-
 ral conviction, especially on strongly prejudiced minds, let us
recur to matters of  fact, and let these decide whether,  in re-
 ality, any, and  more especially a febrile, contagion has been
produced  by putrefaction.   In  former ages,  when ignorance
and credulity, which always accompany each  other, were pre-
valent,  many surprising aad alarming stories were reported,
and believed, of widely-spreading diseases produced by this 
95
cause, and more especially by the putrefaction of  animal sub-
stances.  Fortunately, the truth, or falsehood, of such reports
may he easily ascertained by facts within our own knowledge;
for, as the same causes, cseteris paribus, must always produce
similar effects,  we have a right to expect that, if putrefying
carcasses, fish, &c. were ever able to generate contagious, or
other, fevers,  they should still be  able to do it, especially
when collected in the  largest  masses, and  when  the  impres-
sions, to be made by their effluvia, are assisted by the most
favourable circumstances.
  Many writers of celebrity, and among them the great Lord
Bacon,  have thought that no effluvia were  so infectious, and
pernicious to mankind, as those which issue  from putrefying
human bodies;  and, although a century and a half has  elapsed
since Diemerhroeck* attempted to convince  physicians that,
at least, such effluvia  could not produce the Plague,  yet the
old opinion has kept its grotind; and it is still believed, that,
in their milder state,  they may cause putrid fevers, and  in
their more concentrated state,  a true pestilence.  There are
facts, however, on a  large scale, which  completely decide
this question:—two of these deserve particular notice.—The
first relates to the exhumations made in the church-yard  of
St. Eloi,  at Dunkirk,  in the year 1783; and the other  to
those made  three years afterwards,  in the church-yard  of
the  Saints  Innocens,  at Paris.  As  the  undertakings and
results  were similar in both instances, I shall,  to avoid re-
petition, here  describe only  the  latter, which  I have pre-
ferred,  because the  corpses here  taken up were^much more
numerous than at Dunkirk,   and probably constituted the
greatest mass  of putrefying   animal  matter, of which we
have  any accurate  information.   The church-yard  of the
Saints  Innocens, at Paris, situated in one  of the most po-
pulous quarters of the city,  had been made, the depository
of so many bodies,  that,  although  its area  enclosed'more
* Tractatus de Peste, Lib. I. Cap. viii. p. 4i 
94
  than  1700 square toises,  or  near  two acres,  yet the  soil
  had  been  raised by  them eight  or  ten feet higher than the
  level  of  the adjoining  streets;   and  upon  the most  mode-
  rate calculation, considerably more than six hundred thousand
  bodies had been buried in it, during the  last six centuries;
  previous to which date, it was already a very ancient  burial
  ground.*  Numerous complaints having been made concern-
  ing the offensive smells, which arose from this spot, and some-
  times penetrated into the adjoining houses,! and the  public
 mind  being  greatly  alarmed,  it  was  at  last  determined to
 forbid all future burials there,  and to remove so much  of the
 superstratum as would reduce  the surface to the level  of the
 streets.  This work was undertaken  in 1786, imder the super-
 intendance of M. Thouret, a physician  of eminence  in  Paris,
 and in two years he accomplished the removal of that  super-
 stratum, almost the whole of which  was impregnated,  or in-
fected, as M. Thouret styles it, with  the remains of carcasses,
 and of quantities  of filth and  ordure, thrown  upon it from
 the adjoining houses.

  * In less than 30 years, more than 90,000 corpses had been deposited here by the
last grave-digger. The poor inhabitants were buried in coffins made of very thin deal
boards, and were regularly stowed as closely as possible, upon and beside each  other,
in large pits about thirty feet deep, and capable of receiving each from twelve to fifteen
hundred coffins. These pits were gradually filled with coffins, and then covered over
with earth about one foot in depth, and the bodies left to putrefy.   But as the  same
space was commonly wanted in fifteen or twenty years for other bodies, this mass of
animal corruption was then dug up, and a like number of recent corpses deposited in
the same pit; and this operation was successively repeated through nearly the whole
extent of the dhurch-yard, from generation to generation, until the earth itself had
been so completely supersaturated with human putrefaction, as to have no longer any
action, or decomposing influence, upon bodies buried therein.
  ■J- According to a Memoire on this subject, read at the Royal Academy of Sciences,
by M. Cadet de Vaux, in the year 1781, " Le mephitisme qui s'etoit degage d'une des
fosses voisines du cimetiere, avoit  infecte toutes les caves: on comparoit aux poisons
les plus subtils, a ceux, dont les Sauvages impregnent leur Heches meurtrieres, la terri-
ble activite de cette emanation.  Les murs baignes de l'humidite dont elle les pene-
troit, pouvoit communiquer, disoit on, par le seul attouchement, les accidens les plus
redoubtables."----See  " Memoires de la Societe Royale  de Medecine," torn. viiT.
p. 242; also Annates de Chimie, torn. v. p. 158. 
95
  " The exhumations," says this gentleman, (in the narrative
of them, which he  published in the Journal de Physique,  for
1791, page 253) " were piiincipally executed during the Win-
ter, but a considerable part  of theni was also  carried on
during the greatest lieats of Summer.  They were begun with
every  possible care,  and with every known  precaution;  but
they wrere afterwards continued, almost for the whole  period
of  the  operations,  without  employing,  it  may be  said,  any
precaution whatever; yet  no danger manifested itself in the
whole course of our labours,—no accident occurred to disturb
the public tranquillity."*   This account  is authentic,—and
was read before the Royal Academy of Sciences at Paris.  It
is  moreover confirmed by the  report of  M. Fourcroy, who
was joined in this commission with  M. Thouret for certain
chemical objects, which report was also read at the Academy,
and is printed in the sixth volume of the Annates de Chimie.
If this result from taking up nearly twenty thousand bodies,
in different stages  of putrefaction, be insufficient alone for my
purpose, there is another almost equally conclusive in  its na-
ture and extent.
   It is well known that  M. Berthe, Professor in the School
of Medicine, at Montpellier, and two of his colleagues in that
 University,  were  sent, by  the  government of France,  into
 Spain, to examine, and report upon, the nature of the Yellow
 Fever, which had  proved so fatal  in  several towns  of Anda-
 lusia,  in  1800.  M. Berthe has published the report of the

  • It does not appear,  after the fullest inquiry, that any febrile disorder was ever
produced by this immense mass of corruption, during the removals made in 1786, &c
or while it was suffered to remain as a burying ground.  The grave diggers were, in-
deed, sometimes thrown down suddenly,  and, for a time, deprived of sense and motion,
(as in what is termed Asphyxia,')  by the concentrated vapours which escaped, upon
accidentally breaking open, by their spades, the abdominal viscera of bodies, in an early
stage of putrefaction. These vapours also, in a more  diffused state, are said to have
sometimes produced nausea, loss of appetite, and, in a course  of years, paleness of
countenance, debility, tremors, &c. But fever of any kind, and much less contagious
fever, does not appear to have been noticed, as resulting from ttie offensive, or putrid
matters of this church-yard, either to the grave diggers, or to the neighbouring inhabit
santt.----'See Annales dc Chimie, torn. v. p. 154, &c. 
96
  commission, of which he was a member, and in it has men-
  tioned  that, being at Seville  only a  few months after  the
  epidemic had ceased, he frequently visited the burying places
  just without the  city,  in  which the victims  of  the fever had
  been interred; that, in these excursions, he  was accompanied
  by the French  Consul at that city, and had  occasion to con-
  verse much  with the guards stationed at these places, and
  with the grave-diggers still employed in them:  and he states,
  that, besides these, many thousands of  the inhabitants of Se-
  ville also came thither,  some  from curiosity,  and others  in
  processions,  to testify their  sorrow and respect for their de-
  parted friends.   In one of these grounds, south-westward  of
  the city, ten thousand bodies had been buried ;  in  two others
  seven or eight  thousand; and  in  that  of Triana  about four
 thousand.
   " The heats of the Spring," says M. Berthe, (which, I need
 not observe, are considerable at Seville) " were, at this time,
 beginning to  be felt, and  the ground of these burial places,
 being clayey, was already cracked into wide and deep cre-
 vices, through which a foetid odour was exhaled, the result  of
 the decomposition which was going on among these heaps  of
 bodies."*
   Filled with alarm at the calamities  which might be pro-
 duced by  such  masses of putrefaction,  M.  Berthe, and his
 colleagues, represented these supposed dangers to the Spanish
 government;  and then went to  Cadiz,  where they found the
 churches more or less filled with  putrid emanations from the
 same cause: but as they did not discover that these supposed
 fomites of infection were  productive  of any mischief, their
 fears concerning them seem at length to have subsided com-
 pletely ; for,  in their  reply to the President and Members of
 the Board of Health, who had requested a statement of their
 opinions, they expressly  declare their  belief,  that " if the
 Yellow Fever could be produced by the effluvia  arising from
  * See page 28 of " Precis Historique de la Maladie qui a rvgni dans l'Anda:ou ,ie,
en 1800, par I. N.  Berthe, Professour de I'ecole de Medecine de Montpellier," &c, 
97
putrefying bodies, it was evident that such a misfortune must
already have taken place, through  the  imperfect manner in
which the tombs and vaults, pointed out by them,  had been
closed,—a defect w#ch they had observed even in the church-
es that they were most frequented."*  Thus it appears that
the putrid emanations from the bodies of many thousand per-
sons, who had recently died of the Yellow Fe\er, did not, and
therefore could not, produce that disorder.
  To the preceding facts I may add another, which is related
by a man whose veracity is as little to be questioned,  as  his
exalted philanthropy,—I mean John Howard^ in his work on
Lazarettos, page 25.
  "^The govertior, at the French Hospital  at Smyrna,  told
me, (says Mr. Howard) that, in the last dreadful plague there,
his house was rendered  almost  intolerable by an offensive
scent, especially if  he opened any of those windows which
looked toward the great burying ground, where numbers were
left, every day, unburied; but that it  had no effect on  the
health of himself or his family.  An opulent merchant, in this
city, adds he, likewise told me that he and his family had felt
the same inconvenience without any bad consequences."
   If the  exhalations from piles of bodies  destroyed by  the
plague itself, and corrupting in the open air, were thus inca-
pable of generating the contagion either of fever or of plague,
even during the prevalence of a pestilential constitution of the
atmosphere, (if any state of the atmosphere ever deserved that
title) it may, I think, be safely affirmed, that there are no cir-
cumstances under wThich putrid animal matter can be supposed
ever to produce febrile contagion.
   I have now before me a great number of similar facts, well
authenticated ; but those which I have just stated will, proba-
bly, suffice to convince most of my readers, that if putrefying
animal matters are  not  completely  harmless,  they  are, at
least,  innocent of the charge of producing  contagious fevers;

                * S«>«? page S31 of M. Berthe's work;,
                             13 
98
 and, therefore, I shall content myself with referring those who
 may desire further evidence on this point, to Appendix, No. 2,
 where they will, I believe, find  rather  a redundancy, than a
 deficiency, of such proofs.
   Whatever  variety of  sentiment may  have been entertained
 with respect  to the supposed  generation of infection by filth,
 or hy putrefying bodies, it appears to have long been  an uni-
 versal opinion, at least  among those who have admitted  the
 existence of  any infectious  fevers,  that,  to use the words of
 Dr. Cullen, (first lines of the  Practice of Physic, Sec. lxxxi.)
 " the effluvia constantly arising from the human body, if long
 retained in the same place, without  being diffused in the  at-
 mosphere,  acquire a  singular virulence ;  and in  that  state,
 being applied to the bodies  of men, they become  the cause of
 a fever, which is highly contagious."
   This opinion is become so familiar, that few persons  hesitate
 to adopt it,  however difficult it be  to comprehend by what
 means these effluvia can acquire such contagious properties.*

  * Dr. Chisholm, in his Essay on the Malignant Pestilential Fever, &c. page 281, of
Vol. i. includes, among the causes of that disease, " the product of animal  substances
of every description, deprived of life, and in a state of putrefaction,  which, exhaling
azote and oxygene chemically combined, and diffusing through the atmosphere  to a
certain extent the basis of pestilential infection,  are equally capable of producing
contagious and pestilential diseases."  The same author has again recently delivered
this doctrine in several parts of his  letter to Dr.  Haygarth, (8vo. 1809,) particular}
at page 133, where he  mentions,  as a  " most important fact in  medical  physics,
that the vapour, or exhalation, arising from animal  matter, accumulated in a putrid
state, and rendered stationary by  the neglect of ventilation, is universally the cause of
the fever of infection,—the Typhus, which annually diminishes the population of these
cities,"  &c.  " The same  causes, (he adds,)  probably gave origin to the Plague."
Very soon after this, however, (i. e. in October last,) Or  Chisholm,  with laudable
candour, thought proper, in a great degree,  to retract this doctrine, by assertin"-,
  " That the effluvia from dead animal bodies, passing through  the natural  process
of putrefaction, and unrestrainedly diffused through the atmosphere, is injurious to
living animal bodies exposed to their action, no more than inasmuch  as  their fetor
is offensive to the olfactory nerves;  that,  when confined to  a very limited space  and
their principles, instead of entering  into new combinations, are  concentered   a:  d in
Uiat state  applied to, or received  iito, the bodies  of living animals, these effluvia
may act as a  poison, producng  in the  living animal frame fever perhaps,  but in-
Communicable, or  incapable of propagation by contagion; or instant death  by a  sud- 
99
  We can all understand that if a person under an infectious
disorder be confined in an ill ventilated room, the infectious
effluvia, when they are of a powerful nature, will, with the
other emanations from his body,  be gradually accumulated,
and the atmosphere of that room may thus, at length, become
loaded with infection; btit, that the emanations from a person
who was not ill  of  an infectious disease, should ever undergo
so remarkable a change in their nature, as from being innoxi-
ous, to acquire not only the power of producing a disease, but
a contagious  disease,  capable of regenerating itself in other
persons, seems to me incredible.
  I  have already remarked, particularly in regard to the
Small Pox, that the  human body has no power  even to alter,
in the slightest  degree, a contagion already existing therein;
and that  it must be infinitely more difficult for it  to  generate
one entirely new.  If it w7ere otherwise, with what certainty
would it not be effected in a variety of places, which are en-
tirely exempted  from  it.   Take, for instance, those  in which
the natives of Kamstchatka dwell constantly  during seven
months of the year, and which  are called  yourts; these are
sunk seven or eight feet below the surface of the ground, and
are covered with a thatched roof,  in the form of a truncated
cone, open at the top; they consist of one small apartment,
which usually contains  six  families with their utensils, and
stock of provisions  for the winter, the chief part of  which is
dried fish almost putrefied.
  If  the  combination of personal  nastiness, with the most

den  exhaustion of the living principle."—See  his paper in the Edinburgh  Medical
and  Suigical Journal, Oct.  1810, page 389.
  But though Dr. Chisholm has so far returned towards what I believe to be  the
path of truth, he still adheres to the commonly received opinion of the  (tent-ration of
contagious  fever, by crowding, and  deficient ventilation.  " The cause, in fact,
(says he,) of Typhus, is,  I believe,  an undefined change in the  atmospheric air,
brought about by its confinement in a very limited space, and incapacity, in a grt at
degree, of renewal, and the respiration of an effluvia, (effluvium) emanating from
the persons  inhabiting the  wretched close dwellings" in which the fever is found."—
See  Note to page 391, of the Edinburgh  Medical and Physical Journal, Oct. 1810. 
106
 putrid smells and foul  air, were capable of creating the con-
 tagion of fever, every  yourt would necessarily be  a  fomes ot
 infection.  " Here they eat, drink, and sleep,  crowded pro-
 miscuously together;  and satisfy all  the calls of nature with-
 out modesty or restraint,  and  never complain of the noxious
 air that prevails in these habitations.*   Yet, instead of being
 generally attacked by contagious  fevers  every winter, they
 seem to enjoy as good health  during this season  of confine-
 ment as any other people; and fevers are not even mentioned
 in the list of diseases, which that respectable  traveller,  M.
 Lessep, either observed, or heard of,  as existing among them.
   The people of the island of Oonalaska, also, " inhabit jourts,
 or subterraneous dwellings, each  common to many families,
 in which they live in horrible  filthiness;"—(Pennant's Arctic
 Zoology, vol. i. page  cliv.) and the Samoiedes live in sub-
 terraneous dwellings, equally filthy,  for almost nine months
 in the year, who yet  are  reported  by travellers to be strong,
 active, and healthy.   In addition to all this filth, crowding,
 and want of ventilation, the food of these  people may be con-
 sidered as little better than putrefaction  itself.  Mr. Pennant,
 describing that of the  natives  of Kamstchatka, says, " their
 ambrosial repast is the Huigal, or fish  flung into  a pit until
 it is quite rotten, when it  is served  up in  a state  of carrion,
 and with a stench that is  insupportable to every nose but that
 of a Kamschatkan,"   But these people, notwithstanding, are
 seldom  attacked by any otlfer disease than scurvy, for which
 they seem to  possess  a remedy in the Allium Ursinum,  or
 Wild  Garlic,  and in the Pinus Cembra.f
   The Greenlanders and Esquimaux appear, by the accounts
 of  those  celebrated  navigators,  Davis,  Frobisher, Baffin,
 Henry Ellis, &c. as well  as of  Bishop Egede and Crantz, to
 live, during the greater part of the  year, in very close, ill-

  . Sec Lessep's Travels,  page 230,  &c. also Pennant's Arctic Zoology, vol. i.
page exxxii. also Voyage to the.Pacific Ocean, &c. vol. iii. p.;ge 374.
  | Arctic Zoology, vol, i. page cxix. also Lessep's Travels, page 90- 
101
ventilated,  and crowded  habitations,  (without  chimneys)
which, notwithstanding the great severity of the  cold, they
keep extremely warm by their numbers and  breath, assisted
by a single burning lamp in each, and by excluding fresh air
so completely, that any other people would think  themselves
hi danger  of being suffocated by the offensive vapours con-
tinually exhaling from the lungs and bodies of the inhabitants,
and which involve them as a thick fog; and  yet fever of any
kind is a rare disease among these people, though, like those
of Kamstchatka, &c. they are much disposed to scurvy.
  Dr.  Matthew Guthrie, Physician  at St. Petersburgh,  in a
letter to Dr. Priestley,  on the Antiseptic  Regimen  of the'
Natives of Russia, inserted in the sixty-eighth volume of the
Philosophical Transactions, mentions, at page 623, that " the
Russian boor lives in a wooden house," " caulked with moss,
so as  to be  snug and close.  It is furnished with an oven,
which  answers the triple purpose of heating the  house, dress-
ing the victuals, and supporting, on its flat top,  the greasy
mattrass on which he and his wife lie."
  " During the long severe winter season, the cold prevents
them from airing this habitation,  so that the air cannot be
very pure,  considering that four, five, or  six people eat and
sleep in one room,  and undergo,  during  th£ night, a  most
stewing process from the heat and closeness of their situation,
insomuch that they have  the appearance  of being dipped  in
water, and raise a steam and smell in the room, not offensive
to themselves,  but scarcely supportable to the person whom
Curiosity may lead thither."
   " Now,  if it be considered that this human effluvium must
adhere to every thing in the room,  especially to the sheep-
skins,  or mattrass on which they sleep, the moss in the walls,
&c. and that the apartment is never ventitated for six months
at least; at the same time that  these people are living upon
salt-fish," &c. " and the whole time without fresh vegetables,"
&c.  " If it be a fact that they are, in spite of all  these pre-
disposing causes, strangers to putrid disease, it will sufficiently 
102
 justify my first assertion, that the regimen, nature has dictated
 to these people, is highly antiseptic."
   Dr. Guthrie had, in a preceding  part of this letter, stated
 that, notwithstanding this mode of life, «* the Russian boor
 enjoys a state of health that  astonishes  an  inhabitant of a
 country where the dreadful  consequences are so well known
 of bad air within, excessive cold without, joined to a want of
 fresh vegetables for a length  of time."
   Dr. Guthrie has stated these facts principally to shew  the
 supposed beneficial effects of the Russian drink  called Quass,
 &c.; but I am entitled to avail myself of them for the purpose
 of demonstrating, that long confinement in close unventilated
 houses, without chimneys, in an atmosphere replete with human
 effluvia, and in very cold weather, when Typhus or Contagi-
 ous Fever is commonly most prevalent, does not produce that
 disease, it being,  as will hereafter  appear, unknown  in that
 part of the world.
   Dr. Charles de Mertens,   an eminent physician  who  had
 resided many years in  Russia, writes,  in a letter  from Vi-
 enna, dated January 14, 1778, and printed in the same volume
 of the Philosophical Transactions, page 661, &c. that "  the
 common people (at Moscow) live in  small wooden houses,
 generally very lpw, in which they crowd together both night
 and day, during three parts of the  year,  on account of the
 great cold.   There  is little air  in the  room, the windows  of
 which are very small.  Here they stew together in  humidity
 and  nastiness; for  except the bath, which they use once a
 week, they are extremely nasty."   These people, he observes,
 enjoyed, notwithstanding, a much better state of health  than
 the higher classes of society  at Moscow, who were frequently
 attacked severely by scurvy.*

 • From the description given by Dr. Orraeus, (Politiae  Petropolitanas Medicus,)
the habitations of the Russian and Polish peasants seem, at least, to equal those of
the poor of any other countiy, in accumulated filth and foul human effluvia.  His
words are as follow, viz.—
 " Eccui ignota  es pauperculorum vivendi ratio.»  Degunt cumulatim in domun- 
103
   Having stated these facts in regard  to  the supposed effects
 of crowding human beings in small unventilated habitations,
 in northern countries, let us see what effects result from  simi-
 lar causes  in the  warmer  regions.   And  here the African
 slave ships most obviously present themselves  for  examina-
 tion.   Until within a few years these vessels notoriously con-
 veyed human beings across the Atlantic  in  a state  of closer
 compression,  and in an atmosphere more offensively impreg-
 nated with human  exhalations* excretions,  and excrement,
 than could  probably be found in  any other  place of confine-
 ment.   " The poor wretches  (says  Dr.  Lind, in his treatise
 on the jail  distemper)  are crowded together below the deck,
 as close as they possibly can lie, with only a small separation
 between the men and women;  every night they  are shut up
 under close hatches,  in a  sultry  climate, barred down  with
 iron to prevent  an  insurrection;" " and though some  have
 been suffocated by the close  confinement,  or foul air, though
 they are subject  tt) the flux, and suffer from  a change of cli-
 mate, yet an infection is scarce known among them ; or  if an
 accidental Fever, occurring from the chaage of climate, should
 become infectious, it is generally much more mild than in the
 opposite situation,"—i. e.  that of ragged felons under trans-
 portation.  It will be here observed, that  Dr. Lind, influenced
 as he was by the commonly-received  opinions, mentions an
 infection  (meaning  of Fever)  as  being " scarce known," in
 the slave  ships, instead of asserting,  as he  might have done
 oulis depresses, angustis, humidiusculis;  esculenta & potulenta sua, partim jam cor-
 rupts & fermentantia  in  iisdem. vaporibus empyrcumaticis obnubilati, apparant;
 quisquilias  raro  everrunt;   illuvies  varias, negligentius  quaquaversum profundunt;
 ut alias immundities ex infantibus  & propriis excretionibns provenientes, taceam.
 Mcphitifli  hinc  products assueti, de renovando aere vix cogitant* Uti Jassise, sic
 '•tiam in Polonia,  ubique fere inter Judseos pauperiores, sordide omnino 81 arete,
uti notum  est, viventes, prima pestis quasi incubatio fiebat. Medici,  qui Moscuse,
in  officinam pannorum, ad examinandum infectos,  repetitis  vicibus mittebantur, dc
foetore  in habitatiunculisoperariorum, cui vix per aliquot mmuta perferendo pares
essent, conquerebantur."—Vide " Gustavi Onsei, M. D  Descriptio Pestis qua; anno
MtMJCLXX  in Jassia,  &  MDCCLXXl in Moscua grassata est.  Petropoli,
1784-."—Page 51. 
101
with  truth, that it is never  known: for after very extensive
inquiries, I am fully convinced that Fever of any kind r.  ij
occurs  on board  these  vessels, and contagious Fa-er  >.>vrrj
though great  mortality has  frequently happened-from  other
diseases, and more especially from Dysentery.*  Dr. Trotter,
who  was formerly surgeon  to a slave ship,  after noticing
what Miave just  stated from Dr. Lind, adds,,  " The confine-
ment of so many  wretched creatures in a small space, deserv-
edly attracted  the animadversion of a physician investigating
the-sources and progress  of contagion.  But  Contagious Fe-
vers we find are not their diseases."  See Medicina Nautica,
vol. i. p. 184.|
   I could readily accumulate proofs  in confirmation of the
preceding statement, concerning slave  ships ;  but the truth in
regard to it is now so generally known and  acknowledged,
that they must be unnecessary ; and there certainly is nothing
in the  constitutions of Negroes,  which exempts  them  from
Typhus or Contagious Fever; on the contrary,  they  have
been  found as  susceptible of it as Whites, and considerable
numbers of them, who were  sent from  this country, and  from
Nova Scotia, to  the new colony of Sierra  Leone, died  of it
on their  passage thither, as  will be more fully  related in
another place.
   An instance of the crowding of Europeans on  ship board,
which  approaches very nearly to  that of  Negroes in  slave
ships, may be  found in the " Narrative of the deportation to
Cayenne," of  J.  J. Job Aime,  and one hundred and ninety-
two  other persons, on hoard the  Decade  frigate, in conse-

  • See Lind on preserving the health of Seamen, page 3 J 7, 31S, Second edition.
 f Dr- Garden, in a letter to the Rev. Stephen Hales, 1). D. dated Charlestown,
South Carolina, March 24, 1756, after mentioning the Guinea slave ships arrivin"
there, adds,  " I have often gone to visit those vessels on  their first arrival, in order
to make a report of their state of health to the governor ar.d council ; but 1 :e-
ver yet was on board  one, that did not  smell most offrnvive and noisome: what
from filth, putrid air,  putrid djsenteries, (which is their coi unon  disorder) it is a
wonder llv.t any escape with life." See Dr. liale's I'rcatise on Ventilators, second
part, pi'ge 95 
165
quence of the revolution (in France) of the  18th Fructidor,
(Sept. 4th,)  1797,  written hy  himself, and  printed for J.
Wright,  Piccadilly,  1800.  In  this narrative the writer
says, (page 78)  " we were placed in the between-decks, be-
fore the  fore-mast  and  main-mast,  occupying  nearly one-
fourth of the superficies of the vessel, having about four feet
and a half in height, and receiving no light but by the scut-
tles ; that is to say, by two openings of three feet square."—
" Partitions had been made in this part of the between-decks,",
&c.   " In  this place,  the  door of which  was  locked, were
crowded  and squeezed together 193 individuals,  mostly aged
and infirm.  We lay in two rows one over the other, forming
as it were, two stories, in hammocks of  coarse cloth, and ex-
tremely narrow."   " Those above could  not raise their heads
without hitting those above ; neither could any of us  make the
smallest motion without disturbing his neighbours; for we all
touched each other, and,  not having the  least  spare room,
formed, as it were, hut one  mass."  " And that nothing might
be wanting to increase  the horror of our situation, as we were
not permitted to go out  for fourteen hours together,"  (i. e.
from G, P. M. until Ti  A. M.) " and sometimes more, tubs had
been placed  in the midst of us, where we might satisfy the in-
dispensible  w ants of nature ;  and  to get to these sorry re-
ceptacles, we were obliged to creep, on our bellies, beneath
the hammocks.   How insupportable then must have been the
infection  of such a close confined place, which  was already
poisoned  by our own exhalations!  Indeed, the air, which
passed from this hole,  was so hot and foetid, that the centi-
nels,  placed at the  hatchways as our guard, demanded that
the time of their duty,  at so  dangerous  a post,  might he
shortened."
  In addition to this morbid atmosphere, the exiles, most of
whom had  been " accustomed to the elegance of life,"  were
condemned to subsist upon the coarsest,  the most disgusting,
half-putrefied food, in the taking of which, says  Aime, " we
resembled a flock of animals who eat their food out of one
                            14 
106
common trough," and  were, besides, made "  a subject of
mirth," by " the officer who superintended the distribution of
our meals," which were also too scanty to satisfy the cravings
of hunger,—(page 82 to 85.)   They were also condemned to
endure the greatest and most offensive personal filth, sw arm-
ing with lice, &c.  " If it be recollected,  (says the author)
that we were obliged to sleep in our clothes, and when it is
known that several  of  us had not taken  off our lesser gar-
ments during  the voyage, it may be  easily conceived that it
was not our linen alone, into which these horrible vermin had
introduced themselves."—(Page 81.)  "  Our  blood,  it  is
true, was not shed,  (says he,) but there was not one of us,
who would  not have a thousand  times preferred  a speedy
death,  to the  miserable state in which we existed."—(Page
85.)  But though they were kept in this state during ninety-
six days,  and, to use the w ords of Aime,  " there was every
reason to expect, that  one half of us would have been  the
victims of such inhuman treatment; nevertheless, astonish-
ing  as it must  appear,  under these  circumstances,  not  one
of us perished."—(Page 85.)  They  were,  indeed, as might
well be  supposed, attacked  by scurvy and other  disorders,
some of which  are called  fevers, though  the  latter appear
to have been  so slight,  and of so short  a  continuance, as
hardly to deserve that  name; hut  certainly  nothing  like
contagious fever existed among them,  or could have exist-
ed in such circumstances without extensive  mischief.  Indeed
there was only one person lost during the voyage,  and he (a
sailor) accidentally fell overboard.  And yet here was every
thing likely to generate febrile contagion,  (if it could be  ge-
nerated hy crowding,   want of ventilation, filthy clothing,
and unwholesome, corrupting food, together with anxiety and
dejection  of  mind,  &c.) to  a much greater extent than in
any gaol within Great Britain.
   In Dr. Lind's  Essay on  preserving the Health of Sea-
men, page 195, I also  find the following  statement, viz.
   "During the  month  of October,  (1759)  the  squadron 
                            107

 arrived from the West Indies, after the reduction of Gua-
 daloupe, so  over-run  with the scurvy, that, when  in  the
• channel, ten or a  dozen persons  usually died of it every
 day.   Out  of  three hundred and  fifty scorbutic patients,
 who were sent ashore from those ships, there was not one who
 had a fever.  This I mention, (says Dr. Lind,) for the sake
 of the  following remark:  The surgeon  of the Panther"
 (of sixty-four guns) " told me, that forty of her men had died
 of the scurvy in their  passage home ;  and, during that time,
 there  were  usually ninety  patients in the sick apartment.
 The place  appropriated for the sick,  was in  the  bay of the
 ship,  (which Dr. Lind calls " the  most damp and unwhole-
 some  part of a ship," page  133)  " and had no  pipe from
 the ventilator,  nor any scuttles cut through its sides, for the
  admission  of  the fresh  air.   A  number of patients, thus
  closely crowded together, rendered the place so  disagreea-
  ble and suffocating, that the sick  were in a manner stifled
  for want of air.  The surgeon,  when  visiting, could scarce-
 ly breathe in it, or remain  for any length of time,  without
 being  obliged to have recourse often  to the  fresh air upon
 deck,  and sometimes  to  spirit of  hartshorn, or  to  a glass
 of wine, for his  immediate relief.   He  observed, that both
  the virulence and mortality of the scurvy were  heightened
  by til?  unvcntilated air of  the place,  in which the sick, for
  several weeks, had been confined;  yet, out of above  an hun-
  dred  patients,  sent to the hospital by this surgeon,  not one
  was remarked to have any symptom of contagion generat-
 ed in that apartment."
    Another fact,  which deserves mentioning, relates to the
 prisoners taken out of the memorable Spanish  galcon, cap-
 tured, by Commodore Anson, in the Centurion, on the 20th
 of June, 1742, and  is  recorded  at pages 492 to 496, 15th
 edition, of the Account of  the  Commodore's Voyage round
 the World,  published by  Mr. Richard Walter, who had ac-
 companied him as his chaplain. 
108
   "The galeon had five hundred and fifty men at the begin-
 ning of the action,"  of whom " sixty-seven were killed, and
 eighty-four wounded."  All  the prisoners  were  " sent  on
 board the Centurion before night, except such as were thought
 the most proper to be retained to assist in navigating the ga-
 leon."  The prisoners were  " placed, all but the officers and
 the wounded, in the hold, where to give them as much air as
 possible, two hatchways were left open." " The sufferings of
 the poor prisoners, though impossible to be alleviated,  were
 much to be commiserated ;  for the weather wTas extremely hot,
 the  stench of the  hold loathsome beyond all conception, and
 their allowance of water but just sufficient to keep them alive.
 All this considered, it was wonderful that not a man of them
 died during their long confinement,"  (from June the 20th to
 July the 28th,) " except three of the wounded, who expired
 the same night they were taken."
   An additional proof of the  like import may he derived front
 the dreadful catastrophe, in the black-hole, at  Calcutta,  on
 the  20th  of  June, 1756,  in  wliich,  out of  one  hundred and
 forty-six  persons, one hundred and twenty-three perished by
 suffocation.   And  a further reason with me for noticing it is,
 to correct the misrepresentations thereof, which I have heard
 and  seen; for it has been asserted, that the twenty-three sur-
vivors were afterwards seized with Typhus Fever, as, indeed,
 they ought to have been, if crowding, with an accumulation of
 human  effluvia, and  want of ventilation,  could produce  it.
 But  whoever will read the narrative of this occurrence, given
 by Mr. Holwell, the chief officer of the British factory at Cal-
 cutta,  (which none of the medical writers I allude to seem to
 have perused, or, at least, not with due attention,) will,  I am
 sure, be convinced, from all the subsequent  events,  that not
 one of the survivors in  question was attacked by any disease
 which could, with  propriety, be called a fever.  It was impos-
 sible indeed for men, who had undergone such extraordinary
 sufferings, and  had preserved their existence with  so much
 difficulty, not to feel exhausted  and indisposed,  when  they 
                               109
          • ■
 were released from their dungeon  the next morning; and it
 seems that, within  forty-eight hours, every one had a consi-
 derable eruption of  boils over his body, which was probably
 caused by the excessively profuse perspiration, which each of
 them had undergone, and is not a rare consequence of very
 copious sweating.   But, as I shall demonstrate in the Appen-
 dix, No. 3, a fever did not ensue in  a single individual among
 them;  and, therefore,  no  febrile contagion was generated,
 even  in  an atmosphere  rendered pernicious  to  life, and  not
 only  loaded with effluvia perspired  from the living body,  but
 also with the most offensive smells from those who  expired in
 the course of the night, and whose bodies had fallen into rapid
 putrefaction,  as soon as  life was extinguished.
   The Lord Chancellor Bacon  seems to have been strongly
 impressed with  a belief of the existence of contagion in  pri-
 sons, and of its being,  at least, greatly augmented,  if not ge-
 nerated,  by filth and deficient ventilation.  " The most perni-
 cious infection,  (says he,)  next to the Plague, is the smell of
 the Jail, where  prisoners have been long, close, and nastily
 kept; whereof we have  had, in our  time,  experience twice or
 thrice, when both the judges that sat upon the Jail, and num-
 bers of those who attended the business, or were present, sick-
 ened upon  it,  and died."*—(In  Sylva Sylvarum,  Cent.  10,
 Num. 914.)

  *  Mr, AnUiony Wood, in his « History and Antiquities of the  University of Ox-
ford," published by  John Glitch,  M. \.  Oxford,  1796, after mentioning the  Hlnck
Assize  in that city as one of the  "Mortalities," which Lord Bacon must have con-
templated in the passage just quoted, adds,  " where the other happened I am not
certain; however, that the like was at Cambridge, at the Assize kept  in the Castle
there, in the time of Lent,  13th  of Henry VIII. Ann. Dom.  1521-2, is evident; for
the justices there, and all the gentlemen, bailives,  and all resorting thither, took such
an infection, that many of them  died; and almost all that were  present fell  des-
perately sick, and  narrowly eseaped. with their  lives."—Vol. ii. page  188, &c.
This  seems to have been the earliest instance of what, perhaps, may be considered
as jail infection, communicated in a Court of Justice, of which any information has
been  transmitted to us;  hut Lord Bacon could  not,  with propriety, have  men-
tioned it, as occurring in his time; it having happened forty years before his  birth- 
                             410

   One of the instances here alluded to, doubtless, was that of
 the memorable Black Jtssize at Oxford,  in the month of July,
 1577, which I shall more particularly notice in the Appendix
 No. 4.  The other instance seems to have been that mentioned
 by Holinshed,  as occurring  at Exeter, during the  Assizes
 there, in March,  1586, of which a further account  will be
 found in the same Appendix.
   From that time I can discover no instance of any remarka-
 ble mortality or sickness,  supposed to have been produced by
 Jail infection, until the year 1730, (an interval of one hundred
 and fifty-three years,) when, at the Lent. Assizes, some pri-
 soners,  who had been removed from Ilchester Jail, to take
 their trials at Taunton, were believed to have infected a part
 of the Court, and produced a  contagious disease, of wiiich the
 Chief Baron Pengally, with some of his officers and servants,
 and Sir James Shepard, Knight, and Serjeant at  Law, died
 afterwards,  at Blandford,  in  Dorsetshire.   John Pigot,  Esq.
 High  Sheriff of Somersetshire,  also died, as was supposed, of
 the same disease, wiiich spread  considerably at  Taunton,  and
 proved fatal to several hundreds.—(See Gentleman's Maga-
 zine, for May, 1750.)
   Twelve years after, viz. in April,  1742, according to  Dr.
 Huxham, (de Aere, &c. vol. ii. p. 82,)  a fever,  which he calls
 putrid, contagious, and highly pestilential,  (" febris putrida,
 contagiosa ac pestifera valde,") appeared at, and in the neigh-
 bourhood of Launceston, occasioning great mortality there.
 This fever, he adds, was generated in the prisons,  and widely
 disseminated by  means of  the County Assize,—(?<  genita hsec
 in carceribus febris et per comitia provincialia disseminata
 longe lateque.")*

  • At  page  83, Dr.  Huxham makes this addition, viz.—" Perfrcquens est utique
generatio febris pestilentis in angustis immundisque carceribus ; etiam ipse aer conclu-
sus in fodinis, speluncis, puteis, tandem evadit exitialis admodum  idque longe  citius,
si accedunt quoque plurima animalium effluvia, quse et ipsa porro magis ma«-isque  in
horas violeiita fiunt, brevique pestifera  maxime."—(Here  he refers to Lancisi de
repentinis mortibus, L. i. C. 6) " Atmosphsera stagnans, frequentia hominum polluta,
mox valde rancet & ad respirationem inepta est prorsus ; imo aqu« dulcis balneum 
                             Ill

   The next remarkable occurrence of this sort happened at
 the Sessions of the  Old Bailey,  in the spring of 1750, which
 proved fatal to the Lord Mayor, and two of the Judges,  with
 several eminent and other persons, who, as was asserted, and
 is now generally believed, were infected by the contagion of
 Jail Fever brought into the Court from Newgate.   With how
 little reason or truth this  assertion was made,  I shall endea-
 vour, by a minute examination of facts, to ascertain, and de-
 monstrate, in the Appendix, No. 4.   And this task  I have the
 more  readily  undertaken, by reason of the very  important
 conclusions respecting febrile contagion, which have been,  as
 I think, erroneously deduced  from the melancholy events in
 question.
   It was in  consequence of, and immediately after, this me-
 morable  transaction, (viz. in May,  1750,) that  Sir  Joho
 Pringle published his " Observations on the nature and cure
 of Hospital and Jail Fevers,"  from  pages four and five of
 which the following extract is made, viz.
   " The  hospitals  of an army,  when crowded with sick,  or
 when the distempers are of a putrid kind, or at any time when
 the air is confined, especially in hot weather, produce a-fever
 of a malignant nature,  always accounted  fatal.  I have ob-
 served the same sort of  fever to take its rise in crowded bar-
 racks, and in transport ships, when filled beyond a due num-
 ber,  and detained long  by contrary winds, or when the men
 were kept at sea, under close hatches, in stormy weather."
   " The cause seems plainly to arise from a corruption of the
 air, pent up, and deprived of its elastic parts by the respira-
 tion of a multitude; or more particularly  vitiated with the
 perspirable matter, which, as it is the most  volatile part of the
 humours,  it  is also the most putrescent."
   As soon as I became acquainted with this fever in the  hos-
 pitals abroad, I suspected it to be the same with what is called

sorde cutanea fredatum putrescit atque putet brevissime. Nee mirum est hoc utique,
quandoquidem a quolibet aijulto  homine unciae 40 feri  rancidi vaporis quotidie
exhalant." 
113
here the Jail Distemper, which I had never seen;  and was
confirmed in my opinion,  by having an opportunity of com-
paring them, which was furnished by the follow ing accident."
   Here the author relates the means hy  which two hundred
men,  of Brigadier Houghton's regiment,  were,  in  1746, at-
tacked  by a " fever, which came directly hy  contagion from
the true Jail Distemper," communicated in a manner which he
describes: and these men, he adds,  " being under my care, I
had the best opportunity of examining the distemper, which I
found differed  in nothing from the  usual  Hospital Fever, in
either symptoms, violence, or cure."  And on this foundation
he proceeded to  " consider the two diseases  as one,'' and to
describe them  accordingly;  having,  as  he observes,  " met
with no author who  has treated them  in  so clear and full  a
manner, as to  enable  a physician  either to  know, or cure
them."—Page 7.
  When this was written, external  putrefaction was believed
to produce highly morbid  and malignant effects upon,  and
within,  the living human body;  and both Dr. Huxham  and
Sir John Pringle,  prepossessed by this belief, were thereby,
probably, induced to promulgate their doctrines and opinions
on  this  subject  with less consideration, and more confidence,
than men of their superior talents and  understanding, would
otherwise have done.  Indeed, Sir John Pringle (and proba-
bly Dr. Huxham) was ignorant of an important fact, which,
if known, might have altered his opinion on this subject; for
he  was manifestly  convinced,  that warm,  or hot  weather,
would  promote the  activity and force of  Jail contagion,  (as,
in truth, it ought to do,  were, that contagion generated by
filth, putrefaction,  and deficient ventilation;)  and in the pub-
lication just mentioned, he expresses his belief, that  the fever,
supposed to have been recently produced  by infection  from
Newgate, would " be, in a great measure, confined to those
who were present at the  trial,  especially if the weather con-
tinued moderately cool;" not suspecting,  what is  now ascer-
tained, that the contagion of Typhus, or Jail Fever, is always 
113
 rendered most virulent and morbific by severe frost,* which,
 by increasing the density and purity of the air, renders ven-
 tilation least necessary, and completely arrests the progress
 and influence  of putrefaction  and  of its products;  while,
 on the contrary, this  contagion is  soon enfeebled, dissipat-
 ed,  and destroyed  by  hot weather,  in which  putrefaction
 proceeds most rapidly,  and crowding  with deficient venti-
 lation is most hurtful.
   The opinions,  however,  of these  celebrated physicians  are
 now generally prevalent in this country, and  more especial-
 ly in regard  to prisons,  whjch  are  considered  as eminent-
 ly the parent as well as the fomes of the contagion of Typhus
 Fever.  That this  fever often  exists  in  them cannot be  de-
 nied; but this circumstance can afford no evidence  of  its
 having been generated  therein,  any more than the multi-
 plication of  vermin  in such places  could demonstrate  the
 spontaneous generation of these, and other insects,  hy  the
 nastiness which favours the deposition, and hatching of their
 eggs.  It must,  indeed, be impossible  to adduce any suffi-
 cient affirmative proof on this subject; for, as the contagion
 ef Jail Fever, though commonly inactive during the hotter
 part of the summer, always exists  in this country; and, as
 it  frequently remains dormant in the human body  several
 months after being  received therein, the breaking out of this
 fever in a prison can never afford  any evidence of its hav-
 ing been  generated,  where it  first appears.  For,  even if
 the person first attacked should have been so long  imprisoned,
 as to make it incredible that he  was infected previously to
 his  imprisonment,  there must  always have been so many
 ways and means, by which the contagion might have been
 introduced  from  without, (e.  g.  by  infected persons, gar-

  • The benevolent John  Howard,  in his  work on Prisons, (page 467,)  observes,
that  " the Goal Distemper  is always observed to reign more in our prisons du-
ring winter than summer; contrar)', I presume, (adds he,) to the nature of other
putrid diseases." Similar,  hut stronger, testimonials will hereafter be adduced.
                             15 
114
 ments,  bedding,  &c.)  that its having been  so  introduced
 will  always be much more probable than  the spontaneous
 generation of contagion; an operation, or process, of which
 we  have no example,  and  which, if it really took place,
 would  to me seem  miraculous.
   I have already proved,  that crowding, filth, and deficient
 ventilation, do  not,  in a variety of other  situations,  pro-
 duce  any thing  like contagious fever; and I might fairly
 conclude, therefore,  that  these causes would not be  more
 efficacious or noxious in jails,  than they are  found to he in
 the places already mentioned.  But least any persons should
 imagine that there may be some  circumstances in a prison
 peculiarly  suited  to  the  generation of what is called  Jail
 Fever,  I will, in  regard to this particular,  undertake  what
 I  have already performed  in  regard to  the putrefaction of
 animals, &c.  and instead of requiring affirmative  proofs
 from  those who  assert the  generation of febrile contagion
 by such causes, will take upon myself to refute these unsup-
 ported assertions hy decisive negative evidence : and for  this
 purpose  I will resort to  the observations and testimony of
 Mr. Howard, than whom  no man  ever took  more pains to
 ascertain the  truth  concerning prisons,  or stated it  with
 more  exactness  and candour;  and the result  of all that  he
 either heard or saw is, that the Jail Distemper is not known
 in the prisons abroad.
   In  his work  on Prisons, he informs us,  (page  125,)  that
 on conversing with Dr. Tissot, at Lausanne, the  latter ex-
 pressed his surprise at our Jail Distemper;  said, " I should
 not find it  in  Switzerland;" and  added, that "he had not
 heard of its  being any where but in England."  "I did
 not,"  continues  Mr.  Howard,  (as  the Doctor said,) "  find
 the Jail Fever in Switzerland."
   In  regard  to  the  prisons  at Venice,  Mr. Howard says,
(page 106,)  of the same  work, "the chief prison is  near
the Doge's  Palace,  and it is one of the strongest  I  ever
 saw.—There  were between three  and  four  hundred priso- 
                            115

 ners,  many of them confined in loathsome  and dark cells
 for life; executions  here  being very  rare.  There was no
 fever or prevailing disorder in this close prison."
   At  page 117 of the same work, Mr. Howard,  describing
 the great prison of Naples, La Vicaria,  says, " it contain
 ed, when I was  there, according to  the gaoler's  account,
 nine hundred  and  eighty prisoners.  In about eight large
 rooms,  communicating with  one another,  there were  five
 hundred and forty sickly objects, who had access to a court,
 surrounded by buildings so high as to prevent the circula-
 tion of air.  In seven close offensive rooms, were thirty-one
 prisoners almost  without clothes,  on account of the great
 heat ;  and in  six  dirty  rooms,  communicating with  one
 another,  were fifty  women."  Here he  adds the following
 note,  viz.  " In visiting the prisons of Italy, I observed,  that
 in general  great attention was paid to the sick;  but I could
 not avoid remarking, that too little care was  taken to pre-
 vent sickness.  From the heat of the climate,  one  might
 imagine  the Jail Fever would he very likely to prevail; but
 I did not find it in any of the prisons."
   Sir  John Pringle, in a discourse delivered by him to the
 Royal Society, as their president, the 30th of November, 1776,
 says,  " the late Dr. Mounsey, (F. R. S.) who had lived long
 in Russia, and been Archiater under two successive sovereigns,
 acquainted  me that,  happening  to be  at  Moscow, when he
 perused my observations on the Jail and Hospital Fever, then
 lately published, (1750,) he had been induced to compare what
 he read in that treatise, with what he should see in the several
 prisons of that large  city.  But to his surprise, after visiting
 them all, and finding them full of malefactors, (for  the  late
 Empress  at that time suffered none, who were convicted of
 capital crimes, to be put to death;) he could discover  no fever
 among them, nor learn that any acute distemper, peculiar to
jails, had ever been known  there.  He observed, that some of
 these places of confinement had a yard  into which the prison-
 ers were  allowed  to come for the air; but that there were 
116
others without that advantage, yet not sickly."  " He conclud-
ed with saying,  that,  upon his return to St.  Petersburg, he
had made the same enquiry there, and with the same result."*
  After adverting  to  this part of Sir  John  Pringle's  dis-
course, Mr. Howard,  in his Account of the  State of the Pri-
sons in England and Wales,  (page 94,) adds,  " in this  an-
cient capital of Russia, (Moscow,)  I found  no  trace of  any
such prisons, or  dungeons, as were common  formerly  in the
castles of England, and in several foreign countries." " That
cruel mode of confinement,  in many of our prisons,  has been,
and still is, a principal cause of the Jail Fever;  no  symptoms
of  which  fever did  I  see in Moscow, or  any part of Russia.]
He had, however, previously described (at pages 87, 88,  92,
93  and 94,)  prisons  and hospitals in Russia, which he found
in a very  apt state for generating febrile  contagion, according
to the generally received opinion  on this subject;  they being
very foul  and close.   Near the end of his work  on Prisons,
(viz. at page 467,) Mr. Howard brings the  result of his ob-
servations and  enquiries,  concerning the cause of the  Jail

  * See Dr. Kippis's Edition of Sir John  Pringle's Six Discourses, &c.  8vo,
page 168.
  ■J-  This has been confirmed by the Reverend William Coxe, M. A. &c. who,
in his Account of the Prisons and  Hospitals  of Russia, &c. (page  25,) says, " I
made particular  enquiries whether there  have been  any signs of Jail Fever, or
Epidemical Distemper, ever discovered among the prisoners in Russia, but could
not  hear of the least  tendency to such disorders."  This fortunate exemption cer-
tainly cannot  he ascribed to  any peculiar advantage in the construction of the Rus-
sian prisons, or any superiority of cleanliness, because  the late Empress  Catharine,
in the answers which she  dictated  to her secretary, and sent to Mr. Coxe  on that
subject, declares, that " there has been hitherto no general plan for the construc-
tion of prisons,  nor rules for their distribution and situation."—And that  " there
is no more regulation for the cleanliness  of the  prisons  than for  their construc-
tion  and situation.  By an  abuse (she adds)  favourable to the prisoners, they are,
in many places,  permitted to go to the  baths."—But, she thinks, " it is probable,
that the cold alone prevents epidemical disorders.—Travels  into Poland,  Russia, &c<
vol  iii. page  133, 8vo.  Cold, however, is now  certainly known not to produce  any
such efTect,  in regard to the  contagion of Jail or Typhus Fever,  which, as has
been already stated, (at page 124, &c) is equally-unknown in the habitations of the
Russian  peasants- 
117
Fever, to  this pointed couclusion.   " If it were asked,  (says
he,) what is the cause of the Jail Fever ? It would, in general,
be readily replied, the want of fresh air and cleanliness : but
as I  have found,  in  some prisons abroad, cells and dungeons
as offensive and dirty as any I have observed in this country,
where, however, this distemper was unknown, I am obliged to
look out for some additional cause for its production."  Mr.
Howard's further experience, in his subsequent  tour over a
great part of Europe, and into Turkey, in (1785, 6,  and 7,)
being in conformity with his preceding statement,  he repeated
it in the same wrords,  in his work on  Lazarettos.—Page 231.
  This " additional  cause," which Mr. Howard thought  it
necessary to look for, in  order  to  explain the production of
Jail Fever, can be no other than the contagion thereof,  which,
however  prevalent in tltis kingdom,  has no existence in most
other countries, and  where it does not exist, there is good rea-
son  to conclude that the true Jail or Typhus Fever never
occurs, though other fevers have been frequently mistaken for
it; this is,  doubtless the  reason why all those accumulations
of filth, in close  crowded places, do  not occasion febrile con-
tagion in prisons abroad, though in  this country, where that
disorder always  exists,  they contribute greatly to its reten-
tion, concentration,  and virulence.
   The  frequent  intercourse between the subjects of  Great
Britain and those of France,  by reciprocal captures at sea,
has been  a cause of  introducing the  Typhus  Fever into the
ships, and among the seamen of the latter.   But, as Paris is
at a considerable distance from the  sea coast, there is  good
reason to believe that this fever has been rarely, if ever, known
in that metropolis;  and that, when it has occasionally exist-
ed at any sea-ports,  or in the interior parts of  France, (as  at
Rouen, see page 71, note,) it has, in general, been originally
derived from  British prisoners.   And it was,  doubtless, for
the reason just given, that an eminent and  justly-celebrated
physician, Professor Sauvages, of Montpellier,  when he ad-
mitted  the Jail Fever (which he denominates Typhus Carce- 
118
 rum) into  his Nosologia Metlwdica,  relied solely  on the au-
 thorities of two  English physicians, Huxham  and Pringle,
 adopting exclusively their descriptions of the disease, which
 he has mentioned in several  parts of his  valuable work, but
 always with references  to the same English physicians only,
 which probably he would not have done, if, with his very ex-
 tensive reading,  he had found any other  sufficient authority
 for the existence of this fever,  (which, indeed, he does not
 appear to have ever seen,)  and for  its characteristic symp-
 toms.
   A further proof of the rarity of this fever, in the interior of
 France, seems to present  itself in the ninth  volume of the
 Memoires of the  " Societe Royale de Medecine," of Paris, in
 which it appears  that this society, in November,  1790, pre-
 sented to the  National Assembly, a plan of a new Medical
 Constitution in France,—(page  102 ;) and at the fifth section
 of the second  part of this plan,  which  relates to  the  " fonc-
 tions du Medecin dans les Depots de Mendicite  ou Maisons de
 travail, et dans  les prisons," the following  observation is
 made, viz.  " On sait que faute de proprete et de soins, et par
 l'entassement des hommes,  ou le mauvais  traitement des ma-
 lades,  les prisons ou depots ont souvent ete le foyer d'Epi-
 demies redoutahles.   C'est  surtout en  Angleterre  qu'on en a
 eprouve les funestes efftts;  c'est la qu'on a vu  la plus expan-
 sive des contagions s'elancer de  ces maisons pour infecter au
 loin  les flottes par la presse;  les armees par les recrucs faites
 dans les Bridewells, (ou maisons de correction  ;) les villes et
 les campagnes par les Sessions des Comtes, & les possessions
 Anglaises dans les iles  par la transportation des criminels."
 I ought here to observe, that four or five years  before this
plan was presented to the French National Assembly, Mes-
 sieurs Tenon and Coulomb, two of the commissaries, nomina-
ted by the Royal Academy of Sciences, for matters relating
to hospitals, had been sent by the French  government  to En-
gland, to obtain information  on that subject; and were here
most  favourably  received, and made acquainted with every 
119
 thing likely to render their mission beneficial.  And, among
 other acquisitions of knowledge, they were  informed of, and
 persuaded to adopt, the opinions prevalent in this country, re-
 specting  the  supposed  generation  of. febrile contagion  by
 crowding, filth,  and insufficient ventilation, which  opinions
 appear to have greatly influenced the Royal Medical Society
 of Paris, in that part of their plan which has been just cited.
 But those who have had opportunities of seeing and  compar-
 ing the conditions of the poor, as well as of the streets, houses,
 prisons, and hospitals, of Paris and of London, must be con-
 vinced, that if the causes just mentioned,  had been sufficient
 to produce the supposed effect, Typhus Fever would have pre-
 vailed in the former, at least as often, and as long ago, as in
 the latter.  And that it could not have been proper or justifia-
 ble in this society,  to select  and represent  England as the
 country in which, above all  others, the pernicious effects of
 contagion so  produced, had been oftenest, and most fatally
 manifested.
   That there may, however, be no doubt on the subject of this
 comparison,  I shall extract, and place in Appendix No. 5,
 certain parts of a large volume in quarto, entitled " Memoires
 sur les Hopitaux de Paris, par M. Tenon, Professeur Royale
 de Pathologie, &c. imprimes par ordre du Roi," .(1788;) by
 which it will appear that the Hotel Dieu,- of Paris, is not only
 the largest, but the most crowded and filthy hospital on earth ;
 that a single building thereof, called " Batiment Meridional,"
generally contains two thousand six hundred and twenty-se-
ven patients, crammed together, from four to six in each bed,
with every circumstance  and degree of nastiness, and deficient
ventilation, so that if such causes could have generated conta-
gious fever, it  must have been there generated, nearly two cen-
turies ago;  and being once generated by them, it must, from
their continual aggravation, have been constantly maintained,
and spread to a greater extent, and with increasing virulence.
  Believing, as  I do, that  any additional evidence  on  this
subject would  be superfluous, I shall content  myself with ob- 
120
serving, tliat the respectable Dr. James Lind, though he had
allowed himself to adopt and  maintain the  common opinion,
that Contagious Fever  might be  generated by  the  means
which  have been so often  mentioned, has, notwithstanding,
upon several occasions,  stated facts, which, with proper at-
tention, might have led him to a different conclusion.  In his
chaptev on the Jail Distemper, at page 315, of his Essay on
preserving the  Health of Seamen,  (second  edition,)  are the
following paragraphs, viz.
  "The origin of the jail infection is a point, at present, en-
tirely unknown.  No person has  given us the least satisfac-
tory account how or where it  is generated.   It does not  seem
to originate in  air, and there are  many  prisons abounding
with filth  and impurities, perfectly free from it.
  " In ships also,  an infection is generally imported from the
land, and many that have been long in a very dirty condition,
at sea,  bring their men  quite healthy into  the harbours.—
Indeed, I have always observed,  that the most healthy ships
were such as arrived from a long foreign voyage,  the scurvy
being the  chief,  and almost the only complaint among them.
Whereas  ships  of  war,  especially when  fitted out  in the
Thames,  even in times of peace,  very often  received this in-
fection from London."
  And, finally, at page 227 of the same volume, we find this
assertion, viz.   " I never heard of any ship wiiich, after  hav-
ing been carefully and properly smoked, did not immediately
become healthy: And if, afterwards,  they turned sickly, it
w7as easy  to  trace  that sickness, from other infected ships,
jails, and the like  places."  Certainly this  would not  have
been the case, if it w ere possible that contagion should be ge-
nerated, de novo, as has been supposed, by the causes in ques-
tion.
  From the  preceding  facts  and considerations,  I think it
may be safely inferred,  that  filth,  crowding,  putrid  human
effluvia, and deficient ventilation, though favourable to  the re-
tention and accumulation of febrile contagion, where Typhus 
121
Fever exists, or has existed, and consequently, to its activity)
do not of themselves either  generate,  or enable the  human
body to  generate,  that contagion;  and  that  fevers are not
contagious,  nor liable to become so, unless produced by con-
tagion.
  Assisted by these inferences,  I shall  next proceed to ascer-
tain, as far  as I may  be able, the causes of the Yellow Fever,
together with the truth or fallacy of those reasonings which
ascribe either its origin or propagation to contagion.
END OF PART SECOND.
16 
PART THIRD.
          OF THE CAUSES OF THE YELLOW FEVER.

 The  Creator of the world, for purposes wiiich it is  our
 duty to  respect as wise and good, has  so  constituted  the
 surface  of the earth, that,  in  a great part  of it, the soil,
 when  moistened  and  assisted by suitable degrees  of solar
 heat,  is naturally  disposed  to  produce certain vapours or
 exhalations,  technically denominated marsh miasmata,  and
 possessing a  specific power  of  exciting fever in the  human
 body,  which fever,  though  most  frequently intermitting or
 remitting, is a great  cause  of  mortality,  especially  in  hot
 climates.
   This important truth is  now  so  well  ascertained,  and
-so  generally admitted, that  many proofs in  support of it
 will scarcely be  deemed  necessary.    Several remarkable
 instances of fevers produced  by  this cause,  have been  al-
 ready  stated  between pages  82  and  88  of  this  volume,
 and to  these it may  suffice to  add the following.
   Dr.  John  Hunter, in his  Observations on  the Diseases
 of  the  Army in Jamaica,  informs  us,  that  the place  in
 Ki.gston Harbour  in that island, at  whicli "  the ships of
war take in their water, being wet and swampy,  it com-
n.on'.y  happens that the men employed  in filling the wa-
ter-casks  are  taken sick, cither at the  time, or a few days
after ;  ami tiieiv arc examples where, out of six y o ■  seven-
ty men sent on taut duty not one has escaped a lever. 
123
  Dr. Blane also, in his interesting " Observations on the
Diseases of Seamen,"  alluding to the same service, at the
same  place in  Jamaica,  says,  (p. 92.)  that "it  was the
practice  of many ships   of war) to  leave the water-casks.
on shore all night, with  men to watch them, and  as there
is  a  land-wind in the  night, wiiich blows over some  ponds
and marshes, there were hardly any men employed on that
duty who were not seized with  a fever of a  very bad sort,
of whicli  a great  many died."  Afterwards,  at  p.  392,
when treating  of "the  bilious  remitting fever," the same
author observes,  that  it " may  generally be  traced to the
air of woods and marshes;  and in  our fleet  hardly  any
men  were  attacked with  it,  but those who  were  employ-
ed in the  duties  of wooding and watering."
   Dr.  Lind, speaking of the  unfortunate attempt  to make
a  settlement at  the  Island  of Balamhangan,  near Borneo,
where scarcely one in ten of those sent thirther  survived
the first  six months, says, "from October till April, during
the north-east monsoon,  the wind comes from the  sea, and
the settlement is  perfectly healthy; but from  April till Oc-
tober, during the south-west monsoon, the wind blows over
the  marshes,  both of this Island and  Borneo,  and pro-
duces fevers of the most malignant nature, which frequent-
ly cut  off the stoutest men in  twelve or  fourteen hours.-"
Sec  his  Essay on the Diseases  incidental to  Europeans in
Hot Climates, p. 99,  5th Edition.
   And finally,—Nicholas Fontana,  who  went  out as  sur-
geon to an  Italian East India ship, in November, 1776,
in which  service he  continued five years, and afterwards
published  some judicious observations concerning  the  dis-
eases of Europeans in hot climates in the Italian language,
informs  us, that  " the ship having arrived at the Bay del
Agoa, on  the  Eastern  Coast of Africa, in  March,  1777,
some tents were pftehed  along  the  bank of  the river  Spi-
rito  Santo, which is  low and swampy, to accommodate the
sick of the scurvy, and  those who were employed in wood- 
124
fug  and watering, and that, of forty-seven sailors who had
slept  on shore,  there was not  one who escaped  a  vio-
lent fever, which proved fatal to twenty of their  number.
—" Observazioni intorno alle  mallattie che  attaccano  gli
Europi ne' climi caldi." P. 11. also p.  76.
   If more proofs  of the specific power of marsh miasmata
to produce fever should be desired,  they may be found  in
the  treatise " De noxiis  paludum efnuvis, corumque reme-
diis,"  by  "Jo.  Maria  Lancisius Archiater   Sanctmi-  Pa-
tris  Clementis  XL ;"  and in  the  works  of Sir John Prin-
gle,  Dr. Lind, Dr. John Clarke,  and several other medi-
cal writers of  eminence,  as  well  as  of undoubted credit.
   Assuming, then, that these miasmata  are a most power-
ful and  frequent  cause of fever,  it  seems expedient to  en-
quire concerning their origin,  nature, and constituent prin-
ciples.
   The exhalations from marshy grounds may be presumed
to consist, either of pure aqueous vapour alone, or of this
vapour, combined or intermixed with other vapours, or par-
ticles resulting or extricated from  some of the various mat-
ters, whicli naturally  constitute the  soil, or  have  been  su-
peradded  to it; and we ought,  therefore, if possible, to  as-
certain whether the noxious effects of these exhalations  are
produced  by pure  water only, either dissolved or  diffused
in the  atmosphere,  as  some respectable authors have assert-
ed,  or whether they  are  solely  or  principally  occasioned
by any other matters  extricated from  the earth ?
   There are two modes  or forms in which water  may  ex-
ist in  the atmosphere; one is that of a complete  dissolu-
tion  by the air, so as to be rendered invisible to  the eye,
and  sometimes insensible  even to the nicest  hygrometers;
the other is that of very small globules, commonly percep-
tible  to  the  eye, and disturbing  the  transparency of  the
atmosphere, as  in  what  is called mist  or fog.
   If pure aqueous vapour  in the former of these states were
really  a cause  of  fever, we  should uniformly discover that 
125
sailors are, and have been, mote 1 able to that disorder on the
ocean than when on shore, or in harbour; since it may safely
he affirmed that the atmosphere at sea is more saturated with
aqueous  vapour,  than it can be  on shore, because a much
greater evaporation must necessarily take place from a vast
expansion of water, than ever occurs from an equal surface of
land, not covered,  or not nearly covered,  by  water.  It is,
however,  notorious, that if vessels are not sent to sea in an
improper condition, their  crews are  generally much more
healthy on the wide ocean than  in  any other situation.   Dr.
Lind,  in  his Essay on Preserving the Health of Seamen,
(p. 218,) states,  as a general proposition, confirmed by long
experience,  "that  persons  at sea  are less subject to fevers
than  those  at  land."  Dr. Blane,  also, in  his work on the
Diseases  of  Seamen, says,  (p.  252,) " The air  at sea in
those climates, (West Indies) as well as every where else, is
extremely pure and wholesome,  and there is no where  that
seamen are more healthy or comfortable."  He had previous-
ly made a similar, and, in regard to  " violent fevers of hot
climates," a more pointed assertion at p. 204.
   To these testimonies may  be joined that  of Dr. John Hun-
ter, who (at p. 14 of his Observations on the Diseases of the
Army in Jamaica states,) that " simple moisture is harmless,
at least as far as relates to the production of fevers, of which
the two last mentioned places (Fort Augusta  and Port Royal)
may likewise be given as examples,  for they are nearly sur-
rounded with water on all sides."  He adds,  " It is true the
air is perfectly  clear, ye^ it must be loaded with moisture in
consequence  of the great heat of the sun  acting  upon the
water."  And finally, not to tire my readers with superfluous
testimonies,  I shall content myself with adding that of Dr.
Gillespie,  who, in his Observations on the Diseases of his
Majesty's Squadron on the  Leeward Island Station, between
1794 and 1796,  states, (page 20) as the general result of his
experience, that  "a  ship of war  is  rarely affected with a
sickly  crew at sea,  in the  West Indies, and as rarely con- 
126
tinues  a fortnight  in port without some of the seamen being
attacked with fevers and fluxes."
   It seems probable,  however,  that  the  morbid  influence,
'whicli was attributed by the late Dr. George Fordyce, to pure
water, in exciting fever, was principally intended to be under-
stood of aqueous vapour merely diffused through the atmos-
phere,  in the form of mist  or fog;  and as his Dissertations
on Fever, which  promulgate  or assert this  doctrine, are
amongst the  most  valuable medical works produced in this
country, it may be expedient to examine this part of the sub-
ject more  minutely, in order,  if his  opinions respecting  it
should be erroneous,  to obviate that extensive  adoption  of
them, which his high authority might otherwise obtain, upon a
question of great importance.
   The following are Dr.  Fordyce's  reasonings  and state-
ment on this subject, at page 146 of  his Dissertation on Sim-
ple Fever, viz.  " A  man going into water of  a moderate
temperature,  and remaining in it for some time, has not been
found  more frequently  afterwards affected with fever, than
after standing,  walking,  or  any  other indifferent  circum-
stance.   It is  certainly,   therefore, not the application  of
the water to the body that gives occasion to the disease ; but
if the  air  has  particles of water floating in it,  and a man
has continued for some time in such an air, fever has ensued
much more frequently than when he had lived in a dry air."
Hence the  author is led to conclude, that moisture  must he a
cause of fever;  and that he may persuade his readers to  adopt
tiie  same conclusion, he assumes tl^e following unsatisfactory
proposition, p.  151. " If those,  who  contend that the  appli-
cation of water suspended in the atmosphere,  in the form of
moisture, does not  produce fever, were  to live a year or two in
Batavia,  they would he convinced,  hy fatal experience, that
men living in a moist atmosphere are more frequently affected
with fever than  in a  dry one."  Surely, if Dr.  Fordyce's
opinion on this  subject were just,  those who thought differ-
ently from him might have been made sensible of their error 
127
by less inconvenient and dangerous  means than a voyage to,
und residence at,  Batavia.  The author then proceeds as fol-
lows :—" Moisture  in  the air produces  more  fevers,  the
warmer the  atmosphere; hut moisture produces fever in all
temperatures.  The  Dutch have  endeavoured  to make the
country of Batavia resemble Holland in the immense number
of its canals.  The  consequent moisture of the atmosphere  is
very great in both places ;  hut although fevers,  therefore, fre-
quently occur in  Holland, they bear no comparison in  num-
ber  to those which  happen  in  Batavia, where the fatality,
owing to  the moisture  and heat of the  climate,  is so great,
that  it is  wonderful  any  person should even approach that
settlement but from the absolute impossibility  of otherwise
obtaining water or food."  This proof of the effects of mois-
ture I cannot but  consider as entirely gratuitous, because,  to
use the words of Sir George Staunton,* (whose description
agrees with those given by Captain Cook and other respect-
able navigators) the settlers  at  Batavia  live " in the midst of
swamps  and  stagnated pools;  from whence they are every
morning saluted with * a congregation of foul and pestilential
vapours, whenever the sea breeze sets in and blows over this
morass;" and, before Dr. Fordyce could have been w arranted
in ascribing  tiie violent fevers  which arc so common in that
settlement to moisture alone,  he ought to have proved,  that  in
such a situation  no  other causes existed by which they  could
have been produced.f

  •  An authentic Account of the Embassy to China.  Vol  i. p. 242.
  ■j-  Dr. Horseneld, an American physician, who now is, or lately was, employed in
ravelling over the Island of Java with the sanction of the government of Batavia,  ob-
serves, in an account of  his voyage to that island, in the year 1800, (published in  Dr.
Cox's Medical Museum,  vol. i p. 75, &c.) that " it is impossible for the imagination
to conceive a situation more favourable to the production of marsli miasmata than that
of Batavia.  «If," adds  he, "human industry and ingenuity should be exerted in
planning and constructing an elaboratory for the production of pestilential vapours, a
situation exactly  resembling that of Batavia and its environs would be the  result."
But even here, Dr. Iiorsefiold states the rainy season to be "comparatively healthy,"
to those who have it their power to avoid inimtdiate " exposure to rain;" contrary to 
128
   The author next allows, that " fevers more frequently arise,
when  the moisture  is evaporated  from a marshy country,  or
from stagnating  water, than  when it proceeds  from the sea,
large  lakes,  or rivers confined within  their  banks, and run-
ning with a rapid stream.  " This,"  says he, " has given oc-
casion  to suppose,  that some  other vapours  proceed from
marshes  besides  water,  and  produce  the disease."  But a9
such a notion must clash with his own hypothesis concerning
simple moisture,  he brings forward a second proof, to show
that fevers  have been  produced  by moisture, when  it has
arisen from the earth in  a state of purity, that is, not impreg-
nated with any of the matters contained in the soil which are
undergoing the process of decomposition.   " It certainly hap-
pens often," he says in page 154, "that a considerable degree
of putrefaction takes place in marshy  grounds, and more  es-
pecially  in warm climates;   hut it is by no  means to be con-
cluded, that moisture in  the atmosphere always produces fever
in consequence of putrefaction.  Putrefaction  can  only take
place in animal or vegetable substances.   If  water, therefore,
not impregnated  with either,  should  be in such  a situation as
to produce moisture  in  the atmosphere, no  putrefaction  can
take place;  therefore, if fevers ensue, they are certainly in
consequence of moisture, not putrefaction.   Many instances
of this may  he brought, as in  the war  which  took place in
Flanders, between 1710 and  1711,  an army encamped upon
a pure sand,  in which water was found in digging  less than a

that which must have been the case had  the doctrine of Dr. Fordyce been  true,—and
Dr. Horsefield assigns as the reason of this greater  healthiness during the rains, that
the rivers and canals are then " plentifully supplied with  water, which flows through
them with considerable  rapidity, and most of the lower marshy situations are entirely
inundated with water."  Hut in July, August, and September, these  waters become
nearly evaporated; and  "the quantities of marsh miasmata  now produced, are not
only inconceivably greater than at other times, but the diseases produced by them are
much more malignant and intractable in their nature,"  And this  (which, if Dr. For-
dyce's opinion were just, ought  to  be  the season o: health) b< coiiies, to use Dr.
Horsefield's own word% " the season of death and destruction, in which the  hospitals
and church-vards are filled." 
129
 foot deep,  and occasioned a great moisture in the air, which
 produced in a fewr days numbers of fevers, although the army
 was perfectly  healthy  before,  and no more fevers were pro-
 duced on shifting their ground."
   This last instance,  apparently more decisive than the for-
 mer, is, however,  of  a very questionable nature in several
 respects.  It would be injustice towards Dr. Fordyce, to sup-
 pose that he could have stated this as a fact, if he had not luvn
 persuaded  that it had really happened, and exactly as he has
 related it; but, unfortunately, he neither mentions  the spot
 where it occurred, nor the author by whom it was related, and
 who might have been greatly  misinformed or deceived as to
 the circumstances;  and every one will agree in this, that no
 fact which is to serve as the  foundation of an important doc-
 trine, can  have any claim to be received  into a philosophical
 discussion, unless it be fully attested.  Now, with regard to
 the alleged purity of the sand, on wiiich the camp was pitched,
 I may observe, that it is extremely difficult, not to say impos-
 sible, to find any soil that does not contain some portion of ve-
 getable and animal matters ; and that, even if these had not
 previously  existed in the sand, they would have been immedi-
 ately supplied by the army encamped thereon,  and being as-
 sisted by the moisture abounding there, would have very soon
 afforded vapours, differing greatly from those of pure water.
  But supposing the  sand on  which  this encampment was
 made to have been  perfectly  pure, still there may have been
 marshy ground at a small  distance, whose exhalations  might
 have caused the fevers  in question;  and it  is not assuming too
 much to say, that,  in  a flat country like Flanders, wherever
 any ground is so low and wet that water is found  at less than
 a foot beneath the surface, the surrounding  land is likely  to be
very marshy.  Moreover, as the fevers broke out among the
troops only " a few days" after they  had encamped on the
sand, there is more than a possibility  that they were caused,
not by  the  unhealthiness of their actual position,  but by that
of the station which the army had  recently quitted; and one 
130
  need only read the description which Sir John Pringle  has
  faithfully given in his work on the  Diseases of the  Army of
  that part  of the  Netherlands in which military  operations
  have been mostly  carried on  in modern times,  in order to be
  convinced,  that a very large portion of the surface of that
  country consists of marshy ground.
    Such are the objections wiiich occur to this second instance,
  as it stands in the Dissertation on Simple Fever;  and with
  these I should have dismissed the consideration  of it, as being
  of too doubtful a nature to deserve  much  notice,  if Dr. For-
 dyce had not adduced a similar fact in support of the same
'doctrine, after a lapse of eight or nine years, which I shall
 quote in his own words, from page 63 of his " Fourth Disser-
 tation on Fever,"  viz.   " The  author has  shown, in a former
 dissertation, that moisture, by dissolving in the air, or by eva-
 poration, is one powerful cause of fever ;  that  it is often  the
 cause of intermittents, as well as of  the other diseases which
 have been  above  enumerated,"  (dysentery,  continued or  re-
 mitting  fever, and irregular  semitertians, under which  last
 title  he  includes the disorder now  known by the name of  the
 Yellow Fever) " without any putrefaction taking place, is cer-
 tain, from several instances.  These  diseases have been pro-
 duced in countries where the water was found at  only a foot or
 two under the surface of the earth, whence the  moisture has
 arisen and contaminated the air,  so  as to  occasion these dis-
 eases, while  the soil has been perfectly dry,* and there has
 not been the least appearance of putrefaction, the countiy be-
 ing clear from woods.   In this case it could be nothing but
 tiie inoisturej that produced the disease.   One instance of this
 occurs in the encampment of  the English  army in the war
 about the year 1745, in a sandy plain in Flanders.   Another

  * Either the soil was not perfectly dry, or so much moisture  did not rise through it,
as to produce a morbid contamination of the air.
  t This is rather an hasty assertion, s-ince it is obvious, that soils,  upon  which not a
single tree  is growinp, may nevertheless contain putrefying  animal and vegetable
substances in considerable quantity. 
131
 in a region of Peru, where water is every where to be found at
 about seventeen inches below the surface of the earth, though
 the country itself is barren for the want of water, and uninha-
 bitable from the number of dysenteries and semitertians which
 take place in it."
   The only difference between these two  encampments  on a
 plain  of sand, is that of  the dates, concerning which a mis-
 take might easily have been made by one who has often stated
 facts very loosely;  and for this reason I am inclined to be-
 lieve, that Dr. Fordyce alluded to the same fact,- while he was
 writing each of the passages I have quoted.  With this idea I
 naturally recurred to  Sir John Pringle's excellent Medical
 History of the War, between 1742 and 1748,.where I expected
 to  find  the  account of this encampment;  but neither in this
 work, nor in  any other I  have met with, relating to the trans-
 actions  at this  period,  have I  been more successful in disco-
 vering the object of my inquiry, than I  had been before in the
 many searches  which  I had made after the  instance said to
 have  happened in  the  former  war.*   There are, however,
 certain passages in Sir John Pringle's book,  wiiich appear in
 some  measure to  correspond with Dr.  Fordyce's  statement,
 and they  are, perhaps, the instances which the latter author
 had in his inind on both occasions.  Sir  John Pringle, de-
 scribing the* face of the northern part of Dutch Brabant, says,
 itf "  is  nearly as flat  as any ground of the Netherlands, the
 only inequalities being some sand-hills and insensible  risings,
 which give  the  advantage of a few feet in height to  some of

  * Among other endeavours to ascertain the circumstances which Dr. Fordyce ought
to have stated, in regard to his supposed facts, I applied  to Dr. Wells, who had edited
 the latter part of his work on Fevers, hoping that, either from the papers  of Dr.
 Fordyce, or from their conversiitions. Dr. Wells might  be enabled to  supply the
desired  information.  The latter gentleman, however, in a letter dated the  30th of
April, 1806, declared himself unable to do this; politely offering, at the same time,
to " make  inquiry among others of Dr.  Fordyce's friends, and, should it be suc-
cessful, to communicate the result."  No such  communication having since been re-
 ceived  7 must necessarily  conclude, that the promised inquiry has proved fruitlcs?;
  f Observations on the Diseases of the Army.  Page 62, 7lh Edition. 
                            132
 the villages.  The soil is a barren sand, and so little water is
Seen, that,  at first sight,  the country might  seem to be dry
 and healthful.  But this appearance is deceitful, for water is
 every where to be found at the depth of two or three feet;
 and in proportion  to its distance from the surface, the inhabi-
 tants are free from diseases."   After this the author mentions
 that, during the summer of 1748, the troops which  were can-
 toned in different  towns and villages became very sickly, and
 that "the  sickness was much  greater near Breda  and Bois-
 le-duc than at Eyndhoven, wiiich lay at a greater distance
from the inundations, and from other marshy  grounds."  The
 following inference comes next, which seems tq me to have
 no necessary connexion with wiiat immediately proceeds, and
 to be not only erroneous, but liable to considerable misinter-
pretation, viz.  "  The moisture, therefore, in most of the can-
 tonments arose  principally  from  the  subterraneous   water
which exhaled through the sand."  Let us now examine if this
 account can be fairly construed into a proof that pure moisture
 was the cause of this  sickness."*  " On  the 12th of  May,
 1748, the army left Hillenraet, near Roermond, and in a few
 days came to Nistleroy,"  (or Nesterle,  which is  situated in
the centre, as it were, of the North of Brabant)  " where they
 encamped for the last time;" and, " on the ninth of July, the
 camp broke up, and the troops went into cantonments;"  the
 war being then at  an end.  During this intervalf " some sea-
 sonable rains, with thunder and lightning,  seemed  to prevent
 any sultry heats;  the ground  besides was dry, and the camp
 airy, so that the sickness was inconsiderable as long as the troops
 kept the jield."  This  is the only encampment which  I can
 discover to have been made on a sandy ground  in  the course
 of the war; but, surely, this cannot be cited as the example in
 which " numbers  of fevers  were  in  a  few  days produced
 among troops previously healthy,  in consequence of their be-
 ing encamped on a pure sand, where water was  found  at less
• Tage 60.
f Page 61. 
                           133

than a foot deep."  Nor does the account given by  Sir John
Pringle, of the health of the  army subsequently to this en-
campment, at all  coincide with Dr. Fordyce's statement, that
" no more fevers were produced on shifting their ground :" on
the contrary, so  many fevers broke out, that* " the troops
had scarce been a month in the cantonments when the returns
of the w hole sick  were increased by two thousand, and  after-
wards  they rose considerably  higher."   Besides  the army,f
" the peasants were great sufferers," from these epidemic fe-
vers.   " This country," says the author, " had not known so
much distress for a number of years, as two such causes" (of
disease) " had not occurred, I  mean the drying up of the inun-
dations," which had been made about the fortified towrns, since
the commencement of the war, " with a hot and close summer
and autumn."  I shall not here inquire what effects might
have resulted from the operation of these causes, because the
inquiry more properly belongs to another jMrt of this work,
where  it will probably appear, that two such causes as these
were fully  capable of producing the fevers in question:  but
having shown, from the best autiiority,  that the health of the
army was comparatively good during  the only encampment
which  is recorded to have been made in the course of the war
between 1742 and 1748, "on a sandy plain, where water was
found at the  depth of two or three feet:" and having also
shown, that the sickness which ensued shortly after  the camp
w as broken up, among the several divisions of the army, can-
not, with any justice,  be ascribed to the transpiration of sim-
ple moisture through  a pure sand, since it is even stated by
Sir John Pringle  himself, who seems to have been  an advo-
cate likewise  for  the noxious properties of  moisture, to have
been proportioned to the distances of the different canton-
ments  "from the inundations and  other  marshy grounds."
I shall  now examine  the validity of the third instance,  con-
cerning the unhealthiness of " a region  in Peru," which Dr.
* Page m.                 J Page 67. 
                           134
 Fordyce has annexed  to his second account of the  encamp-
 ment on a plain of sand.
   The air  of improbability which  accompanies his descrip-
 tion of  the region in question,  (which certainly ought to have
 been  designated by its proper name)  will immediately be
 perceived by  the  reader.   "Water,"  says he,  "is every
 where to be found at about seventeen inches below the surface
 of the earth.—The country itself is barren for  want of wa-
 ter ;" yet so much moisture transpires through the ground, as
 to render the spot " uninhabitable."  Surely, if so much aque-
 ous  vapour passed  through the earth as to communicate to
 the atmosphere a  morbid excess of humidity, the soil  itself
 could not have been  so extremely dry as,  from that  very cir-
 cumstance, to  he rendered barren; warm dry earth would,
undoubtedly,  absorb some  portion  of  the aqueous vapour
in question during   its passage ; and we  may safely infer,
 that,  so long  as jhe  soil remained  dry,  the ^vapour which
 arose from the subterraneous  water must  have  been too  lit-
 tle  for its  saturation,  and consequently,  insufficient to load
 the air  with a noxious degree of moisture. But neither this
 objection,  nor such of the  objections advanced against  the
 preceding instance,  as are applicable  to the present  case,
 deterred me from  endeavouring to discover  if any part of
 Peru  answered the description  given hy Dr. Fordyce of this
particular region : and since the  author,  who never was out
 of Great Britain,  has, on  this occasion also,  neglected to
 mention whence he derived  his information, and none of his
 surviving friends are able (so far as I  can learn) to supply
 the omission,  I had recourse  to tht best accounts hitherto
 published of  that  most singular  and  interesting  country,
(Peru,)  particularly to those  of Don Antonio  Ulloa,  who,
 to the rank of Lieutenant-General  in  the Spanish Navy,
 and Naval  Commandant  in Peru,  added scientifick attain-
ments sufficient to  procure his  adoption into  most of  the
learned  societies in Europe.   This  distinguished author has
given a  narrative of his voyage with Don George Juan and 
135
the French Academicians, who  were sent by  the Govern-
ments of Spain and France to South America, in 1735; and
he afterwards published some observations on Peru and other
parts of America, in Spanish, under  the  title  of " Noticias
Americanas," of which a translation  in French, was printed at
Paris, in 1787, with  the title of"Menioires Philosophiques,
Historiques,  Physiques, concernant  L'Amerique, &c."  It is
more especially from the latter* of these works, that the
following account of what  Dr.  Fordyce would  probably,
call  " the regions"  of Peru,  is extracted.    The western
coast of South America, adjoining the Great Pacific  Ocean,
consists of low land, wiiich forms  a kind of zone along the
shores of that ocean, varying in  breadth from eight to twen-
ty leagues, and extending from  7°  or  8° of North Latitude,
to 27°  or 28° South of  the Equator, the whole of  which
bears  the name of " Voiles."  " Au  point ou  finissent ces
plats pays commencent les Cordilleros,"  an  immense chain
of mountains, which  runs southward almost to  the Streights
of Magellan,  and occupies at its  base  a breadth of  from
thirty to  fifty leagues.  Upon this great  mass  of mountains
are  found large  habitable tracts,  called  Sierras, to  distin-
guish them from the lowr land on  the coast;  and we learn
that these tracts,  which Ulloa has named, "La Partie haute
Hahitee," are at an^elevation of  4536 varas, (of Castile, or
12,451  English feet) "au dessus des terreins.qui  avoisinent
iin; ediatement a la mer."   " On voit par la, que  cette partie de
l'Aiuerique a une bande de terrein sensiblement plus  elevee,
que toutes les autres cont ees habit :es du globe."   " II y a dans
la partie haute hahitee,  des royaumes  tivs etendus, des pro-
vinces fort peuplees;  il s'y voit aussi  de  vastes cont* ees de-
sertes."   This high  ground, however,  serves but  as  a base
for an higher range of mountains: " les cimes des montagues
qui s'elevent sur cette meme plaine elevee,f ont  plus de 6,600

  * ', nd from pages 22  -23, 24. 38, 20, .37, 222 244, of the first volume.
  f The summit of Chimbora^on is stated to be 19,595 feet above the ocean. 
136
varas de haut (18,117 feet;)  elles surpassent done les autres,
de 2,063 varas (5,664 feet.)"  These surperincumbent  moun-
tains, far exceeding all others  on the surface of the  globe,
and  eternally covered with snow, are, of course, uninhabit-
ed, and therefore  cannot be the objects of our present consi-
deration : neither is it  the " Partie haute Hahitee," the ob-
ject of it, since  according to Ulloa, " on n'y voit ni fievres
intermittentes, ni putrides."   Besides these parts,  there  are
ravines,  extending in different directions  through the Sierras,
which  he thus describes.  "Dans la partie eh^ee, la terrc
est entrecoupee  de vastes profondeurs, qu'on  y  appelle  Que-
bradas."  " Le fond sert de lit aux eaux qui y coulent, et tien-
nent presque toujours le milieu.   Ces eaux suivent les detours
et les deviations du terrein lateral—& continuent ainsi leurs
cours dans ces profondeurs entre les  montagnes, & arrivent
enfin dans la partie basse  du terrein, d'ou elles se rendent a
la mer; mais la masse d'eau qu'elles  forment dans cette se-
conde partie a pen de profondeur, '&  semble n'etre  repandue
que sur la surface du sol."  These Quebradas,  as Ulloa be-
lieves, have been gradually worn by the torrents, which have
descended  for a long  succession of ages from  the heights;
they vary in their depth and  breadth, the perpendicular depth
of some  of those  chasms being  1,769  varas,  (4,855 feet)  or
even more,  and their width sometimes exceeding two# leagues,
so that " Elles ont assez de surface pour devenir le local  de
nombre d#'habitations  fort peuplees,  qui en  tirent tous les
produits necessaries a la  vie ;" and their  soil  is moreover
sufficiently rich  and fertile to  permit an  extensive cultivation
of the sugar  cane.  It is true, that intermittent fevers  of a
dangerous kind  are occasionally  seen in the Quebradas, (from
causes which produce them in other countries ;) these spots,
however, are neither uninhabited nor barren,  but exactly the
reverse,  and, therefore, we cannot consider them as the un-
healthy region  which Dr. Fordyce  meant: nor  does  there
appear, from the accounts I  have met with, to  he any other
part of Peru to  which he  could have  alluded,  except  the 
                            137

 country lying between the sea and the  foot  of the Cordille-
 ras.  Upon this low country of the "Valles"  it is remarka-
 ble that no formal rain ever falls;  but there are wetting fogs,
 called "garuas," during what is there named winter; ind as-
 " le sable domine dans les terreins has,  meme a des distances
 assez considerables,"  one is at first led to suppose, that the
 soil must here be barren for want  of water; but it  will be
 immediately perceived, that this is far from being the case.
 During about one half of the year, viz. from July to Janua-
 ry,  which is called  winter in the  low lands of Peru,  the
 ground receives  an ample supply of moisture for all the pur-
 poses of the most luxuriant vegetation, by  a contrivance of
 nature,  no less  singular  than bountiful:  while this season
 continues, the low country is constantly covered with a thick
 fog, through wiiich the sun is  scarcely ever able to penetrate ;
 and this  fog,  although not sufficiently damp  to wet one's
 clothes, yet is moist enough *"poiirpen2trerlaterre, pour fer-
 tiliser le sol le phis aride et le plus sterile de sa superficie, par-
 ceque le soleil ne peut la dissecher."  During the rest of the
 year, which is the rainy season in the high lands,  and  is there
 termed the winter, the earth is likewise supplied with mois-
 ture, hy means of artificial irrigations,  which appear to have
 been in general use among the Peruvians, long before  the dis-
 covery of America by Columbus.    At this time numerous
 streams  are pouring  through  the  Quebradas into  the low
 •ountry,  where many  of them lose a part of their  waters
 in irrigating the land.   " Comme on y  a le degre de  chaleur
 requis,  (says  Ulloa) il ne s'agit plus que  d'y faire des petits
 canaux pour conduire l'eau  ou il est necessaire; ainsi de ter-
 reins steriles on en fait des campagnes, dont la  fertilite  ne le
 cede pas aux terres les plus grasses."  We must also take no-
 tice  that these streams do  not all  discharge themselves into
 the sea:  some of them which happen to flow into situations

  * Voyage Historique de I'Amerique, par Don Geo. Juan & Don Ant de Ultotft
Fom. i. p. 454.
18 
138
 so low, that " les terreins n'ont pas assez de pente pour leur
 ecoulement," are there arrested in their course ; and at these
 places the ground becomes swampy ;  it is from this cause that
 " on voit dans les terreins has quclques etendues de terre fan-
 geuse."   After this  description of the low country, we cannot,
 certainly, be surprised  at learning,  that intermittent  fevers
 occur  frequently  among its  inhabitants :  we  find, however,
 that even these  fevers  do not correspond with the  account
 which Dr. Fordyce has given, either of the nature, or  of the
 cause  of  them; for Ulloa says, that " Dans  la partie  basse,
 cos fievres ne sont point dangereuses, quoique longues et trt-s
 fatiguantes :"  and it is unnecessary to observe, that fevers of
 this mild  nature are not likely to depopulate a district; and,
 in regard to  their cause, it could not be asserted,  with  truth,
 even if the country had been rendered uninhabitable by fe-
 vers, that these  were produced by pure moisture, since, al-
 though sand may predominate in  the  low lands, as  Ulloa
 states, yet the soil is not exclusively composed of sand,  and it
 cannot be imagined, that pure aqueous  vapour could alone be
 exhaled from  a  tract of  country, of  wiiich  a considerable
 part consists of  land which  is not only  cultivated,  but ren-
 dered  extremely fertile  by copious irrigation; and in  which
 there also appLia- to he  some extensive patches  of  marshy
 g:ui;jid.   Hence  we must he convinced,  that Dr.  Fordyce
 has been - as little correct in referring us to Peru,  as in  send-
 ing us to  Batavia,  in  search of the noxious  effects  of sim-
 ple moisture.
  The deference which  I  conceived to be due  to the opinions
 of this author, especially  when,  they seemed  to he  corrobo-
 rated, so  far as  regards the  tendency of moisture to produce
 fever,  by those of Sir John Pringle,  and some other respec-
 table physicians,* and  the importance of the subject  itself,

  * Even Dr. Lind, overlooking many facts of a contrary import, stated by  himself,
appears to have adopted an opinion similar to that which I am now controverting.
In his work on " the Diseases incidental to Europeans in Hot Climates."—(5th editionl
we find, at page 9,  this passage, *iz. «In ray Essay on preserving  Seamen I have 
139
have drawn me into a long examination of the proofs  adduc-
ed by the former writer, in order to point  out their  insuffi-
ciency.  It may, however, here be mentioned,  that Dr.  For-
dyce, although he entertains no doubt concerning the  validi-
ty of his proofs,  nevertheless finds great difficulty in account-
ing  for the alledged  effects  of moisture;  and, towards the
close of his discussion* of this  subject,  after repeating  au
observation already quoted,  viz. that since water is innocent
when applied  to the  body in a mass, as  during immersion,
but causes fever when applied in the form of small particles
floating in the air, " it cannot he the mere application of the
particles of the  w ater that  produces the disease ;" he says,
" it must,  therefore, be something that they apply to the body
which occasions it;"—but " what this may be," he confesses,
"is  not very clear."   He afterwards throws out an  idea,
 that, " as  the evaporation of water  produces cold, moisture
 may only  be a means of suddenly applying cold to the body,"
 and that the cold so produced  may be the cause of the fever \
aware, however,  of some  objections to this idea, especially,
as he had  previously stated, that heat rendered the moisture
more noxious as a cause of fever, he concludes with saying,
" but this the  author leaves  to future experiment and discus-
sion."   From expressions so full of uncertainty, and, I may
say, of contradiction, it is evident that he was by no means
satisfied as to the soundness of his favourite doctrine; and his
doubts on the subject would have been still greater, if  he had
recollected  a  very interesting fact, related in page 57  of Sir
John Pringle's " Observations on the Diseases of the Army,"
(from which Dr.  Fordyce, as I have  already  said,  seems to
have intended  to borrow his second instance, relative  to the
encampment on a plain of sand)  wiiich is so demonstrative of

said, that a malignant fever of the remitting  kind, most frequently a double tertian,
is the genuine produce of heat and moisture, is the autumnal fever of all hot countries,
and is the epidemic disease between the tropics: to which I may add, that it is also the
disease most fatal to Europeans in hot climates."
               * Dissertation on Simple Fever. P. 1?6, 
140
the opposite effects of pure moisture,  contrasted with those of
marsh effluvia, that no apology can be necessary for introduc-
ing it here.
  According to Sir John's statement, four battalions, of about
seven hundred men each,  were stationed in the two islands of
Walcheren and South Beveland, during  the very hot summer
of 1747.  These islands  are  from one to two  miles asunder,
and form part of Zealand, which province (p. 2,) " is not only
low and watery, hut surrounded with the oozy  beaches of the
Eastern and Western  Scheld, and the most marshy parts of
the country,"  (the  United Provinces and  Dutch Brabant
along the  Maes) " so that almost every wind, except from the
sea,  adds  to its native  moisture and unwholesome exhala-
tions."* Under such unfavourable circumstances of situation
and of season, the troops, " both in the  field and in quarters,
became so very sickly, that,  at the  height of the epidemic,
some of those corps had but one hundred men fit for duty,
and the Royals in particular,  at the end  of the  campaign, had
but four men who had  never sickened.   But Commodore
Mitchel's  squadron, which lay all this  time at anchor in the
channel between South Beveland  and the Island of Walche-
ren, in both which places the  epidemic prevailed, was  neither
afflicted with the fever  nor the flux;  but amidst all that sick-
ness enjoyed perfect health ;  a proof,"  as the  author justly
observes,  «« that the air of the marshes was dissipated,  or cor-
rected, before it could reach them." This account,  had it
been known to Dr, Fordyce, or remembered by him,  would,
probably,  have weakened  his confidence  in  the power  of
moisture to produce fever; for he would, I presume,  have
readily acknowledged, that the  atmosphere could not  have
been less moist (and he might have  found, that it was more
moist) where the squadron lay at anchor, surrounded as it
was by water, than in those islands;  and, consequently, that,
if simple moisture had  been the real cause of the fevers which
were so prevalent on shore, the sailors  must have  suffered at 
141
least equal sickness with the  soldiers.*  But his  confidence
therein, would,  perhaps,  have ceased altogether,  if he had
attended to  the well-established fact, of  whicli it  cannot be
supposed that this author was ignorant,  that the occurrence
of  marsh fevers may, with certainty,  be prevented,  by laying
the marshy grounds  under wrater;  an  operation  which cer-
tainly would  not diminish  tiie humidity of the atmosphere.
 But proofs  still more convincing,  if possible,  than  the two
just mentioned,  may be offered in refutation of Dr.  Fordyce's
 doctrine.   Indeed, we  know  that the air which passes over,
or  is  incumbent  upon marshes, during  winter, in this cli-
mate,  is generally harmless  in regard to the production  of
intermitting or remitting fevers, although  it  is  then com-.
uionly  more replete with moisture,  than in summer.   And,
 moreover, persons who live on peat-bogs or moors,  are, at all
 seasons,  for reasons to be  explained hereafter,  completely
 exempt from  the fevers to which the  inhabitants of marshy
 grounds are subject; although it cannot be pretended, that
 less moisture is evaporated  from the  surface of the former,
 than from that of the latter.   Again, every one can recollect

  * A similar exemption from  the fevers raging epidemically in the Islands of Wal-
cheren and South Beveland, occurred in regard to the people on buard of the British
 ships belonging to the late expedition against Zealand.  This fact, concerning which I
 have received numerous corroborating testimonies, from respectable officers employed
on that service, has been officially declared in the report made to the Secretary at War
from Middleburgh, the 10th of October, 1809, by Ur. Blane, Dr. Lemprieie, (physi-
cian to the Army) and another  medical officer, who were sent by his Majesty's go-
vernment to Walcheren, for the purpose of investigating the nature and causes of the
malady prevailing among the troops in that island, wherein they state, that they had
 u ascertained  that the crews of the vessels stationed  in  the very narrow channel, only
a few yards from the land, between Beveland and Walcheren, have continued perfectly
healthy during the whole campaign; thus decidedly proving that the noxious exhala-
tion is nearly  confined to ift original source."  See the «' Military Papers relating to
 the Expedition to the Scheldt, presented by his  Majesty's command to both Houses
of Parliament, February, 1810."  Marked E. page 110.  Certainly the crews of the
ships in question, (between Beveland and Walcheren) who continued  in health, must
have been exposed to at least as much moisture, as the soldiers labouring under fever
en shore; 
142
a multitude of instances in  which persons have been exposed
for hours together in the heavy mists which  arc frequent  in
this climate during  the winter, without having  been after-
wards attacked by fever.   But the remarkable healthiness of
the men employed in the Newfoundland  fisheries, where,  as it
is well known, they are generally enveloped in the dampest
fogs for several months together, affords the least ambiguous
proof,  wilhin  my  knowledge,  that  the atmosphere,  when
loaded  with pure  moisture only,  has  no greater  power of
causing fever,  than it has when in any usual state of dryness.
" It is  difficult," says that celebrated astronomer,  Mr.  Cas-
sini, in the account he has  given of his  voyage to New found-
land, " for one who was never there, to form an idea of the
life the fishermen lead at the Great Bank.  It must be no less
powerful awotive than the thirst after gain, which can pre-
vail upon  these  poor wretches to  spend six months between
the sky and  water, in a climate where they are almost always
excluded from the sight of the sun, and constantly  breathing
so thick a fog, that they can hardly  see from one end of the
ship to the other." Page 125.*  In such an atmosphere then,
if any  where,  we might expect to find the effects  of moisture
on the human  body, manifested and  exemplified  in the  most
decisive manner; but fevers,  or other severe disorders, are so
little to be included among those effects, that Dr. Lind,  after
mentioning " the surprisingly healthy state of the ship's com-
panies, who  annually visit the Banks of Newfoundland," adds,
" it is a constant observation, that the men belonging  to the

  * The waters which issue from the Gulph of Mexico, forming what is commonly
called the Gulph Stream, flow with considerable rapidity near the Banks of Newfound-
land, bringing with them a temperature «f from six to ten or twelve degrees warmer
than that of the super-incumbent atmosphere, and of the sea itself in that part of the
ocean, according to the season of the  year.  This superior heat in the Gulph Stream,
aided by its motion, produces a copious evaporation of aqueous particles  from the sur-
face, which are immediately condensed by the coldness of the air, so as to produce those
fogs which, during summer, prevail on the Newfoundland station, to  a greater excess,
probably, than in any other part of the globe, unless it be in the " valfes'' of Pern. 
14S
Newfoundland fleet,  return every autumn  to England with
much more healthy and robust constitutions than they left it."*
  From the  preceding  remarks I deduce these conclusions,
viz. that pure water existing under any form in the  atmos-
phere, does not cause fever; therefore, that marsh exhalations
would be innocent, if they consisted  merely of  simple mois-
ture ; and finally, that, since these exhalations do produce fe-
vers, they  must contain  some other  matter  than moisture,
which  imparts  to  them the noxious  qualities they possess.
This leads me to inquire what this matter may be.
  The substances  which  compose the soil  of marshes  differ
little, if at all, from those which are found in other soils, and,
according to the most recent investigations of chymists, they
seem to be the following,  viz:  calcareous,  siliceous, and  ar-
gillaceous earths;   sometimes  magnesia, oxide  of iron, and
vegetable and animal matters, in various proportions,  with a
few saline compounds,  (often in quantities so  small as not to
he  easily detected)  and water : but they differ as to their rela-
tive  quantities; the proportions of the water and of the  ve-
getable  and animal matters, compared with the other  ingre-
dients, being much greater in  marshy than in dry soils.   If
these various substances be classed  according to their  respec-
tive kingdoms,  we  shall readily  perceive that none of those
 which belong to the mineral kingdom, can constitute  the  va-
pours which arise from marshes, because none of them is able
                        t
  * See Dr. Lind's Essay on the Diseases incidental to Europeans in hot climates.
Pages 30, 31.  Since the above was  sent to the press, the author being at Falmouth,
on his way to Jamaica, went to one of the copper mines at St. Dye, about ten miles
distant, into which he descended with several gentlemen, his fellow passengers, more
than 120 fathoms, and remained there three hours, in an atmosphere so overloaded
with moisture that the clothes, with which they had been supplied for the  descent at
the  mine^were soon made wet, as was every thing which they had occasion to touch.
Bui this humid air did not produce  the slightest injury to the health of any of them ;
.nor could they discover, after having made very particular inquiries, that the workmen
in this and'the other minis were more liable to fevers than persons otherwise employed
above ground; though it  was stated, that pulmonary affections were more frequent
among them, probably from causes which do not relate to this subject. 
144
 to assume an  aeriform state, at least in any temperature to
 which the atmosphere, or the earth are ever naturally heated ;
 and for this reason,  as well  as  for many  others, which are
 sufficiently obvious,  it is plain that the  noxious effects of
 marsh  exhalations, cannot be produced by the mineral sub-
 stances contained in the soil.  With regard to the other mat-
 ters, I mean those which belong to the animal or the vegeta-
 ble kingdoms,  we know that in suitable circumstances of tem-
 perature, air,  and moisture, all organized bodies begin to de-
 compose as soon as the principle of vitality is destroyed, and
 that, in the decomposition of them, a large portion of their
 constituent parts is converted into seriform fluids of different
 kinds, such as  those which are at present known by the names
 of nitrogen, hydrogen, carbonic acid, hydro-carbonated, j h is-
 phorated,  sulphurated, and other gazes.   It is therefore evi-
 dent, that in a marsh, % where myriads of plants and animals
 are constantly perishing, and  where the  presence of water
 causes them afterwards to undergo a  variety  of decomposi-
 tions and of new combinations, an abundance of vapours must
 necessarily be  disengaged  from those  decaying substances,
 and arise from  the surface of the earth, along with the mois-
 ture which is evaporated at the same time.  Hence it appears,
 that the atmosphere of marshes must necessarily contain, be-
 sides common  air and moisture, a quantity of  vapours extri-
 cated from vegetable and animal matters during their decom-
 position ; and since the fevers caused Hy marsh effluvia do not
 proceed from the action either of pure  atmospheric air, or of
 pure moisture, on the human body, it follows,  that they can
 only be produced by that of the vapours last mentioned.   Se-
 veral ingenious persons have endeavoured  to analyze the air
 of marshes ;  but as their experiments are very imperfect, and
 the results of them,  in some respects,  contradictory to each
 other, we  are  yet without any decisive or  satisfactory infor-
 mation  on the  subject.*  When science shall he more  ad-

  • Air collected immediately over, and close upon, the surface of marshes, has com-
Buouly beeu found to contain hydrogen and carbonic acid gaz in considerable propor- 
145
vanced,   all  the  chemical  ingredients  of marsh  exhalations
may, perhaps,  be discovered;  but as most, or all, of the airs
or gazes hitherto known, have  been respired either singly, or
variously combined, by persons who have submitted to the ex-
periments of what has been called Pneumatic Medicine, or by
others engaged  in chemical pursuits or  manufactures,  without
any  of these  persons having been attacked by  fevers  after-
wards, (although some of those airs have produced other inju-
rious and even  fatal  effects ;) it is very possible that the  pro-
perty  of causing  fever does not  belong to any one  of those
gazes  in particular, but rather  to  several of them collectively,
or, perhaps  to  some peculiar miasm emitted at the same time
with the gazes,  which it may be as impossible to detect by any
tests,  however  ingenious, as it is to  detect the  contagions of
the small-pox, measles, typhus  fever,  &c. when existing in the
common air.   We may  never  even  discover whether the va-
pours  of marshes derive their property of causing fever from

lions, with a great deficiency of oxygen gaz.  That this should be the case might well
be expected, considering what the constituent parts of vegetables and of water are, so
far as we have been able to discover them,  and how  they must natm-ally act upon each
other, when undergoing spontaneous decomposition.  Animals are supposed to consist
of principles similar to those of vegetables, with the addition of nitrogen, (or azote)
and of sulphur and phosphorus, in different states.  A few, indeed, of the vegetables
are composed of nearly the same matters as animals.  Ammonia, of which nitrogen is
a constituent part, has been supposed, particularly by Van Mons, to have the property
of correcting or meliorating air, when it abounds with carbonic acid gaz.   If this sup-
position lie well founded, will it enable us to understand why the vapour of animal mat-
ters only, when they are decomposing or putrefying, does not excite fever in mankind
as that of vegetables appears to do ?
  Dr. William Cunie, of Philadelphia, seems to believe, " that the unwholesoment ss
of low and moist situations in the  summer and autumnal months is not owing to any
invisible  miasmata, or noxious effluvia, which issue from the soil, and lurk in the air,
but to a deficiency of the oxygenous porlion of the atmosphere in such situations, in
consequence of vegetable and animal putrefaction, in  conjunction with the exhausting
and debilitating heat of the days, and the sedative power of the cold and damp air of
the night."  (American Philosophical Transactions, vol. iv. p. 128.)  But if the mere
abstraction  of a part of the ordinary proportion of oxygen in the atmosphere could oc-
casion imermitteuls or remittents, these fevers ought to be produced hy every crowded
assembly, and in a multitude of situations,  where no such effect has been observed or
suspected.
                                 19 
146
vegetable matters alone, or from animal,  or from the mixture
of both :  indeed, the discovery,  could it be made, might prove
of little utility  towards explaining the effects of marsh exha-
lations;  but at present  it  seems probable  that  this property
is derived  from vegetable  matters exclusively;  because some
decomposing plants,  particularly hemp and flax, during their
preparation by  steeping in water, and the indigo plant laid in
heaps (after  the colour  has been extracted) to  form manure,
have often been accused, and  in several instances with  great
apparent justice, of occasioning dangerous levers among per-
sons living near them ;*  while, in regard to animal matters,

  * Some difference of opinion lias formerly existed among medical writers, concern-
ing the  morbid eftects produced by the steeping and partial decomposition of hemp
and flax to fit them for subsequent  operations.   Luncisi, however, after having consi-
dered all the known  facts respecting  this question, thinks them easily reconcilable by
admitting that this operation is harmless, if performed in streams of running water,
(" nihil obesse lini maceratione in aquis fluentibus;") but noxious  in stagnant shallow
water, ami confined situations ;  (" contra vero ejusmodi macerationcm pestilentem esse
constat,  ubi palustres desident  aqua;, ventiquc silent;")  and he gives the history of an
epidemic fever, commonly intermittent  or remittent, and often resembling the terti-
ana lethargica of Torti, which, for several summers, infested  and almost  depopulat-
ed the ancient town of Urbs \ etus, in an elevated and salubrious part of Etruria ; and
which was occasioned  by ponds or stagnant waters,  in the lower part  of the town, in
which hemp and flax were macerated ; (in quibus linum  fcc cannabis  macerabantur")
but this being prohibited in 1705, the fevers did not afterwards recur.  See Lancisius
de noxiis paludum effluviis, pages 32, 242, and 254.  I was also  informed at Naples,
that in several places near that city, and particularly in some beyond the (Jrottoof
Posilippo, the sleeping in hou-ies contiguous to ditches,  in which hemp or flax were
steeping, had been almost constantly followed by fever.
  Equally injurious effects have been ascribed to the preparation of indigo,  both in the
East and West Indies, by several  writers; and,  according to the  best information,
which 1 have obtained on the subject from well-informed gentlemen, who had been
largely concerned in  the manufacture of that article,  these are chief!) jeeasioned by
the exhalations, arising from  vast  leaps of the indigo  plant,  whic'  are  negligently
formed  (after the colouring principle has been extracted) near the   oiks  and houses
of the labourers, and there left to decompose and become manure which is of an ex-
cellent quality after two or  three  years.  These heaps, wetted iroru time to time by
heav\ rains, and afterwards heated  by the powerful nys of a vertical sun, emit  very
copiously, vapors, or miasmata, resembling in their eftects those of marshes, for those
persons « ho live near to,  and  especially on  the leeward side of,  these fermeming ve-
getable  masses, a e  commonly attacked by fevers, chiefly remittents, and similar to
those which prevail in  swampy situations.  And, according to  my  information, the 
147
  numerous facts already mentioned, seem to prove that, how-
  ever putrid they may become, their effluvia do not excite fever
  of any kind;  and, in regard to the mixture of putrefying  ani-
  mal and vegetable matters, we have daily proofs that vapours
  may  arise  from them,  for example, from  large dunghills,
  without sensibly affecting the health of  people who live close
  to them, or  who are enveloped  for  hours together  in their
  fumes, while  working upon them.
    As  it appears, from these observations, that the noxious in-
  gredients existing in marsh vapours can only be yielded  by
  vegetable or  animal* matters during  their decomposition;
  this conclusion leads us naturally to suppose, that the marshes
  best adapted  to emit powerful  miasmata   must be  those in
  which the proportion of  vegetable or  animal  substances is
  greatest,  and in which their decomposition  will be  the most
  rapid  and complete.   The circumstances, therefore, which fa-
  vour  such decomposition,  deserve particular notice, as  fa-
  vouring the production of miasmata in an equal  degree.
    Animal and vegetable substances require for  their  sponta-
  neous  decomposition,  moisture, the contact of air,  and cer-
  tain degrees of warmth.   With regard  to  the  first of these
  agents,  (moisture) it is so  necessary, that  there is  nothing
 more efficacious in preventing such substances from putrefy-
  ing, even for centuries,  than the total deprivation of it.   It
 may, therefore,  be affirmed, that moisture  is  essential  to

connexion of these fevers with the heaps of fermenting indigo plants is now so well
understood and believed in that part of the world, that the more intelligent indigo-
makers no longer permit such heaps to be formed near their works, or the habitations
of their  workmen,  but cause them to be placed at considerable distances, and to
the leeward thereof,  and thus preserve their labourers in health.
  * In this and other places I mention animal substances as concurring with the vege-
table in producing marsh miasmata, because there are, probably no grounds whence
these miasmata arise, which do not contain some dead insects and reptiles, with other
animal matters ; and I cannot venture to assert, that these have no share in producing
the morbid exhalations in question ;  though, for the lately-given reasons, I am disposed
to believe, that they  are wholly formed by the mutual decom'os'ti mis of vegetables and
of water ;  and that  animal matters, when in considerable proportions, may even have
an opposite, or correcting effect. 
                           148
putrefaction,  and, consequently,  that no  miasmata can lie-
formed, in a soil which  is perfectly dry.  Accordingly,  it is
found on the west  coast of Africa, and in some of the  W est
Indian islands, which arc liable to long droughts, as Barba-
does, and more particularly Antigua,  that marsh fevers occur
very seldom in those dry seasons; but that they become very
prevalent whenever these droughts are suddenly terminated by
frequent rains.   But neither  will putrefaction take place
without the presence of air,  moisture  alone being insufficient
for that process;  thus  substances, which  would have  been
readily  decomposed in the open air, have been preserved un-
comipted for ages, while immersed in water, and thereby, in
a great degree, secluded from the air; for although it be true
that air or oxygen exists naturally in water, yet it exists in  a
quantity which is often too small for any,  but very slow,  pu-
trefaction, at least in certain substances.
   Examples  of this fact are not,  indeed,  frequent with ani-
mals, probably because they naturally contain  more air, and
therefore require less for their decomposition than vegetables ;
but  it is very certain,  that many  kinds of timber have re-
mained under water for a great lapse of time in a perfectly
sound state.   Hence we may perceive, also, that the forma-
tion of miasmata, instead of being assisted, will he greatly
impeded by a superfluity  of water, (dividing and separating
the matters to  be decor.;posed, and obstructing the access  of
air  to  them) and that  it w ill  be  most abundant in that soil
which contains no more moisture than is really necessary for a
complete decomposition of the vegetable and animal matters
existing therein.  An attention to this important truth  will
enable  us to understand why, in some countries, frequent and
heavy  rains  render marsli fevers  prevalent,  while in others,
the  deprivation of  rain for  two  or three months  produces
equally morbid  effects.  Dr. Lind  was  fully convinced  of
these similar  results from  such seemingly opposite causes  in
different countries ; and, at page 43 of his volume on preserv-
 ing the Health of Europeans in Hot Climates, (5th edition)  he 
149
appears to have thought it difficult to assign satisfactory rea-
sons for them.  What I have just mentioned  respecting the
Western Coast of Africa and the Islands of Barbadoes, An-
tigua,  &c.  will serve to illustrate and prove the morbid effect
of much rain  in dry situations ; and for instances of equally
morbid consequences in opposite situations, from the want of
rain, we need only refer to certain countries between the tro-
pics, which being naturally very low, are mostly overflown
during the rainy seasons, in which their inhabitants are com-
monly healthy;  fevers being rarely seen among them until
the prevalence of dry weather has so far caused the water to
evaporate from  the ground as to leave the surface uncovered
in many places.  Thjs notoriously happens in the Dutch and
French Colonies on the Coast of Guiana; I mean  Surinam,
Berbice, Demerary, and Essequebo,  as well  as at Cayenne,
and the adjoining settlements on the Continent, where marsh
fevers only prevail in the latter part of the dry seasons.  The
like causes produce or  augment the noxious influence of marsh
miasmata at Fort Royal, and its  neighbourhood in Martini-
co; and, to  use the words of Dr. Gillespie,  " with greater
effect when the rivers are low by the continuance of dry wea-
ther, and when the tides, which  never rise  more than one
foot, are weak.—This," he adds, " seems to  account for the
 generation of remittent and intermittent fevers more power-
fully in dry than in wet weather, as  is the case here.'*  Ob-
 servations on Diseases, kc. on the Leeward  Island Station,
 &c. p. 24.   Dr.  James  Clarke  also, when  treating of the
 bilious remittent  fever in  Dominica,  observes, that  " when
 there was much rain in the months of  May and June, and dry
 sultry weather prevailed in the following months of July and
 August, this  fever raged much among the troops and stran-
 gers."  Treatise on the Yellow Fever,  &c. p.  75.
   This is also the case in a great part of St. Domingo, as has
 been observed both by French and British writers.   Among
 the former, M.  Gilbert, who was chief physician  (medecin en
 chef)  to the army sent, in  1802, under General Le Clerc, to 
150
 reduce that island, ascribes the aggravated violence and pre-
 valence  of the  yellow and other  marsli  fevers,  which,  in  a
 few months, nearly destroyed that army, to " les effets d'une
 secheresse extraordinaire, et d'une chalcur devorante."  See
 p. 4 of  his " Histoire Medicale de l'Armee Fran90i.se a St.
 Doininguee."   He afterwards refers,  at p. 69, to the work of
 M. Poupee Desportes, who  died at  St. Domingo in  1748,
 and who, after  having attentively  observed the Yellow Fever
 in that island for fourteen years, found •• qirYlle a  ete tou-
 jours d'autant plus cruelle, que les annees ont e.te  plus seches."
   Baglivi  informs us,  (Opera Omnia, p. 157,  158,)  that the
 marsh  fevers,   arising from  damp  situations in and  about
 Rome, were greatly  aggravated by the like causes;  and he,
 therefore, adds  •* niirum non videatur si consulibus L. Yale-
 rio Potito & M. Manlio, Pestilentia orta sit  in agro Romano,
 06 siccitates Sf  nimios  solis  calores,   teste Livio,  Lib.  Y."
 That which Livy here, and in some other places, has  denomi-
 nated Pestilence,  was, probably, no other than a violent epi-
 demical  marsh  fever,  differing,  perhaps, a little in  degree
 (only)  from what is now called Yellow fever.
   These  facts  suggest, and  enable us to understand,  the ex-
 pediency of sometimes inundating a marsh, during the heat of
 summer,  when its exhalations prove noxious to the inhabitants
 of a neighbouring town ;  it having been always found,  that so
 long as marshes are completely overflowed,  the vapours aris-
 ing therefrom  are innoxious,  and that they only  become inju-
 rious when so  much of the water has been evaporated  as to
 expose  the surface of the  soil to the air.*   For these reasons

  * Of this Sir John Pringle gives a decisive proof, at p. 62 of his Observations on the
Diseases of the Army, Tib Edit. viz.  The country round Tireda had been inundated at
the commencement of the war, for military purposes; but early in the summer of 1748,
the preliminaries of peace having been signed, the water was let off, and the grounds,
which had been covered by it, were, by this operation, made bare and exposed to tiie
sun's rays, so that " a dangerous epidemic fever, of the remittent kind," soon " ra»cd
at Breda and the neighbouring villages. The St tes of Holland, bring made sensihh- of
this, gave orik-rs to let in the water a^ain, and keep it up till witter.'''   \n expedient
which produced the desired effect, as it has done on other similar occasions. 
151
it  appears very probable that any piece of ground, in  a hot
climate, which contains a portion of fresh,  or undecomposcd,
vegetable matters, and whicli, hy being low  and flat,  with a
suitable substratum,  or intermixture of clay,  is  adapted to
the retention of moisture, would, if  supplied with only a mo-
derate quantity of water, be soon in fit condition for emit-
ting very concentrated miasmata; and it seems very  proba-
ble,  also,  not only that the quantity of water  necessary for
this  effect might  not  be sufficient to  convert  the ground  into
what is commonly called a marsh, but that it might even be
so small as to escape common observation.*
   Here,  however, it is  necessary to observe,  that,  under
some circumstances,  the earth may contain very large quan-
tities of vegetable matters, and an abundance  of moisture,
and yet not he in a state  to give out  vapours  capable  of caus-
ing  fever,  although the temperature  should be such as to  per-
mit  the formation of them.—This is the Case with peat-bogs
or moors, the inhabitants of which,  as I have before remark-
ed, are exempt from those intermittent fevers,  which  are so
frequent over marshy districts.—These bogs possess,  in a re-
markable  degree, the power of preserving substances  from
putrefying,  it being  well  ascertained, that not  only plants
and trees, but even  human bodies with their  clothing, when
completely  immersed in the peat-soil,  will scarcely undergo
any change during a long course of  years; and  it is proba-
bly owing  to this peculiar property that they do not exhale,
and, perhaps, do  not generate, miasmata  similar to those
which arise from marshes.—For proofs of this exemption of
the inhabitants of peat-bogs from intermitting fevers,  see Ap-
pendix, No. 6.

  * Dr. M'LeanJ in his volume on " The Diseases  of the Army in St Domingo," at
page 25, says, " it must be  admitted, that fatal miasmnta arise where there are no
very certain appearances of a marshy soil. The Mole and St Marks, (St. Domingo)
do not appear surrounded with marshes, and yet the fever reigns in both these places
with great activity" 
                            152

  Some chemists, who have made experiments with a view to
discover the nature of peat, are of opinion, that its antisep-
tic powers arc derived from that vegetable principle to  which
the  name of Tannin has been  recently  given.  It appears,
however, that a certain proportion of iron is always found in
peat;  and as this metal, when either dissolved or oxydated,
is capable both of preventing putrefaction and of tanning, or
converting skins into leather,  (a fact not  generally  known at
present) there is room to suspect that chemists may have at-
tributed to that imperfectly-understood principle, tannin, those
properties which,  in reality,  belong to  the oxide  of  iron
alone.*
   Heat is the last of  the agents  requisite to the formation of
miasmata, which we are to notice.   Putrefaction, it is known,
is wholly suspended in a freezing temperature,  and proceeds
 very slowly, while the mercury  in Fahrenheit's thermometer
continues below 45°; but, in proportion  as the mercury  rises
above this degree, putrefaction takes place more readily, and
proceeds with greater activity, being most rapid and complete
in a temperature of about 100fc;  every addition of heat,  how-
ever,  beyond 100°, seems to check that process.
   Hence we perceive how much more copiously the miasmata
given out by vegetable and animal substances during their de-
composition must arise from  marshy  grounds  in hot  than in
cool weather; moreover, a warm  temperature is suited, in a
remarkable degree, to the growth and multiplication of plants
and animals—and thus it yields a plentiful supply of materials
from which miasmata are formed;  it is not surprising, there-
fore, that we should uniformly find the exhalations of marshes
to be most powerful when the seasons are hottest, or that the

  * 1 ought here to observe, that the antiseptic power of  these bogs, (whatever it may
be) is not sufficient to preserve animal and vegetable matters  from decomposition, in a
very high temperature ; and it is, perhaps, for this reason that peat-bogs, although fre-
quent in countries in which the summer is warm enough for the producUon of intermit-
tents, are not known to exist between the tropics, unless,  perhaps, in the more elevat-
ed parts of Quito and Peru, where the heat is less than in France and Spain. 
153 '
violence of marsh fevers should  always correspond with the
heat of the atmosphere at, or some time previous to, their oc-
currence.   Where  the surface of the earth  remains  frozen
for a considerable space, as, during the long winters of north-
ern countries, these exhalations have no existence,  and marsh
fevers never occur, unless it be from miasmata, generated and
imbibed  during the preceding summer  and  autumn.   They
begin, however, to make their appearance soon after the re-
turn of spring, but at first only in their mildest and most in-
nocent form; that is,  as regular  intermittents, generally of
the tertian type; and they preserve this type while the tem-
perature continues  to be moderate,   Afterwards, when  the
weather becomes warmer, these fevers become less regular
and more severe:  and, in the hottest parts of  the summer or
autumn, they frequently assume the more  aggravated types of
double tertians, or  of  remittents.  In this country, however,
where the summer is but moderately hot, the  last-mentioned
types of marsh fever are not usually of a dangerous charac-
ter ;  but in Holland,  the Netherlands,  Germany, &c. where
the heats  of  summer  are generally greater than  in this  cli-
mate,  marsh fevers are often attended with considerable mor-
tality, as  may be  seen  in  the able account which Sir John
Pringle has  given of them in his work on the Diseases of the
Army;  and  as was recently experienced  in the  unfortunate
expedition to Zealand.
   In the still hotter summers or  autumns  of Spain, Italy, and
more southern regions, these remittents are yet more violent,*

  *  " Principio sestatis febres, ut plurimum tertianse, non malignse, corripiunt: adaucto
vero sestu, febres continual, atque etiam exitiales urgent;  longe tamen deteriores eva-
surec, et plane pestilentes circa sequinoctium antumnale, pnecipue si pluvise, nebulte,
rubigines, ventique australes  accesserint. Tandem circa hyemale solstitium de perni-
cie uhique remittunt, kc."  Lancisi de noxiis pallidum effluviis, pag. 42.
  " The epidemic of autumn, and prevailing distemper of this, (Zealand, Brabant, and
Flanders) and other marshy countries, is a fever of an intermitting nature, commonly
of a tertian form, but of a bad kind, which, in the dampest places and worst seasons, ap-
pears as a double tertian, a  remitting, or even an ardent fever. liut however these
fevers may vary in their appearance,  according to the difference of constitutions and
                              20 
154
 and, as will hereafter be shown, they very frequently appear
 in the form which is known at present by the name of yellow
 fever, the most fatal  examples of which may commonly he
 found in  the hottest parts of the globe,  when other circum-
 stances are favourable to the  production  of marsh miasmata.
 Experience, therefore, warrants us to conclude,  that  in cool
 temperatures, none but the milder types of these fevers are
 ever produced, and (as will he abundantly proved hereafter,)
 that it is only in the hotter, that they occur in their most ag-
 gravated  and violent forms:  and although  a  considerable
 share of  their increased severity should, as  I think, be as-
 cribed to  the direct operation of heat upon the human  body,
 a greater  ought,  1 presume, to be  imputed  to  its powerful
 chemical agency,  in promoting the formation of  marsh mias-
 mata, more copiously,  and probably  with greater morbific
 powers.
  I ought here to notice the well-known  influence of clay, in
 promoting the formation of marsh miasmata, either as a stra-
 tum for the soil, in which they are formed, or  when  mixed
 with it in a large proportion.   The celebrated  Linnaeus, who,
 in the early part of his life had travelled over nearly the whole
 kingdom of Sweden, found, or thought he had found, that in-
 termitting fevers occurred in  all those places, where the soil
 abounded with clay,  and only in such places.  Strongly im-
 pressed with this fact, he was led  by it to  imagine and be-
 lieve,  not  that  clay  contributed to  the  production of  marsh
 miasmata, by retaining the water necessary for the decompo-
 sition of organized matters, (as is probably the case) but that
 the particles of clay being dissolved in  the water,  drank by
 the inhabitants of these places, were conveyed into the blood
 vessels, and there occasioned  fevers, by creating  obstructions ;
 according  to the Bcerhaavian doctrine,  then  prevalent.  In

other circumstances, they are all of a similar nature. For, though in the beginning of
the epidemic, when the heat is greatest, they assume a continued, or  a remitting form,
yet, by the end of autumn, they usually terminate in regular intermittents."   Pringle,
Observations on the Diseases of the Army, p. 6. 
155
this belief, he published his " Hypothesis nova de fehriuin in-
termittentium  causa;" as an  inaugural  dissertation  for  the
degree of Doctor in Physic, which he took at a later time of
his life than was usual.  In this dissertation he  mentions the
"loca natalia," or places in wiiich he had found intermittents
to exist; and the different degrees of force and frequency in
which they occurred, and  also  those in which these fevers
were wholly or almost unknown.  By this account they ap-
pear to have been prevalent in the Southern and Eastern pro-
vinces of Sweden, but not in the Northern, where, with a very
few  exceptions, they  had never  been  seen;  a  circumstance
which might naturally have led  him to take into his conside-
ration the effects of temperature  in contributing to their pro-
duction.  Attending,  however, only  to the supposed co-exis-
tence of clayey  soils, and  intermittents,  (which a Swedish
clergyman, at Philadelphia, had represented as being a fact,
in that part of America  also,) Linnaeus delivered his new hy-
pothesis in these  words, " Nostra igitur  est sententia quod
intime  solutse particulse argillacese,  quae  lubricae  sunt, cum
aqua simul potae et cibo mixta,  sanguinem intrent et tandem
ultimis vasis arteriosis resideant, & morbi symptomata cre-
ent."   In the truth of this hypothesis he wras so confident as
to advance this assertion, " Vana  tamen est omnis cura, ni
caveator simul a causa data, scilicet aqua argillacea, quod ex-
perientia toties comprobavit."  Linnaei Amaenitales Academ,
Vol. I.
   Besides the greater or lesser  aptitude of particular soils to
retain the portions of moisture best suited to the decomposi-
tion of organized matters,  some differences, both in the quan-
tities and qualities of miasmata  generated therein, will pro-
bably result from the particular vegetable and animal sub-
stances dispersed  in  them, and  from their  relative propor-
tions to each other.  Lancisi  "De noxiis  Palud." &c. p. 44,
supposes the marsh effluvia of particular places  to differ from
each other, as well in their nature as effects—and Sir John
Pringle asserts, " that the putrefaction  of animal or vegeta- 
                           156

hie substances, in a dry air, is apt to produce a bad  lever ot a
more continued form; whereas putrid effluvia, in a moist at-
mosphere, have  a greater tendency to  bring on paroxysms
and remissions."  (Diseases of the Army, p. 324,  7th edit.)
Probably, however, this distinction, if it has any foundation,
must  principally depend on a greater concentration of the mi-
asmata extricated in a dry air, than of those which have been
diluted and diffused by the redundant aqueous particles whicli
necessarily accompany great moisture.   Whether this greater
or lesser concentration constitutes  the  whole difference  be-
tween the morbid exhalations of particular places and seasons
is a question which I am afraid to answer, because the known
facts  connected with it are too few to warrant a  decision.  It
is, indeed, probable, as will hereafter be mentioned, that the
miasmata of particular tow ns, (mostly either sea-ports or ac-
cessible to shipping) in which the aggravated forms of yellow
fever  have  almost exclusively prevailed in the West Indies,
the United States of America,  and the southern  parts of  Eu-
rope,  differ from  the  common exhalations of  marshes, in
quality as well as in degrees of concentration ;  hut whether
this difference be occasioned merely by the greater heat which,
at such times,  commonly exists in these towns than in the sur-
rounding country, and  which  may  exalt the powers of such
miasmata, by  perfecting  the  decompositions  which produce
them, or whether it be partly  the result of a difference in the
organized matters decomposed hy that excessive  temperature,
I am unable to determine.
  But, besides the influence of rain in the formation of mias-
mata, it seems to assist afterwards in promoting their extrica-
tion from the soil, and their diffusion in the atmosphere.  Dr.
Blane, (p. 261  of his Observations on the Diseases of Seamen,)
considers moist air as " a vehicle of noxious exhalations, with
which (says he,) it seems  to have a greater chemical  affinity
than dry air."  This is, at least, true of carbonic acid gaz,
which is,  doubtless,  one ingredient of these  exhalations.
There are, moreover, some countries,  in which rains may 
157
promote the extrication of miasmata without any chemical at-
traction, merely by loosening and opening the surface of the
earth,  which,  particularly on the coast of Africa, is often
overspread by a hard crust in the dry seasons.  Dr. Lind, in
his work on the  Diseases of Europeans in Hot  Climates,
states this fact (p. 47,) adding, that,  " by the continuance of
rains this crust is softened, and the long pent-up  vapours are
set free,  which thence become the cause of sickness."
   Dr.  Henry  Warren, also,  seems to have observed the effect
of rain "in assisting the  extrication of marsh miasmata, but
without suspecting the mode of its operation,  which indeed he
was not likely to  do,  because he believed the yellow, or, as
he called  it, malignant fever, of  Barbadoes, to  arise solely
from contagion.  He states, however,  at p. 8 of his Treatise,
and, as he  thinks, " with great  certainty, that,  at the  time
this malignity is actually harboured among us, (i. c. in Bar-
badoes) a continuation of dry and sultry weather has been so
far  from giving  any  aggravation to it,  that  it has rather
seemed to repress  it,  and make it lie more lulled  and dor-
mant,  until the returning rains,  and a moist atmosphere, had
set it at liberty to exert its rage."  It is  difficult to conceive
how rain could have produced such  an effect, if the disease
had  been propagated,  as  Dr. Warren supposed,  by personal
contagion ;  and therefore his statement of a fact, at variance
with his theory, is the more  to be depended  upon, because it
must have clearly  manifested itself to  his senses; and it will
serve to  confirm what I lately mentioned at p.  198 of the sa-
lubrity of the  air  at Barbadoes during the continuance of hot
and  dry weather.
   It has been  frequently observed by others, as  well as my-
self, that the prevalence of cold easterly winds, in the spring,
has  been soon followed  by that of intermittents in persons
who had been  exposed to marsh effluvia.  Dr. Lind, at p.  16
of his volume on the Diseases  of Hot Climates,  mentions
this to have happened in a very extraordinary  degree, in the
years  1763 and 1766;  and he appears to think that an eastcr- 
                          158
ly wind has some peculiar aptitude for extricating or absorb-
ing marsh  miasmata,  or,  to  use his  own  words,  that  it
•* raises a copious vapour from water mud, and all marshy,
or damp places."   I am, however, disposed  to believe, for
reasons to be hereafter mentioned, that, in this case, the east
winds act merely as an exciting cause upon persons who had
imbibed marsh  miasmata during the preceding summer and
autumn,  and whicli  had remained inactive during the winter.
  From  this general view of  the  sources of marsh effluvia,
and of the  circumstances which are requisite or favourable to
their production and extrication, it will be .perceived that the
former depend entirely  on the  joint influence of seasons, and
of local circumstances :—The seasons, indeed,  vary so much,
as rarely, if ever, to resemble each other exactly in the course
of many years, and are  sometimes in one year the Very re-
verse of  what  they  were the year before  at tiie same places;
thus of the two winters  of 1794-5, and  of 1795-6; the for-
mer,  says  Dr.  Heberden,  in  his  paper  on the influence of
cold upon health, (in the philosophical transactions for  1796)
was " the  coldest,  and the latter the warmest, of which any
regular  account has ever been kept in  this  country."  "We
may  conclude,  therefore, that considerable variations,  with
regard to the formation of miasmata, must annually occur in
every place; and we ought to find, not that the health of per-
sons living in or near  a swampy or  low situation is affected
in the same manner every summer or  autumn, but, on  the
contrary, that it is very differently affected in different years,
as it is known in reality to be, by all medical practitioners in
marshy  countries.
   Thus it was observed many years ago by Dr. Chalmers,
who practised  medicine with great reputation for a long time
at  Charleston, in South Carolina, and paid very minute at-
tention to the climate,  that the yellow or putrid bilious fever
 appeared in that city whenever " the weather was very  warm 
159
and wet withal."*   This, he states to have happened  in the
year  1770, when  " much rain having  fallen throughout the
summer,"  and  the weather  becoming  " so warm that the
mercury often rose to the 96th degree of the thermometer, the
putrid  bilious fever appeared in August, and  continued till
the month of  October  following."!  The  same observation
lias repeatedly been made, before and since his time, concern-
ing the effects of a very hot and  moist season on the health of
the inhabitants of Charleston,^: and  when we recollect that the
city itself is placed on a low flat point of land,  between two  ri-
vers, upon  which great encroachments  have been made by
wooden wharves, &c. and that the  adjoining country is, also,
very  low, and in  many parts swampy, we shall readily per-
ceive, that a season like this must have been extremely favoura-
ble to the formation of miasmata in that situation.  But a very
different effect resulted  from the  very hot summer of  1752,
described hy the same  author,  vol. 1,  p.  22,  and in which
" the mercury often rose above the 90th degree throughout
the months of May, June,  July, and August; and, for  twen-
ty successive days, excepting three in June and July, the tem-
perature of the shaded air varied  between the  90th and the
100th degree; and sometimes  it must have been 30  warmer
in the open sunshine,  to which great numbers of people were
daily exposed for many hours together."—When the mercury
rose to the 97th and 98th in the  shade, the atmosphere seemed

  * The ground, upon which the city of Charlestons built, though very low, contains
a large proportion of sand, and more frequent falls of rain are, therefore, necessary for
the production of marsh effluvia therein, than would otherwise contribute to that effect.
  f See his account of the Weather, and Diseases of South Carolina, vol. 1, p. 163.
  t Dr. Moultrie, of Charleston, in South Carolina, in his valuable " Dissertatio inaug-
uralis de febre maligna biliosa Americae,'' printed  in 1749, mentions it as having been
there observed, " Quo calidior est cceli temperies, ed vehementiusfebris maligna bilio-
sa grassatur"  And in confirmation of this observation he  adduces the following in-
stance, viz. " Anno 1748, in eodem loco (Caroli oppido) febris haec erupit circa
medium mensis Augusti, prima cujus septimana nulla ibi unquam calidior erat, ut mer-
curius in Fahrenhetii thermometro ad 97", 97 1-2 et 98 in aere umbroso ascenderet, et
calor hicce cum multis imbribus dm duravit: a  cceli temperie in frigidiorem verst
mitescit,etinintermittentemfebrimmutabatur.v  Page 8. 
                              1G0
 in a glow, as if fires were kindled around us : in breathing, the
 air felt as if it had passed  through fire :  nor  were the nights
 much  less  sultry and  distressing than the days; refreshing
 sleep, therefore,  was a stranger to our  eyes, insomuch that
 people were, in a manner,  worn down with watching, and the
 excessive heat  together."  It is not,  I  believe,  easy to con-
 ceive tliat any state of the body  could have been more favour-
 able to the occurrence  of the yellow  fever than the above;
 yet, says Dr.  Chalmers, " a more healthy season had never
 been known than this, so long as the  weather continued stea-
 dily warm and fair."   The cause of this singular healthiness
 is,  however, easily explained:  for during this time, as  ap-
 pears  from  another part of his work, (i. e.  p. 18  and  19)
 •' a general drought prevailed."  " The earth  was so parched
 and dry that not the  least perspiration appeared on plants,
 which shrunk and  withered; all standing waters were dried
 up,  so that travellers  could not find water  for themselves or
 their beasts for a whole day together:" " in  several  settle-
 ments no water  could  be found by digging  ever so deep."
 While the earth was  so completely  exhausted  of moisture  it
 is obvious that no miasmata would be formed in it.*
  Having offered these  examples of the opposite effects, which
 two different seasons have actually produced in the same place
 it would be superfluous to enter upon a detail of the divers
 consequences which may result from other varieties of season.
 Nor is it necessary to present a statement of  particular facts

 • Dr.  John Hunter, in his Observations on the Diseases, &c  of Jamaica, observes,
at p. 13, that " the heat of tropical climates, though generally reputed the  cause of
their unhealthiness, will not alone produce fevers, as is strongly exemplified in those
living on board of ship,  who remain free from fevers; and, also, in the inhabitants of
certain dry sandy spots, along the coast, in which the heat is uncommonly great, yet
the situations are healthy, as Fort Augusta, Port Royal, and others."
  In Egypt, when the British army, at the siege of Alexandria, in the summer of 1801,
was encamped on dry sand, at a distance from all swamps, wiih the sea on  one side
and the Lake Maadie on the other, a fever was rarely, if ever, seen.   I observed a
similar exemption from fever in the same season at Rosetta, which is at some  distance
from any swamp. 
161
to shew that the differences of local circumstances are neither
less numerous nor less important, towards the generation of
noxious exhalations than those of season.   It  may, therefore,
be affirmed, that as the inhabitants of any one place cannot be
affected in  the same manner in  regard to health every  sum-
mer, or every autumn, so likewise they may be very different-
ly affected, in the same season, from the inhabitants  of another
place situated within a short distance from themselves.  Thus
it seems perfectly consistent with the laws of nature that the
summer of 1800, which produced the epidemic yellow fever in
Cadiz and  Malaga, should not have been able to produce it at
Gibraltar; and  that the summer of 1804 should  have been
such as to occasion the disease in each of these towns.  In an-
other part of this volume I shall endeavour  to sh~ew that the
above variety in the occurrence of the disorder at those pla-
ces may justly be ascribed to situation ; and will therefore, ab-
stain  from any further observatWfiV at this time ou the  influ-
ence,  which mere locality possesses over health,  under differ-
ent circumstances of weather.
  The  distance  to  which  the exhalations of marshy grounds
may be conveyed from their source, and retain the power of
causing the yellow or other marsh fevers, will  partly depend
on the force of the wind, and partly on the extent of the sur-
face  from which they arise,  and on their being more or  less
copiously extricated from that  surface.  If the wind be  very
moderate, and blow  steadily from the same point, and if the
miasmata be  abundantly emitted from a very  great extent o f
surface,  it seems probable that so large  a mass of the in as
would thus be formed might be conveyed a quarter, and  per-
haps half a mile, before it became so diluted with atmospheric
air, or so dissipated by the wind, as to lose its morbific power :
and, it is obvious that such a mass  of exhalations, if it  were
wafted into a town, would be able to produce  fever in the ma-
jority of the people inhabiting the quarters which it traversed,
with as much ease as it  would produce fever  in an  individual
■n 
162
only ; or, in other words, that it would within a certain ex
tent, as easily cause an epidemic as a sporadic fever.
  In mentioning " a quarter, and perhaps half of  a mile," as
the greatest distance at which  marsli effluvia seem capable of
being conveyed, even under the most favourable circumstan-
ces, from their source, so as to  produce disease.   I have  con-
fined their morbid influence within much narrower limits than
those which are generally described by medical writers ;  most
of whom suppose marshes capable of exciting fever at the dis-
tance of several miles.  It is, indeed, to he regretted, that ob-
servations on this subject, have not been made, and  reported
with greater care and precision.  Sir  John  Pringle, indeed
appears to have thought more justly on  this subject, and  after
describing the epidemic marsh fever which raged in Zealand,
both among the inhabitants and the British troops, in the year
1747, he adds, " But Commodore Mitchell's squadron, wiiich
lay all this time, at anchor* in the  channel between South
Beveland  and the island of Walcheren, at both which places
the epidemic prevailed, was neither afflicted with the fever
nor the flux; but amidst all  that sickness  enjoyed perfect
health."  (Diseases of the Army, p.  57.)  This immunity of
the British seamen is, by the author, justly ascribed to  their
having been out of the reach of that which he calls " the moist
and putrid air of the marshes," though the whole width of the
channel is,  I believe,  in general, but little more than one  mile
and therefore the squadron could not,  even at midway, he pla-
ced at more than half  that distance from the grounds whence
noxious miasmata  arose.   Dr.  Lind (on  preserving  the
Health of Seamen,  p.  69) notices this fact, and makes the fol-
lowing addition to it, viz. " when Commodore Long's squad-
ron, in the months of July and Augnst, 1744, lay off the mouth
of the Tiber, it was observed  that one or two of the ships,
which lay closest to the shore, began to be affected by the perni-
cious  vapour from the land,  whilst some others, lying further
out at sea, at but a very small distance from the former,  had
not a man sick; at the same time, the Austrian  army, under the 
163
 command of Prince Lobcowitz, suffered  so great a sickness,
 through  the proximity of their situation to the  marshy coun-
 try, that they were obliged to decamp."
   Dr. Blane,  also, observes, that " it is  difficult to ascertain
 how far the influence of vapours  from  wood and marshes ex-
 tends, but there is reason to think that it is to a  very small
 distance.  When ships  watered at Rockfort,  (Jamaica) they
 found  that if they anchored close to the shore,  so as to smell
 the land air, the health of the men was affected, but upon re-
 moving two cables' length,   no inconvenience was perceived."
 (Diseases of Seamen, p. 206.)
   But the most decisive evidence on this subject has been ob-
 tained by the late expedition to Zealand.  Drs. Blane, Lem-
 priere, &c. in  their  report to the Secretary  at War,  dated
 Middleburg,  October 10,  1809, and printed by order of the
 House of Commons,  assert  their  " having  ascertained that
 the  crews of the vessels stationed in the very narrow channel
 (only a few  yards*  from  the land) between Beveland  and
 Walcheren, have continued  perfectly healthy  the whole cam-
 paign; thus decidedly proving that the noxious exhalation  is
 nearly confined  to  its original source."  Here  it  should be
 recollected, that it is stated, in the same report,  that ■" the
 number of  sick and convalescents, in  the different hospitals,
 amounted to more than two-thirds of  the total force,"  at that

  • This expression of " a few yards" is much too indefinite. In conversing on the
subject afterwards with Dr. Blane, he appeared only to be certain that the  vessels in
question, or, at least, many of them, were stationed at less than a quarter  of a mile
from the shore.  According to the best information which  I have been able to obtain,
the ships of war at Flushing were anchored generally at  about one quarter of a mile
from, the shore.  Those in the Roompot channel at about three-fourths of a mile from
land.  It was chiefly in the latter channel, and at about that distance from shore, that
the transports having on board the cavalry, (viz. 2d Dragoon Guards, and 9th and 12th
Light Dragoons) were stationed. These did  not land, and, consequently, did  not
partake  of the sickness.  Mr. Webb,  Inspector of Hospitals,  in his evidence at the
House of Commons, asserts, that  " the men who remained on board the ships were '
extremely healthy.'' 
164
  time,  "notwithstanding about 1500 sick had  been already
  sent home by different conveyances from Walcheren alone."
    The general prevalence of lea'th on board the ships of war
  and transports was also confir ned, on my enquiry at the
  Transport  Office,  by Mr.  M'Leay,  Secretary,  and  Mr.
  Houseman, chief clerk of that department.  Dr. Blane, also,
  had the goodness to communicate to me a letter from Captain
  Hanchett,  who commanded  the Raven Sloop of War, during
  the expedition against Zealand,  and being wounded, had re-
  mained thirteen nights on shore* (for the cure of his wounds)
  by which he contracted an obstinate intermittent.   In his let-
 ter, dated Exeter, April 29th, 1801, Captain Hanchett writes
 as follows: " the Raven, while I commanded her on the late
 expedition,  was more through the narrow  channels of Zealand,
 and  more in shore than any other vessel,  of  any description,
 employed there; her station being that of the leading ship of
 the  squadron in shore withal; and after the action of the 3d
 of August,  I went up the narrow pass between Schowen and
 Goree, (within four miles of Williamstadt) laying not more
 than ^.pistol shot from that shore, and was the last down upon
 the retreat.   There  was,  however, no ague  in  the ship  but
 mine, which was, no doubt, occasioned by my wound ; and, I
 believe, there were very few in the other vessels of Commodore
 Owen's squadron."  " I had forgotten to mention that, dur-
 ing  the time we were  refitting at Ter Veere,  the  men had
 leave (to go) on shore,  but never staid the whole night;  and,
 when laying off Schowen, they went on  shore to bathe and
 watch, under the charge of the commissioned officer of each
 division, every evening at five o'clock; and after bathing they
 ran  races along the dykes for half an hour,  but there was
 never any appearance of ague except in myself."
  The people of Italy have long had frequent and fatal expe-
 rience of the noxious power of miasmata, (by them denomi-
 nated MaV Aria) with which Rome, in particular, is greatly
 infested during and  after very hot and  dry summers; yet
Dr.  Lind  observes, that the effects of the Scirocco, or South 
165
   east wind,  "which passes over the adjacent marshes,"  havtj
   been experienced to extend only to the paits of the city which
   lay  nearest the marshes,  occasioning  an  epidemic fever  in
   these,  while the rest of the  city was  healthy."   See his vo-
   lume on Preserving the Health of Seamen,  p. 67.
     In like manner Baglivi  represents the Mai'Aria of Rome,
   as acting only in particular spots or parts of the city,  and as-
   serts as matter of wonder, that the healthy are separated from
   the unhealthy spots, only by very short spaces ;* the former be-
   ing chiefly  on  the northern and eastern quarters  of the city,
  farthest from the river:  for the Piazza, and  Porto del Popolo,
   though on the north, are extremely, unhealthy, hy being low
   and close to the Tiber.   Indeed, marsh  fevers at  Rome com-
   monly begin about the Porto del Popolo.


    * Aer ltomanus Squallidus est & insalubris, non quidem omnibus in locis, sediis po-
  tissimum quae deficientibus sedificiis, pigro atque immoto aere  sordescunt;  multo ma*
  gis si Tiberi adhserent, vel, convallium instar, raontibus obsepiuntur, aut exhalationibus
  subjacent quas veteres parietinse, cryptae, & antiquorem sedificiorum rudera emittunt
  Ex quo patet regionem Circi Maximi, inter Palatinum atque  A ventinum sitam, om-
  nemque ilium campum qui inter aventinum ac Tiberim,  portamque Ostiensem jacet,
  plane  noxium esse fci damnabilem."  " Qusecunque loca crebris sedificiis amhiuntur,
  atque editiora  sunt,  in  septentrionem atque orientem spectant et  multem a Tiberi
  distant, salubriora : Contra, quse sejuncta  sunt & remota a frequentibus tectis, situque
  sunt humili, ac  maxime in  convallibus,  turn propiora Tiberi,  in  meridiem  atque
  occasum spectantia, minus salubriora judicantur:  Quibus etiam in locis  (~quod sane
  ndrumj brevissimi intervalli discrimine, hie aliquantum salubris existimatur aer; illic
 contra noxius k damnabilis."  Baglivi Opera Omnia, p. 157,158.
   The reason why particular spots within the walls of  Home were destitute, or almost
 destitute of houses, seems  to be that their (notorious) insalubrity had either destroy-
 ed or driven away those who formerly lived thereon, and when the  existing houses
 were decayed, had deterred other persons  from rebuilding  in those  situations: and
 therefore, Baglivi justly mentions these places  (" deficientibus sedificiis") as being
 among the most noxious. It is from a similar motive that the General Committee  of
 Health, of the City of New York, in their report on the  means of securing the health
 of its inhabitants, (dated  the  '20th of January,  1806) after stating  that  "various
 houses, in different parts of the city, have, on the recurrence of every malignant fever,
 proved to be the principal seats of disease, and the graves of their tenants," " suggest
 the propriety of  prohibiting the same to be let or occupied as dwelling houses, that
 they may be converted into warehouses, and that any injury sustained by the proprie-
ors be defrayed by the public."  Seep. 95 of Documents, relating  to the Board of
Health, printed at Yew York, 1806. 
16b'
   I was repeatedly told at Rome, in the  year 1802, by  per-
 sons deserving of confidence, that these fevers sometimes pre-
 vailed among the inhabitants on one side  of a  particular
 street, whilst those on the opposite side entirely escaped their
 attacks; and this  was said  to have often happened in a cer-
 tain portion of the Corso; the western side of which was dis-
 tinctly pointed out to me, as being much more unhealthy than
 the  other.*  Professor Berthe, in his work  on the fever of
 Andalusia, has mentioned similar facts as occurring in some
 of the streets and squares of Cadiz,  in  the year  1800 ;  though
 he ascribed it not  to the very  limited action of marsh effluvia,
 hut to that of the contagion, by which he supposed the prevail-
 ing fever to  have been propagated in that city.  And it seems
 highly probable, that in  many cases the miasmata producing
 yellow fever in  sea-port towns of the  West Indies, and the
 United  States of  America,  arise from the soil immediately
 around,  and perhaps,   sometimes  under  the  very  houses,
 wharves, &c. where they  are imbibed, by the persons in whom
 that fever afterwards appears.  Accordingly  we find that, in
 New-York,  Philadelphia, Baltimore,  Norfolk, and Charles-
 ton, this fever always begins,  and often continues,  exclusively
 in the low streets  immediately adjoining to the harbours  and
 wharves of these towns, except in the cases of some individu-
 als, who, after having imbibed the noxious exhalations of the

  • Similar facts are stated by Lancisi,  particularly  in the 3d chapter of his second
 book, de ISox. Palud. Effl. in which are  several  instances of mursh fevers prevailing
 in particular parts of Home, and  its vicinage, whilst other parts closely adjoining re-
 mained healthy.  In one of these he says the salubrious districts might be separated
 from  the insalubrious, by a diagonal'line  drawn,  "a  postica Pontificii Palatii parte,
 quara JJelvidere appellant, usque ad emissarium inagnse illius cloacx, quae in Viberim
juxta  Arcis fossam eo loco apeiitur," &c.  p. 199.   And in the  next page he refers to
 several  authors w ho have attested similar events, particularly Kamaziui, De (Jonstit
 anni,  1690,  who  describes a tertian  epidemic, which occurred at Modciia, in that
 year, but was wholij  confined to the  low parts, in which there was stagnant water,
 and extended no further.—" Non ampliora spatia occupasse."  The  people in other
 parts, (which he designates) having never,  within their remembrance, been more
 free from fevers  •« Nunqnam alias a ti bribus magis securos se vixisse meminerint.T' 
167
wharves and low streets in question, by residence or employ-
ment in or near them, happen to fall sick in other situations.*
   After these  observations, respecting, the distances to which
marsh  effluvia may be  conveyed horizontally,  without  losing
their morbific power, it  may  be proper to inquire how far
they are capable of retaining it, when raised perpendicularly,
or nearly so,  from their source.  Unfortunately, our stock of
facts relating this point,  is  even more deficient  than in re-
gard to the other;  though it  is sufficient to  ascertain that their
power of exciting disease, is  rapidly diminished at very small
distances from the earth.
   Dr. Hunter, in his  work on the  Diseases of the Army in
Jamaica, p.  306, says, "the barracks at Spanish  Town,  con-
sist of two floors, the first upon the ground, the second on the
first.  The difference in the health of the men on the two floors
was so striking as to engage the attention of the  assembly of
the  island, (of Jamaica) and, upon investigation, it appeared
that three were taken  ill  on the ground floor,  for one on the

  * Being at the Horse-Guards on the  1'M.h of November, 1S10,1 saw there Captain
M'Koy, of the '21st regiment of foot, who had then  just arrived with dispatches from
Sicily, and was informed by him that,  in July and August, 1808, while his own and
another company were quartered at the post of  Venetico, in a barrack AY nearly 100
feet in length, which consisted of one (ground) story, forty  men of the latter com-
pany, occupying one-half of Uie barrack,  were attacked by a violent mal' aria fever,
which proved fatal  to eleven of them, but did not reach a single man of his  own com-
pany, occupying the  other half of the barraok, though  there was no division be-
tween the  parts or halves occupied by the two companies, nor any perceptible dif-
ference in the soil  on which the different parts or ends of the barrack stood.   Each
had, indeed, its own door to pass into and out of the barrack,  but both doors opened
on the wune side;—nor was there any difference in the discipline, diet,  or manage-
ment of the men  of the two companies.  Venetico is situated between  JVLclazzo,
and .Messina, and is supposed to be more elevated than the  Hock of Gibraltar,  and, at
least, 1500 feet  above the sea. The barrack stood at the summit of this mountain,
upon a rock  covered by a clayey loam,  and the noxious miasmata were, most  proba-
bly, emitted more copiously from the sol! at or about one end of the barrack, than
that of the other, though no difference  was discoverable therein.  Great elevation, in
a warm temperature,  is no securitv against noxious vapours, if the  elevated spot be
covered by earth, containing vegetable matters, and in  which clay predominates.
Very pernicious marsh fevers notoriously prevail in such situations in the East Indies,
(where they are called hill fevers) and in other  places within ihe tropics 
168
 other.  The ground floor was not, therefore, used as a barrack
 afterwards."  A similar fact occurred at St. Anne's barracks.
 in  Barbadoes, between  the  27th July  and 20th of August,
 1805, when two hundred and seventy-eight men of  the  15th
 regiment of foot, then very lately arrived from England, were
 attacked by the Yellow Fever, of whom seventy-seven died.
 These men chiefly occupied the barrack which runs towards
 the sea, and  is nearly at right  angles with  the officers' or
 stone  barrack, and has " low wet ground on each side."*   In
 this barrack the men on the lower floor were " taken ill in the
 ratio  of three  to one, of those on the upper floor."  This state-
 ment  I have taken from a report made to Dr. C. Ker, then In-
 spector of Hospitals in the West Indies, by Mr. Major Car-
 roll,  Surgeon to  the Forces, under  whose  care  the sick in
 question were placed;  wiiich  report was  dated  Barbadoes,
 10th of September, 1805, and  a copy of it put into my hands,
 by the writer, in November, 1806.
  Whether similar differences  occur in all  climates between
 the ground floor,  and  the next above, in regard to the influ-
 ence of marsh miasmata, I cannot determine; I believe that
 the former are, in this respect, every where,  much more un-
 wholesome than the latter.  Sir John Pringle, after  mention-
 ing the prevalence of intermitting  and remitting fevers at
 Ghent, and still more at Bruges, in  the summer and autumn
 of 1742, adds, "it was then observed that such as lay in the
 upper stories, were  much more healthy, than those who were
 below in the ground floors, which were all very damp." (Dis-
 eases   of the  Army, p.  13.)   The same ill effect  upon  the
 ground floors  was experienced during the late expedition at
 Walcheren, and, therefore, Drs.  Blane, Lempriere, &c.  in
 their  report to the Secretary at War, lately mentioned,  say,

  * Dr. Chisholm,  alluding to this part of Barbadoes, observes, that, " the eastern
side, where Constitution Hill is situated, and  where the king's-house, and an exten-
sive barrack stand,  is thought to be affected by marshy miasm, from a branch  of tht
sea, which runs a considerable way into the country."  Essay on Malignant Pestilen-
tial Fever, &c. vol.  2, 160. 
169
•* on no account should ground floors be used as sleeping apart-
ments.  The more lofty the buildings the better;  for the te-
nants of the  upper stories, not only enjoy the  best health, but
wiien taken  ill, have the disease in  the mildest form; an in-
stance of which came under our observation  when we visited
Fort Ramakins, and the same is confirmed by the experience
of the  natives."  When the small elevation of a single  story
(not exceeding twenty feet) from  the  ground, is found so
greatly to diminish the power of noxious exhalations, it might
be expected  that  the tops  of hills rising a few hundred feet
above the level of the  sea, or of  the surrounding country,
would always he found healthy.   Experience has, however,
often proved the contrary, particularly on the Morne-fortune
at St.  Lucie, and on the Hospital,  and Richmond Hills, at
Grenada, where very great mortality has repeatedly occurred
among British soldiers.  But  in these and  similar cases it
seems probable that the soil, at or near the tops of these hills,
contained matters suited to the formation of marsh miasmata,
with sufficient proportions of clay to retain the necessary
moisture.  There can,  indeed, be  no doubt,  that this is the
case of the  Morne-fortune, which I observed  to be very wet,
and,  in  some degree, swampy.  This and  Richmond  Hill,
being at their xtops more  than  seven hundred  feet above the
level of the  sea, could not, I am persuade!, he so greatly af-
fected merely by exhalations from any low  and damp grounds
in their neighbourhood.
   After these facts,  relating to the heights  and distances at
which marsli effluvia  may be conveyed from  their source, so
as to produce fever,  it may be proper to  notice the  greater
degree of noxious power, which they are supposed  to  exert,
when applied to  the  body during  the  night, than when ap-
plied in the day.  This  greater noxious power in the  night,
and especially during sleep, has  been strongly asserted by
Cancisi, de Noxiis paludum effluviis, p. 77, occ.; and he was
so perfectly convinced of  the fact that he has devoted a  parti-
cular chapter, (the 21st)  to  explain the cause.   " Cur juxta
                            22 
170
paludes noctu prascrtim indonnientes magis quam vigilantes
Isedantur?"  And he begins this chapter  by saying, " Nemo
Arbitror de facti veritate dubitabit qui diu mcdicse  arte  ope-
ram dederit;" and then declares. " Nos certe Roinana Noso-
comia per  {estatem, &  autuinnun plena videmus miseris agro-
rum colonis;  ac per urbem ssepe dolemus  incautos  venatores.
ac peregiinos, quamquam non longo tempore  palustria  loca
incolurrint, quia tamen brevem somnum prope lacunas csepc-
runt, malignis febribus afflictari."  These facts he ascribes
partly to an increased  susceptibility of our bodies. " quae in
somno ad labem suscipiendani proniora fiunt,"  and partly to
a difference in the condition of the effluvia themselves, "quse
per noctem prsecipue deteriora evadunt;"  and he explains the
cause of this  difference in these words, " Quod vero  attinet,
ad effluviorum pravitatem,  certe  eadem  post solis occasum
perniciorior est: quidquid  enim per vim  solis attenuari, dis-
siparique continget, eo  recedente, concretione gravius effici-
tur,  terrseque rursus incumbit, et dormientes  infestius adori-
tur," &c.  p.  79.   Lancisi refers  to several  authorities and
instances in support of his assertions and opinions, and con-
cludes by admonishing those who,  in summer,  travel  through
the Pontine marshes, between Rome and Naples,  even with-
out sleeping,  not to do  it at night, as was  too often done, to
avoid the  greater  heat of the day.*  Similar admonitions
sire still given at Rome to all strangers, and they are  founded
on the uniform experience of ages, which has  afforded nume-
rous instances of travellers, who,  in consequence of their pas-
sing these  fens during the night, (though  the passage requires
but six  or  eight hours) have been attacked with  violent and
mortal fevers.   This is confirmed by Baglivi, in the following
words : " Vetus enim  Latium desertum fere hodie est, & squa-

 * » Nfeqne vero solum dormientibus noxius est per  noctem palustris aer; sed etiaro
iis qui vigilantes per cojnosa loca interfaciunt.  Qua de re monitos veltem quotquot vel
Nt-apoli Homam, vel Koma Neapolim contendimt,  ut diurnos  potius  astus subeant,
quam nocturni frigoris voluptate decepti contemeratatn ambientis aeris vim excipiant,"
fco. p. §0. 
171
 lidum ; Austri flatibus immediate objecitur ; & variis ejusdem
 in locis, insaluberrimus aer observatur, ut pote circa Ostiam9
 et Portum aestivo prsesertim tempore; quo quidem si aliquis in
 prsefatis, aliisque Latii locis pernoctaverit, & exinde urbem
 revertatur,  corripitur  statim maligna febri,  quam vulgo  ex
 mutatione aeris dicunt."  Opera Omnia,  p. 158.
   It  will be recollected,  that in the instance of the Phenix
 Ship  of War, mentioned  at  p. 96  of this volume, " none of
 those who slept on shore escaped the sickness, and only three
 of them survived it;"  and that,  though nearly all the rest of
 her crew, consisting of 280 men, went, in parties of twenty
 or thirty,  at different times,  on shore in the day, and " ram-
 bled about the island hunting and shooting"—" bartering for
 provisions,  washing linen," &c. " not  one of those who re-
 turned to the ship at night was taken ill,  or suffered even the
 slightest indisposition."   And that exactly similar effects oc-
 curred  the  following  year,  with the same ship at the same
 place, where  " she lost eight men out of ten, who had impru-
 dently remained  all night on shore;" whilst  the rest of the
 ship's company, " who, after spending the greatest part of the
 day  on shore, always returned to  their ship before  night,"
 " continued  in perfect health."  In like manner the  crew of
 the Hound Sloop  of War, (then in company with the Phenix,)
 hy never sleeping on shore, continued in good health.  It may
 be recollected also, that in the cases of the  Ponsborne and
 Nottingham East Indiamen, (p.  99)  those who had slept on
 shore were exclusively attacked  by the fever; and,  in parti-
 cular, that  " the carpenter  (of the Ponsborne) and his crew,
 nine in number,  by their all sleeping on  shore, catched the fe-
 ver and  died, except  one, who  was a negro.  The effects
 were  exactly similar in the  cases mentioned  by Drs. Clark
 and Trotter, (p.  99 and  100) and  in that of Fontana.  Dr.
 Lind  has, moreover, in different places, mentioned other in-
 stances of similar morbid  effects, resulting from  exposure to
marsh effluvia by night, and the like has  been done  by Dr.
 Blane,  Dr.  John  Hunter,  kc.  &c.   We have, therefore, 
172
reason to believe,  not only that the morbid miasmata are con-
densed or precipitated with the falling dews,  by the diminish-
ed temperature of the night, and thus accumulated  near the
surface of the  earth, hut that the body is rendered more ac-
cessible to their noxious  influence during sleep, by its greater
relaxation, and hy a suspension of those protecting exertions
of the living power,  which accompany our wakeful exercises.
Perhaps something may also be  owing to  the fact discovered
by Dr. Ingenhouze,  that vegetables only emit  azote or nitro-
gen at night, instead of the  oxygenous or vital air, which is
copiously  separated  from  their leaves  when exposed to the
sun's rays.
   I  ought, were  it  possible, here to ascertain how,  and
tlirough what channels, the morbid influence of marsh effluvia
is applied to, and exerted  upon,  or within the  body, so as to
become the cause of fever.  But here  our knowledge  is hut
little better  than complete  ignorance.  The miasmata, in
question, being absolutely  imperceptible by any of our senses,
can only he known by the disorders which they excite : these,
however,  are not  such as to indicate the manner in which they
were produced, nor  the passages hy which the  morbific power
has gained admittance.  The throat, trachea,  bronchiae,  and
lungs, obviously  present themselves,  as the  parts through
which all  seriform and respirable substances  might be most
readily and naturally introduced within the system,  but these
parts appear to suffer much less than the stomach, brain, and
nervous  system,  from the impressions of marsh miasmata;
and  as there is  much  uncertainty and  difficulty  attending
every explanation whicli has occurred to ine on this subject, I
shall abstain  from proposing any; and proceed to enquire,
how soon these miasmata, after being sufficiently applied to
the  body, commonly produce fever, and  how long they may
remain inactive therein, without manifesting  any change or
effect.
   On this subject Dr. Lind says (p. 182  of his work  on the
 Diseases  of Europeans in Hot Climates) that  " from com- 
173
paring many instances of people who have slept on shore dur-
ing the sickly  season, and in consequence  of it, wlio alone
have been taken ill out of the whole ship's company, then lying
in  an  open road,  it  appears  that some  are  immediately
seized with sickness or delirium, many are not  seized  with
either, till they have been on board two or three days; several
have  been only  slightly indisposed for the first five or six
days ; and, in  a few, the symptoms of  indisposition have not
appeared before the 1 Oth or t<2th day."
  The same author (on Preserving the Health  of Seamen,
p. 78) says, " there are numerous instances of boats' crews
having suffered greatly hy sleeping near  the  mangroves,  with
which the sides of rivers are  frequently planted in the torrid
zone.  I  have  known the whole of a boat's  crew  seized next
morning with bad fevers."  And at p. 81, he mentions a simi-
lar fact,  communicated by the  Surgeon  of a Guinea Ship,
which, going " up one  of the rivers for the  sake  of trade, it
was  found  very  dangerous to sleep on shore."—" First the
captain, then the  mate and two or three  seamen were taken
ill, each of them  the morning after they Jiad lain on slwre."
But  such very sudden attacks of fever from  marsh effluvia
are, I believe, uncommon,  even  in the  hottest  climates or
worst situations.   They, indeed,  occur not unfrequcntly with-
in four or five  days; hut are much oftener  delayed until  the
9th. 12th, and  15th days, after exposure to  marsh miasmata,
even  at Batavia,  Gambia, St. Thomas's, Mohilla,  &c.    Dr;
Jackson,  who, like some  others, is disposed  to  believe  that
these  attacks  "  take  place  chiefly at septenary  periods,"
asserts " from his  own observations   made upon  numerous
bodies of  men,"—and upon healthy soldiers, sent to the con-
centrated sources of endemic fever," that " among such, fever
scarcely ever appeared before the seventh day,  commonly not
before the fourteenth;   and in numerous instances, not till
the expiration  of  six weeks or two months, though the cause
of disease, during this time, was  ordinarily  in great activity."
 Outline, &c. of Fever,  p. 248. 
                           174
  Dr. John Hunter  observes, that " after the  human  body
has been exposed to the poison, (of marsh effluvia) sometines
a longer, sometimes a shorter period elapses, before a fever is
produced.   " Men, (he adds)  on the watering service, are
not all taken ill at the same time ; some fall  sick the first or
second day, others not till several  days, after they have ceas-
ed to be exposed to the cause of fever,  by returning  on board
of ship."—"  Some have embarked on board the ship in good
health, and have been seized after ten or fourteen days with
the remittent fever.   Examples in  this way have come to my
know ledge, of the  fever appearing three weeks after ceasing
to be exposed to the  cause of it."  Observations on the Dis-
eases of the Army in Jamaica.—He adds, in a note to p. 329,
that, " it would be curious and interesting in the  history of
the remittent fever,  to ascertain  the interval that may take
place  between exposure to the cause, and the appearance of
the disease;"  and then mentions the West Suffolk regiment of
Militia,  called,  in 1793, from their own county, vone of  the
healthiest  in  England)  to  Hilsea  barracks,   of whicli  the
"low, marshy,  and  unhealthy  situation,  has been fatally
known to the army, since their  first erection."   The  men
were then " all in perfect health;"—hut " became very sick-
ly ; and twenty-two  died of fevers, before they left the bar-
racks,"  about the  end of June following.  In July this regi-
ment, with eleven other battalions, was encamped at Water-
down, in the neighbourhood of Tunbridge Wells, and " their
sick list soon amounted to  100,  out  of  500,"  among which
were  many with fevers, that " had all  the  marks of a bad
remittent;" some of which terminated fatally—and the deaths
in this regiment exceeded the amount of those in all the eleven
other battalions together, on the same ground.   But the point
of most importance  is that some of this  regiment "were
taken ill of the fever, in the month of October, who had never
had it before;"  i. e. nearly four months  after their removal
from  "  the cause  of  the disease, at Hilsea barracks." 
175
  In addition to this, he mentions the case of the 18th Regi-
ment of Foot, in 1783 and 1784,  as  stated by Mr. Venour,
then Surgeon of the regiment,  and now Deputy Inspector of
Hospitals.   By  his statement it appears, that the 18th regi-
ment, after having been stationed at Hilsea barracks, from
the 22d June, 1783, to the 9th October following, was then
embarked for Gibraltar, where, though the regiment consisted
only of 400 men, the number of agues  was increased, by the
beginning of May,  to 280, including women and  children,—
of whom a considerable part were then recently attacked  for
the first time; and whilst no agues existed in any other part of
the garrison.  On these facts, Dr. Hunter remarks,  (p. 334,)
that " the 18th regiment of- Foot,  and the West Suffolk regi-
ment of Militia, after leaving Hilsea barracks, were both in
situations  where they could not contract fevers, and the regi-
ments encamped with the latter,  and those in garrison with
the former, had no fevers.  There  cannot, therefore, be  a
doubt that the poison  had  remained quiescent in  their bodies
for four, five, and six months."  When thus poisoned, " get-
ting wet in the open air, proved  a  strong existing  cause of
fever, as  was observed both in the  West  Suffolk and 18th
regiments."  He adds, " ships returning  from  a warm  cli-
mate, particularly if  they have been in harbour during the
 unhealthy season,  have  many of their men taken ill of the
remittent fever, even two or three  montlis after being at sea ;
and care  should be taken,  not to confound  this fever with
what is called the Jail, Hospital, or Ship fever."   P. 335.
   Extraordinary as these facts  appeared  to be, when first
made known, the fullest confirmation of them has been since
produced by the late expedition to Zealand;  in which it  has
been  indisputably ascertained, that considerable numbers, both
of officers and soldiers, who were employed on that service, and
 who  escaped the sickness, whilst at Walcheren,  and other
 parts of Zealand,  were attacked by  intermitting fevers,  and
 some of  them  as  late  as six, seven,  eight, and even nine
 months,  after being brought  back  to  this country;  though 
                              I7ti
tare was taken to place  them  generally in situations remote
from all the known sources of marsh miasmata.   This fact is
now become notorious; I have seen it verified in the returns
of several regiments, and  it has  been confirmed to me by a
great part of the physicians, and by several of the surgeons,
both staff and regimental, to whose care the sick of that army
were committed in this country.
  We may,  therefore,  now understand, what had before ap-
peared  to me very difficult to explain  satisfactorily ;  I mean
the cause of those intermittents whicli occur, more especially
in fenny countries, at an  early part of the spring and summer;
before the soil or atmosphere can be supposed to have, at any
time, in that year, acquired sufficient warrnlh, either to form,
or  extricate marsh miasmata,  capable of  producing fever.
Consequently vernal intermittents may now be considered as
resulting  from miasmata received into the  body during the
preceding summer  or autumn, and (after having remained   in a
quiescent state during winter)  rendered active hy sonic excit-
ing, or proximate, cause of fever -in the spring.   It may be
presumed, however,  that in such cases, the original dose, if I
may so call it,  of marsh  miasmata, was but moderate,  be-
cause its effects would otherwise have been sooner manifested,
and this  will account for  the  well known mildness of vernal
intermittents, and the facility with wiiich they are  generally
cured.*

  * Dr. Jackson, at p. 60 of his Outline of the History and Cure of Fever, mentions
a detachment who were embarked at the Mole, in St. Domingo, for  St Marc, and
landed on the 3d of June, among which several were taken ill of Yellow Fever, du-
ring the passage, and twenty were sent on shore from one ship with that disease, after
her arrival at St. Marc, of whom eleven or twelve died, within four days, though they
were all apparently in good health when  embarked.  He also mentions, as a  circum-
stance which " appeared inexplicable," that at St Domingo, « uncommon sickness
and mortality took place under every transportation of troops, to different  posts."
It seems probable, however, that, in all these cases, the troops had previously imbibed
certain portions of marsh miasmata, which, though quiescent for some time, ac-
quired a  morbid activity by sea sickness, getting wet, or other debilitating causes, du-
ring their transportation from one port to another,  it  is  even probable, that actual
 disraso was sometimes produced by such causes, in persons whose constitutions might, 
                            177
  From all these facts it may be inferred, that hy differences
either in the quantity or quality of the noxious exhalations of
marshes, their operation, as a cause of fever, is liable to great
varieties,  in regard to its celerity, or the length of  time in
which  disease actually appears;  which is sometimes within
twenty-four hours,  and sometimes not until six, eight, or even
nine months have elapsed, and then only when  assisted hy
some accidental or exciting cause.  The longest periods, so far
as I can discover, have occurred  exclusively in cold,  or tem-
perate climates;  the shortest,  only in the hotter; and in ge-
neral there seems to be some foundation for believing, that,
cseteris paribus, the disease will be most violent in those cases
where it appears soonest after the morbid cause has been ap-
plied to the body; and that the rapidity of its production, will
be in proportion to the quantity and  concentration or force of
the noxious miasms; differing in this respect from the small-
 pox, and some other specific contagions, whose morbid influ-
ence,  together with the mildness or severity of the disease re-
sulting from it, seems to depend  exclusively upon the  state of
the body,  in which it is exerted, and the treatment of the pa-
tient in regard to temperature,  diet, &c.  &c. and not upon
either the quantity or quality of the contagion, producing the
 disease.  The state of the body,  indeed, and other circum-
 stances, have a considerable influence in regard to the mild-
 ness or severity of the fever from marsh effluvia, but not an
 exclusive one, as they seem to have in regard to the effects, of
several, at least, of the specific  contagions;  e. g. Dr. John
 Hunter observes, that if persons  are exposed to the  exhala-
 tions of marshes,  "when fatigued by hard labour and long
 fasting, the poison gains  admission more readily  into the
 body, and produces immediately the worst kind of fever.  It
 is in this  way, (he adds,) that soldiers suffer so much on ac-
 tual service in the West Indies :  the few cases of fever which

under more favourable circumstances,  have withstood, and finally subdued the poison,
without any attack of fever.
                             23 
178
proved fatal in twenty-four hours, that occurred to me, were
all contracted in a similar manner."   (Diseases of the Army
in Jamaica,  &c.)
  There is, however, another condition  of the body, which is
of great importance, in regard to the production of yellow fe-
ver, and which, therefore, requires a particular investigation;
I mean the cause of that remarkable susceptibility to this dis-
ease, wiiich  is commonly found in persons who have just ar-
rived at places where it occurs, from cold  or temperate cli-
mates; and of the  equally remarkable exemption  from it,
which  is commonly experienced by  the  old inhabitants of hot
countries; and which, in the latter, is universally ascribed to
their having become seasoned, as it is  called; but however
familiar this term may be, and of  whatever  importance its
proper signification really is,  (since it involves the means of
preservation from one of the  most  dreadful  maladies whicli
afflict the human race) it has been long employed  either with-
out any precise meaning, or  with meanings which are inad-
missible.  Thus it is often said, that a person is seasoned who
has once had the Yellow Fever; but very improperly, because
the same individual may have the disorder several times; be-
sides which, many persons become exempt from the fever, and
ought, therefore, to be considered  as being truly seasoned,
without having ever suffered an attack of the disease.  It is,
also, frequently believed, that one may become seasoned by re-
siding long in those towns in which the Yellow Fever is apt to
recur; but the very great numbers of the inhabitants of Phi-
ladelphia, New-York, Malaga, Cadiz, Seville, &c. who have
been swept off by the distemper, within a few years,  are me-
lancholy proofs that an efficacious  seasoning is not to be ac-
quired merely by such residence.  Nor can  it be said,  that
those who live near marshes are peculiarly seasoned, because,
in  hot countries, numbers of  persons, who live at a distance
from  marshes, are proof against  the Yellow Fever, although
thf-y are sometimes attacked  with slight remittents,  or inter-
mittents. 
179
  After some reflection on this interesting subject, the various
degrees of susceptibility which are observed in different indi-
viduals,  or in different places, seem to me capable of expla-
nation on a very simple principle, I mean the effects of tem-
perature on the human frame, which does not appear to have
been sufficiently noticed.
  The body, whilst in  health, is found always to be, with
very slight variations, at the temperature of 98 degrees  of
Fahrenheit's thermometer, and there is good reason to think
that any considerable  variation from this point would neces-
sarily produce morbid effects.  It seems, therefore,  to he  of
high importance, that  the body should  be preserved from such
deviations ;  and  the author of nature has, accordingly, pro-
vided efficacious  means for  that end :—different opinions are,
indeed,  entertained concerning these means; and  since the
later chemical discoveries have been made, it has been gene-
rally believed, that,  in  an  atmosphere, the  temperature  of
which is less than  98  degrees,  the heat of the human body is
maintained at that  point, by a process similar to that of com-
bustion, and depending  upon a  combination of oxygen gaz
(taken into the lungs  by respiration) with carbon and hydro-
gen : and  that,  in  an atmosphere heated above 98 degrees,
the temperature of  the body  is kept down at that point by the
effect of an evaporation of matters  perspired from  the  skin.
There  are,  however,  insurmountable difficulties opposed  to
this doctrine, but  a full statement  of them would,  in  some
degree,  be foreign to the subject under our consideration.*

  * In June, 1794,1 controverted this  chymical doctrine, regarding the production of
animal heat, at an act, or public exercise, in the University of Cambridge, previous to
the taking of my first degree in physic.  Perhaps a sumtnary of some of the facts and
arguments, which render that doctrine inadmissible, may be acceptable here.
  1st.  Animal heat is a natural production : and no chemical process like combustion
can take place naturally in  a healthy animal, because the power of life, while it subsists,
naturally counteracts and  suspends all chemical attractions, or affinities within  the
body j and even, after death, when this suspension is removed, they spontaneously occa-
sion a different process, that of putrefaction. 
180
   I will,  therefore,  at present, only remark, that it is utterly in-
   credible that these  opposite processes should ever be carried on
   so accurately in reference  to each other, and  be so  exactly  ba-
   lanced,  as invariably to keep the body  at the  heat of 98 de-

     ad.  The attractions or affinities subsisting between oxygen, hydrogen, and carbon,
  even if unrestrained by the living power, would not,  so far as our knowledge extends,
  enable them, by combining to form water, and carbonic acid gaz, with a disengagement
  of sensible heat, as, according to this doctriue, they are supposed to do, unless they were
  actually ignited, which they never can he in the  lungs or blood-vessels of an animal in
  health.
     3d.  Were it even possible, that the air naturally inspired by the lungs should com-
  bine and  afford  heat in  the manner supposed, the heat, so afforded, being necessarily
  limited and proportioned to the quantity of oxygen  inspired,  would, at all  times, br
  greatly insufficient for maintaining the human body at its natural temperature, even in
  the milder parts of Europe ; and, in an atmosphere below the freezing point, it would
  greatly fall short of the quantity of heat commonly abstracted from the body, and car-
 ried out  of the lungs, by the warm moist vapour copiously expired from them. So
 that in cold, and even in  moderate  weather,  one  effect of respiration is to cool thi
 blood, according  to  the opinion  which, during several ages, prevailed on this subject.
 And, if the quantity of oxygenous gaz, naturally inspired by mankind, be incapable of
 affording heat, sufficient to maintain their natural  temperature, the quantity inspired by
 animals of the celaceous order, must be yet more, and much more, insufficient to main-
 tain the heat natural to them, living, as they commonly  do, from choice, at  the edges
 of ice, near the poles, and  immersed in a fluid,  (salt water) so well suited to abstract,
 and rapidly conduct away their heat, however it be acquired.   The degrees of animal
 heat na^irally belonging to the several genera and species of this order, have not been
 accurately ascertained ;—it is known, however,  to exceed that of mankind in some,
 and  probably, does so in all of them.   Some of the species of  whale, particularly the,
 Baleena mysticetus, (the common or larger whalebone  whale)  are  of an  enormous
 size, and  from 50 to 100  feet in length ;  in a few places they are said to have been
 found 160 feet long.  And, it is ascertained that,  in  most animals of this  order, the
 passage for air through a part  of the trachea, is proportionably " veiy  small or  con-
 tracted ;" and that the pulmonary cells  are smaller than in quadrupeds, which, says
 .Mr. John Hunter, " may  make less air necessary." (See his Observations on the Struc-
 ture and Economy of Whales,  in the  Phil. Trans,  vol. 77, p. 418, 419)  And as
 these animals,  in addition to the smaller quantity of air taken in their lungs at  each in-
 spiration, do not commonly breathe  oftener than once in about fifteen minutes, and
 when frightened, only once  in about haf an hour,  (See Phil. Trans. No. 387,  p. 256.)
it must  be  absolutely impossible  that oxygen, so sparingly received into their lungs,
should,  upon any  principles  jet  known,  afford  supplies of  heat sufficient to
maintain the high natural temperature of these animals, (whose ceconomy nearly resem-
 bles that of men and quadrupeds) in the cold water, by which they are surrounded.
   Finally,  to avoid unnecessary proofs,  and demonstrate  beyond the  chance of  con-
tradiction, that animal heat is not produced by respiration,  we need only recollect, 
181
 grees, in  all the diversities  of temperature that occur in dif-
 ferent climates  and  situations, and,  therefore, that  this im-
 portant  conservatory function must depend on  a  power more
 exalted in its nature,  and more certain in its operations; which
 can  be no other than the power of life,—a power  which,  in
 proportion as it is more  vigorous in robust  individuals at the
 prime of  life,  notoriously enables them to resist the  opposite
 extremes of heat and cold,  and preserve their bodies at  the
 proper standard, more perfectly,  and  for. a greater length of
 time, than at a more advanced age.   I will not venture to as-
 sert that no  addition to  the heat of the body can be made,
 either directly  or indirectly,  by  the  combination  of oxygen
 with the blood,  and I readily admit, that its temperature may
 be diminished by a copious evaporation  from the  surface ;—
 but, if either of these causes should co-operate with the living
 power to a small extent,  the one  in raising, and the other in
 lowering, what is called animal  heat, it  must always  he in
 complete subordination to the higher principle of wiiich I have
 been speaking,  and to which nature has committed the impor-

(what is well known)   that it continues to be produced for some time after respiration
has entirely ceased, more especially in  persons  who die by apoplexy, or by suffocation,
from fumes of burning charcoal, &c. who are frequently  observed to retain their for-
mer temperature undiminished for several hours after all breathing has stopped ;  and
in some cases, it has even been raised above the  standard of health;  e. g. Dr.  Clarke,
 (on Diseases, &c in Long Voyages, vol. 1, p. 44,) says of a seaman, who died  by apo,*
plexy, from a " coup de soleil" that, after all the external signs of life had disappeared,
when " no motion was to be felt in the  thorax, nor  any pulsation  in the arteries;"
when his jaws were locked, his eyes dead, and staring, " the heat of his body was much
above the standard of health, and communicated a burning pungency to the touch; he
was bled largely from the arm and jugular;  the blood was very hot, and it was with
difficulty stopped." Indeed, heat continues to be more or less generated in all persons
after what is called death, so long as they retain any  portion of excitability or living
power. Were it not for this they would be  reduced  to the temperature  of tiie sur-
rounding atmosphere, as speedily as another body of the same species and size,
which, after  being absolutely dead and cold, had been artificially heated  to the same
degree.
   The natural heat  of vegetables seems  to  be analogous to that of animals, and
equally the product of a living power, independently of  any process  resembling
combustion. 
182
taut (barge of preserving the  temperature of the body at the
standard of health, amidst all the varieties of climate,  and  of
external circumstances.   This is a  charge  which cannot  be
fulfilled in an atmosphere like that of England, the mean tem-
perature of which may be estimated at  50°,  without a consi-
derable expenditure of the living  power,  in order to  generate
constantly, at the mean rate of 48° of animal heat: and after
the  body has been, for a length of  time,  accustomed to make
this exertion, it is easy to perceive that, upon removing into a
warm  climate,  such  as that of the West  Indies, the general
mean temperature of which may  be taken at 79° or 80% very
material changes in  the functions of the system become abso-
lutely  necessary  for the  preservation  of health.   But  these
changes are  not to he suddenly effected; and,  until  the body
becomes perfectly accommodated to the heat of this  new cli-
mate,  the whole  animal oeconomy must be  considered as  al-
most  ih a state of morbid  excitement.*   It is not this state,

  * There is a great analogy between animals and vegetables in regard to their pre-
disposition, from habit,  to generate certain portions  of heat; and in their susceptibi-
lities  from the same cause, of being inordinately excited by a removal to climates or
situations, warmer than those to which they have been accustomed, 31 r T  A Knight,
in  his " Observations on the  Method of Producing New and Early  Fruit," (in the
Trans, of the  Horticultural  Society, part 1, p.  30) mentions the following facts:
"If two plants of the vine, or other tree of  similar habits,  or even if obtained from
cuttings of the same tree, were placed to vegetate during several successive seasons in
very different climates; if the one were planted on the banks of the Rhine, and the
other on  those of the Nile, each would adapt its habits to the climate in which it was
placed ;  and, if both were, subsequently, brought in early spring  into a climate  simi-
lar to that of Italy, the plant) which  had adapted its  habits to a cold climate, would
instantly vegetate, whilst the other would remain perfectly torpid.  Precisely the same
thing occurs in  the  hot-houses of this country,  where a plant, accustomed to the
temperature of the open air, will vegetate strongly in  December, whilst another plant,
of the some species, and sprung from a cutting of the same original stock, but  habi-
tuated to the temperature of a stove, remains apparently lifeless.  It appears, there-
fore, that the powers of vegetable life in plants,  habituated to cold climates, are more
easily brought  into action than in those of hot climates; or, in other words, that the
plants of cold climates are most excitable."  P. 191.  " But, the influence of climate
on the heat of plants,  will depend less on  the aggregate quantity of heat in  each
climate,  than  on the distribution of it in the  different seasons  of the year.   The
aggregate temperature of England, and of those parts of the Russian empire,  Uiat 
183
(of excitement)  howrever, which alone  is productive of fever;
since we  know that innumerable  persons have  gone  from
Europe to the hottest regions of the globe, and have continued
there for years, without being attacked by fever, when  other
causes  did not assist in  producing that disease.  The inhabi-
tants of South Carolina, as I lately mentioned, were exposed
to this kind of excitement, in an  extreme degree, during  a
great part of  the summer of  1752, and  yet  had never been
more healthy ;  and other instances of the same import, might,
if necessary, be adduced.   But, although the simple operation
of the warmth of hot climates upon the human body be not the
cause of this disease,  yet it is chiefly, if not entirely, to  the
various degrees of that derangement which it occasions in per-
sons not  accustomed to warm climates,  that  I attribute all
those varieties of  liability  to the epidemic  Yellow Fever,
 which are  observable  in  different individuals,  from  tiie ex-
 treme susceptibility of  northern  strangers to the almost com-
 plete immunity of Creoles, and more especially of African ne-
 groes.  It may be very difficult  to point out  the particular
means  by whicli heat  occasions this extreme  susceptibility;
and yet it is  not difficult to understand,  that  a morbid cause
 may be able to produce a  much more violent disease,  when it

are under the same parallels of latitude,  probably does  not differ very considerably ;
but,  in the latter, the summers are extremely hot, and the  winters intensely cold ;
and the changes of temperature between the different seasons are sudden and violent.
In the spring, great degrees of heat  suddenly operate on plants which have been long
exposed to intense cold, and in which excitability has accumulated during a long period
of almost total inaction; and the progress of vegetation is, in consequence, extremely
rapid. In the climate of England, the spring,  on the contrary,  advances  with slow
and irregular steps, and only very  moderate and  slowly-increasing degrees of heat
act on plants in which the powers of  life has  scarcely, in any period of the preced-
ing winter, been totally inactive.  The  crab is a native of both  countries, and  has
adapted alike its habits to both; the Siberian variety, introduced  into the climate
of England, retains its habits, expands its leaves, and blossoms on the first  approach
of spring, and  vegetates strongly in the  same temperature, in which the native crab
scarcely shows  signs of life ; and its fruit acquires  a degree of maturity, even in the
early part of an unfavourable season, which our native crab is rarely or never seen
to attain." 
184
is assisted by the co-operation of so powerful an  agent  as
heat, than it could produce when acting by its own single in-
fluence ;  and it  is upon this principle that  I  shall endeavour
to explain the general law, by which the susceptibility to the
Yellow Fever is, ceteris paribus,  regulated.  To accomplish
this object, it will be necessary to take a concise view of the
climates, in which the Yellow Fever has  principally raged,
and  to  apply the principle just mentioned  to  the results,
which the experience of several years,  in  each of them, has
afforded.
  The variation of temperature, to which the climate of the
West Indies is subject in the course of the year, is comprised
within a few degrees ; for the mercury in the thermometer sel-
dom descends below 70° during the winter months, even in
the coolest part of the mornings, and I have rarely found it
(in the smaller or  windward islands) to rise above 88° in the
shade on the warmest days of the summer ; though the heat is
said to he sometimes a little greater in St.  Domingo, and the
other large islands.  The excitement  in  the system, which
ensues immediately upon  a person's coming  into so wrarm a
climate from a  temperate region, renders him, as I have  al-
ready said, eminently liable to the Yellow  Fever,  when expo-
sed to the influence of marsh effluvia:  by degrees,   however,
the excitability  producing this commotion abates,  and,  at  the
end, sometimes of twelve months,  but oftener of a  year and
half,  or two  years, he acquires the power of supporting this
high temperature, and then becomes almost as insusceptible of
the disease, as the natives or old inhabitants ; and afterwards
retains this happy immunity, so long as he continues in that
climate,  the great uniformity of which does  not, indeed,  af-
ford him any means of losing it.  He may, likewise, go from
the West Indies to those parts of North America, or of Spain,
where the Yellow Fever is raging with the utmost fury, with
almost a certainty of escaping the  disease;  and even if  he
should not preserve his health perfectly in such situations,  he
will, at the worst, be only seized with a mild remittent or in- 
185
termittent fever, though living in the midst of those who are
dying with the yellow7 fever in its aggravated forms.
  The horrid massacres and pillage of the white proprietors
in the French West Indian Islands, by their negro slaves, (in
consequence of the principles instilled by the French revolu-
tion) had so alarmed the wretched survivors, that great num-
bers of them fled  for safety to different parts  of the United
States.  We were about  three  thousand  French, says  Dr.
Valentin,  (the author of a late Treatise on the Yellow Fever,
who was,  himself, one of  that number,) when we landed at
Norfolk and Portsmouth, in the Bay of Chesapeake,  in July,
1793, after the dreadful catastrophe at the Cape:  some of
those  who remained in these towns were seized with a  remit-
tent,  but  not one with the yellowT fever, although our sudden
transition from affluence to absolute want, might have been
fully  capable of predisposing us to this malady, which a stag-
nant  and heated  atmosphere, and a low  swampy situation,
seemed, of  necessity to produce,  in  the country in which we
arrived.   (Page 68.)
  Many of these refugees were also living at Philadelphia in
the same  summer of 1793, during which  above 4000 of the
inhabitants died of the distemper; but (as we are distinctly
told by Dr.  Rush,) they universally escaped it.  In this place,
however,  it will  be proper to  remark, that  the immunity
which Creoles possess, relates chiefly to that variety of  yel-
low fever  which is epidemic.  I  have already mentioned that
a fever, attended  with all  the symptoms which are held cha-
racteristic  of the yellow  fever,  may, in hot  climates,  he
brought on by intemperance, great fatigue after being over-
heated by the sun's rays, sudden  diminution of  temperature,
violent agitations of mind, and other causes, which are known
to be  capable of exciting fever in all countries :  to this spora-
dic fever Creoles are subject, though in less violent degrees
than Europeans; for no length of residence in any climate
24 
18b'
  can  be supposed to  exempt  one from  the operation of such
  causes.*
    The climate of the United States of America is very  unlike
 that  which prevails between the tropics ;  for the variation of
 temperature,  within  the year,  is not in the former limited to
  18 or 20 degrees,  as  in the  latter, but  extends from  60  to
 80 degrees; the heat in summer being  often greater than in
 the West Indies,  and the cold  in winter being in many  parts,
 much below the freezing point.   Nor does the same climate
 prevail  over all the states; for although, during the warmest
 part  of the year,  the heat being nearly as great at  Philadel-
 phia, New-York, and  other towns  in the latitude of 40 or 41
 degrees north, as at  Charleston, in South Carolina, which is
 seven or eight degrees  nearer  to the equator,  yet the annual
 mean temperature of the more northern states, is considerably

  " Dr. Lempriere does not seem to believe that these causes alone will produce the
 fever in question.  He says, (Diseases of the  Army in Jamaica, vol-ii p. 112)  "that
 how much  soever persons  are exposed to the sun where marsh miasma does not pre-
 vail, the attack of  fever does not ensue;  and that, whenever there has been an in-
 stance  of Idiopathic fever, in situations that are deemed healthy, it will  be found,
 upon careful inquiry, that the patient had been exposed to marsh miasma, in  an occa-
 sional visit to some place where it exists "  That this may often be true 1 believe, but
 not that it is always so;  for, though mere exposure to the sun, without  a sudden
 cooling  of the body, or the co-operation of some  of the other causes just mentioned,
 may not be sufficient to produce fever, yet I am  fully convinced of its having done so,
 not unfrequently  with such cooperation.  But,  whether the fever so produced, will
 be, in all other respects,  exactly similar to an Idiopathic fever produced in  the way
 which  Dr. Lempriere supposes, and especially, whether it will have an equal tenden-
 cy to remit, is more than I  am willing as yet to decide.
  Though  Dr. Hillary  practiced, with the highest reputation,  in Barbadoes,  for a
 considerable number of years, there is good reason to  believe that all the cases of
 yellow  fever which fell  within his observation,  were  merely sporadic, and most of
 them produced by some of the causes which 1 have mentioned,  as sufficient for that
 purpose; and it must be principally to such cases that Dr. Lind  alludes, at p.  120 of
his volume  on Preserving  Health at Hot Climates, when he says, "I am very sensi-
ble  that one or two persons  may sometimes be  seized with the yellow fever  when
no otn« r person in  the  neighbourhood labours  under it; and even that at such a
 time, its most mortal symptom, the black vomit,  may attack a person newly arrived,
wiihout any previous complaint " He afterwards observes, at p  178, that  " drunk-
enness,  or any debauch,  will often give  a fever, which in less than forty eight  hours
terminates in  the  death of the patient." 
187
less than that of the southern, because, on the one hand, the
season of heat is of shorter duration,  and, on the other, the
winter is much  more severe  in the former than in the latter.
The cold at Philadelphia, for instance, is so great, that the
Delaware " river is frozen  from three to  nine  weeks almost
every winter,"* and is yet more intense at New-York,  and
in most of the  towns of New England: but at Charleston, as
we are informed, by Dr. Chalmers, " it seldom freezes  more
than  four or five times in that season; and then a thaw so
soon succeeds, that in the space  of ten years the  ice may not
be strong enough to bear a man."  (See  an Account of the
Weather and  Diseases of South Carolina,  by  Lionel Chal-
mers,  M. D. vol. i. p. 23.)
   It is owing to these differences between the  same seasons
that, while the annual mean temperature of  Charleston is es*
tiinated at  66  degrees, (according to  a Register kept by Dr.
Chalmers,  for ten years,) that of Philadelphia is  reckoned at
only 52  5, and that of New England at from 50 to 48 de-
grees ;  and from these differences there will also result cer-
tain physical effects in the inhabitants, which claim a particu-
lar attention.   In the southern  states, where the  summer be-
gins earlier, and the  autumn lasts longer, than in the higher
latitudes, the inhabitants have to endure  a long continuation
of hot  weather; and in  doing this, they at length acquire, in
a considerable degree, the power of supporting heat; of which
power they lose but a small portion during the winter, because
the frosts  being there neither frequent nor of  long continu-
ance, their bodies  accommodate themselves with  ease to the
mild temperature of that season, and there are  few occasions
in the course  of it, when those greater efforts arc  required
which the body is obliged to make whenever it has to resist a
severe degree of cold, and, by the frequent making of which,
it seems to be  always rendered less able afterwards to sustain
heat.  Hence  it results,  that the southern inhabitants  can

  * Geography of the United States of America, by Jed. Morse, A. M. 4to. p. 426. 
                           188

scarcely be affected by the moderate warmth of the ensuing
spring,  or the gradual increase of temperature, during that
season; and that they will be able to support the subsequent
heats of the  summer, with  little or no  morbid excitement.
But, in the northern  states, the comparatively  short term of
the hot season does not there permit the inhabitants to acquire
an equal share of the power of supporting heat with their fel-
low citizens in the south :  and that share of it which they do
acquire, is much diminished afterwards, or, perhaps, wholly
lost, during the  long  and  rigorous winter of those latitudes,
when great and continued  exertions of the animal powers be-
come necessary that they may be enabled to  sustain so cold a
temperature.   It is, therefore, obvious, that on the return of
the summer, the  transition which the inhabitants of the north-
ern states will then have made, from extreme  cold to exces-
sive heat,  must be the means of causing a much  higher degree
of excitement in them than will ever be produced  in those of
the southern states, for the reasons before given, and, on re-
curring to facts, it appears from them that when  the yellow
fever has  raged over this part of the  world,   (which seems
never to have happened except  when summers  have been ex-
ceedingly  hot) the degrees in which the citizens of the diffe-
rent towns of America were liable to the disorder, correspond
exactly with the power of supporting heat conferred on them
habitually by their respective climates.   Accordingly,  the
citizens of Savannah and Charleston are almost equally ex-
empt from the yellow fever with Creoles, as I had the oppor-
tunity of  witnessing in both places in the  year 1797.  But,
that this may not seem a mere assertion of mine,  I shall beg
permission to quote the testimony of Dr. Ramsay, of Charles-
ton.  This very respectable physician, after mentioning  that
the yellow fever had occurred  there in seven  out of nine  of
the last years, of the last century,  and had continued in all
those years from the month of July to the following Novem-
ber, distinctly says, that, " with very few exceptions (chiefly 
189
 children,) it exclusively fell on strangers to the air of Charles-
 ton."*
   The situation of Norfolk, in Virginia,  is  nearly midway
 between Charleston and Philadelphia, and its climate corres-
 ponds with its situation, being colder than that of the former
 city, but  warmer than that of the latter.   The yellow fever
 has frequently appeared there; and,  according to the testi-
 mony of Drs. Taylor  and Hansford, (residents in that town)
 it has, at least,  " in its malignant form, always originated on
 tiie (hanks of the) river,  or on low, new-made grounds, and in
 houses built on the docks.  In all  cases, it begins with stran-
 gers and new settlers,  affecting every one in proportion to his
 time of residence, and leaving the old inhabitants  not wholly
 exempt, yet proof against its destroying power."   " Persons
 from  higher latitudes often fall victims,  but with  European
 strangers, the fever was generally uncontrollable."  (New-
 York  Medical Repository,  vol. iv. p. 205, 6.)   This account
 is strongly  confirmed  by Doctors Seldon  and Whitehead, of
 the same place, in a well-written statement, which will be in-
 troduced hereafter.
   With regard to the towns of the more northern states, as
 Baltimore, Wilmington, Philadelphia, New-York, New-Lon-
 don,  Boston, &c. there is ample proof that the inhabitants of
 each of them become more subject to the disease, as their situ-
 ation  approaches to the north:  for, it is but too evident, from

  * See  Dr. Ramsay's Review of the Improvements, &c. in Medicine, in the eighteenth
century, read on the first day of the nineteenth century, before the  Medical Society
of South -Carolina, p. 39.  If this testimony, delivered  before so many persons ac-
quainted with its  truth or falsehood, and never, as I believe, controverted by any
one, «ould need  confirmation, I might adduce that of the late governor of that Slate
(Mr. Drayton) who, in his Review of South Carolina, printed at Charleston, in 1802,
has made the following statement, at pages 27 and 28.  " The Typhus icteroides or
putrid bilious, or Yellow Fever, is, however, particularly local to- Charleston;  and is
not known to have originated in the country.  To the natives, and long inhabitants of
this city it has not yet been injurious.  But those who come from the country, during
the autumnal  season, or who have not been accustomed to spend the fall months in
Charleston, or to foreigners at their first arrival, it is particularly dreadful, and  marfv
are those who fall victims to its fatal influence" 
190
the registers of the  deaths, reports of the  Boards of Health,
and other authentic documents, which have been made public,
that whenever the epidemic has broken out in those places,
the  mortality has not been  there almost wholly confined to
strangers, as in the  southern towns;  hut, on the contrary,
that a very large majority of those  who  had  the fever  and
died, consisted ot fixed residents.  This has been especially the
case in the four last  mentioned towns, the citizens of which
seem to have been almost  as readily attacked and carried off
by the disorder,  as foreigners  even from the  north of Europe,
though persons lately arrived from hotter climates generally
escaped it.  In like manner, the official account of the yellow
fever at  Cadiz,  in  1800,  asserts, that, "persons lately ar-
rived in  that city from the West  Indies, did not suffer an at-
tack of the  epidemic," while those persons who had  come
" from Canada,  and other northern countries," were very lia-
ble  to the disease.
   Thus, hy attending to the usual and  necessary  effects of
heat on  the human  frame, under  different circumstances of
climate,  it will be perceived, that we obtain  a simple explana-
tion of some of  the most  important general  facts with which
the  occurrence of the Yellow  Fever is connected.  An  addi-
tional proof, that the security from that disease is principally
derived  from the ability  to  endure  great heat,*   without  its

  * The natural ability to endure great heat varies not only among different  races of
men, but also among individuals of the  same race, though  living  constantly in the
same situations, e. g. light and red-haired  people with very white skins, universally
bear cold better, and are more incommoded by heat, than the black-haired with dark
skins. But, besides these constitutional differences, there is another, which  depends
more immediately upon the established habit of generating certain degrees or  portions
of animal heat, for the purpose of keeping the temperature of the body at the health-
ful standard ; and it is  this difference extending generally to all sorts of persons, that
is now more immediately in my contemplation; though  its  effects  are  liable to be
augmented or diminished  by the constitutional peculiarities of individuals, and of the
several races among mankind.  Probably the  power of habit may also, as Lancisi, and
others, have believed, extend so far  as to diminish  the  morbid influence of marsh
miasmata upon persons who, from their birth, or, for a considerable number of yeai-s,
have been more or less exposed to their impressions, at least there are facts, or snp- 
191
 causing any considerable derangement in the  animal o&cono*
 my,  is, tbat this security continues only so long as this  abi-
 lity continues:  for,  if the  inhabitants of warm  climates re-
 move,  for a few years, into cold  countries,  and afterwards
 return, they are then  found to  be liable  to the fever.   So,
 likewise,  the refugees from the French West-Indian islands,
 in America, who,  as was before observed, at first universally
 escaped the disorder, were frequently attacked by it after  they
 had  passed three or four  winters  in  that country.  Another
 important proof of the same nature, is the  more  frequent ap-
 pearance, and  the greater severity of the Yellow  Fever, in
 populous cities,  than  in the country  : circumstances which it is
 natural that we should  expect, when weyecollect the various
 causes which contribute to warm the atmosphere  in towns,
 and  which  do not exist out of  them ; such,  for example, as
 the absorption of solar  heat by,  and  the reflection  of it  from
 the walls of houses,  and the pavements of streets,  the assem-
 blage of  a number of living bodies;  the many fires kept up
 for domestic purposes, and the obstruction to the circulation
 of the air,  occasioned by large collections of houses.   By a
 combination of these causes,  the  temperature of  the atmos-
 phere, in a large  town, may  be raised  to  a degree sufficient
 to produce the Yellow Fever within it, while that of the neigh-
 bouring country may not be high  enough  for its rural exist-
 ence.!   There is an interesting fact connected with this  last,

posed facts, which support this belief.  In regard to individuals, who, by long residence
in cold climates, have become habituated to the generation of large portions of animal
heat, it must be remembered, that the cold, which forces this habit upon them, will
naturally produce in them a considerable rigidity and strength of fibres,  with an  inflam-
matory diathesis, and  that, when they remove  directly to an intertropical situation,
they will commonly cany with them a great accumulation of excitability, which, co
operating with  the  established habit of generating much  animal heat there, may
readily produce in them a most aggravated and violent form of fever, from a cause or
causes which, in the relaxed systems, and with the diminished excitability of persons
who have resided many years in hot climates,  would only produce  an  intermittent or
remittent.
 ■(• Dr. Caldwell, in his Medical and Physical Memoirs, says, " Philadelphia, like
every other large and populous city, possesses a factitious climate of its own, different 
192
 which ought not to be omitted.   Dr.  Ramsay,  whom  1 have
 before  quoted,   after mentioning,  that persons  coining  to
 Charleston from the higher northern latitudes of Europe and
 America, had been most subject to this disease,  and had most
 rarely survived it,  states,  that " the inhabitants of the coun-
 try parts of South Carolina had little better chance of escap-
 ing it altogether, if they came into the city, or of  recovering,
 when  attacked  ;"* but,  considering  that,  according  to Dr.
 Chalmers,  the atmosphere is always from. 10" to 15"  hotter in
 Charleston than in  the country, where it frequently  freezes
 pretty hard, whilst, at the same time, no signs  of ice appear
 in town, we shall instantly  perceive that the people from the
 country are  susceptible to the fever in the same degree, when
 compared with  those of the town,  as  persons coming from
 towns considerably to the  north of Charleston;  and it is also
 plain,  that the  same reasoning is applicable to the  country
 people residing  near most  other large towns.f

from the climate of the surrounding country."  "The summer climate of Philadel-
phia, and of other large cities, similarly situated, is an artificial torrid zone, in which
the thermometer rises from four to six degrees higher than it does at the distance of a
few miles in Uie country."
  By a very accurate account of Uie state and variations of two Register thermo'neters
kept, one in London, and the other at Newick Park, in Sussex, in the winter of 1806-7,
it appears, that, though the latter place is thirty-five geographical miles south of the
former,  yet  the weather was commonly between four and five degrees  colder at
Newick Park than it was at the same hours and days in London. This account was given
to me by the late Mr. Tiberius Cavallo, whose care and love of truth are well known.
  * We are informed by Spanish and  other writers, particularly Humboldt, that this
also happens at Lavera Cruz, where the Yellow Fever exclusively attacks strangers
from more temperate northern climates, or persons eoming to town, from higher and
cooler situations in the country; and this is  also the case in Jamaica, &c. See Dr.
Dancer's Medical Assistant; or, Jamaica Practice of Physic, p. 84.
  f The younger Michaux, who, under the auspices of the French government, made
a second voyage to the United States of America in 1801, tells us that he  landed at
Charleston, in South Carolina, on the 9th of October in that year, contrary to the ad-
vice which was given him, and which was followed by the other passengers, of retiring
to Sullivan's Island until the appearance of frost; that he was soon after attacked by
the Yellow Fever, which,  in that very year, proved fatal to eight-tenths of all the
strangers in that city, and which had nearly cost him his life.  He observes, that this
disease varies in the degrees of its intensity  every year, and that the inhabitants of 
193
   If after all  these facts, which  are not less  in conformity
 with the simplest  laws  of nature, than in harmony with each
 other, and which  appear to me to form a chain of convincing
 and even decisive evidence, any further proof could be desired,
 concerning the uniform correspondence of the exemption from
 the  Yellow Fever, with the power  of  supporting heat, it is
 afforded by the knowledge of the  various degrees in which ne-
 groes are  susceptible to the disease under different circum-
 stances.
   The  annual mean temperature of those  parts of  Africa,
 which  are peopled by  the various tribes of negroes, is, per-
 haps, no where less than 84"  upon the coast, and it is, proba-
 bly, several  degrees higher in the interior.   This,  however,
 is only to be understood of the temperature in the shade, or in
 the  coolest places, and  does not indicate 14ie greatest heat
 which  the  natives  of  Africa  can  sustain,  nor  even that
 which  they may  be said to  bear habitually:  for  it  will be
 recollected,  that they  pass  a  great part of the day  in the
 open  air, and  as their bodies are  generally  naked,  ex-
 cept about the  middle,  they are fully  exposed  to the  ac-
 tion of the sun's rays, the direct  heat of  which has been esti-
 mated,  and,  I believe,  without exaggeration,  to vary from
 120° to 160°, while the  thermometer in the shade marks from
 85°  to  110°.   But the bodies of  blacks,  and  especially their
 colour,* are so  admirably adapted for supporting, or rather for
 Charleston are but nttle affected by it.   But, that those who live in the higher parts of
 that state, at the distance of two or three hundred miles, and who came to Charleston
 during the four months, in which the Yellow Fever commonly prevails, are as liable to
 be attacked by it as  strangers ; and, therefore, (he adds) all intercourse between the
 country and city is suspended for one-third of the  year, excepting that of a few white
 persons who, from  necessity, go to the latter, always taking care, however, not to
 sleep there; and that of negroes bringing provisions, who are but little subject to the
 disease. See Voyage a L'Ouest des Monts  Alleghanys, &c. par  F. A. Michaux,
 M. D. &c. A Paris,  1804. p. 2, 3, 4, and  5. This account accords with the information
which  I have received from medical and other gentlemen of unquestionable veracity,
and well acquainted  with Charleston.
  * See in the Philosophical Transactions of the Royal Society, for 1804, « An Enquiry
Concerning the Nature of Heat," &c. in  which the effect of a black skin, or of a black
 external surface, in  promoting the cooling of bodies,  is proved by experiment  See
 also Mr. John Leslie's "Experimental Inquiry into the Nature and Propagation of
 Heat. 
194
 residing,  the intense heat in which they are naturally destin-
 ed to live, that, at all times, their skins feel cool to the touch
 of an European.  Endowed  with these physical peculiarities.
 they are there so little subject to fevers, that the disease does
 not appear to have a distinct and peculiar name in any of their
 languages.  Sometimes,  indeed,  they  are  affected by  slight
 febrile  indispositions ;  but  these  as  Dr.  Winterbottom  ob-
 serves,  in his  Account of  the  Native  Africans  of  Sierra
 Leone, (vol.  II. p.  13,)  are seldom of longer duration  than
 twenty-four  hmirs,  and  they are usually the  sequel of some
 debauch,  and especially of  that excessive  intemperance, in
 which they indulge at the funerals of their friends.*
    In the West-Indian Colonies,  blacks are still so far exempt
 from febrile disorders, that even  intermittents,  the mildest of
 fevers, seldom oecur among those negroes who arc employed to
 labour  in the  fields,  and they  do not often even among those
 who have diminished their power of enduring heat by  wearing
 clothes,  and hy  living with peculiar indulgence in  the cooler
 dwellings,  provided for  the comfort of Europeans-!   Nearly

  * Vitruvius seems to have been the first who noticed a difference in regard to the
predisposition to fevers, and the po ver of supporting them with fortitude,  between the
inhabitants of cold and  those of hot climates.  He says, Lib. vi. cap 1.  " Sub Septen-
trionibus nutriuntur gentes immanibus corporibus, candidis coloribus, directo capillo &
rufo, oculis csesiis, sanguine multo, quoniam ab humoris plenitate coelique refrigcrationi-
bus sunt confirmati.  Qui autem sunt proximi ad axcm meridianum subjecfique solis
cursui, brevioribus corporibus, colore fusco, crispo capillo,  oculis nigris, cruribus in-
valids, sanguine exigus, solis impetu perficiuntur; itaque eti9m propter sanguinis
exiguitatem timidio es sunt ferro resistere, sed ardores ac febres sujferunt sine timore,
quod nutrita sunt eorum membra  cum  fervore ; itaque corpora  quae  nascuntur sub
septentrione a febri sunt timidiora & imbccilla, sanguinis autem abundantia ferro rc-
sistunt sine timore."
  f Dr. Mosely, in his Treatise on Tropical Diseases, (3d edit. J  p. 146,  asserts, that
none of the Europeans sent in 1780 on the expedition against St. Juan, " retained their
health above sixteen days, and not more than three hundred ever returned; and those
chiefly in a miserable  condition.  It was otherwise with the negroes who were em-
ployed on  this  occasion; a very few of them were ill, and the remainder of  them
returned to Jamaica in  as good health as they went from  it."  He adds, it was the
same at the taking of Fort Omoa from the Spaniards.  " On that expedition half the
Europeans who landed died in six weeks.  But very few negroes; and not one of
two hundred that were African born. The Creole negroes did not bear hardships so 
195
 the same may he said of the negroes belonging to plantations
 of rice, in the Floridas, and the State of Georgia, which, it is
 well  known,  are almost  always made on swampy grounds,
 because they require to he overflowed at  certain times : on the
 rice plantations,  in the  Carolinas,  however, blacks some-
 times have intermittent and remittent  fevers,  though  neither
 so frequently, nor so severely, as  the whites, who reside on
 the same spots;  but they seldom or never have the epidemic
 Yellow Fever, as Drs. Moultrie,  Lining,  and Chalmers, of
 Charleston, have formerly attested; and, as subsequent expe-
 rience has sufficiently proved.   In Virginia, however,  and in
 Maryland, negroes have  occasionally been attacked  by the
 latter disorder,  and they are found to be  still  more subject to
 it in the states which are to the north  of these, as Delaware,
 Pennsylvania, New-York, and New England.    Dr. Rush
 says,  that he was led to believe, from  various  publications on
 the Yellow Fever,  that the blacks  would escape it, while it
 was epidemic at Philadelphia,  in 1793 : but,  as  he candidly
 confesses, it was  not long before he was convinced of his er-
 ror, for it seems that, although the disease was commonly
 lighter in them than in white people, *' yet many of them died
 with it,"  at that unfortunate period,  and many more of them
 have also died of it, in that city, during the epidemics  of the

 well." This accords with Dr. Dancer's account of that expedition ; but  he adds, that
 though the Mosquito Indians, who were sent upon it, suffered from fevers, and still
 more from fluxes,  the Indians of Cape Gracios a Dios, who  have an admixture of ne-
 gro blood, suffered less than any other Indians. The great and almost peculiar exemp-
 tion from fevers, enjoyed by the black natives of Africa, is also asserted by M. Bour-
 geois, in  his Dissertation " Sur les Maladies de St. Domingue," printed in a volume,
 entitled "Voyages Interessans Dans  Differentes  Colonies. " p. 417, where he says,
 "Les Negres de la Cdte," (d'Afrique) «et les Negres Creoles font presque en ce
genre deux especes difft'rentes ; car ceuxci, quoique d'une complexion forte et vigo-
 reuse dont n'approchent point nos Creoles blancs,  ont pourtant plus frequement que
les autres la fievre et les diverses sortes de maladies auxquelles les blancs paraissent
specialement affectes.  Les negres  nouveaux, qu'on nous mene d'Afrique, sont d'un
temperament plusdur;" "Jamais les negres novcaux ne patent, en arrivant dans la
 eolonie, ce qu'on y appelle le tributfm 
196
  following years.*  Thus we find that negroes, by long resi-
  dence in cool or temperate situations,  become susceptible  to
  the Yellow  Fever, from the same physical causes  as whites :
  though always in  an inferior degree to the latter, under simi-
  lar circumstances: and, to complete the analogy,  they  are,
  like whites, very liable to it, when, after having passed some
  years in cold countries, they are carried hack to hot climates.
  This has been  sufficiently proved by  the results  of the three
  great importations of  blacks into  Sierra Leone, which have
  been made within  a few years; the first from this country,  in
  1787, and the others from  Halifax, (Nova  Scotia) in 1792,
  and in 1800.  Upon  each of these occasions,  a considerable
  number of the blacks were  seized  with fevers, and many  of
 them died; hut the proportion both of sickness and of mortality,
 was much smaller in  them than in  the whites,  w7ho were sent
 out  at the  same time  to superintend or assist the  new  set-
 tlers.f
   In the preceding enquiries, I  have attempted to  ascertain
 and describe the uniform course of nature in  regard  to  the
 formation and  operation of miasmata,  and in regard  to  the
 effects of heat on the  human body ; and, if the principles, to
 which I have been led,  be not erroneous,  it will, I think, be
 admitted, that the joint  influence of marsh miasmata,  and of
 an atmosphere unusually and sufficiently  heated upon persons
 habituated to a  cold or  temperate climate, is,  of itself, fully
 capable of causing an epidemic Yellow Fever, exactly  resem-

  • These negroes had many of them been born in Pennsylvania, and the others  must
 have lived in that part of America, long enough to lose a great part of their constitu-
tional peculiarities; for no importation of negroes had been permitted by the laws of
that state during the preceding ten years.
   f  I have now before me a statement of the progress,  extent,  and decline of the
sickness and mortality which attended each of these importations of negroes, compared
with what befel the whites at Sierra Leone, in these respects, made from official docu-
ments, reports, and correspondence which I was permitted to inspect.  The results ac
cord with, and fully confirm, the principles and conclusions here advanced : but I ab-
stain from printing this statement, as I had intetfed,  because it may not be thought
sufficiently interesting for the space it would occupy. 
197
bling that which has committed such ravages in the West In-
dies,  the United  States of America,  and the South of Europe;
I mean a disorder which does not recur but after very irregu-
lar intervals,  and with degrees  of severity, varying at  each
recurrence, and  which uniformly attacks with  violence per-
sons of  a certain physical  constitution,  while it allows other
persons to  escape with a mild,  and  often without any disease.
It will,  moreover, be perceived  from the same principles, that
the influence of these causes, when it is sufficiently powerful
to produce an  epidemic Yellow Fever, can only produce one
of the above description.   With the assistance of those princi-
ples, it  will he easy to understand by what simple means the
atmosphere of a town, in certain climates, may become, and
must occasionally become, so vitiated,  at least in some parts,
 and so  productive of dangerous fevers,  as justly to claim the
 appellation of an epidemic constitution,  and this, without re-
 quiring the smallest aid from contagion,  or from those occult
 causes  and supernatural agencies,  to which writers have had
 recourse,  when  they undertook to explain the meaning of that
term;  without admitting,  in short, the operation  of a single
agent,  of whose actual existence there is not as complete evi-
dence as we can possibly  have  of the existence  of  any agents
in physical cases.*   And, however  few the causes may appear

   * Sydenham appears not to have known, or even suspected, the influence of marsh
effluvia as the cause of intermitting or remitting fevers, though Hippocrates, Galen, Var-
ro, Columella, Palladius, Vii-truvius, DiodorusSiculus,DionysiusHalicarnassensis,Strabo,
and others, had observed, and very distinctly mentioned, the insalubrity of stagnant wa-
ters, swamps, 8cc. without, indeed, properly understanding the ways or means by which
their morbid effects were produced.  Sydenham, after telling us that he had,  in vain,
laboured to discover why seasons, apparently similar to each other, w ere  accompanied
or followed by  very dissimilar effects, in regard to health and diseases, adds, " Ita enim
se res  habet; Varise sunt nempe annorum  conslitutiones, qua neque calori, neque fri-
gori, non sicco humidova ortum suum debent, sed ab ocultd potius et inexplicabili qua-
dam alteratione inipsis terra visceribus pendent, unde aer ejus modi effluviis contami-
natur,  qua humana corpora huic aut illi morbo addicunt determinantque."   (De
Morb.  Epid. c. ii. p. 41.)  Thus he manifestly overlooked the materials, th&situations,
and the conditions of the atmosphere (in regard to heat and moisture) whieff contribute
to the production of marsh miasma, and sought  for  occult and inexplicable changes in
the very bowels of the  earth, whence he supposed  effluvia to issue, contaminating the 
19b
 to be,  by whicb I have endeavoured to shew, that the various
 gradations of severity,  observed  in  fevers,  which   originate
 from  miasmata,  are produced, let it only be  recollected  that
 (as every new discovery demonstrates,) nature accomplishes
 all her wonders,  not by employing a multitude of agents, but
 by merely varying the combinations of a few simple means.
    That fevers,  occasioned by marsh  effluvia,  often prevail
 epidemically, is a fact which has been so frequently observed
 and  attested,  that any proof of it  would be superfluous.*  It
 ought, however,  to be  remarked,  that  the  epidemical  pro-
 gress of these fevers often  very much resembles that of  a dis-

atmosphere, and  subjecting the body to various diseases.  These notions he repeats
in other places : and,  when  he attempts to assign a reason for the prevalence of inter-
mittents epidemically in autumn, he seems to think, that so far as they  resulted  from a
change of air, such change was accidental.
   * " Intermittentes febres scepius epidemics grassantur quam alii morbi. Van
Swieten, Tom. ii. p.  2C4 sect 659.
   " Certa Uomanorum observatione constat, post ingentes Tyberis ' inundationes oriri
febres epidemicas in urbe valde graves ac perniciosas."   Baglivi Opera Omnia, p. 51.
   Sir John Pringle (Diseases of the Army, p. 192) has justly supposed the fifteen
plagues, mentioned by Livy, as having occurred at liome before the year, (Urb. Cond.)
59  to have been so many destructive epidemics produced by exhalations from the ad-
joining marshes ;  and I may add  from the low grounds, at the bottom of its hills, espe-
cially those along the Tiber, where marsh fevers appear to have greatly prevailed, from
the earliest  periods  of its history.  These seem to have been most commonly of the
semitertian  form  ; as Galen (de Temperam. lib, ii) represents the Hemitritx as being
the common epidemic of Rome.
   " Les maladies epidemiques ou populaires sont la source, presqu'exclusive, des mor-
talites." " Le rapprochement des observations  sur les maladies populaires demontre
leur parfaite identite.  En effect, ces maladies sont les memes dans tous  les pays, tous
les climats, &c. elles sont dans l'abord, de la classe  des fievres remittentes & intermit-
tentes;  elles eprouvent seulment quelques varietes qui ne sont pas plus considerables
d'un pays a un autre, que d'un individu a l'autre dans  le meme pays."   Precis  sur les
maladies epidemiques qui sont les sources de la  mortalite parmi les gens de guerre,
les gens de Mer, &c.  (a Paris, 1787) Par M. Retz, Medecin ordinaire du  Roi, ci-de-
vant medecin ordinaire des Hopitaux de la Marine, a Rochefort.  Not to extend these
references unnecessarily, I  will only add,  that Lancisi, in his second book De Nox. Pa-
lud. Effluv. has given distinct histories of five epidemics, from marsh miasmata, which,
in his time,  had  greatly infested the Roman  or ecclesiastical territory.  He writes
" Daturus%item hoc secundo libro, quinque historias insignium epidemiarum, qua prse
aliis nostra atate propter  palustres aquas, varia Ecclesiastics ditionis loca parvagata
sunt,"&c. p. 188, &c. 
199
 ease propagated from person to person by contagion, with
 only this exception, that it  is frequently more rapid ; a cir-
 cumstance  which  has, however, been  commonly overlooked
 by indiscriminating observers.   Upon such occasions, thos6
 persons in  each family  who  happen to be  most exposed  to
 marsh  miasmata,  and most  susceptible of their effects, will
 he first  attacked;  those  who  are exposed and susceptible,  in
 the next degree, will be the next attacked,  and so  on in suc-
 cession.
   This, which is the natural course of a disorder arising from
 that cause,  has very commonly induced a belief, especially in
 times of general  alarm, that those  who first  sickened, had
 communicated the  fever to the next,  and these  to others suc-
 cessively ;  and, consequently, that the fever was contagious.
 And, in this way, even Stahl,  with all his good sense, and dis-
 cernment was so far misled, that, though justly  convinced that
 regular sporadic intermittents were destitute of any contagious
 property, he strangely believed  them to change their nature,
 and acquire that property merely by attacking great numbers
 of persons,  in the same season and neighbourhood.*
   It is not my intention here  to notice all the supposed varie-
 ties of marsh fever, which have been minutely described by
 Torti and  others,  with little or no practical advantage.   It
 will be  sufficient  for my purpose to  observe, that the forms
 most prevalent in  hot climates seem to be derived  from the
 tertian,  variously  complicated,  or compounded; and that  of
 these, the form which was called Hemitritaeus, or semitertian,
 by Celsus,  (the Hemitriteon  of the  Greeks)  and  to which
 Lind, Sauvage, and  many  other modern writers, have ap-
 plied the name of Tertiana Duplex, or double tertian, is ge-
 nerally the  most malignant  and destructive of all the marsh
 fevers in hot climates and seasons; and more especially when,

   * " Quid notius quam febris tertiana ? quid certius quam quod ilia legitima, longe
absit a contagiosa  communicatione ? quid vero familiarius quam  ut etiam epidemici,
imo contagiosigrassari observetur.'" Stahlius de Febribus.a Goez. p. 29. 
iOU
 by  great excitement* from  the causes  already mentioned,
 the paroxysms are so  much  prolonged and  crowded  upon
 each other, as to  appeal" like a continual fever, or, at least,
 to  leave  no  sensible  remission during the  first  thirty-six,
 forty-eight, sixty, or seventy-tw o hours; as  commonly hap-
 pens in  what is  called yellow fever.]   This  seems  to he
 the " irregular semitertian"  of Dr. Fordyce, in which,  ac-
 cording  to  his Statement, (4th Dissert,  p.  61,  &c.)  "the
 hot fit is  frequently prolonged,  so  as to leave  no  other
 mark of  an intermittent to distinguish it from a continued fe-
 ver,  excepting the exacerbations not taking effect in the even-
 ing."  He concludes, however, that it is not  a continued fe-
 ver,  from " an agreement of all those  who have had, or have
 seen, or  have treated the disease, in the following observa-
 tion."  " It happens often,  that a patient apparently becomes
 greatly relieved, and appears in a state as if he were recover-
 ing,  when,  all at once,  a fresh attack  takes place, and car-
 ries him off."  This,  he adds,  " is the most formidable dis-
 ease  incident  to mankind.    It  has  frequently been called the
 plague."
   Alexander  seems, as  Dr. Fordyce has  observed, to have
 died  of an  irregular semitertian,  caught  hy surveying the
 marshes   adjoining  the  river  Euphrates,   to ascertain  the
 means  by which they might be most advantageously drained.
 The daily reports or bulletins^ respecting the progress of his
 disorder,  have .been  preserved  and  transmitted  to us by
 Arrian.

  * Dr. Fordyce, at p. 46 of his fourth Dissertation, mentions as a mischievous effect
of strong artei ial action, or general inflammation in intermitting fevers, its prolonging the
 hot fit, so as 10 render the intermissions imperfect, and converting an intermittent into
 a continual fever.
   The late  Captain Bernard Romans, w ho was a man of observation, as well as ve-
 racity, says, in his Natural History of East and West Florida, (p. 238)  that the inter-
mittent fever, in that part of America, " attacks people in the same form as the con-
 tinued fever; the first fit frequently lasting three days, without intermission."
  t Dr.  Gillespie says of the Yellow Fever among the W est India Leward islands, in
1794, 5, and  6,  that it might  « be called a remittent fever, or tertiana continua, as
there were always remissionsin cases terminating well,"-and, « as the epidemic insec
 sibly changed into  the form of a tertian fever." 
201
  In thus connecting what is called yellow fever with inter
mittents and remittents, as being only an aggravation of the
latter,  and, consequently,  as being devoid  of  contagion,  I
feel myself  supported by  great authorities,  and by facts,  as
decisive as they are indisputable.  There are, however, per-
sons of considerable eminence as medical men,  who strongly
contest the derivation of yellow fever from marsh miasmata,
asserting that it has no relation to marsh fevers, but is exclu-
sively produced and propagated by a peculiar  contagion.  This
opinion seems to have been very extensively and inconside-
rately  adopted,  especially in  Europe;  and  as  a demonstra-
tion of its fallacy, if  it  be, as I think,  fallacious,  must con-
duce to the  best interests  of  mankind, I propose, in the next
or fourth part of this  Essay, to exhibit a summary statement
of the principal facts regarding the history  of  yellow fever,
in different  parts of Europe and America, and  regarding its
manifest connexion with fevers notoriously originating from
marsh effluvia; confidently believing that this statement, (sup-
ported by ample proofs,) with the conclusions fairly deducible
from it, will completely remove all uncertainty or doubt from
the mind of every impartial  and judicious reader,  who shall
bestow proper consideration on the subject.
  All this, however, will not accomplish my undertaking,  be-
cause there  are persons, particularly Dr. Chisholm, who ad-
mit that yellow fever, as it existed in the West Indies, previ-
ously to the year 1793, was derived from marsh miasmata,
and destitute of contagion, but assert,  that a " nova pestis,  a
peculiar, original,  foreign pestilence, recently generated, and
utterly unknown  before, endued with a new and distinct cha-
racter, possessing new powers of devastation, and  capable of
propagating itself throughout the world," was introduced by
the ship Han key,  into Grenada, on the 19th  of  February,
1793.  See  Dr. Chisholm's Letter to Dr. Haygarth, p. 217,
and 218.
  From Grenada, Dr. Chisholm states this new pestilence to
have been propagated over not only  a great part of the West
                            26 
202
Indies and North America, hut also to Ireland,  Cadiz, Ma-
laga, Carthagena,  and other places in Spain,  and also to
Gibraltar,  and in some of these places, to have supplanted
the yellow  fever, properly so called.   However strange and
chimerical this recent generation of a new plague may appear,
now  that miracles are believed to have ceased, it has been, in
some degree, admitted  and believed  hy a considerable num-
ber of persons,  among whom are several for whose judgment,
in other respects, I feel  great deference, and,  as the purpose
of this Essay w ill not be fully attained, unless it can be made
evident that there is no reasonable foundation for believing
that  the supposed nova  pestis was essentially or  specifically
different from the common yellow fever, of the West Indies, I
shall undertake to perform this service, also, to what I tbink
the cause of truth, in a separate Appendix*  No. 7.
   In addition to  all this, I  must observe, that  some physi-
cians, of great respectability, appear to  have believed, that
the yellow fever  is either commonly or occasionally a sort of
hybrid or mongrel disease,  resulting from an application of
the contagion of typhus fever, to persons who have been pre-
viously exposed to the impressions of marsh effluvia, or from
the action  of the latter, upon persons who  have before im-
bibed the former. As either of  these causes  is  undoubtedly
capable of  producing fever  alone, in suitable circumstances,
we may reasonably  suppose, that an  effect equally morbid
vv ould result from their joint operation, unless there be some-
thing in their natures, which disposes them rather to counter-
act than assist eacli other.  But of this I  believe nothing is
known; and, therefore, I  see no decisive objection to the pro-
duction or  existence of a fever,  from the united action of con-
tagion and of  miasmata;  though there  is  not, within my
knowledge, any fact which either proves or  renders it very
probable,  that  any such hybrid production  ever  has  taken
place; and, in general, it is not philosophical, or proper, to
assign two causes for an effect which may be produced by one.
If, however, a mixed disease were producible by these causes, 
203
      I should expect to find it at, or in the neighbourhood of Ports-
      mouth, rather  than in the West Indies; because,  at the for-
      mer, persons  are often exposed simultaneously to  the  action
      of both of these causes, which can rarely if ever happen in the
      West Indies, where the heat soon extinguishes the contagion
      of typhus fever, and would, probably, hinder the propagation
      of any hybrid disease, like that under consideration, if it could
      be either produced in,  or conveyed to, that part of America :
      whereas, such  a disease,  occurring at Portsmouth,  in  any
      season  when the temperature is moderate,  might, from its
      affinity with typhus, reproduce itself in persons who had been
      exposed to the exhalations of marshes, or in the  absence of
      such persons, it might occasion a pure typhus fever only.
        Sir John Pringle has supposed, (Diseases of the Army, p.
      188,) that the  Hungarian fever,  described by Sennertus,*
      without his having any personal knowledge of it,  and which
      is said to have  spread widely in the year  1566, (as was be-
      lieved by contagion) must have been " a compound of our au-
      tumnal and hospital fever," or the hybrid disease in question :
      and Dr.  Lempriere, though he represents typhus  fever as a
      rare disease in the West Indies,  (see vol. 2d of Diseases of the
      Army in Jamaica, p. 25,  32, 33, &c.) yet at page 38 and  39,
{     of the same  volume, he treats of a fever at Jamaica, which he
      supposes to have been a  typhus combined with  yellow fever,
      or  modified by the causes producing yellow fever: and,  at
      page 81, he mentions a "variety of yellow fever," attacking
      sailors  and  soldiers almost exclusively, and with great mor-

       • Medical writers have often described fevers as being contagious with so little con-
     sideration or foundation, that we may reasonably suspect the spreading of this fever, to
     have  been merely an eflcct of marsh miasmata, imbibed by the imperial troops in the
     marshes of Hungary, and producing their  morbid effects, some moiUlts after, when the
     army had  separated  and removed into othei situation*, as happened with the British
     troops who were lately at Walcheren.  If this were the case instead  of the  mixed
     disease supposed by Sir John Pringle, the fever in question could not have specifically
     differed from the marsh fevers which so frequently prevail in Hungary, viz  the Mor-
     bus ilungaricus Lang. Leinb. 1. 1. cp. 4, the febria Jluntjarica seu oastrensis of Juuck-
     er, the amphimcrina Hungarica of S^uvage, Sic 
                           ^04
tality,  which he supposes to have been a combination of  the
tropical endemic and of typhus fever.
  Dr. Chisholm,  also, in some parts of his account of  the
supposed New Pestilence at Grenada, appears (as far as I am
capable of discovering his meaning) to imagine  that it was
generated by a sort of conjunction of contagion,  with marsh
miasmata, as I shall have occasion to notice in my Appendix,
No. 7.  And, finally, Dr. Blane also appears to connect yel-
low fever with  the contagion of typhus,  at least when it pre-
vails extensively.   He says, (p. 609 of his  Observations on
the Diseases of Seamen.)   " After laying together,  and con-
sidering fully all the facts relating to this subject, it appears
to me that the yellow fever cannot be produced, hut  in a sea-
son or climate, in which the heat of the atmosphere  is pretty
uniformly,  for a  length  of time, above the 80th  degree of
Fahrenheit's thermometer;  that, under the influence of this
heat,  Europeans newly arrived, and more  especially in cir-
cumstances  of intemperance, or fatigue in the  sun, may be
subject  to it in many instances; but that it has usually become
general  only  by the  previous influence of that infection which
produces the jail, hospital, or ship fever, or from the influence
of putrid exhalations; and that, when so produced, it con-
tinues itself by infection.   It would be  too tedious to enume-
rate the multiplied proofs of this, which have occurred  to me
in my connexion with the public service."  But, though Dr.
Blane did not think it expedient, on this occasion, to  favour
his readers with a  statement of the  " multiplied prtfofs" in
support of his opinion, which  had  occurred to himself,  and
which,  by that circumstance,  would have been highly impor-
tant,  he seems to have  afterwards  intended to  make  a full
compensation for this omission, in his  letter to Rufus  King,
Esq.  (late minister plenipotentiary from the United  States of
America,)  in which, to justify  his belief of the contagious na-
ture of the yellow fever,  he refers to, and strongly relies upon,
the events which followed the capture " of two  French armed
ships from Gaudaloupe," by the Thetis  and Hussar frigates. 
205
in May, 1795, on the coast of America.  This transaction,
though  unfortunately, he had no personal knowledge of  it,
Dr. Blane, selects and holds up to Mr. King,  and the public,
as affording " a conviction of the reality of infection as irre-
sistible,  as volumes of argument:" and he  afterwards  refers
to it,  in his letter to Baron Jacobi,  the Prussian minister,  as
affording decisive evidence on the subject.   I w as,  therefore,
induced by my particular regard for the writer of that letter,
and by  the great estimation in which his judgment  and expe-
rience are deservedly  held, to enter upon a minute  investiga-
tion of this transaction,  which I should not have done had it
been brought forward on less respectable authority.   The re-
sults of that investigation will be found in my eighth and last
appendix, and they will, I am persuaded,  sufficiently  prove
that yellow fever was not the disease supposed to have  mani-
fested contagious properties on that occasion.  Having thus,
as I hope,  encountered and  removed all the difficulties which
were  opposed to the adoption of my own conclusions on this
subject, I shall proceed to the last part of this Essay.
R3TD OF PART THIRD.
/* 
PAH T  FOfJ KT1I.
As one important purpose to be attained by the view which I
am about to take of the hi tory of Yellow Fever, is that of
establishing its  identity, or near affinity  and connexion, with
the fevers which are indisputably  and notoriously  produced
by marsh miasmata;—it seems expedient, first to  ascertain
the characteristic peculiarities of  the latter, as they have been
generally manifested in the temperate climates of Europe, in
order that,  being ascertained, they may afterwards  serve as
points or features of comparison and recognition, in regard to
those which  distinguish the Yellow Fever.
   These characteristic peculiarities of marsh  fevers appear to
be, 1st, that of occurring in their simple and  mild form of
intermittents during the spring; 2d, that of  being exasperat-
ed, and converted to remittent, and, apparently, to continued
fevers, by excessive summer heat, and this  generally with a
great increase of malignity,  (especially in low and moist
situations) when  this excessive heat is long continued and  ac-
companied with a total  or  very unusual deprivation  of rain;
3d, that of being reconverted and brought hack to their mild
intermitting form, at the approach or  commencement of win-
ter, and afterwards extinguished or suspended by a continued
frost: 4th, that of  most frequently and  violently attacking
strangers from colder climates,  and  more salubrious situa-
tions;—and 5th,  that of never being communicated from per-
son to person by a  contagious  property.   Several facts  and
authorities,  tending to prove these peculiarities of the fevers
in question,  have been incidentally mentioned in the preced- 
207
ing parts of this  Essay.   A multitude of others«might be
added, but the following will suffice.
  Dr.  Lind, in  his Essay  on the  Diseases of Europeans in
Hot Climates, after  mentioning, that " in partiadar spots of
the low  damp island of Portsea,  agues frequently  prevail,
and  sometimes the flux, during the autumnal season," adds
" in some years they are  much more frequent and violent
than in others.*'  It is  observable, that their attack proves
always most severe to strangers, or those who have formerly
lived on  a drier soil, and  on a  " more elevated  situation."
He next  mentions, tiie regular tertians vv ith perfect intermis-
sions,  wiiich  prevailed   at Portsmouth fin  May,  June,  and
July,  1765, and then   proceeds in  these words,  " In the
month of August, the quicksilver,  in Fahrenheit's thermome-
ter,  rose to 82° in the middle of the day.  This heat,  toge-
ther with the  want of refreshing rains,  spread the fever, in-
creased its violence, and, in  many  places, changed its form.
At Portsmouth, and throughout almost the whole island of
Portsea, an alarming continual, or remitting fever raged, which
extended itself as far as Chichester.  At  the  same time the
town of  Gosport, and the opposite side of the harbour, though
distant,only one mile from Portsmouth, enjoyed an almost total
exemption from sickness  of every kind; and in the neighbour-
ing villages and farm houses on that side, only a mild regular
tertian ague prevailed,  which however distressed whole fami-
lies.   The violence  of  the fever,  with its appearance in  a
continued remitting or  intermitting form, marked,  in  some
measure, the nature of the soil.   In Portsmouth, its symptoms
were bad,  worse at Kingston, and still more dangerous and
violent at  a place called half-way  houses, half a mile from
Portsmouth, where  scarcely  one  in  a family escaped this
fever,  which there generally made its first attack with a deli-
rium.  In  the large suburb  of Portsmouth, called the com-
mon,  it  seemed  to rage  with more  violence than in the town,
some few parts excepted: but even whole streets of this suburb, 
208
together with  the liouses in the dock-yard, escaped it.  P. 18,
19, 20.
  This exemption of particular streets, kc. from the disease,
is an  important fact which often occurs in regard  to marsh
fevers, and will be easily understood from what has been  men-
tioned between pages 224  and 229 ; and it well deserves  to be
remembered,  not  only as a distinguishing  mark  of  these
fevers, (produced by  a cause arising immediately  from the
soil) but also  as an incontrovertible evidence of their total  want
of any contagious property ; for contagious fevers are not thus
narrowly confined and limited in their progress.
  To this  testimony of Dr. Lind, I will join that of the late
Dr. Robert Hamilton, who practised as  a physician,  with
great reputation,  for more than forty years, at Lynn, in  Nor-
folk ; and published " Observations on the Marsh Remittent
Fever,"  which prevailed, with unusual  violence  and malig-
nity,  in that part of England, during several uncommonly hot
summers, which followed a great inundation from the sea in
1779, so as very  nearly to resemble " its appearance in  many
places between the tropics."  Of this fever,  he says generally,
" If a very wet winter and spring are succeeded by a very hot
and dry summer,  in which the ditches  and marshes are nearly
dried  up,  it is very generally epidemical, and spreads widely
around us.  It most commonly  appears about the  middle of
August,  and  lasts till the ditches are filled with water, and
the marshes somewhat  covered; which, with a frost, usually
puts a period  to its raging in that form, for that season; for
it now generally changes to the type  of a genuine  intermit-
tent." He deemed this fever, as  it prevailed after  the  inun-
dation, in 1779,  "to be the same distemper with the bilious
remitting fever of the Netherlands,  the tertiana duplex of
Minorca, the  remitting fever of Bengal, tiie yellow fever of
the West Indies, and the bilious remittent of Senegal."   Sup-
posing it to " differ only in malignity and fatality from  those
of hot countries, in proportion to the  difference  of  climate."
See pages 27,  28,  32, 
209
   If we  proceed  to the continent of Europe, we shall find,
 that even in  the  northern, but low  and  damp  island,  upon
 which  Copenhagen is situated, an  excessively  hot and dry
 summer, in 1652, was able to produde a violent  epidemic ter-
 tian, of which Thomas Bartholine,  (who was attacked, with
 all his  family, by it) has given an account ;*  and which fever
 was the  more remarkable, because, upon  dissecting  the bo-
 dies of those  who died of it, he found the stomach and  duode-
 num always mortified, or, at least,  inflamed,  as is almost in-
 variably the case, in those who die of Fellow Fever.
   Passing over what Forestus and others have related of the
 violent marsh fevers, (once  called  the plague,)  which fre-
 quently infested the city of Delft, (almost surrounded by stag-
 nant waters,  and placed on low moist ground) we learn from
 Silvius de le Boe, that a very malignant remitting, and inter-
 mitting fever raged within his own  observation,  at Leyden, in
 1669,  in consequence of a very hot summer  and autumn, with
 little or no rain,  and  an  unusual stagnation of the air; by
 which  the water of  the canals and ditches became greatly di-
 minished, and highly corrupted.   He mentions  two-thirds of
 the  principal  inhabitants  of that city as having died of this
 epidemic.  Sec Prax.  Med. tract. X.
   Sir  John  Pringle, treating of the autumnal  fevers of  the
 British army  in Flanders, says, "this remitting fever attend-
 ed every campaign, and was most frequent  and fatal after the

  • Thorn* Bartholini Historiarum anatomicarum rariorum  Cent. I & II.  Historia
LVI.  Febris tertiana Epidemia.
  « -Estate 1652 prater morum & cceli nostri consuetudinem calidissima & siccisslma.
Hafnice & vicinis locis grassabatur febris tertiana intermittents epidemia, quse multas
familias velut  conspiratione quadam invasit, prostravitque.   Varium in hac observavi-
mus typum ;  niodo enim singulis recurrebat diebus, raodd alternis, mod6 vaga, ssepis-
sime  post **y<tf« redibat.  Symptomata varia comitabantur,  ingens  capitis dolor,
imprimis colli seu musculorum occipitis, lumborum & dorsi, calor urens, vomitus biUo-
sus, skis,  inquietudines, nonnunquara dcliria, & petechia remissionis tempore evanes-
centes, & cum paroxysmo revertentes," &c.  « Multis in hac urbe diutumus vomi-
itus post  febrem istam remansit, ut ventriculum in febre hac imprimis affectum, siout
in matignis solet non dubitarim," &c.                        ■;
                            27 
                                 210
j^   hot summers  of the  years 1743 and  1747 ;* but,  in the cam-
     paigns of 1744 and  1745, the seasons being tempera!e,  fewer
     were seized,  and the cases were milder."  See Observations
     on Diseases of the Army* p.  172.   The same respectable au-
     thor, treating, at p. 180, of the fevers  among the troops sta-
     tioned near the inundations,  in  Dutch Brabant,  in 1748,  ob-
     serves that, " in the greatest heat of the weather,  and rage of
     tiie distemper most of these fevers answered the description of
     the khvc-os,  or ardent fever of the ancients, whicli Hippocra-
     tes does not rank with the inflammatory diseases of the winter
     and spring, but with the epidemics of  summer and autumn.
     (Aphor. lib.  iii. Aphor. xxi.)  Sir. J.  Pringle  adds,  " but
     it was observable, that even in the worst parts of the country.
     as soon as the weather cooled,  in the decline of autumn, the fe-
     vers began to assume a milder form; and, in the end of the
     season,  differed little from the common  intermittents of other
     places."   In  the next page,  he makes the  following observa-
     tion :  " At the height of the  epidemic,  it appeared that both
     intermittents and remittents, hy extending  or doubling their
     paroxysms, frequently clmnged into  a  continued and dangerous
    form,  and that most of those whom  we lost died in this way^"
       Dr.  Francis Home,   who  also served  at  the same time,
     with the British army in Flanders and Holland, gives a simi-
     lar account of  these fevers.   " The change of weather, (says
     he) from heat to cold,  made  always a  sensible  alteration in
     the symptoms.   In Jiot weather they wrere more severe,  and the
     disease inclined more to the continued fever."  Medical  Facts
     and Experiments, p. 46.f

      * Werlhof de febribus, p. 3, mentions the excessive number of fevers of various
    types, which infested almost all Europe, and especially marshy places, from the enor-
    mous heat of two. summers ; " ab enormi illo colore cestivo annorum 1726 & 1727."
     Van Swieten also makes a  similar observation: " Sic  observatur post fervidissimat
    restates pragressas autumnum hseraitrsearum febrim fera cissimum esse," torn.  ii.
    \>. 455, and another,  (torn. iii. p.  06) viz.: " Ubi  post fervidissimas &  siccissimas
    estates autumnali tempore  grassantur epidemics; febres continue,  remittentes, &c."
       f All the epidemic marsh fevers described by  Lancisi, appear to have begun about
    the summer solstice, and  to have increased and become more exasperated by great 
211
  The latter  of these authors treating,  at p.  18, of the
••Epidemic Remittent Fever" of the Camp at Worms, in
1743, says, " there is another symptom which attended this
fever, and that is a jaundiced colour in  their eyes and skin,
and very often a complete jaundice."  Sir John Pringle also
describing (at p. 72.)  the marsh  fevers of Flanders,  says,
" some grow yellow as in the jaundice: this colour was ob-
served to  be more frequent iii the first campaign than after-
wards :  it was  an  unfavourable,  but  not  a mortal  sign."
Aftervv ards Dr. Brocklesby mentioned,  (at p.  269 of his Ob-
servations) as occurring in the autumnal fever of 175T3, among
the soldiers,   on the Isle  of Wight,  a "suffusion of bile,
which had often tinged the  skin of the deepest yellow, and
sometimes blackish colour."  We see,,therefore, that even in
temperate European climates, fevers from marsh miasmata
sometimes have this symptom, in  common with  the  bilious
remittent, and Yellow Fevers between the tropics.
   These testimonies, concerning the intermittents  of Europe,
and the changes of which they are susceptible, might,  proba-
bly, be thought sufficient for the purpose intended to be an-
swered  by them; I cannot, however, omit to notice their ap-
pearance and  effects, as they  have occurred in Zealand, par-
ticularly during the late expedition to that province.
   Dr. Wind,  who translated into Dutch,  Dr. Lind's Essay
on Preserving the  Health of  Seamen, and  who, with  his fa-
ther, had practised physic twenty-eight years in Walcheren,
has  added to that translation,  as  we  are informed hy Dr.
Lind, the following  account  of these fevers, viz:  " at Mid-
dleburgh  a sickness generally reigns towards the latter end of
August,  or the beginning of September, which is always most
violent after hot summers.   Its makes its appearance after the
rains which  generally fall in the  latter  end of July: the

heat and dry weather until the autumnal  equinox; after wiiich they were found to de-
cline: and,  finally, cease upon the accession of cold winds and  rains at the beginning
of winter; and wherever fevers observe  this  course^they may safely be considered
as resulting from marsh miasmata. 
212
sooner it begins the longer it continues, being checked only by
the coldness of the weather."
   " Towards the end of August, and the beginning of Sep-
tember, it is a continual burning fever, attendetf with a vomit-
ing of bile, which is called the gall sickness." ^He afterwards
mentions that  "strangers, who have been; accustomed to
breathe a dry pure air do not recover so quickly" as the na-
tives ;  adding that this fever  is "the  same with the  double
tertian fevers between the tropics," that it is, " not infectious,"
and seldom proves "mortal to the natives."—But that " the
Scotch  regiment,  in  the  Dutch service has, at Slays, been
known to bury their whole number in  three years."   See
Lind, on the diseases of Europeans in Hot Climates, p. 23,
&c.  This account of the morbid influence of marsh effluvia in,
Zealand, was but too well confirmed by the extensive sick-
ness which so lately, and in a few weeks, disabled the British -
army there,  at a time when no extraordinary heat or drought
had occurred to aggravate the  symptoms.  In  Dr. Blane's
Letter to the Physician-General, dated Middleburgh,  Octo-
ber 3d,  1809, and  printed, with  other official documents,
presented to both Houses of Parliament,  in  February, 1810,
marked E. p. 103, is tiie following passage, viz :
   " It appears, from the last general weekly return, that near
two-thirds of the wlwle numeral strength of  the army is inca-
pable  of duty.  The  mortality, during  the last four weeks,
has been about one thousand.  All the regiments are affected in
nearly an equal degree;  and it does not appear that their ill-
ness is connected with the nature of their duty, nor that it is
owing  to privation or  neglect of any  kind;   for  those are
equally sickly who have enjoyed tiie utmost ease and comfort
in cantonments,  as those who have been engaged in the siege
of Flushing." " Nor has it been owing to any thing unfa-
vourable in  this year, in comparison of former  ones;  on the
contrary, the native inhabitants affirm that they are now less
sickly than usual at the same season; and they account for it
from the unusual quantity of rain that has fallen the last two 
213
or three months ; and they consider it as fully established by
observation,  that the most sickly seasons are those in which
there are great drought and heat in the latter end of summer,
and  the early parts of autumn, owing, probably,  to the in-
creased putrefaction and exhalation produced by these causes.
I find,  upon inquiry, that a like degree of sickness prevailed
among the French troops,  who occupied Flushing during the
last  seven years; and that, in former times, the Dutch troops
from the  Northern  States of the United Provinces  suffered
equally.   Other proofs,  if necessary, could be adduced, to
evince  that the present unfortunate state of the army here, is
solely  imputable to the  contamination of the air, from a soil
the most productive  of deleterious  exhalations of any perliaps
in Europe, producing an endemic fever, which has, at all times,
been particularly severe upon strangers in the autumnal months*
I find also, upon inquiry, that though this is by far the  most
sickly  season, the residents  of  this, and the neighbouring
islands, are  far from enjoying at  any season, the same de-
gree of health  as  in the more salubrious parts of Europe;"
and, in an unpublished letter on this  subject from  Dr. Blane
to the  Surgeon General, dated at Middleburgh,  October the
4th,  1809, I find the following observation: " it is fortunate
that the administration  of  medicine is simplified by the uni-
formity of the cases, which almost all consist of the endemical
intermitting and remitting fever."
   This deplorable calamity has, however, enabled us to make
some very useful additions to our stock of knowledge, respect-
ing marsh fevers;  and one of these is a full and indisputable
confirmation of the fact, which the most judicious and best in-
formed physicians already believed,  that these fevers do not
possess any contagious power or quality whatever: of this I have
numerous and decisive proofs now lying before me:  a part of
them will, however, be sufficient.
   But I ought previously to observe, that, as all the troops
landed in Zealand were more or less exposed to the influence
of marsh effluvia, it must have been difficult, if not impossible, 
                          211
to distinguish the effects of contagion,  had it existed among
them, from those of miasmata; and, therefore, I shall draw
no conclusion on this subject from any  thing which occurred
to the twenty-six thousand eight hundred and  forty-six pa-
tients,  including relapses, who  were admitted into the gene-
ral and regimental  hospitals of the British army there, pre-
\ious to the  18th of November,  1809,  or to those afterwards
added to this number, before the final evacuation ; but I shall
confine my inferences solely to what followed the return of se-
veral regiments or battalions not required for the occupation
of Walcheren, and the removal of twelve thousand eight hun-
dred  and sixty-three  sick,  (including a small number of
wounded) from  that island,  and from South Beveland, be-
tween the 21st of August and 16th December, 1809, who were
all  landed,  and placed in dry, wholesome situations, within
the Kentish and Eastern districts,  under the general superin-
tendence of Mr. Keate, the Surgeon General.  That gentle-
man, at different times,  visited, and minutely  inspected, the
several hospitals in these districts; and, upon his return to
London, on the 5th of October,  1809, immediately after he
had performed  this duty throughout the Eastern district, he
obligingly put into  my hands a statement  of the results of his
observations respecting  the prevalent disease, from which I
was permitted to make the following extract,  viz.
  " It is certain, that more or less of the poison w hich created
this sickness, has been imbibed by  all the troops previously
to their  leaving Walcheren,  and that,  in many instances,  it
has not produced its noxious effects until the men have reached
this country, and have even marched to their respective quar-
ters.   This is  obvious at Colchester, Weeley,  and  Wood-
bridge, where many have fallen down with this disorder, af-
the slight fatigue of a short inarch."
   " It does not appear that this disease is of a contagious na-
ture, not one of the attendants, whether nurses, orderlies, or
medical officers, having contracted it, as I am  informed."
 Mr. Keate told me, relative to this point, that he had made 
215
very minute inquiries on the subject, of every medical officer
with whom he had an opportunity of conversing, and particu-
larly of Drs. Fellowes, Roberts, Wardell, and Tice,  and of
staff-surgeons,  Ross and Emery, and that they were all unani-
mous in stating that no instance had fallen under their know-
ledge of the disorder having been communicated to any per-
son about the sick.
  Nor did subsequent  information or  observation  alter the
Surgeon General's opinion on this subject, as is fully proved
by the  following extract  from his letter to  Francis Moore,
Esq. Deputy Secretary at War, dated 14th December, 1809.
  " I must also remark, after much inquiry from the iriost re-
spectable medical officers  into the subject, that neither in the
Kent nor in the Eastern district, had any instance'of conta-
gion been know n to have occurred in the General Hospital;"
(i.  e.  those appropriated for the Walcheren  sick) "a fact
which  sufficiently demonstrates the fallacy of the assertion ad-
vanced against these establishments,  and so readily credited
by many persons, viz. that they are the chief cause and source
of contagion in armies."
  The observations made by the Physician-General, w hen he
visited the sick,  returned from Walcheren, at Harwich,  Col-
chester, and Ipswich,  in September,  1809,  were  similar to
those of the Surgeon-General, in regard to  the total absence
of contagion,  as, appears by his  three official letters to the
Deputy Secretary at War, of the 11th, 13th, and 15th of that
month, printed in the  Minutes of Evidence on that subject,
by order of the House of Commons ; and that his subsequent
information, from the army physicians,  and  other medical
officers, was of the same import, may be inferred from his
printed testimony to  the  House of Commons,  on the 8th of
March, 1810,  when, being asked this question, " might not a
fever,  of  a more fatal  kind  than that which subsisted among
the troops at  Walcheren, be generated  on  board the trans-
ports in which they came from that country, so that no infe-
rence is to be drawn as to  the state of the sick, at the time 
216
 they were put on board ?"  he answered,  " if that had been
 the case, there would have been contagion in the different hos-
 pitals 1 saw at Harwich, Colchester, and Ipswich,  and there
 was no contagion—nor has there been any contagion."
   To these testimonies 1 may doubtless be  permitted to add
 tiie results of  my own very minute and extensive inquiries on
 this, to me interesting subject, which have, without  exception,
 most unequivocally manifested the total absence  of  contagion
 in or by any of the sick from  Zealand.  Such was the infor-
 mation given to me by Mr. Warren, Deputy Inspector of Hos-
 pitals, who, under the Surgeon General, had the superinten-
 dance of the sick  from Zealand,  in the  Kentish district,  as
 well as of Dr. Neale, then  principal  Medical Officer of the
 General  Military Hospital,  at Deal, and  also of Doctors
 Faulkner, Faber, Turner, and Morgan, all Fellows of the
 College of Physicians,  and physicians to the army,  or em-
 ployed as such temporarily, with the sick  from Zealand,  in
 that district;  such also was my  information from  sir James
 Fellows and  Dr.  Roberts, army  physicians, and  from Drs.
 Harvey and Laffan,  who were then employed as such  in the
 Eastern district.  These gentlemen, as well as those  in the
 Kentish district, uniformly assured me, that no patient, hav-
 ing the Walcheren or Zealand fever,  had, as they believed,
 given  that disease to  any other; and that, according_to their
 knowledge and information,  none of the attendants,  or others
 employed  in the several hospitals,  and who had not been ex-
 posed  to marsh miasmata in Zealand, were attacked with the
 fever in question.*

  * Mr. Nixon, Surgeon to the first regiment of Foot Guards,  favoured me with
 some valuable information respecting the extent and effects of the Zealand fever, upon
 the 3d battalion of that regiment, which, to the number of 872, landed at South Beve-
land, the 2d  of August; of  these 359 were attacked with this fever, between the
 19th of that month and the 14th of September, (sixteen  days :) and though, on the
last of these days,  they  embarked on board the Leyden, to return to this  country,
and actually re-occupied the barracks at Chatham, on the 16th of September, only
 117 of the battalion had ultimately escaped thefrver, on the 8th of  Mareh following;
and  some of  the 117, who had so escaped, were, for the first time, attacked by it, 
217
  In addition to those inquiries I made others, respecting the
hospital  ships and transports  employed in removing the sick
from Zealand to Harwich, Deal, and other ports in this king-
dom,  in  order to ascertain whether any  of  their respective
crews had been infected hy this service; but I did not hear of
a single  instance in which this was even  suspected to have
happened.  Deputy Inspector Warren, in a letter to me, da-
ted the 9th of October, 1810, wrote as follows:  " In reply to
your question,  relative to the state of health of the crews of
the transports that were employed in conveying the sick from
Walcheren to this country ? I have every reason to believe they
remained free from the  disease, with which  the  troops were
affected ;  as I do not find that more than twro  or three applica-
tions were made  for admitting sick seamen into the Hospital
at Deal,  and such applications would have been made to a
considerable extent, if they had at all partaken of the disease."
   At my request,  Dr. Faber made a  similar application  to
Staff Surgeon Lidderdale, who had been employed at  Flush-
ing, in superintending the embarkation of the sick,  removed
thence to England; and, in  consequence thereof, Mr. Lid-
derdale wrote  to Dr. Faber,  on the 22d of October,  1810, a
letter, of which  the following is an extract,  viz. " The same
transports were not always,  but frequently,  employed in  re-
moving  the sick from Walcheren to this  country; and I did
not observe that  their crews laboured under  the same  disease
as  the sick;  and, from conversations with the navy,  I learn-
ed, that only those men who were  on shore, and exposed to
the same causes as the troops,  laboured under the Walcheren
fever."   He afterwards mentions his having  had opportunities
of observing the Asia, (a large Hospital ship, carrying about

as long afterwards as the middle of June,  1810, Mr.  Nixon, however, assured me,
th:it neither in the Hospital at Chatham,  nor in that of Westminster, to which this
battalian was afterwards removed, had  there been any appearance of contagion.
None of the Hospital servants who were not in Zealand having taken the fever, nor
any of the soldiers'wives, or connexions.
                             28 
218
 sixty patients in cradles) and declares, that he " saw nothing
 like infection extended to the crews of that ship."
   My inquiries were afterwards extended,  in order to disco-
 ver whether any effect, indicating the existence of contagion,
 had been  produced by the bedding and  clothes used  by the
 sick at Walcheren, and removed to this country mostly with-
 out being washed,  and in a very filthy condition, as I was in-
 formed by Mr. Moss, Purveyor of Hospitals there, and by
 his Deputy,  Mr.  Boning,  verbally.  To the former of these
 gentlemen I  addressed certain written questions, in the  month
 of August, 1810; but he, being then  on the eve of his depar-
 ture for  Sicily, could  not, as he stated in his letter to  me of
 the 13th of  that month, " answer them otherwise than in a
 general way,"  viz. " several thousand  articles of wet and
 dirty bedding,  cloathing,  kc.  were  received from the regi-
 mental hospitals throughout the island, of which time did not
 permit either the drying or  washing:  I  found it, therefore,
 necessary  to require  a board of survey, in order to decide
 upon  the propriety of shipping them in their  actual state;
 the board having decided that,  in so short a voyage,  no dan-
 ger or damage  could be expected,—the whole of the articles
 in question were shipped by the Asia, Ceres, and Eleanor."
 He adds—
  " I have not heard that the least sickness whatever prevail-
 ed among the crews of either  of  the  above ships; and when
 it is  considered that  the stores were not landed for several
 weeks beyond the calculation of the board  of survey,  it  seems
 clear that the members were fully justified in their opinion."
  The bedding  and clothing in question having been landed,
 after considerable delay, was  transferred to the store-keeper
 general, whose deputy, Mr. Barker, in answer to a note from
 the Surgeon-General,  on this subject, wrote,  (on the 25th of
 September,  1810)  "that the dresses* and bedding, received
  * These dresses were all of flannel, and mostly worn by the sick next to their
skins; they were, therefore, well suited to retain, as well as imbibe, contagion, if any
had existed.  And even if none had existed, it ought, according to the general opinion 
219
from the  several transports returned from Walcheren, were,
in general, in a very foul state, and were immediately sent to
the  mills to be cleansed,  but he did not hear of any infection
having arisen from them to any of the parties through whose
hands they passed.
   Considering these facts  as more than sufficient to prove that
the  marsh fever of Zealand does not possess any contagious
quality, I shall now proceed to a rapid view of the History of
Fellow Fever in America and Spain.
   It has been asserted and believed, that the Yellow Fever, at
least in its  most violent form, did not attack the first settlers
in America.  Of the  truth of this assertion it is now difficult
to decide, because no one of the earlier historians has left us
any account of their diseases sufficiently minute and discrimi-
nating.   It is,  however,  manifest from various facts related
on good  authority, and several passages  in  the writings of
Peter  Martyr, that  the earlier Spanish adventurers to  the
West Indies suffered greatly by marsh miasmata, particularly
those  who first attempted to establish themselves in Darien
about  the year  1512, at  a place wbich the Spaniards called
Sancta Maria Antiqua,  where  many of them died.   Of  this
place  Peter Martyr  writes, in the 6th chapter  of his third
Decade,  "that the air  is more  pestilential  than in Sardus
(Sardinia).   The Spanish inhabitants are all pale and yellow,
like unto them which  have the yellow jaundice."  And this
he ascribes not to the latitude but to the local circumstances
of the place, situated "on the banks of the  river of Dariena,
in a deep valley,  and environed on every side with high hills;
by reason  whereof it receiveth the sun-beams at noon-tide,

on this subject, to have been  generatedby  these dresses, and  by the bedding of the
sick, (which, as I was informed by Mr. Moss, amounted to more than 10,000 separate
articles) considering the  foul condition in which they were brought and kept together
for, I believe, six or eight weeks; and, as no such effect happened, we may  here
find another proof that contagion, properly so called,  is not generated by accumula-
tions of  mere animal filth, even when derived from living human bodies, under disease,
and especially that of marsh fevers. 
220
 directly perpendicular over their heads ; and they are, there-
 fore, sore vexed by the reflection of the beams," kc.  " The
 place is also outrageous by the nature of the soil, by reason it
 is compassed about with muddy and stinking  marshes, the
 infection whereof is not a little increased  by the heat,"  kc.
 He  adds, " now, therefore,  they consult  of removing  their
 habitations: necessity caused them first to  fasten their  foot
 here, because they,  which first arrived in those lands,  were
 oppressed with such urgent hunger, that they had no respect
 to change the place, although they were  thus  vexed by the
 contagion of the soil, and heat of the sun ; beside the corrupt
 water and infectious air,  hy reason of venomous vapours and
 exhalations  arising  from  the  same."   See Robert Eden's
 Translation, in black letter, which I have here used, (but with
 modern spelling)  not  having the  Latin original  at  hand.
 This extract  will sufficiently prove what, indeed, could not
 reasonably be doubted, that marsh effluvia have, at all times,
 destroyed human life in America,  as well as in other parts of
 the w oiid:  and if they did not produce an  epidemic yellow
 fever, in  the highest degree, among the first European adven-
turers thither, the reason, probably, was, that before consider-
 able towrns were built, the solar heat would not have arisen so
 high, as it now does in the cities where that disease has most
 often prevailed,  nor would the soil, wliilst nearly covered by
 trees, be accessible to tiie sun's rays, or capable  of producing
 miasmata so highly  concocted, (if I may use  that expression)
 and virulent, as when deprived of its natural verdure and pro-
 tecting shade, nor would they so readily find the means  of in-
 temperance  and debauchery which large cities afford.
  The earliest marsh, and probably  Fellow  Fever,  of which
 we have any distinct account, as prevailing epidemically, and
 with great mortality, in the West Indies, was, I believe, that
 which occurred at Barbadoes,  in the year 1647.  From two
 letters,  written by  Mr.  Richard Vines, then a planter and
 practitioner of physic in that island,  (which were published
 hy the late Gov ernor Hutchinson, in his collection of Massa- 
**»* I
 rhusett's  Papers) and from Mr. Ligon's History of Barba-
 does,  it appears,  that this fever began in or about the month
 of August, after a severe drought of six months continuance,*
 attended  with  very  hot weather, and  followed  by  a  great
 scarcity of food.  Mr. Vines' letters  were  addressed to Go-
 vernor  Winthorp, in  New  England,  whence  he had  lately
 arrived ;  a circumstance which will account for his sentiments
 and language on this subject.   He appears to have considered
 the fever as  a punishment  for the sins of the people of the
 island,  proceeding from " the  Lord's heavy hand in  wrath;"
 and, being satisfied with this cause,  he does not seem to have
 inquired for, or thought of any other,  but says, in his second
 letter, dated April 29th, 1648, that,  " the sickness was an ab-
 solute plague, very infectiousf and destroying, insomuch that
 in our parish, there were buried twenty in a week, and  many
 weeks together fifteen or sixteen.   It first seized on the ablest
 men both  for account  and  ability  of body.  Many  who  had
 begun and almost finished  great sugar  works,  who dandled
 themselves in their hopes, were suddenly laid in the dnst, and
 their  estates  left unto strangers.   Our  New England men
 here had their share,  and so had all nations, especially Dutch-

   *  But little more than twenty years had then elapsed since the  first settlement
 was made in that island; and so little of it was at that time cleared and cultivated,
 that dry weather, assisted by great heat, was best  suited to the production of noxious
 miasmata; contrary to what has been the case at Barbadoes, since it attained its high-
 est state of cultivation many years ago. About the time when this fever prevailed,
 there had been a great and sudden influx of inhabitants from England, in  consequence
 of the civil commotions at home, and of other causes.  Indeed, there never has been
 an extensively epidemic Yellow Fever known in the West Indies without  the previous
 arrival of considerable numbers of persons from more temperate climates.  Hence
times of sickness have there commonly been times of war.  During peace, a few pas-
sengers, arriving in single ships, and dispersing  themselves in the cooler, and more
wholesome parts of the country, are mostly enabled to escape the Yellow Fever; and
the seasoned inhabitants are rarely susceptible of it.
   f  Believing the disease to be "an  absolute plague," Mr. Vines, must naturally
 conclude that it was " very infectious," especially  as many persons were attacked  by
it nearly at the same time; a circumstance which, in that age, was thought sufficient
evidence of the contagious nature of a disease. 
222
 men, of whom  died  a great company, even the  wisest  of
 them."
   Mr. Richard Ligon, whose History of Barbadoes was pub-
 lished in 1657, tells us that he arrived there early in Septem-
 ber, 1647, when " the inhabitants of the islands, and shipping
 too, were so grievously visited with the plague, (or as killing
 a disease) that  before a month was expired after our arrival,
 the living were hardly able to bury the dead."  Though not
 a medical man like Mr. Vines, he appears to  have bestowed
 some thought on the physical causes of this disease,  and upon
 the question, " whether it were brought thither in shipping :"
 or occasioned " by the distempers  (irregularities) of the peo-
 ple of the island, who, by the ill diet they keep, and drinking
 strong waters, bring diseases upon  themselves."  And though
 lie observes that the truth on this subject " was not certainly
 known," he  adds, that he has " reason to believe the latter;
 because, for one woman that  died  there were ten men;  and
 the men were the  greater deboystes"  (i. e. most debauched).
 "In this sad time (says he) we arrived in this island;  and it
 was a doubt whether  this disease or famine threatened most,
there being a  general scarcity of victuals throughout the
whole island."   P. 21.
  The reason wiiich  induced Mr. Ligon. to think that the
disease had not been  imported, is certainly deserving  of at-
tention : for to have been imported it must have been conta-
gious, and  a contagious disease  would  not have spared the
women in a manner  so extraordinary,  merely because they
 lived more temperately.  There were, however,  much  better
 reasons for  not considering  it as an imported disease, which
 Ligon mentions at p. 25, without being sufficiently sensible  of
 their operation at that time;  I mean those arising  from the
situation and local  circumstances of Bridgetown and its har-
bour, where the disease  seems  to have  mostly prevailed.
" Upon the most inward part of the Bay (says Ligon) stands
the town, which is about the bigness of Hounslow,  and  is
 called the Bridge, for that a  long  bridge was made at first 
223
over a little nook of the  sea, whicli was rather a bog than a
sea.   A town ill situate;  for, if they had considered health as
they did  conveniency, they never  would have set it there,"
kc. kc.   " But (adds he) the main oversight was  to  build
their town  upon so unwholesome  a place.   For  the ground
being somewhat lower than the sea banks are, the spring tides
flow over, and there remain; making a great part of that flat,
a kind of frog or morass, which vents out so loathsome a sa-
vour, as  cannot but breed ill blood,  and  is, no  doubt,  the
occasion of much sickness, to  those that  live there."   And
when it is recollected that this morass was at the  east  sideof
the town, and  that the trade wind blowing over the morass
upon the  town,  would directly convey its  exhalations to the
inhabitants, and that the  long-continued  hot and dry weather
would necessarily render these exhalations uncommonly noxi-
ous, we  surely need not look for any  other morbific agent or
influence.
   A similar fever, and  doubtless  from similar causes, pre-
vailed about the same time at St. Christophers, Guadalupe,
«kc.   Mr. Webster has lately published  the following extract
respecting  it,  from a MS. of the New England Historian,
Mr. Hubbard, viz.: " It extended through the plantations in
America,* and in the West Indies.  There died at Barbadoes
and St. Kitts  five  or six thousand each;  whether  it  was a
plague, or  pestilential fever, it prevailed  in the islands, ac-
companied with great   drought,  which cut  short potatoes,
(doubtless  the sweet  potatoe,  or convolvulus  battatas)  and
 fruit."   See New-York Medical Repository, vol. vii. p. 322.
   P. Du Tertre also  mentions this disease,  and calls it the

  * Governor Winthrop, in a letter to Mr. Vines, dated at Boston, 34th  August, 1647,
had mentioned an epidemic sickness which then lately overran that part of  America,
and which appears to have been an influenza, and not a marsh, or Yellow Fever.  Mr.
Vines, after acknowledging the receipt of this letter,  writes, (with sentiments like
 those he had entertained of the epidemic at Barbadoes) " I perceive by your letter,
 that  the Lord did  shake his rod over JVew England: it was his great mercy, only to
 put you in remembrance." By these expressions we may conclude, that the disease ot
 New England was attended with little or no mortality. 
9 ) |
plague, (la peste, jusqu' alors inconnue dans  les isles, kc.)
He says it began at St. Christopher, and in eighteen months
carried off one-third of the inhabitants.  That it was accom-
panied with a violent pain of the head, great  debility of  the
limbs, and a  constant vomiting;  and that in three days it
sent the patient to his grave.  Perhaps this is nearly as good
a description  of the  Yellow Fever  as one, who was not a
medical man,  might then he expected to give of it.  He adds,
that this disease was  brought to Guadalupe by a ship called
" Le Bceuf," from La Rochelle, in France.  He had previously
stated that it was imported by some ships (" quclques navires")
into the French islands, (St. Christopher's being then  half
French) without any mention of  their names or the places
whence they came, and, probably, he had no better reason
for this loose statement that a belief that the plague, till then,
as he says, unknovv n  in that part of the world, must have been
imported, and, of course, imported by ships, when the places
to which it was supposed to have been introduced were islands.
He did not know that the plague (even if it had then been at
La Rochelle)  could not  exist, much less spread epidemically,
within the tropics; I need not observe that this is  also true
of typhus fever; because the  latter  has  not the  smallest re-
semblance to  a  disease,  attended with constant vomiting,  and
which generally proved  fatal in three days.  Therefore,  Du
Terre's supposition, that the disease was  imported and con-
tagious, deserves no attention.
   Fortunately, those  peculiarities of season, and of local  cir-
cumstances, which  are necessary to render marsh fevers both
'epidemical and violent, do  not commonly  recur  but at con-
siderable  intervals : and I  do not find that the Yellow Fever
again became prevalent  in  the West Indies until  about  the
year 1686, when it appeared at  Martinico, and subsisted for
several years.  And, as a French ship of war, the Oriftamme,
arrived about the same time at that  island, with a number of
French people, who had, some time before, settled themselves
at Merguy and  Bancok, in Siam, (whence they  had been 
225
driven,  when the  French intrigues at that court  were frus
trated)  the disease, as usual, was supposed to have  been  im-
ported by that ship, and, therefore, was  called  Mai  de Siam.
There is not, however, so far as I can discover, any account
of the supposed introduction of this disease by the Oriflamme,
except that.wThich is given by Father Labat,  a Dominican  or
Jacobin Friar, who arrived  at  Martinico  the  29th January,
 1694, seven or eight  years  after the event in  question;  and
his account (which must have depended on hearsay)  is  ex-
tremely loose and defective.*   He  tells  us that the Oriflamme

  * Father Labat, after mentioning that one of his order, le Pere Loycr, had been
Tately attacked with a disease of which, in the course of it, he was supposed to be dead
five or six times, but which without.proving mortal,  lasted thirty-two days,  adds,
" On appelloit cette maladie le »lf.i' de Siam, parcequ'il  avoit ete apporte a la Martin-
ique par le Vaisseau du Roi, V Oriflamme,  qui, revenant de Siam, avec les debris des
Elablissemens qu'on avoit fait a Merguy & a Bancok, avoit louche au Brdsil, 01&
il  avoit gagne cette maladiey qui y faisoit  de  grands ravages depuis Sept ou huit ans.
Ce vaisseau perit  en retournant en France.  Les Symptotnes de cette maladie etoient
autant differens, que I'etoient les temperamens de  ceux qui en etoient attaqgez, ou
les causes qui la pouvoient produire.  Ordinairement  elle commencoit par un grand
mal de  teste & de reins, qui etoit suivie tantot d'une  grosse  fievre,  et tantot d'une
fievre interne, qui ne se  manifestoit point au dehors."
   " Souvent  il survenoit un debordement  de Sang, par tous les conduits du corps,
meme par les pores,- quelques fois on rendoit des paquets de vers de differentes grandeurs
& couleurs, par haut & par bas. II paroissoit a quelques uns des  bubons sons les aislelles
& aux aisnes, les uns pleins de Sang caille noir & puaut, & les autres pleins de vers.
Ce que cette maladie avoit de commode, c'est qu' elle emportoit les gens en fort
peu de temps; six ou sept jours tout au plus terminoient I' affaire."   He adds, that
he had known  but two persons who died of the disease,  after it had continued
more than fifteen days;  that some persons, who felt nothing more than a little head-
ache, fell  down dead in  the street, while walking  for the air;  and that in most of
 them, the flesh  became as black and  putrid in a quarter of an hour after death,
as if they  had been dead four or five days :—That the English,  who were frequently
made prisoners,  carried the  disease to their  islands;  and that  it was communicated
 by the .same  means to  the  Spaniards and  Dutch,  and made great ravages when he
 left the islands, in 1705.  He concludes by saying, that he  was attacked twice with
 this disease;  that he escaped the first time, after  four days of fever, and vomiting of
blood,-  (" aprds quatre jours de fievre 8c de vomissement de  sang") but, that the se-
 cond time he was in danger six or seven days.  Such is his account, faithfully and ful-
 ly extracted, from pages 72,  73, and 74, of  the  1st vol. of the original Paris edi-
 tion of his " Nouveau Voyage Aux Isles de 1'Ameriques," in  6  vols. 12mo. printed in
 172.'.   Dr. Chrisholm,  at  p. 105  and 106, of the  2d vol.  of  his essay,  has given
                                    29 
226
 touched at Brasil, and caught the disease, which he represents
 as  having been  prevalent there  for  seven  or  eight years.
 There is, however, no reason, that I  can discover, to believe
 that any contagious fever has, at any time, subsisted in Brasil,
 though that country is not exempt from violent marsh fevers;
 nor is it probable, considering the known jealousyof the Por-
 tuguese government, in regard to  the admission of strangers
 at Brasil, that any would have been  permitted  to land from
 the Oriflamme, and communicate with the  inhabitants, so  as
 to become infected  by a fever of that sort, if it had existed
 there.   We are not even told wiiich of the harbours in  that
 extensive  country  tiie  Oriflamme entered; she might have
 anchored in one which was  surrounded with  marshes,  and I
 should conclude this to have been  the case, if it were  ascer-

an extract on this subject, taken avowedly from the Histoire Generale Des Voyages,
which extract is very incorrect and  defective, though he asserts that his readers
will  fi:id it " is  literally taken from the original "  An assertion which ought not to
have bfen made, because it is not true, and because he manifestly had had no op*
portunity of  comparing this extract with the original of Pere Labat.  Unfortunately,
there are but too mauy other instances of his  want of caution in  making assertions,
even the most positive ; thought  am willing to believe,  that an intention to mislead
has not been among his motives.  Such also is the accounjf of a disease which, accord-
ing to Dr Chisholm, " differs materially  from the endemic yellow  remittent, and
bears a  striking  affinity to the true plague,  as  well as to the malignant pestilential
Fever of 1793;" and we, therefore, need not wonder that this gentleman,  who is
anxious  to. assimilate Yellow Fever with plague, should state this account to have
been given by La Fabat,  with his accustomed accuracy  and minuteness,"  though I
believe few other persons  will  be satisfied with it in these  respects.   I'o say nothing
of its important omissions, who will  believe  the occurrence of buboes, sometimes
fiilled with stinking, black,  coagulated  blood, and  at other times with  worms ?
or that there was any foundation for what he says  of packets or bundles of worms,
6f different sizes and colours, discharged  upwards  and downwards ? excepting this,
that  persons troubled with worms, often discharge them in consequence of fever,
and some other diseases; though their doing so is not a symptom peculiar to any dis-
ease, and much  less to the Mai de Siam  But in  truth,  Pere Labat does not seem
to have intended fully to describe the symptoms of that disease,  which he says
were as different as the temperaments of the individuals  attacked by it, and as the
causes by which it was produced; a plain indication that he considered the disease
as arising  from different causes, and,  consequently, not always from contagion.
This part, however, of Labat's account,  is one of those  which are omitted in Dr.
Chisholm's  extract. 
221
 tained, that * fever was prevalent among her passengers  and
 crew  before  they reached Martinico,  and  not  until their
 arrival in  Brasil; but  if, as seems not  improbable, this only  ,
 happened upon  their arrival at  Martinico, we can have no
 difficulty in finding abundant, and  much  more likely causes
 for the  disease in  the  carenage  of that island, which even
 Dr. Chisholm  declares to  be " the  most  sickly  hol& in the
 West Indies;" (vol. 2. p. 84.) or, indeed, at  St. Pierre, the only
 other  harbour of that island in which a ship of war, circum-
 stanced as the Oriflamme was,  can be  supposed to  have  re-
 mained.*  And, indeed, the greater part of Martinico, is  so
 abundant in every thing favourable to  the production  of the
 most deleterious miasmata, that there is  no  island in  the West
 Indies of the same size in  whicli all the  varieties of marsh
 fevers  prevail oftener,  or with   greater mortality; nor  can
 any thing be  more chimerical or unreasonable than the having
 recourse either to  Brasil or Siamrf for contagion, as the cause
 of any fever which ever  was prevalent in the West Indies.
 Of this a multitude of proofs  might be given, if the notoriety
 of the facts did not render them completely unnecessary.
  * DY. Chisholm, having mentioned that " the prevalence of the yellow remittent fe-
 ver, at a certain period of the year,  at Fort  Royal,  (Martinico) should not  excite
 surprise, the cause being so abundant in ift neighbourhood," adds, u that part of the
 city of St. Pierre, called  the inouillage, being veiy low and moist, although not marshy,
 is also subject to the destructive fever during the same period, the hotter months."
  f Ksempfer, who touched at Siam, in his way to Japan, gives the following account
 of the river Merinan, the part most connected with the subject of marsh fever.  " It
 overflows its branches like the  Nile in Egypt, though, at contrary times, .and by setting
 the country under water, renders it fruitful.  This overflowing begins with the month
 of September." "In December, the waters begin to fall  by degrees."  "When the
 waters fall, and return to their former channel, (the river)  they (the inhabitants)  are
 apprehensive that a great mortality will ensue,  among men and cattle; to avert which
 calamity, a solemn festival is  kept throughout the whole country, in order to appease
 the destroying spirits,  (miasmata) which remain after  the  water is run off." "The
 banks of this river are low, and, for the greater part, marshy, yet'*—" they are pretty
 well inhabited : along  them appear many villages,  the houses of which are raised on
 piles." " From Bankok to the  harbour, there is nothing but forests, deserts, and moras-
 ses." K«mpfer's  History of Japan, vol. 1. p. 44.  In such a country and  climate,
 marsh fevers may  well be  supposed to prevail, whenever the surface of tije  inun-
dated ground is left bare,  and exposed to the sun's rays. 
228
   Soon  after this epidemic prevalence of  Yellow Fever  at
Martinico, it seems to  have  occasioned  great  mortality  at
Nevis, (i. e. in  1689, ■ but  no  description  of it, worthy  of
notice, has been preserved.
   The same fever appeared  again  as an  epidemic at Barba-
does,  in  1695, and continued for  several years after.   Mr.
Hughes.mentions this on the authority of  Dr. Gamble, who is
stated by him to remember that this fever " was very fatal" in
that year; and,  as all who had any accurate knowledge of it
in 1647,  were probably dead or  removed, " it was then called
the new distemper," and  afterwards " Kendal's  fever;"  also
"  the pestilential fever, and  bilious fever."   It is said to have
been frequent and fatal  in May,* June, July,  and  August,
and then mostly  " among strangers ;" " though  a great many
of the inhabitants, in  the year  1696, died of  it; and a great
many at different periods since."   " The same symptoms did
not  always appear in  all patients; nor alike in every year."
See Natural History of Barbadoes, p. 37.
   This  statement is  amply confirmed by  Captain  Thomas
Phillips, in the  account of his Voyage to Africa and Barba-
does,  published in the 6th  volume of Churchill's Collection.
He was at Barbadoes  with  a  large ship in  1694, and says, it
was the fate of that island to be*then  " violently infected with
  * Barbadoes  was then so^ generally and highly cultivated, and the soil so much
more apt to become  deficient, rather than redundant  in  moisture, that the  rains,
which commonly begin there  in the  month of May, were then,  as at present, bet-
ter suited  to the production of Miasmata, than the very dry weather which produ-
ced them  in 1647.  Some other West Indian islands have undergone a similar change,
particularly Antigua.  Dr. Chisholm states, that when the French, under Mons.
IJ'Enambuc, were driven from St. Christophers by the Spaniards,  in 1G29, and
"sought an asylum in Antigua, they found it so unhealthy, so marshy, and so  inca-
pable of cultivation, that  they,  with one accord, intreated their leader to conduct
them to .Vloutserrat," them " inhabited by the Carai'bes."  Since that time, however,
both the soil and atmosphere have frequently become so dry as to produce eftects
highly detrimental to the  inhabitants and their cattle, &c. Some of these Dr.
Chisholm mentions as having occurred in 1779, adding,  " when these destructive dr
tracts of weather are suddenly succeeded  by a profusion  of rain, which generally
happens once in three or five years, .a very fatal epidemic remittent is the conse-
quence."  See his Essay, &c. vol. 2d, p. 276 and 279. 
                          229

the plague, so that, in the late war, it proved a perfect grave
to most that came there, all new comers being generally seized
with pestilence; of which very few recovered.   Captain Tho-
mas  Sherman, of his Majesty's  ship Tiger, in  two years
that he lay there,  buried out of her,  600 men, as he told me,
though his compliment was but 200; but still pressing new
out of the merchant ships that came in to  recruit Ids number
in the room of those that died daily."   " I lost (adds Captain
Phillips) about eighteen of my men by it, and, in truth,  I did
not expect to escape myself, and was, therefore, so indiffe-
rent that there  was not a friend, or acquaintance of mine,
seized  with the distemper, hut I freely and frequently went to
visit him, which possibly was the reason that I escaped, by
having accustomed myself to the town, and most infectious air
from the beginning, which  I  did by the advice of the ever-
honoured and worthy Colonel Kendal, &c." "while those
that kept in the  country,  in better  air for fear of it, were
commonly infected when they came on any business to town.
Here died about twenty masters of ships during my stay here,
of wiiich number were  Captains Gurney and Bowles, who
commanded  his  Majesty's  ships,  Bristol and Play-Prize."
P. 253.
   It appears from this account that the disease prevailed chief-
ly in Bridgetown, and that persons coming to it from healthier
parts of the country, and imbibing miasmata, produced by the
local circumstances which Ligon had long before described,
were attacked by the fever, as constantly happens on similar
 occasions, at Charleston, Philadelphia, &c.
   Here  it may be observed that, in every instance,  wherein
 the causes of marsh fever have been so powerful as to produce
 a violent epidemic in the West Indies, and with that exaspera-
 tion of symptoms which seems more incidental and natural to
 this kind of fever, than to any other disease, persons have
 been disposed to  consider it as the plague, or a new distem-
 per.   Dr. Henry Warren fell into  the same mistake after-
 wards, (as Dr. Chisholm appears to  have done, more recent- 
230
 ly, at Grenada,) when the Yellow Fever again became preva-
 lent  at Barbadoes,  between the year 1732 and  1738.  The
 true  plague, indeed,  had not appeared in any part of Europe
 holding a communication with the West Indies,  subsequently
 to the years 1720 and 1721, when  it proved most fatal at Mar-
 seilles and in some other  parts of Provence;  and,  therefore,
 Dr. Warren concluded, that the Yellow Fever,  which he saw
 at Barbadoes, in  1732, and the following years, and which he
 denominated a " malignant fever," was  a continuation of the
 plague,  which  he imagined to have been brought from Mar-
 seilles to Martinico,  and thence to  Barbadoes, in 1721, by the
 Lynn ship  of  war;  although  Dr.  Towne,  who lived and
 practised as a physician at Barbadoes,  about that time, and,
 in 1724, wrote upon the Yellow Fever there,  under the deno-
 mination of  " Febris ardens biliosa," appears to have had no
 knowledge or suspicion of any such importation, or of any dif-
 ference between the Yellow Fever of his time, and that which
 had previously occurred ;  nor of  its being any other than an
 indigenous  production of that  island ;*  yet  Dr.   Warren
 charges Towne with  having confounded " two most different
 maladies," viz. " the malignant and the ardent fever of Barba-
 does ;"  and he represents the former as being a fever  " truly
 of the pestilential  kind," upon grounds and reasons which Dr.
 Hillary, and others,  afterwards  contested  as being chimeri-

  * Towne describes his ardent bilious fever as commonly terminating " in a favoura-
ble crisis, or the death of the patient, about the fourth day after the attack." (Trea-
lise on the Diseases of the West Indies, &c. p. 20.) He supposes this fever to pro-
ceed from a redundance of bile, and that the  yellow suffusion was produced by the
efforts of nature, to depurate the blood, by throwing this redundant bile upon the
surface.  " The regular crisis, therefore, of this fever, (says he) generally disco-
vers itself by a suffusion of the bile all  over the surface of the body about the third
day."  He adds,  that an appearance of it  may  often be discovered "in twelve hours
after the attack,  if you carefully inspect the coats of  the eyes, and the sooner it ap-
pears the more encouraging is the prognostic," etc.
  I have mentioned, at p. 34, my belief, that the yellowness  might, with attention,
be, in many instances, " first discoven d on  the eyes."  Probably  this would always
be the case, if their predominating redress,  in the early part of this fever, did not
render the yellow tinge, in a great degree,  imperceptible. 
231
cal or fallacious.   But, independently of their facts and argu-
ments  on this subject, what I have mentioned, at  p. 222,
224, of the acknowledged and absolute impossibility of pro-
pagating the plague within the tropics, will sufficiently refute
Dr. Warren's opinions and allegations.
   Dr.  Hillary was a well-educated physician, and practised,
with unequalled credit, for many years, in Barbadoes ; and,
as the  Yellow Fever  does not appear  to have  prevailed there
epidemically, during his  time, he must have had the best op-
portunities  for ascertaining  whether it possessed any conta-
gious  property or not;  especially as he, undoubtedly, saw
cases of it, arising from all the several causes wiiich have been
already mentioned as capable of producing idiopathic Yellow
Fever; some of which might he supposed, more likely than
marsh miasmata,  to occasion fever with a contagious quality.
And he has delivered  the result of all his observations in the
following passage, viz.:
   " I never could observe any one instance, where I could say,
that one person was infected by, or received this fever* from,
another person who had it; neither have I ever seen two people
sick in this fever in  the same house, at, or near,  the same
time, unless they were brought into the same house when they
had the fever upon them,  before they  came in.   From whence
(adds he) we may conclude,  that it has  nothing of  a  conta-
gious or pestilential nature in it, and that it is a different fever
in all respects, as it will more fully appear hereafter."  See
his volume on air, and Epidemical Diseases,  in Barbadoes,
2d edit. p. 145,  6.
   In confirmation of Dr. Hillary's testimony,  I shall adduce
that of Dr. James Clark, now, or late, of Dominica, deliver-
ed in his Treatise on the Yellow Fever, &c.  after twenty-five
years constant and extensive practice in the West Indies.   At
p. 22,  he states facts  respecting the appearance of this fever
in Dominica, during the years 1793, 4, 5, and 6,  in  which
years  Dr.  Chisholm  asserts the fever at that island to have
been,  what he calls, the  malignant pestilential fever, brought 
232
to Grenada  by the Hankey, in 1793, and thence  propagated
to the other islands :  these facts  decidedly prove  that this
supposed malignant fever manifested no contagious quality in
Dominica; but I shall reserve them to be employed in my
appendix, No.  7, on that subject.  The following paragraph,
taken from p.  52, 3, of Dr. Clark's Treatise, appears to re-
late more immediately to the Yellow Fever, as it commonly
occurred before the year 1793.
  This fever has not prevailed much  in these  Windward Ca-
ribbee islands for many years past.   At Fort  Royal, in Mar-
tinique, where  there is a great prevalence of mephitic efflu-
via, arising from the marshy ground at the back of the town,
it generally broke out in the summer or autumnal season,  on
the arrival of troops from France, or of a number of seamen
wtio had never been in the  West Indies before: and  the  same
thing  happened at Point a Petre, in Grand Terre,  Guadaloupe,
almost annually, and  from the same cause ; but it was  never
looked upon as  an infectious disease, nor.did it ever spread
among the natives of the towns, or  among those who  were
seasoned to the climates; nor was it ever carried from thence to
the other islands.  In this island but few cases have occurred
for these last twenty years,  and these have chiefly  been at
Prince Rupert's Head, where from the stagnated  water in a
large morass near the town and fort, the marsh miasmata pre-
vails in a  higher  degree.  Since the swampy places, whicli
were in the town of Roseau,  have been filled up, this  fever
has been seldom observed; but, previous  to  the year 1792,
we had generally violent thunder storms, heavy rains,, or se-
vere gales of wind, during the autumnal season:" and  these
Dr.  Clark  considers  as obviating  the prevalence of this
fever.
   I have the more readily availed myself of Dr. Clark's tes-
timony, concerning the Yellow Fever at Martinico  and Gua-
daloupe, because, for more than twenty years, he resided in
an island between and very near to both,  and because I believe 
233
that no French physician, practising in either of those islands,
has written any thing on the subject worthy of notice.
  In  regard to Gienada, I have Dr.  Chisholm's  authority
for  asserting, that, from the  year  1763, when  that  island
"was ceded to Great Britain, and till the year 1793, (thirty
years) noncontagious fever, and no epidemic,  of  the charac-
ter  of the malignant pestilential fever, appeared" there.  See
Essay,  &c.  vol.  1, p. 295.  Whether the fever of 1793 was
such as Dr.  Chisholm has described it,  will, I hope, be fully
ascertained in my seventh appendix.
  And  here I shall close my  view of this subject, so far as
relates  to the Windward Caribbee islands, with an addition
of only one  document, declaratory of the opinions and expe-
rience,  in those islands, and on this  question, of the officers
of the hospital-staff,  in  the army, commanded by Sir Ralph
Abercrombie, during the year 1796, and a great part of 1797,
when, unfortunately,  they had but too many opportunities  of
seeing and treating the Yellow Fever.  That my readers may
be informed of the origin of this document, I  must observe,
that,  in November, 1796,  the medical staff-officers at Marti-
nico,  were assembled at the General  Hospital of La Charite,
when an order from the army medical  board was read to them,
requiring their opinions, concerning the disorders most pre-
valent in that army:  and  it being proposed that a  committee
should be appointed, to prepare a statement of our opinions,  I
suggested that a single general statement would,  as  I con-
ceived, but imperfectly answer the purpose, and that it might
be better that each individual should separately state his own
opinions; and this suggestion being adopted, Mr.  Young,
Inspector-General of the Hospitals to that army, after some
delay,  was  furnished with our separate  opinions,  and  with
those of the Hospital-staff officers  in the other islands; an,d,
in  consequence thereof, he wrote a  letter to the  army me-
dical board, dated St. Pierre, 23d July,  1797, of which the
following is an extract, viz.:
   By his Majesty's ship,  Arethusa,  I send, agreeable  to my
 letter of the 25th ult.  under cover to the Secretary to the 
234
 board, the opinions of the medical officers of this staff, on the
 prevailing diseases' among  the  troops  in this country,  by
 which the board  will perceive  that contagion, or infection
 has had little or no share in the mortality ; and  I must  beg
 leave to add, that it has never occurred in a single instance, to
 my observation."  My own individual opinion was in exact
 conformity with that  which Mr. Young has here expressed.
 I had  never discovered any  appearance  of  contagion at  St.
 Lucia, nor  when placed at  the head of the hospital depart-
 ment,  at  Barbadoes,  in the summer  of 1796,—nor  after-
 wards, when officiating as physician to the forces at Martini-
 co ; nor again when placed at the head of the medical staff in
 Grenada,  during a great part of 1797,  and until my return
 to England.
  St. Domingo next presents itself to our observation,  in re-
 gard to the  history of Yellow Fever: of its aptitude in  many
 parts,  to-  produce highly noxious miasmata, and the  fevers
resulting  therefrom,  in all their various forms,  there  has
been but too  much evidence even  within a few  years.  Wit-
ness  the  many  thousands of British soldiers, who perished
there by these fevers,  between the years 1793 and 1799,  and
the numerous French army, sent tliither in 1802, under  Ge-
neral Leclerc, and which in  a short space was nearly annihi-
lated hy the same  fevers; of which a very sufficient account
has been  given  in the Medical History (Histoire Medicale)
of that army by its chief physician, M.  Gilbert.
  The earliest mention which I recollect of the  prevalence of
Yellow Fever in  St. Domingo, is contained in certain manu-
scripts, of M. Bourgeois,  formerly Secretary to the Chambre
 of Agriculture, at Cape Francais, published, after his death,
 by his  nephew, in 2 vols. 8vo. under the title of " Voyages
 Interessans Dans Differentes Colonies;" from these  it ap-
 ye&rs,  (p. 202) that, in the year 1731, a Spanish  squadron
 arrived at Cape Francais, commanded by Don Manuel Lopez
 Pintado, in the St. Louis, of eighty guns, who, besides several
 other ships of war, had, under his convoy, some very rich 
235
galloons.  They were returning to  Spain from Porto Bello,
and, having suffered greatly by a storm, had put into the Cape
to refit, where they  remained five  months, surrounded by
sources of marsh miasmata;  and having already, as we  are
informed by Don Antonio Ulloa,  (in the 5th chapter of the
first book of his Voyage to South America) been grievously
attacked by the Yellow Fever,  " vomito prieto," before they
left  Carthagena,  we need not wonder that, in this last situa-
tion, they continued  to be  afflicted by the same disease,  and
of a form probably  more  violent than had been previously
noticed at  the Cape:  especially  in regard  to Petechias  and
Hemorrhages, from  different parts of  the bothy, proceeding,
as I conclude, from a scorbutic disposition to which sailors, at
that time,  were  almost invariably subject,  especially  after
long voyages.  Here they expended great  sums  of money,
and thereby enriched many of the inhabitants, but, like the
Oriflamme, at Martinico, they were accused of introducing,
at Cape Francais, a new pestilential fever:  " On pretend,"
says the author of the manuscript in question, (p. 205) " qu'elle
occasionna l'esp'ce de  mal pestilentiel  qui a long terns regne
dans le Cap, k que I'on traitait faussement du nom de Maladie
de Siam," kc.   At p. 432, M. Bourgeois, in a " Memoire,"
written by himself,  " sur  les maladies les  plus communes a
St. Domingue,"  reverting to this event, observes, that " Le
nom de Maladie de Siam vint a l'esprit de quelqu'un, a cause
d'une espece de resemblance dans la malignite ; aussitot cela
se repandit, k cette denomination impropre,  est demeuree aux
fievres malignes, tres  communes dans ce pays-ci.  Les  plus
mal fesantes, s'attachent principalement aux nouveaux ar-
rives," ka   He  then  proceeds to mention  the most remark-
able symptoms of these fevers, especially the violence of their
first attack, with a strong determination to the head, inflamed
appearance of the face,  yellowness of the skin, and profuse
hemorrhages from various  parts  of the body, and sometimes
even through the pores of the skin.   He adds, p. 434, that all
the  fevers  of St. Domingo are of the same  kind, and nearly 
236
  related to the intermittents, double tertians,  and continued
  fevers, with or without exacerbations, (" avec redoublemens,
  ou sans redoublemens") in Europe.
    The name of Maladi* de Siam having been  thus applied to
  the most violent form of marsh fever in St. Domingo, it was
  adopted by M. Poupie-Desportes, a physician of great merit,
  who  arrived there in the following year, and, during the
  fourteen succeeding years, kept an account (founded on accu-
  rate observations) of the weather and diseases, as they oc-
  curred first at the Cape, and afterwards at  Fort Dauphin, by
  wrhich it was acertained, that the prevalence  or absence  of
  Yellow Fever, at those places, invariably depended upon the
  Changes of season or  constitution,  in  regard to heat and
 moisture,  especially during the summer and autumn.   Thus
  at the Cape, in 1733 and 1734, after very copious rains,  ex-
 tremely hot and dry weather commenced,  and lasted  during
 the summer and  autumn, inducing a violent  Yellow  Fever,
 ('* Mal de Siam"  w liich reigned exclusively for the fcpace of
 four months, and earned off more than half of the new comers
 and sailors; while there was very little sickness in the more
 elevated country situations.   Again in 1739, 1740, 1741, and
 1743, after extremely hot and dry weather  for a considerable
 time, the Yellow Fever again became prevalent, and fatal  to
 a great  part of those who were attacked by it, and who, as
 usual, were chiefly strangers.  On the other hand, the tem-
 perature in  1735, 1736, 1737, 1738, and 1742,  was mild, or,
 at  least, moderate; and, in those years, this  fever only oc-
 curred sporadically, and with diminished  violence, so that
 most of the  new comers, who were attacked by  it, recovered.
 Mr. Poupee-Desportes  also  observed, that when this fever
 prevailed as an epidemic  among  strangers, and in its more
 violent forms,  at the Cape, and at Fort Dauphin, it affected
the seasoned inhabitants only as a mild bilious remittent, or,
as he called it, a  lymphatic  fever.  From this constant de-
pendance of Yellow  Fever upon  the  state  of  weather, this
author infers that it ought to be regarded " comme-une de ces 
                           237

 maladies dont il faut chercher la cause dans la constitution de
 l'air;"  and, consequently, not as produced by contagion.  See
 Histoire des Maladies de St. Domingue, torn. 1. p.  191.
   I ought here to mention, according to the information given
 by M. Valentin, formerly "  Premier  medicin des Armees de
 St. Domingue, kc. at p. 58  and 59 of his Traite de la fievre
 jaune d'Amerique, that, in the French West Indian colonies,
 and especially since  the time of Poup'e-Desportes, a distinc-
 tion has been made  between " la maladie de Siam,  and la
 fievre jaune," which last was known under the  denomination
 of  '• fievre ardente maligne,  ou fievre bilieuse  maligne;"
 ami  sometimes under that of " la Matelotte."   That these
 dis uses were " identiques," or,  at  most,  only presented  a
 variety  in their effects.  That the name Mal de  Siam  was
 given when the signs of dissolution of the blood were present
 in the highest degree, (" au  Comhle") when, besides a jaun-
 dice, the blood became extravasated under  the skin, making
 its way through different  natural outlets  or passages,  and
 transuding by the pores at some points of the cuticular  sur-
 face, (par  les pores de quelques points de la surface cuticu-
 laire.")   It seems probable, therefore,  that this  distinction,
 and this application  of the name  Mal de Siam, were derived
 from an unusual prevalence of Hemorrhages and Petechia,
 observed in the crews of the Oriflamme, at Martinico, andjof
 the Spanish squadron, at St. Domingo, when labouring under
the Yellow Fever; and  that, in both cases, there was, as
might well be expected in such long voyages,  and at those
 times, a great predisposition to scurvy, or to a dissolved state
 of the blood, in the persons so affected; though Hemorrhages,
 &c. have occurred not unfrequently in other situations to per-
 sons under Yellow Fever, and sometimes when  there was no
 appearance of.a scorbutic disposition.
   Unfortunately, this account of the weather and  diseases at
 St. Domingo was not continued by any other physician after
 the death of M. Poupee-Desportes:  though it appear? from
 M. Valentin's Treatise, that the French  physicians at St. 
238
 Domingo had generally thought the  Yellow Fever to he not
 contagious, and that this was also his own opinion.
   Of the Yellow, and other marsh fevers, as they affected the
 British army at St.  Domingo,  during the  late war, a very
 good account has been given by Dr. Hector M'Lean, to which
 I must refer those of my readers who wish for more ample in-
 formation on this subject; only observing that, he also deli-
 vers it as  his decided opinion, that  " what has been called
 Yellow Fever there, is not an infectious disease; that it is the
 common remittent  endemic  of that  country,  applied to the
 English or European constitution."   This opinion is repeat-
 ed almost in  the same words, at p.  71,  and again at p. 78,
 where he says,  " there  is no  point on which I am  more de-
 cided than  the absence  of contagion  in  the remittent of St.
 Domingo ;"  and this he declares to  have been the opinion of
 Dr. Scott,  Dr. Wright, and Dr. Gordon, (all physicians, on
 the St. Domingo Staff,)  and of every medical man with whom
 he conversed at that island.*
   In regard to the  fever  which destroyed the army undei*
 General Leclerc,  at St. Domingo, in 1802 and 1803,  I  must
 refer my readers to M.  Gilbert's Histoire Medicate, only ob-
 serving that he also declares  it not to have been an imported
 disease, but to  have  originated in an atmosphere extremely
 heated,  and  filled  with marsh effluvia (" elle a son origine
 dans un air  tres-chaud,  sature d'emanations marecageuses")


   * Dr. Jackson, who was also  on the Hospital-staff at St Domingo, has delivered
similar opinions in his  Outline of the History and Cure  of Fever, &c.; in w.hich  he
states the endemic fevers of the West Indies to be produced by exhalations from the
surface of the earth, and that, " though they often destroy life, they beget no power
of propagation in the  patient,"—" that they may become epidemic, but not conta-
gious." Of their varieties, he says, " the disease, in the  more violent forms, is, or ap-
pears to be, continued, in some situations;  in others it is remitting, and of regular
type.  In wet weather, and on swampy grounds, the endemic of the country (St. Do-
mingo] is usually remitting in form; and, under this form, exhibits appearances of
jaundiced yellowness, of black vomiting, purgings of black matter, haemorrhage from
different parts of the body, petechia, lividness," &ic. 
239
 p. 93.  He adds,  in the next page, that it is not contagious ;'*
 and that  this is the opinion of the generality of Practitioners.
' —But, that it is epidemic for almost all  new  comers;  and a
 tribute whicli must commonly be paid by them  within the first
 year after landing.  And having asked, at p. 77, whether the
 Fellow Fever be a disease, from the bilious (or marsh) fevers,
 he answers, " il y a tout lieu dc croire  qu'elle n'est  autre
 chose que le maximum des fievres remittentes bilieuses," i. e.
 there is every reason to believe that it is  only the highest or
 most violent form, of bilious remitting fevers.    At p. 80, M.
 Gilbert advises those who are under the necessity of living in
 the city of Cape Francois,  to remove  from the shores of the
 sea, and  especially from the environs " de L'embouchure de
 la rivLre du haut du Cap;  lieux ou la brise  de tcrre porte
 chaque jour les Emanations  marecageuses de cette surface im-
 mense de  lagons, qui s'etendent de  L'einbarcadere de la Petite
 anse,  au  bourg du haut du Cap."
    The first epidemic fever, in Jamaica, of which I have found
 any account,  is that  mentioned by Dr. Trapham,  in a little
 volume,  entitled, " State of Health of Jamaica,"  printed in
 1679, about twenty-four years after the capture  of  the island
 by Cromwell's forces.  In  this volume the author, after re-
 presenting Jamaica as not  liable to any  pestilential or epi-
 demical disease,  adds, p. 81,—" I know it hath been com-
 monly received, that,  about eight years since, when the vic-

   * It must be observed, that M. Gilbert delivers this opinion that the  Yellow Fever
 is"  not contagious with a sort of qualification ; because he  supposes that, wheu great
 numbers of patients, under this putrid gangrenous disease, as he calls it, are collected
 together, the emanations from their bodies may excite fever in persons  who are con-
 stantly exposed to them, and also exposed to the causes which originally produced the
fever,"  ("a faction des causes qui la font naitre") but these causes (miasmata) must
 be sufficient alone, and the emanations from the sick must, therefore, be superfluous.
 He had observed that the attendants on the sick in hospitals at the Cape, were fre-
 quently attacked with the fever; but, as this was the case of almost every one out of
 the hospitals also, and, as the hospitals were, according to his own statement, placed in
 the most unwholesome part of the town, (whence he says thev ought to be removed)
 it  would have been extraordinary  indeed, if persons, by remaining in them, had
 escaped the disease. 
240
torious fleet returned from the signal Panama expedition, that
then they brought with them an high, if not pestilential fever,
of which many died throughout the country.  But, this being
a foreign distemper, brought from abroad, the causes of which
I could not so well judge of, I am not as  yet forced from my
opinion thereby, but conclude Jamaica more happy than to be
annoyed therewith, directly and originally."
  Dr. Trapham here alludes to the famous expedition  under
Henry Morgan, who,  at the head of about 1200 Bucaneers,
took Panama, in 1670, and returned to Jamaica with so much
plunder that his own  share amounted  to 400,000 dollars.
With this he became a planter,  was made Lieutenant-Govern-
or of the island, and knighted.   Of the fever, with which
these men were affected, at and after their return, I can find
no distinct  account; but, as in their march across  that part
of the continent, they must have been almost continually ex-
posed to marsh effluvia, and, after their return,  with so much
wealth, would naturally have run into debauchery and intem-
perance of  all  sorts,  there can be no difficulty in finding suffi-
cient causes to produce among them  even the most  violent
fevers in that climate.  That marsh fevers have subsequently
prevailed at Jamaica, to great and fatal extent is but too cer-
tain ; though distinct and   accurate  accounts of  them  are
wanting; at least, I have found none anterior to the Essay
on Yellow Fever, by Dr. John Hume, who, for many years,
had the direction of the Royal Marine Hospital,  at Jamaica,
and was afterwards commissioner for the  sick and Inirt of the
Royal  Navy.   This gentleman  computes that in  1741  and
1742, after the return of Admiral Vernon's fleet, from the un-
successful attempt upon  Carthagena, 11,800 sick  were sent
to the Royal Hospitals of Jamaica, and that, of this number,
not  less than  7000 were attacked with the Fellow or bilious
Fever.  "  Of  these (says he)  I used to  compute that 1500
died, that is something less than one in four; but,  in this,  I
pretend not to be exact"   See Dr.  Hume's  Essay,  in the 
241
volume  on West India Diseases, published by Dr. Donald
Munro.
  Dr. Williams, in his Essay on the Bilious Fellow Fever of
Jamaica,  (which Essay occasioned a duel between the author
and  Dr. Bennet, and the deaths of both) says, this disease,
at the time of the expedition to  Carthagena, was " so gene-
ral  and fatal, that people  looked upon it  as  a plague,  and
shunned the  sick as they would  contagion."   It does not. ap-
pear, however, that he,  or any well-informed medical man at
Jamaica, then believed it to be contagious.  On the  contrary,
Dr. Hume says, (p. 238)  "we have undoubted proofs that the.
disorder is neither a plague noncontagious, as Dr. Warren has
alleged."   He observes, that it commonly made  "  its attack
after hard drinking, violent exercise, dancing, and sleeping
in the open  air ; that " strong muscular men  are most liable
to it, and suffer most;"■ that " Creole white men are rarely
seized with it;" that he "never knew any  Creole white wo-
men ill of it;"  hut has known it prove fatal to  European,
white women, though " they are not so liable to  it as the
other sex."   He adds, " I have never seen any negro, male or
female, native or foreigner, attacked with the bilious fever,"
p. 237 and 238.  In all these particulars the fever  at Jamai-
ca appears to have  agreed  with  what has generally been ob-
served of yellow and other marsh fevers.   It appears  also,
that many of the cases which fell under the care of Dr. Hume,
were extremely  exasperated, and  attended  with vomitings
" of a coffee  colour,"  as well as  " black," and with  a mortifi-
cation of the stomach, which, he says, was always found after
death, " in all such subjects as I have either  opened myself,
or seen opened by others,  after having had  black vomiting."
See p.  217.
  Dr.  Lind, in" his work  on Preserving the  Health of  Sea-
men, says, that the Lords of trade and plantations wishing to
ascertain, for a particular purpose, whether the Yellow Fever
of Jamaica was contagious or not, " a physician wTas consult-
ed,  who had long practised in that island, who gave it as his
                            31 
242
 opinion, that from the Fellow Fever of that island  there was
 no infection."  This  (he  adds)  was not only the opinion of
 that gentleman in the court, hut is  the belief, as  I am in-
 formed, of the best practitioners in that island, and also of
 Dr.  John Eliot," (since  Sir John,) " a skilful physician in
 London, of Mr.  Nasmyth," (Surgeon to Admiral Holmes,
 of Jamaica) *« and many others, who have had opportunities
 of being well acquainted with the diseases of Jamaica."   See
 p. 292, 3d edit.
   Of similar import is the testimony  of the late  Dr. John
 Hunter, as delivered in his excellent work on the Diseases of
 the Army in Jamaica,  in whicli, at p.  83, he declares him-
 self «< able to say with certainty, that it, (the Yellow Fever,)
 is not infectious."  He adds, " in the Military Hospitals,  the
 sick, admitted with fevers, were above three quarters of the
 whole;  and they were often much crowded together,  yet there
 wTas no  reason to believe  that a man,  with  any  other com-
 plaint,  ever caught a fever in the Hospital."  This testimony
 has,  indeed, been repeatedly given, though not in the same
 words,  by Dr. Hunter, in different parts of his work.
   These facts and opinions might probably be thought suffi-
 cient in regard to the Yellow Fever at Jamaica, had it  not
 been  supposed  by some persons that a  malignant pestilential
 fever was introduced at that island, from Grenada,  in  1793,
 and there mistaken for Yellow Fever: to ascertain the fallacy
 of this supposition, it may not be improper  to adduce the tes-
 timony  of Dr.  Lempriere, now physician to his Majesty's
 forces,  who was then employed in that island.  This gentle-
 man,  at p. 22 and 23 of the 2d vol. of his Practical Observa-
 tions  on the Diseases of the Army in Jamaica, says of  the
 Yellow  Fever, that it  became so prevalent, and  proved so
 fatal in  Jamaica,  during the years 1793, 1794, and 1795, as
 to give rise to a very general opinion, that it was highly infec-
tious, and that it had been  imported from the  windward
islands by  contagion."—" But,  to those who understand  the
influence of contagion, it  will appear, that this disease did 
                           243

uot prevail as  if it were of such kind ; for it chiefly affected
the newly-arrived European, as yet unnerved by the climate,
whose high health alone rendered him subject to its ravages ;
while the delicate and weak persons, particularly liable to the
influence of contagious diseases, were  altogether exonerated
from this fever."   The  same author, at p. 29 and  30, posi-
tively denies the existence of any contagious property in this
fever;  adding, p.  31, that it did not spread generally over the
island  as a contagious disease would have done, in the then
existing circumstances ; but " was confined to those situations
only w here remittent fevers are most prevalent and fatal,  and
to those subjects who had lately arrived from Europe with ro-
bust and plethoric constitutions."  At p. 47, Dr. Lempriere,
to account for the occurrence of this  fever, with uncommon
violence in 1793, mentions that the rains usual in the month
of May were then  excessive,  and that  they were  followed by
very extraordinary heat in June, July, and August; which
naturally occasioned a  more copious and more concentrated
exhalation of miasmata, than in former years ; and as a much
greater number of  persons arrived about that time from  Eu-
rope, in consequence  of the war, the violence of the fever, and
the numbers attacked by it, were very much increased, as
might well have been expected; though it attacked none who
had long resided at Jamaica, and  entirely ceased,  as usual,
about the  month  of  January;  until  re-produced by  similar
causes,  in the following summer and autumn.
   In a paper  concerning the Yellow Fever, which  prevailed
at Jamaica in 1793, 1794, and 1795, read by the late Dr.
James Walker, to a medical society, which had  been formed
at  Port Royal to investigate  the  nature of this  fever, the
author  describes it as  attended with a constant propensity
to vomit, by which mucus and bile were first thrown up ; and
afterwards, generally about the third  day,  a matter resemb-
ling coffee grounds, and sometimes of the colour,  consistence,
and tenacity of tar.  Hemorrhages were frequent, from the
mouth, nose, and,  sometimes, from the axilla, anus, and va- 
                           244

 gina.   Near the close  of the disease, in those cases which
 terminated fatally, a yellowness  appeared, first in the eyes,
 and on the neck, gradually extending over the whole body,
 and acquiring  a darker hue; very few  had pastechial erup-
 tions.   In 1793 and 1794, the  fever  did  not intermit, and
 often terminated fatally  in  two  or three days.  In 1795, it
 became somewhat milder, and more protracted.  It was near-
 ly confined to newly arrived Europeans,  though some old re-
 sidents in the interior (and probably high and cool) parts of
 the island, were reported to have  been affected  by it.   The
 author believed the disease  not communicable from one per-
 son  to another; observing,  that  "in the  public  Hospital,
 where  many people were necessarily in the same wards,  with
 numbers in this fever, neither any of them, nor of the atten-
 dants upon them, were infected."   See  New  York Medical
 Repository, vol. 1, p. 486, 7.
  I shall dismiss this subject,  so far as regards Jamaica, by
 referring my readers to a small, but very valuable, Treatise
 on the Yellow Fever of that island, by Dr.  Grant, a physi-
 cian (as I am informed)  of the greatest  eminence,  and most
 extensive practice there.   He considers this fever decidedly as
 not being contagious ; and as being only an aggravated form
 of the  remittent of hot climates, exclusively attacking those
who have lately arrived from colder countries, and who bring
with them an inflammatory diathesis.   He observes, however,
p. 27,  that " in its mildest state,  under its clear  remitting
form, it attacks both the long resident and native;" and that,
" for several  years past," (i. e. previous to 1801) " the native
and European,  of long residence, have experienced it, under
a greater degree of  aggravation of symptoms," than  for-
merly.
  Were I to, extend this  view to other West-Indian islands,
and to  the Spanish  settlements on the continent of America,
particularly at Carracca, La Guayra,  Venezuela, Carthage-
na, Potto-hello, and  Lavera-crux,  it would present a repeti-
tion of nearly similar facts.  Believing, however, that a state- 
245
    ment of them  would he thought superfluous, and even tire-
    some, I beg leave to direct the attention of my readers to the
    United States  of America,  where the  occurrence of frost in
    winter presents the disease in different  circumstances,, and
    where  the facts,  regarding  its origin, nature,  and  supposed
    contagious property, have been, within  a few  years,  atten-
    tively observed, and also discussed with great ability, as well
    as nice discrimination.
       Proceeding,  then, from Jamaica northward,  Charleston,
    in South  Carolina,  first offers itself to our observation.   And
    here  I  gladly  avail myself  of a statement  on  this subject,
    made by  Dr. David Ramsay,  of that city,  in  his " Review
    of the  Improvements,  Progress, and  State of Medicine, in
    the  18th  century, already  cited at  p.  188.  The  statement
    in question is at p.  39,  and in the following words :
       " In the year 1699, a disease prevailed in Charleston, which
    swept off a great part of  the inhabitants, and some  whole fa-
    milies.  This was then called  the plague, though afterwards
    supposed to have been the Yellow Fever." *
       In the  year  1732, the Yellow Fever began to rage in May,
    and continued  till September or  October.   In the height of tiie
    disorder, there were from eight to twelve whites  buried in  a
    day, besides  people of colour.  The  ringing of bells-was for-
    bidden, and little or no business was done, j  In the year 1739,

      * This  disease  is mentioned at  p. 142, of the first vol. of the  History of South
    Carolina,  (London,  1779) as .having "carried off an incredible number of people;"
*   among whom  were the chief justice, the episcopal clergyman,  the  receiver-gene-
    ral, the provost  marshal, "and almost half the members of the assembly."  In-
    deed, the situation of Charleston,  however convenient for trade and navigation, ap-
    pears to  have been, from the beginning, eminently productive of marsh fevers in
    summer and autumn.  Governor  Drayton, in his View of South Carolina, (p. 24)
    says,  " at its first settlement, Charleston was  said to be so unhealthy, in the au-
    tumnal months,  that, from June to October,  the public offices were  shut up, and
    people retired to the country."
      f Dr. John  Moultrie,  whose father was, during forty years,  at the head of  his
    profession in Charleston, and who, in  1749, published, at  Edinburgh, an excellent
    inaugural Dissertation " de febre maligna biliosa America;, 4to.  after mentioning:
    therein, that this disease prevails most vio^ntly in proportion as the heat of the  at- 
246
the  Yellow  Fever raged  nearly  as violently as in  the year
1732 ; and it was observed to fall most severely on  Europeans.
In 1745 and 1749, (rather 1748) it returned, but with less vio-
lence; however, many young people, mostly Europeans,  died of
it.  It appeared again in a few cases, in 1753 and 1755, but did
not spread.   In all  these visitations,  it  was generally  sup-
posed  that the Yellow Fever was  imported; and  it was re-
marked that it never spread in the country, though often carried
there  by infected persons, who  died out  of Charleston, after
having caught the disease in it."
   " For forty-two years after 1749, there was no epidemic at
tack of this disease,  though there were occasionally, in  differ-
ent  summers, a few  sporadic  cases of it.   In the year 1792, a
new era of the Fellow Fever commenced.   It raged in this city-
in  that year, and also in 1794,  1795,  1796,  1797, 1799,  and
1800.   In these last seven  visitations of this disease, it ex-
tended from July to November, hut was  most rife in August
and September;  with  a very few exceptions (chiefly children)
it exclusively fell on strangers to  the air of Charleston, and was,
in no instance, contagious."

mosphcre is greatest, adds, " in Caroli-op\m\o exeunte mense Junk), anno, 1732, cum
nullU aura per aliquot hebdoiuadas ccstum torrentem  refrigerasset, adeo sseviebat hsec
febris, et tam acuta et lethalis erat, ut multis  post diem 2m. vel 3m. mortifera esset."
" Anno 1748, in eodem loco febris hsec iterum erupit, circa medium  mensis Augusti,
prima cujus septimana nulla ibi unquam ealidoir erat,  ut Mercurius in Fahrenhetii
thermometro  ad 97°, 97 1-2°, et 98«, in nere umbroso ascenderet, et calor hicce
cum multis inibribus diu duravit," p.  8.  He adds, at  the top  of the next  page,
that the atmosphere,  sometime after,  became cool, and the epidemic, from a Yel-
low Fever, changed to an intermittent " a cceli tern perie in frigidiorem versa,  mites>
cit et in intermittentem febrim  mutabatur." fie observes, in the same page, that
though most people thought the fever  contagious, he  had seen many persons
who maintained a close and daily intercourse with the sick,  and did not get the dis-
ease,  if they avoided violent exercise, and  exposure to external injuries. He says, p.
6, that the North  Americans pretend they derive the disease from the West Indies,
but that the West  Indians say it is not indigenous there.  He thinks,  however, that
Sufficient causes exist among both; with  and among these causes he includes " ingens
■astus aeris,'" marsh effluvia, violent exercise, drinking to excess of ardent spirits,
Sec.  He says, the epidemic of 1745 manifestly began from the latter cause, in a sailor,
and not from any imported contagion- 
247
   This uncontradicted statement, publicly made by an eminent
 and respectable physician, in the hearing of hundreds, who, if
 it had been erroneous, and  particularly if the Yellow Fever
 had manifested any contagious quality in South Carolina, must
 have been able, and disposed, to assert the truth, may well be
 considered as decisive evidence on the subject; especially as it
 was printed at the request of the Medical Society of that state.
 Dr. Ramsay had, indeed, previously stated this fact more cir-
 cumstantially in his address to  the same Society, on the 24th
 of December,  1799, when, speaking of the disease in question,
 as it had appeared there during the preceding summer and au-
 tumn,  he says, " We have  no reason to believe that the Yel-
 low Fever was either imported among us, or communicated by
 contagion.  It raged most  in the north end  of King Street,
 where "the greatest number of persons from the country resided,
 and in those streets where sea-faring persons  usually fixed
 themselves. No physician, or nurse, took the disease.  Stran-
 gers, who left the city, and afterwards sickened and died in the
 country, were not the occasion of death, or even of disease, to
 those who attended them  in their last illness."  See New York
 Medical Repository, Vol. 4, p.  100.
  Again, in the Charleston Medical  Register, for 1802, Dr.
 Ramsay, alluding to the Yellow Fever, which had then recently
 terminated, declares  that " no instance can he recollected in
 which  there was any ground to  suppose that the Yellow Fever
 was either imported, or had been contagious.  No physician,
 nurse,  or other person," having " intercourse  with persons la-
 bouring under Yellow Fever, caught the disease.  It was ex-
 clusively confined to strangers,  and among them there was  no
evidence of its being communicated from one to another."
  The like  absence of a contagious  quality  continued to be
 manifested by this disease in succeeding years.  Dr. Ramsay,
 in giving  an account of the Yellow Fever, as it had appeared
 at Charleston in the summer and autumn of 1804, (in a letter
 addressed to Dr. Mitchell, and dated  the 14th of December,
 1804), writes as follows:—" A  few cases of Yellow Fever oc- 
248
curred prior to the 10th of July; but, from that day +H1 about
the 20th of September, it might be said to be epidemi- .  From
and after that time  it gradually declined, and finally disap-
peared about the 1st of November."  " The weather was un-
commonly warm, while the epidemic raged, and the number
and mortality of its  subjects increased with the increase of
heat.  The disease was marked with the  ordinary symptoms
which have been so often described, and are so well known as
to make a new statement unnecessary; but, in the following
particulars, an unusual proportion of patients deviated  from
what had  been the more common form of the disease in pre-
ceding years.  J\Teglected intermittents frequently terminated in
Fellow Fever.  The  black vomit was neither violent nor  con-
stant, even in  fatal cases, where the depleting system was car-
ried to a proper extent."   " As usual, the disease was con-
fined to persons  who were strangers to the air  of Charleston ;
but it  attacked some who had  resided among us one or two
years,  and, in a few  cases, more."   But in these there " has
generally  been a great proportion  of exciting  causes, such as
intemperance, long exposure to the damps  of night, or the
scorching  rays of the sun."   This disease, in no instance proved
contagious."  See New York Medical Repository, vol. 8, p. 365.
  I shall conclude these statements, in regard  to Charleston,
by  the following extract from Dr. Ramsay's Letter to Dr.
Miller, dated the 18th of November, 1800,  viz. "The disputes
about the origin of the Yellow Fever, which have agitated the
Northern  States, have  never existed in Charleston.  There is
but one opinion among the physicans and inhabitants, and that
is, that the disease was neither imported nor contagious.   This
was the unanimous sentiment of the Medical  Society, who, in
pursuance of it, gave their opinion to the government last sum-
mer, that the rigid enforcement of the quarantine laws was by
no means  necessary, on account of the Yellow Fever."  " My
private opinion is, that the Yellow Fever is a local disease, ori-
ginating in the air of Charleston."   See New York, Medical
Repository, vol.  4, p. 218 and 219. 
249
   North Carolina having no large city, has been less fre-
 quently infested with the violent forms of marsh fever.   But
 Dr. De Rosset, of Wilmington, in  that  state, has described,
 what he calls a pestilential 'fever, which prevailed there in the
 autumn of 1796, accompanied with yellowness of* the eyes and
 skin; and " ultimately the true black vomit, as  described by
 writers on the  Fellow Fever."  He describes Wilmington, as
 being much exposed to marsh effluvia, and the weather of that
 summer as having been unusually hot and dry subsequently to
 a very wet spring:  Of this fever, he says, " I have no doubt,
 in my own mind, of its having originated  among us, nay more,
 of  its differing from our common bilious remittent but in de-
 gree ; of its originating from the same causes, and being aggra-
 vated by the circumstances of the season." " I did not observe
 one instance of its being communicated by contagion; nor do  I
 believe it was so."   " A few cases every year, of our common
fall fever, take  on all the symptoms of a violent Yellow Fever."
 See New York Medical Repository, vol. 2, p. 143, 4.
   In proceeding northward,  our next object will be Norfolk,
 in Virginia, which, being a considerable port, and abounding
 in the sources  of marsh  miasmata, has,  on several occasions,
 been  severely attacked with Yellow Fever, as I  have already
 noticed, at p.  191.  Several of these attacks fell  under the
 observation of M. Valentin, who landed in Virginia, with
 many other fugitives, from St. Domingo, in the summer of
 1793, as is mentioned at p. 185 ; and  this  gentleman, after
 noticing the various  attempts made at Philadelphia, to prove
 that the disease in question had been produced by importation,
 says, at p. 84. of his  Treatise, " Nous avons vu la Maladie
 eommencer a Norfolk, sans qxCon ait pu'en accuser aucun na-
 vire recemment arrive:  les Medecins de ce lieu n'ont meme
jamais eu cette  opinion."   In the next and following pages he
 observes, that  the Yellow Fever never  appears there but in
 those months when  the air is extremely hot  and sultry, with
 but little motion.  That, in 1796, the summer was very wet,
 and  the  Yellow Fever  only appeared  sporadically; being
                            32 
250
little more than the common bilious remittent.   But, in 1797,
the drought was extreme at Norfolk, (and, consequently, the
heat) during the whole of July, August,  September, and
October; and that the Yellow Fever then raged furiously as
an  epidemic, and with  symptoms of unusual malignity, be-
ginning  about the end of August, and continuing until about
the middle of November, when the weather, becoming cold
for two or three days,  the fever entirely disappeared, as it
has invariably done in every part of the United States, soon
after the occurrence  of frost.  Between pages 92 and 102,
M. Valentin states  a  number of facts  and reasons, proving
the local origin of the disease at Norfolk, &c. and its having
manifested no contagious property in circumstances  where
such property,  had it existed, ought to have become evident.
He describes the situation of Water Street,  at  Norfolk, and
the composition of the  new-made ground,  as  it  is  called,
which  serves  as a foundation to  the  houses of that street,
adding, that it is in that part of the town that he has con-
stantly seen the greatest number of Yellow Fever patients,
labouring under the  disease in its worst forms, with  he-
morrhages, &c.  See p.  101.
  At p. 191 of this volume, I have inserted  an  extract from
an  account, given by Doctors Taylor  and Hansford, of the
Yellow Fever, as it prevailed at Norfolk, in the summer and
autumn of the year 1800; and I will here subjoin extracts of
another  account,  given of this disease at the same time and
place, hy Doctors Selden and Whitehead, two  other  physi-
cians of Norfolk, viz.  " Europeans and natives  of the North-
ern States, who had not been accustomed to warm climates,
were most exposed to  the attack of the disease in its severest
forms; those, from the same countries, who had resided here
for some time, and strangers from this and the  neighbouring
states, were not exempt,  but the disease  (in them) put on  a
milder form ; while those who  were born  in Norfolk, and
were old residents of the place, never enjoyed a greater  portion
of health, in any former season, none of them died, or were 
251
even affected with the prevailing epidemic.   This entire ex-
emption of the permanent inhabitants of Norfolk, different from
what was experienced in more northern parts of America, as
Philadelphia, New-York,  and Baltimore, may probably be
accounted for, on the supposition that our situation and cli-
mate here,  approach nearer to the circumstances of the West
India islands, where strangers in general are the only persons
attacked with Yellow Fever."
  These gentlemen  further observe, that, " for  more than
two months, subsequent to the 25th of June,"  (of that summer)
" the inhabitants of Norfolk lived in an atmosphere constantly
heated above the 85th degree of Fahrenheit's scale, and some-
times to the 94th and 95th  degree, but very frequently above
the 90th."  That, " on the 5th of October, a, deluge of rain
fell,  accompanied with a powerful sweeping wind from  the
North-East; the weather  became suddenly very  cool;  the
mercury fell to 48° on the morning of the 6th, and, on the 7th,
it was  as low as 42° of Fahrenheit.   In a/ew days after this,
not a vestige of Yellow Fever was  to  be  seen  in Norfolk."
The  same gentlemen add, " that part of the  town, where the
malignant  fever chiefly prevailed,  stands entirely on made
land, reclaimed from the river by sinking pens of  large logs,
and filling them up chiefly with green pine saplins, which  are
slightly covered over with  earth, or gravel.  In some places
large openings  are left for the formation of docks ; in  others,
wharves are formed next the  channel of the river, while the
interior parts  are still covered with water,  and, in many
others, the lots remain in  their original state."   They also
mention other sources of marsh effluvia, which acted upon, as
they observe," by the powerful rays of an almost vertical sun,"
must have been very sufficient to produce this disease, which,
as they state, " for  several weeks,  after its commencement,
was quite local."  See New-York Medical Repository, vol. 4.
p. 129 and seq.
  The same disease prevailed again at Norfolk in 1801, when
thq four physicians,  before-mentioned,  subscribed  a  declara- 
252
 tion, dated the 12th of October, 1801, in these words, viz.
 " we do certify that the malignant Yellow Fever, which pre-
 vailed  with violence  for  some  time past,  has now nearly
 ceased, and that the health of the town appears to be improv-
 ing daily.   We know of no instance in which  the disease has
 been communicated by contagion."  Medical Repository, vol. 5,
 p. 225.
   Baltimore, in Maryland, falls next under our observation.
 In this city, especially  at Fell's Point, or  East Baltimore,
 (which is greatly infested by marsh effluvia,) the Yellow Fever
 has several times  prevailed, and with great  mortality,  since
 the year 1793.  In a Treatise  on this  Disease,  published in
 1798, by Dr. Davidge, a physician of eminence in Baltimore, he
 states, that in the preceding year, 1797, " the bilious or re-
 mitting fever, in its ordinary form, prevailed in that town,
 and particularly at the Point;" and that this continued " un-
 til it was gradually lost, in the severer degree of Fellow Fever,
 as the season advanced in  the month of August:"  that, " from
 this time, until early in November, when  it  became entirely
 extinct, the Yellow Fever alone was observed; and it  was
 obviously more severe, more early in its occurrence,  and more
 general in its prevalence, in the direction of  the winds  which
 blew over certain marshes, stagnant waters, and depositions
 of filth."  He,  therefore,  considers " intermittents, remit-
 tents, and Yellow Fever, as merely varieties  of one  disease,"
 —asserting " that the Yellow Fever cannot  be propagated
 by contagion, out of the sphere wherein it originated."   See
 New-York Medical Repository, vol. 2. p. 83, 84.
  Of the epidemic Yellow Fever which occurred at Baltimore,
 in the year 1800, the faculty of medicine  of that city, in  a
 report to the mayor, say, " after the  most scrutinizing in-
vestigation, the faculty have found no proof, or even cause of
suspicion, that  the  fever which  lately so unhappily afflicted
our city, was derived from  foreign causes;"  and, in support
of this declaration, they give a particular  account of thirteen
 eases, in which the disease  first appeared, all  of whom were in 
253
persons who had been exposed to  marsh miasmata,  but had
not communicated with any vessel, " engaged in foreign com-
merce ;" and  " were attacked at  such distances  from each
other as to preclude the probability of any one of them having
derived it  from the other."   They proceed,—" the gradual
manner in  which this disease  becomes epidemic,  is an  addi-
tional proof that it is not deriv ed from foreign sources;" and
after describing the milder cases which occur at the beginning,
before the causes acquire fidl farce, they add, " if this disease
were imported, the  prominent features would develope them-
selves at first, and these precursers, and more mild grades of
the disease, could not affect thousands  on  shore, who never
had any communication with vessels from the West Indies, or
any diseased body."  " The faculty believe the following to
have been the  principal sources of this late malignant fever,"
—First, " the cove which extends  from the  mouth of Jones's
Falls to the interior of Fell's Point, the bottom of which was
left bare, by the recess of the tide, for some weeks, immedi-
ately preceding the epidemic  appearance of the fever.   This
was occasioned by the prevalence of north and east winds,
which continued a great part of the summer."  " Such is the
situation of this pestilential cove,  that all  the filth conveyed
into it by the west, north-west, and south winds, must remain
to stagnate and putrefy under  a summer's sun."   " From the
united testimony of the physicians  at Fell's Point, the disease
began on the borders of this cove; and  its  progress could be
traced through the streets,  in whatever direction the winds
wafted its poisonous effluvia.  Such was the pestilential  con-
dition of this sink of putrefaction, that tiie labourers, employed
in filling up its northern  shore, were compelled to relinquish
their undertaking early in the summer."
   " Second.—The docks, in general, but more especially the
interstices  between the wharves, where the water stagnated,
and afforded a proper matrix for the generation of pestilential
effluvia."
   They  afterwards  mention  several  fither causes,  of  more 
254
limited operation, such " as stagnant  water retained in cel-
lars," " ponds, and low grounds in the city, and its vicinity;"
—and, finally, " the made  grounds,  of whicb  the wharves,
and the lower parts of some of the streets, arc formed," a<id
then conclude,—" from these sources we derive the first cases
of the late  fever, and, from these, fomented by the summer's
sun, we believe it to have become afterwards epidemic.  We
are more strongly impelled to ascribe our late malignant fever
to these causes, from having ascei'tained that it did not exist in
the higher parts of the city, remote from exhalation, unless it
had been carried there from the Point,  or from the lower parts
of the city."
  The course I have taken leads us next to Wilmington, on
the river  of Delaware, situated on a spot which gradually
rises to the height of 109 feet, as it recedes from the river of
Delaware, between  which,  and  the  town,  is an  extensive
marshy lowr flat, more than a mile wide.  On two other sides,
it is bounded by two large Streams of water, called Christiana,
and  Brandy-wine creeks; and by the side of the first is an
extensive marsh, whicli, in the spring  of the year 1798, was
drained for the first time, so that a surface  of 100 acres  of
mud were in the following summer, exposed to the sun, which
produced very offensive exhalations;  and, in consequence of
these,  the Yellow Fever, with its most violent  symptoms, be-
came generally prevalent in September of that year, in  the
lower parts of the town, and  occasioned the deaths of above
300 persons in that quarter; whilst the more  elevated  parts
were  almost wholly exempt  from the disease.   Dr.  John
Vaughan, who has given a minute account of this  fever,  in
the 3d volume  of the New-York Medical Repository,  at  p.
368  and seq.  and who had previously believed the Yellow
Fever to be a foreign and a contagious disease,  was induced,
by the facts which  then fell under  his observation, to  adopt
the contrary opinion.   Here was abundant evidence to  pro\ c
that the disease had arisen solely from the noxious exhalations
to which the lower part of the town was particularly exposed; 
255
 and he could not discover a single instance in which the fever
 had been communicated to any person who had not been with-
 in the reach of these exhalations.
   This  fever  again recurred at Wilmington, in September,
 1802, subsequently to  an interval of very hot weather, whicli
 began about the middle of August, and in wiiich the tempera-
 ture varied from 80° to 96~ of Fahrenheit's thermometer, as
 is stated  by  Dr.  Vaughan,  in his  "Concise  History" of
 this fever, printed  at Wilmington, in 1803 : according to his
 statement, "the sources of noxious effluvia  in  the southern
 and flat part of the town were much  increased by  a regulation,
 but partially executed, for bringing the streets to an uniform
 descent  from the  summit of the hill.  A number of cellars
 were filled with water;  a new dock formed, and the  gutters
 lowered in some places, and raised  in others, forming nume-
 rous depositories of filth."  " The fogs (says he) collected in
 the evenings, were suspended on the flats during the nights."
 " This semi circuit of the fogs, from  Market Street  southward
 and  eastward, was the seat of concentrated disease."—" The
 poisonous matter exciting disease, was evidently a constituent
 part of the  fogs.  Many persons visited the infected district,
 in clear  weather,  and in the day-time, without  injury; and
 several of the same persons contracted disease by a single ex-
posure in the night time, after the fog had collected."  " The
 non-contagious nature of the disease  was repeatedly attested,
 by persons  sickening  after removal,  from  the  lower to the
 higher parts of the town, and being nursed with  every atten-
tion, and dying without communicating the malady to  their
attendants."   He adds, "the indigenous nature of the  disease
 was evidently characterised,  by the  ultimate sameness of eve-
ry form and grade of fever.   After the  middle of September,
the subordinate forms and grades of fever, not arrested  within
48 or 72 hours, invariably passed on to  the  malignant grade of
the disease."  There was a final termination  of  its progress
" by a single frost." 
256
  Philadelphia falls next under our observation.   This city
was originally intended to occupy the^af space of ground be-
tween the Delaware and Schuylkill Rivers, a few miles above
their junction; it has,  however, been found more convenient
to extend it to a greater distance along the west bank of the
Delaware, under which hank, upon a  low space  of ground,
originally  intended as a cartway to  the  wooden wharves
which abut and encroach upon the bed of  the liver,  an exten-
sive street, called Water-Street, has been formed, extending
from the northern line  of the city, southward to  the swampy
ground given by the founder, William Penn, to be  formed into
a dock, which, not  being done,  and the exhalations from this
swamp proving noxious to the inhabitants, it has  been arched
over, and covered with earth, so as to  become the foundation
of a street, called Dock Street, near which an offensive sewer
empties itself into the Delaware.
  The ground between the southern extremity of the city, or
rather of the suburb, called  South wark,  and  the  junction  of
the Delaware  and Schuylkill, is generally  very  low, rich,
and damp,  I might say swampy in many places ;  and, appa-
rently, is as well suited to  produce marsh miasmata as any
part of Zealand, and  with  greater morbific powers,  because
the summers at Philadelphia are much hotter.  On the north-
ern extremity also, in and about the suberb called Kensington,
are low swampy grounds, of considerable extent;  and a great
part of the city  itself  stands upon a loamy,  or  brick earth,
which is very impenetrable to water.   Thus  situated, it can
hardly be necessary to observe,  that  Philadelphia has been
frequently infested by  marsh fevers, though  it is not known
that, previous to the year 1793, they assumed epidemically the
violent form of Yellow  Fever, except in the years 1699,  1741,
 1747, and 1762.*  The great mortality which the Yellow

   * Dr. Hush,  in the 4th vol.  of his Medical Inquiries, &c. p. 69, refers to a cli-
 nical lecture, delivered December 3d, 1766, at the Pennsylvania Hospital, by the
 late Dr. Thomas Bond, and preserved by order of the managers, in the 3d vol. of
 their Minutes, in which he declures, "that he had seen the Yellow Fever five times 
                            251

Fever produced  in 1793  at Philadelphia, is well  known.
From the great numbers attacked by it, at that time, and
the influence of pre-existenf opinions on  the subject of conta-
gion, the physicians, as well as the inhabitants, seem to have
immediately,  without  enquiry or  consideration, concluded
that it must be a contagious disease, and  most  of them in-
ferred, as a natural  consequence,  that it had  been imported
from some part of the West Indies; though there was much
disagreement in regard to the  particular vessels, chargeable
with this importation, as well as in regard to the places whence
it had been  brought;—some deriving tiie evil  from Grenada,
others from different ports of St. Domingo, &c.   On that oc-
casion Dr. Rush, dissatisfied with  the contradictory evidence
about the importation of the disease, though he admitted it to
be  contagious, and,  consequently, capable of importation,
thought he had discovered a more probable cause  for  its pro-
duction in a cargo of damaged or putrefying coffee.  Thus
overlooking the influence of marsh miasmata, which ought, at
least, to  have been strongly suspected,  considering that  the
fever began in  Water  Street,  and afterwards appeared  in
houses adjoining other swampy grounds near Dock Street,
Kensington, and Southvvark; and considering, also, that it
resembled a marsh fever in almost every  circumstance,  es-
pecially in the season at which it  appeared ; in the evident
remissions with which it  was  attended ; in the circumstance
of its leaving unhurt  all the French fugitives from the West
Indies, and others who had long resided in hot  climates ; and,
in its cessation immediately after frost.
  At the commencement of this disease, M. Devese, late Sur-
geon-General of  the  troops, in the northern  division of  St.
Domingo, who had long practised at Cape  Francais,  having
escaped from the ruins of that city, reached Philadelphia, and
though the Physicians there had generally declared the fever

in Philadelphia. The second time it was indigenous, from evident causes, and was
confined to one square of the city."  Upon this Dr. Rush remark1, that " the loca- '
lity of this fever designates its putrid origin," i. e. from marsh effluvia.
                            33 
258
to be a  contagious  disease,  he honestly and courageously
maintained the contrary, and ascribed it, exclusively, to local
causes, probably without making any converts to his opinion
at that time; but the committee of  superintendance,  and the
physicians,  willingly availed themselves of his experience in
the treatment of the disease, so far as to intrust him  with the
direction of the spacious  Hospital at Bush  Hill, which  had
been just established for  patients  under the Yelhrw Fever;
and in which  his  practice was attended with great success,
perhaps, in  some  degree, from its salubrious situation.   In
the following year, M.  Devese published, at Philadelphia,  a
Dissertation on the Yellow  Fever of the preceding year, (in
that city) stating his reasons for believing the disease to have
been neither imported nor contagious ; which,  though not so
conclusive  as we  can now give, probably helped  to induce
some, at least, of the  physicians there to inquire and think,
with  greater  freedom, on  the subject.  For in 1796,  Dr.
Rush, when giving an account of this fever,  as it occurred in
1794, (though much less extensively than in 1793) would not
admit contagion to be one of its characteristic  marks;  deeming
this quality to be rather accidental, and to depend on circum-
stances of season, country, &c. ; and, on this occasion, he ap-
parently, for the first time,  ascribed the fever to exhalations
from gutters, and stagnant ponds of water, in  the neighbour-
hood of the  city ;  having  observed, that " where there was
most  exhalation,  there  were most persons affected by the fe-
ver."  See  his Medical Inquiries and  Observations, vol. 4.
p. 63.
   In the month of November,  1797, Dr. Rush, Dr. Caldwell,
and eleven other physicians,  of Philadelphia, whose opinions,
respecting the Yellow Fever, were now at variance with those
of a majority of the College  of Physicians there,  being  called
upon  hy  the governor of Pennsylvania to state, for the infor-
mation  of its legislature,  the  results of their researches  and
experience,  respecting the " origin, progress,  and  nature,"
of the epidemic Yellow Fever, wrhich had then just terminated, 
                              259

(on the occurrence of frost,) these gentlemen, in their answer,
say,  " we conceive the fever, whicli has lately prevailed in
our city, commonly called the Yellow Fever, to be the bilious
remitting fever of warm climates, excited to a higher  degree
of malignity by circumstances to  be mentioned hereafter ;"
and they  allege the following, among other reasons, for  this
belief, viz:
   1st. That both fevers have a similar origin.
   2d.   That  the  Yellow  Fever  occurs in " those  months
chiefly in which the bilious fever usually prevails,  and is  uni-
formly checked ami destroyed by the same causes,  viz. heavy
rains and frosts."
   3d.   That  " the  symptoms of the bilious and  Yellow  Fe-
vers are the same in their nature, and differ only in degree."
   4.  That the common bilious  and Yellow Fevers often run
into each other, &c.
  '5.  But  after having made these approaches to the truth,
they state,  as another reason, that " the common  bilious and
Yellow7 Fevers are alike contagious, under certain circumstances
of the weather, and of predisposition in the  body :"*   Not
suspecting it  to be  impossible  that contagion  should ever be
either acquired or lost by the presence or absence  of such cir-
cumstances.  In the following year, the same  physicians and
others,  being then incorporated  as  " the Academy of Medi-

  • It deserves here to be remarked, that  while Dr  Rush and his associates thus
erroneously represented the common bilious, as well as the Yellow Fever, to be some-
times contagious,  the College of Physicians, in their  answer to  the governor of Penn-
sylvania, dated  December  5, 1797, state,  as their  principal  reason for believing
the two diseases to be essentially different, " that a malignant remittent lever has
never  been, to our  knowledge, contagious in this climate."  They had, immedi-
ately before, admitted the occasional existence of " solitary cases  of malignant re-
mittent fevers, the symptoms of which resemble so much the disease in question, (Yel-
low Fever)  that  they are very often supposed to be the same."   Hence we see,
that to raise up a baseless distinction  between these fevers, the College, after ad-
mitting one to be void of contagion, assume the other to possess that property,
though without proof, and at  a time when, except among the physicians in Philadel-
phia, there was  not one in twenty  of those who  had seen the disease in other
parts of the United States, that believvd what  was thus  assumed. 
260
cine of Philadelphia," were again called upon by the gover-
nor, in regard to the Yellow Fever of the preceding summer
and autumn, (of wiiich 3648 persons were computed to  have
died at Philadelphia, exclusive of many who fled and died in
the country,) and they declared, in their  letter, dated De-
cember 3d, 1798, "that  the  disease is not contagious in the
West Indies, and rarely, if ever,  so in  the United States, in
hot weather, at which time only it makes its first appearance in
our country.  So general (they add) is this opinion, that  some
physicians have unfortunately refused to admit the  existence
of the fever in its commencement in our  city, only because it
was not contagious."  Here was a farther  approximation to
truth, made by these gentlemen ; and it  is probable  that they
would have then completely  renounced all belief of the suppos-
ed contagion of Yellow Fever, had not their doing so been op-
posed by Dr.  Rush, whose mind had been so strongly biassed
in favor of that belief, that  he  could not relinquish the notfon
of an occasional or accidental occurrence of that quality until
very many proofs, in opposition  to it, and  those of  the  most
decisive nature,  had been presented to his consideration.  At
length, however, he obtained the fullest conviction  on the
subject, and announced it by a long statement of "  facts, in-
tended to prove the Yellow  Fever not to he  contagious," &c.
" In a letter to Dr. Edward  Miller," published in the  New
York Medical Repository, vrol.  6, p.  135 to 150.   Towards
the conclusion of this statement are the following passages,
viz :
  " You will perceive, from the facts and reasonings contain-
ed in this letter, that I have  relinquished the opinion published
in my  account of the Yellow Yever, in the years 1793, 1794,
and 1797, respecting its contagious nature.  I was misled by
Dr. Lining, and several West India writers," kc.----"  I am
aw are of the infiuence which such changes in medical opinions,
as I have acknowledged, have, upon a physician's  reputation;
but small, indeed, should I consider the total sacrifice of mine,
could it avert the evils which are  connected with a  belief in 
261
the importation of pestilential diseases,"  &c.  Not content
with having done this,  Dr. Rush, in the preface  to a subse-
quent  edition of his Medical Inquiries and  Observations,
made the following  declaration,  and caused it, moreover, to
be inserted in the Medical and Physical Journal, No. 85,  and
in other periodical works, viz.
   " In the 4th volume the reader will find a retraction of the
author's former opinion of the Yellow Fever  spreading by
contagion.   He begs forgiveness of the friends of science  and
humanity, if the publication of that opinion has had any in-
fluence in increasing the misery and mortality attendant upon
that disease.   Indeed, such is the pain he feels, in recollecting
that he ever entertained or propagated it, that it will long, and,
perhaps, always deprive him of the pleasure he might other-
wise have derived, from a review of his  attempts to fulfil the
public duties of his situation."
   And here I must observe, that  if the conviction  of any one
man can reasonably influence the opinions  of others, on  this
subject, the preceding declaration, by Dr. Rush, ought to pro-
duce that effect; made  as  it was, not precipitately or capri-
ciously, but with slowr  and cautious deliberations ; not from
the impulse of former prejudice, hut in direct opposition to it;
not from a vain desire of appearing to be infallible, by vindi-
cating opinions inconsiderately promulgated, but with a  con-
scientious and humble, (I had almost said humiliating) purpose
of condemning and renouncing such opinions, and  of atoning
for them, if necessary, even by the sacrifice of his reputation,
at the shrine of truth.   I flatter myself, however, that no loss
of reputation has been incurred  by this  proceeding.  To me
Dr. Rush appears as being more  estimable  after  this honest
avowal of an  error,  than he would have been,  had  he  never
fallen into  it: and I earnestly hope, that in similar circum-
stances, I should, most  willingly, follow his example.
   When Dr. Rush thus denied the supposed contagion of Yel-
low Fever, he had probably seen more  of that disease  than
any other physician in  any country; and  if the many thou- 
262
sands of cases of it, which fell under his immediate observa-
tion,  and the still greater number of which he was doubtless
informed, not only did not  afford any  such evidence of con-
tagion, as, with the aid of his prepossessions, could maintain
him in his former belief on  that subject, but, on the contrary,
manifested so unequivocally a total absence of any contagious
quality,  as, in  spite of these prepossessions to impel  him to
make the declaration before-mentioned, who that supposes Dr.
Rush  to  have possessed  common  intellect and discernment,
will believe  the Yellow  Fever to be  contagious;  unless he
knows it to be so by unquestionable facts within his own ob-
servation, and of  the  most decisive import.  Facts, such as I
believe to have  never existed, in regard to this disease.
  Numerous statements,  concerning the origin, progress, and
nature of the Yellow Fever, at Philadelphia, in different years,
are now  before  me ; all agreeing in the niost important points
with those which  I have recently  introduced, concerning its
appearance at Charleston, Norfolk, Baltimore, &c. and, there-
fore, lest I should exhaust the  patience of my readers, I will
only select a few passages, from a lecture, introductory to a
course of clinical lectures,  delivered  at  the Infirmary of the
Public Alms House,  in  Philadelphia, by Charles Caldwell,
M. D. respecting the Yellow  Fever, as it occurred  there,
in 1803.
  After various preliminary  observations, together with an
account of the very sultry,  humid atmosphere, which prevail-
ed  at Philadelphia during the month of July,  and  excited
many distressing  apprehensions, (the thermometer commonly
indicating a temperature between 80  and 90 ) Dr. Caldwrell
mentions two cases of disease, which appeared on  the 19th of
that month, " in adjoining  houses  at the corner of Chesnut
and Water Streets; and were but too well calculated to realize
and confirm these  melancholy anticipations."   These  cases
were  those of two " females, under the age of sixteen years;
one of whom died on the  5th day of her illness, and the other
recovered ;  but they both exhibited unequivocal symptoms  of 
263
malignant fever.*  It is worthy of remark, that, adjoining to
the houses where these  persons resided, were a yard and pri-
vate alley, containing stagnant water and putrid substances,
which, for a week or ten days previously, had emitted a smell
highly offensive to the  neighbourhood.  The families where
the sickness occurred,  did not hesitate to attribute their mis-
fortune to this insufferable stench."  " From  the 28th of July,
till the 5th or 6th of August, four other cases  of malignant
fever appeared in the  same neighbourhood, three  of wiiich
terminated fatally."  These persons had  not " the slightest
intercourse with each other, nor with  any common source, ex-
cept the atmosphere of the place where they resided.  A know-
ledge of this induced  most  of our  citizens  to  consider this
disease as nothing else than  a high grade  of autumnal fever,
or, what was  afterwards very emphatically  denominated the
Water Street fever."  Another " very decided case (of malig-
nant fever)  made its appearance in the person of Mrs. Cole,
on  the  23d, and terminated, in death, on the 27th  of July."
She " resided  in Water,  near South  Street, upwards of a
quarter of a mile from  the  former situation,  and had not
been out of her  own  neighbourhood for several weeks pre-
viously to her illness."
  " There existed another point where malignant fever threat-
ened at the same time to attack us.  This was in  Water, near
Race Street, about a quarter of a mile in an opposite direc-
tion from Chesnut Street."  " Mr. Jolly,  of that neighbour-
hood, sickened  on the 28th, and died on the  31st of July,
with symptoms of high  malignity.   Between the 1st and 10th
of August,  six  other  persons,  in the same neighbourhood,
but  who had no  intercourse with each other, were attacked
by the disease, one of  whom died on the 4th day of his ill-
ness : the others all recovered."  In none of these cases was
the fever communicated to any other person.

  * It will, doubtless, have been  already observed, the terms Yellow Fever, and
 Malignant Fever, are used by the physicians of the United States as synonymous. 
                           2U

  " As yet all parts of Philadelphia, except  Water Street,
which must be regarded as the low ground of the river Dela-
ware, enjoyed an unusual  exemption from disease."*  " On
the 12th of Angust we had a  heavy fall of rain, which  was
succeeded by a remarkable change in the temperature of the
atmosphere, the mercury sinking ten degrees," by a preva-
lence of northerly  winds for ten  days,  during which " the
city remained free from any further  cases of malignant dis-
ease."
  " On the 23d of  August the wind shifted to the southward,
and the  atmosphere  became humid,  warm, and  oppressive.
This  change was viewed  by many as  a  precursor of further
sickness."   " On the morning of the  25th, a dreadful fire
broke  out  in Water, near Market,  Street," and " drew to-
gether a vast concourse of people.  Of these  some were en-
gaged in violent exercise, while others were standing idle in
the streets,  on the  tops of houses, or at windows, many  of
them  only partially dressed."  This occurrence  "was  well
calculated to act as the exciting cause of disease; accordingly,
in the course of two  or three  succeeding days, eight or  nine
persons, immediately adjacent to where  the fire had raged,
were  attacked  by malignant  fever."  They had  all "been
more or less exposed at the fire," without having  " previous-
ly had any  mutual intercourse."   " The disease appeared
suddenly, and  nearly at once; in five or  six families, the in-
dividuals of which had  never  exchanged a visit,  or even a
word,  either business  or ceremony.   From this time,  the
number of sick continued daily to increase."   " But  this was
not all.   During the first week of September,  the disease re-
newed its attack, in all those neighbourhoods wiiere it had
made its  appearance in preceding parts  of the season.   In-

  * Here Dr. Caldwell remarks, that, in the autumn of the summer in question,
 " the low grounds of most large rivers in the United States, were subject to malig-
 nant fever. Along the banks of the Susquehannah, the ravages of this disease
 were melancholy and unprecedented. In some instances it hurried whole families
 to the grave." 
265
deed,  there were now scattering cases of it in most parts of
Water Street, between  Race and Almod Streets;  a distance
of somewhat more than a mile.  But the district, extending
from  Market to  Walnut  Street, and from  the east side of
Front Street to the river Delaware, constituted the principal
theatre of its ravages.   With such violence did it rage within
these  limits, that, on  the 12th of the month, the Board of
Health thought it right to advise  the inhabitants to remove,
and to interdict all  unnecessary  intercourse with  the  sickly
neighbourhood."
   " Throughout the remainder of the month of  September,
and till near the close of the first week in October, the dis-
ease continued,  by feeble efforts, to advance  slowly from the
low ground of the river, towards the  more elevated parts of
the city.  Except, however, in alleys, and other filthy places,
 inhabited by the poor,  it did not make its way across Second
 Street, nor did it, save in a few places, advance even so far.
 It may be confidently asserted,  that that portion of Philadel-
 phia, which lies  to the  westward of Second Street, never
 enjoyed a higher exemption from disease, than during the late
 season.   As the fever receded from the lowr ground,  and ma-
 lignant  atmosphere  of  Water Street,  it became more and
 more mild, and  manageable, till  its  evanescent shades  in
 Second Street were, in many instances, much lighter than the
 common  remittent of the country."
    "  After  the  10th  of October,  the disease was no  longer
 spoken of as a thing dangerous or alarming; and, before the
 20th, there was scarcely a case of it  existing in the city."
    " As it has never been alleged by any one, that the malig-
 nant fever  of last season  was introduced  into  Philadelphia
 from the West Indies, through  the  channels of commerce,"
 &c.  those  who considered  it as an evil necessarily  of extra-
 neous birth, looked to New York  alone,  as the immediate
  source of our misfortune."
    " Though facts were daily occurring to convince them, that
  the  disease could not, by any mode of communication, be
                            34 
26b'
 transplanted from Water Street even to Third Street," (i. e.
 across two  parallel streets only) " they still contended, that
 it had been conveyed from New York to this place, either by
 land, by  water, or  perhaps  on  the  wings  of the easterly
 wind."  To shew the absurdity of this Dr. Caldwell observes,
 that this fever first " appeared in New York on the 17th, and
 in Philadelphia on 19th of July ;"  and that " contagion could
 not possibly be  conveyed thence to Philadelphia, and there
 communicated so  as to produce its effects,  in the short space of
 two days;"  and, moreover, that " it has been clearly proved,
 as far as a negative  proposition is capable of  proof, that the
 late  fever of New York could not be  propagated  even in
 Newark, Brunswick,  Amboy,  nor any  of the neighbouring
 towns or villages,  though thousands of the citizens removed
 thither, many of them actually labouring  under  the disease.
 How then,"  says he, " could  it be conveyed ten times the dis-
 tance by one person in health."   Other cogent reasons are join-
 ed to these,  which I omit as being superfluous. I have been
 induced to prefer this account of the Yellowr Fever of  1803,
 in Philadelphia, (extracted from the New York Medical Re-
 pository, vol. 1,  second Hexade, p. 143 and seq.)  principally
 because the early interruption,  which it received by a  dimi-
 nution of the temperature of the atmosphere, rendered its pro-
 gress slower, and its extension more limited, than  usual, and
 thereby afforded  opportunities of distinctly observing,  and
 circumstantially  describing,  the  facts,  regarding its  com-
 mencement  and   propagation,  which  is  often  impossible, in
 more rapid,  violent, and extensive epidemics.
   Next after Philadelphia, the city of  New York  claims our
 attention.*  Many  sources  of marsh  miasmata  appear  to

  • An accurate description of the local circumstances of this city is perfixed to Dr
Miller's report to the governor of the state, " on the malignant disease which  pre-
vailed in the city  of New York in the autumn of 1805."  It is in these words,—
 •' The city of New York lies in lat. 40° 42. 8. N. and long. 74e 9. 45. W.; at the
confluence of the River Hudson, and  of Long-Island Sound, or the East River;
and on the southern and narrow extremity of Mahattan  Island, which is about fif- 
267
 have  been created  and annexed to this city,  subsequently to
 the peace and independence of the United States, in 1783.  It
 was,  however, long since, and, probably, from its beginning,
 very  frequently troubled with intermittent,  and what  were
 called bilious remittent fevers;  probably sometimes aggra-
 vated,  by great summer heat, into the violence and mortality
 of Yellow  Fever:  though,  by  the  want, or  negligence of
 medical writers, we have no accurate account of them.  It
 may, I think, be presumed, that  an epidemic of this kind oc-
 curred at New York, in"the months of August and September,
 1702;  mention being made of one which in  those months
 (when no other fever is likely to have prevailed epidemically)
 killed about seventy persons weekly, by George Keith,  in the
 account of his travels  from  New Hampshire  to  Curituck:
 (printed in London,  1706.)   He  had then  become  a clergy-
 man of the Church  of England, after having been a Quaker;
 and appears to have preached on the 30th of September, at a
fast  appointed by  the governor,   on  account  of  the recent
 great mortality which then amounted  to 500 persons, a very

teen miles in length,  and  from one to two in breadth.  The site of the city, as it
originally  stood, was veiy  irregular,  being broken into hills and declivities, and in-
dented with small rivulets or creeks, skirted with marsh.  Many of the hills are level-
led ; but the marshy grounds, though covered with houses and pavement, are still
low and moist.  The  city is about  twenty-seven miles from the ocean,  and  is
washed on both sides with water of great depth, whose  current is very rapid,
whose  tide ebbs and flows about six feet,  and which is nearly as salt as that of the
neighbouring sea. On both sides of the city  considerable encroachments have been
made on  the water, by artificial ground,  the  whole extent of which   may be
computed at  not less than 132 acres.  Of this, ninety acres lie along the East River,
and forty-two along the  Hudson.  The portion of it on the East River forms that
part of the city where malignant level's have always first become epidemic, and
chiefly prevailed'*  The wharves and docks are constructed of logs and  loose stones.
All the fresh water, used by the inhabitants, is procured from wells within  the city,
and is  now  become extremely impure.  The population of New York may be
estimated  at about  76,000.
  • Dr. Miller explains this in another place, by observing, that the  " made ground
on the  North, or Hudson's River, is much less extensive,  and the materials com-
posing it much less foul and corrupt, than that on the East Uiver ;" and that "the
miasmata  come  to maturity on the one side, two or  three  weeks sooner  than on
the other." 
                          268

considerable proportion of the inhabitants at that period! Over-
looking the intermediate space of time until 1791, we find,
that a considerable number of cases of Yellow Fever occurred
in the  autumn of that  year, in a part of Water Street, near
Peck Slip, then noted for the filthy state of the  neighbouring
docks.  Others occurred to a greater extent  in  1794; but
were confined to persons who either lived,  or were commonly
employed near the slips, wharves, and other obvious sources
of marsh miasmata; and this was the case in the three follow-
ing years.  In 179$, the disease prevailed more violently and
extensively as an  epidemic, and was computed by Mr. Har-
die, in his plain and circumstantial account of it,  (printed in
8v0.  at New York,  1799,) to have  occasioned the deaths of
2086 persons in that city.  The committee, appointed by the
Medical Society of the State of New York, to inquire into
the symptoms, origin,  &c. of this disease, appear, by their
printed report, to have been convinced of its domestic origin,
from local causes: and they declare, as  the result of their
experience, that " it is not a contagious or catching disease,"
in the popular and common acceptation of the phrase; that it
is not communicable from  person to person," &c.  See New
York Medical Repository,  vol. 3,  p. 293.
   During the summer and autumn of  1800, in the neighbour-
hood of  Water Street, and of the different slips, and other
 acknowledged sources of miasmata, one hundred or more cases
 of Fellow Fever  occurred simidtaneously and  intermixed,  in
 the same situations, with  intermitting and bilious remitting
 fevers:  of the former, more  than fifty terminated fatally,  in
 a  few days; many  of them " exhibiting  the  symptoms  of
 yellow skin, black vomiting,  and  stools, Hemorrhages, &c."
 On this occasion it was not pretended that any  importation
 of the disease had been made, nor that it had been propagated
 by contagion, " beyond the  limits of that portion of the at-
 mosphere of the town, allowed  hy every body to have been
 contaminated by the exhalations of putrefaction; and  within
 such limits it is well known that an  adequate cause  is con- 
269
atantly in  operation," independently of  contagion."   See
New -York Medical Repository, vol. 4, p. 207-8. About twice
as many cases of Yellow Fever occurred in the following year
at New -York in the same months,  and in nearly the same
situations, with similar results.
   In the summer and  autumn of 1803, this disease recurred
more extensively, and with greater violence, in consequence
of the  excessive hot weather which began  early in July, and,
excepting five or six days in that month, (say Doctors Mitchell
and Miller,) was more intensely and uniformly hot, than we
ever remember before to have experienced in this climate, for the
space of^somc time."   " The first public alarm took place
from some deaths  about the Coffee-House slip, and  in  that
neighbourhood, where, from the number and malignity of the
cases, the atmosphere must have been charged with miasmata
of great virulence."   " The streets lying near the margins of
the two rivers, and those inhabited by the poor," kc. " suf-
fered the principal ravages of the disease."  A large portion
of tne  sick  " consisted of instances in which one individual
only was attacked in the midst of a family, the members of
which  assiduously attended  the  patient, without contracting
the disease.   Many aged, and very young persons, whose con-
dition imposed confinement in their houses, without the occur-
rence of  any preceding case in their families, were attacked
with the disease  in its most virulent form.   Multitudes, also,
took the disease, who had not previously approached any sick
person, any suspected vessel,  or any families alleged to be
imbued with contagion.  One person was attacked in the
Debtor's Prison, who, for three months before, had not been
beyond its walls, and no other person in the prison was pre-
viously, or subsequently, affected with the disease;  many who
fled from the city, were attacked with  the  disease and died,
not only  in  all the surrounding country,  but at Newark,
Elizabeth town, Brunswick, kc. without communicating  in-
fection, in a single  instance,  to physicians, nurses,  or any
other attendants.  But, they  add, one of the most decisive 
270
proofs of the non-contagiousness of Yellow Fever, is derived
from the absence of all contagious influence from our Yellow
Fever Hospitals."  " These  asylums are  generally erected
within two or three miles of  the cities to which they belong,
but entirely beyond the reach of an atmosphere contaminated
by the  local miasmata of the city.  Neither in  New-York
nor in Philadelphia, is there a single example of a person em-
ployed  in these Yellow Fever Hospitals, being attacked by
that disease, unless he had previously passed sometime within
the limits of the sickly city."  See  New-York Medical  Re-
pository, vol. 7, p. 183-4.
   In  a letter from  Dr. Miller, the resident physician for the
city of  New-York, to his excellency Governor Clinton, dated
January 6, 1804, the preceding facts are more minutely stated,
with the others, proving, as far as the subject was susceptible
of negative proof, that the fever in question did not arise from
any foreign or imported contagion.  Of the mortality produced
by this fever, from its commencement, about the 20th of July,
till its cessation, at the end of October, Dr. Miller says, " the
number of deaths in this city  amounted to 503 ; those at the
Hospital at Bellevue, to 103,  and those  at  the Marine Hos-
pital, in Staten  island, to  68; making  a  total of 674 : to
which should be added an indefinite  number,  who  fled from
the city, and died of this  disease in the neighbouring country
and  villages."  See  printed  "  documents,  relating to the
Board of Health."  (New-York, 1806, 8vo.) p. 35.
   The summer of 1804 was but very moderately warm along
the coast of America, northward of  Carolina, and, as might
be expected,  the Yellow Fever did not recur at New-York,
&c. in that year.  But the summer of 1805  was, according to
Dr. Miller's official statement,* "remarkable for the duration,
as well as the intensity, of heat, along the whole of our coast
(United  States);  and the  consequence was, not only  that
  * In his  masterly report, made as resident-physician for the city of New-York, to
Uie governor of the state, dated January 12, 1S06, and printed with "documents re-
lating to the Board of Health," 8vo. 
271
 nearly all the Atlantic cities were visited with pestilence, bin
 that, in several of them, it made its appearance in forty-eight
 hours, or nearly of the same time, an occurrence which cannot
 he explained on the  contingency of contagion."  As usual,
 sporadic cases of the disease first occurred :  but,  at the begin-
 ning  of September, these,  according to  Dr. Miller's official
 report, " had become so numerous as to ascertain the exist-
 ence  of tiie  epidemic;"  which, throughout  September and
 October, continued to prevail with more or less  severity,  ac-
 cording to the fluctuating states  of the weather;  hut, towards
 the close of the latter month, the coldness of the season had
 evidently checked its progress, and, at the beginning of No-
 vember, the city was  nearly restored to its usual  health.
   From returns,  authenticated  by  the  city  inspector,  (Mr.
 Pintard)  it  appears that  the  number of inhabitants then
 amounted to 75,770,  and that of these 26,996 retired from the
 city : and, as may be presumed, from  the  most unwholesome
 parts of it;  by which the number of persons attacked by the
 disease was doubtless much diminished  :  as it only amounted
 to 645, and that of the  deaths to 302 :  Of these  twenty-eight
 were in the Marine Hospital, and fifty-two in that of Bellevue:
 and about forty  others  are supposed to have  sickened and
 died in the country, after their flight.
   Dr. Miller, in  his  report to the Governor, states that,
 " during the early period of the epidemic, nearly all the cases
 took place" (as formerly) " on the  eastern side of the city,  in
 Front, Water, and Pearl Streets, and principally below Bur-
 ling Slip :"   But  " afterwards became more diffused :" and,
 " about the 20th of September, began to prevail near the  north
 river :"*  Where, from circumstances already mentioned,  he

  * Party zeal and prejudice often render men incapable of deriving any evidence or
information from facts, but such as suit their own views and purposes.  Dr. Chisholm,
at page 205 of his letter to Dr Haygarth, introduces one to himself, from Dr. Ilosack,
dated New-York,  July 9th, 1808, in which there is an abundant display of zeal,  I do
not say for maintaining the cause of truth, but for asserting the supposed contagion and
importation of Yellow Fever: He also communicates his intention to torite and print 
272
 supposes that " the  miasmata  come to  maturity"  later  than
 on the east side.   He adds,  " on the whole,  the low grounds,
 on the margins of the two rivers,  certainly produced a chief
 part of the cases."   P.  46.

a letter, charging Dr. Miller with " want of candour" in his official report to the go-
vernor;  which charge he founds upon the following statement,  viz.
  "As a member of the Board of Health, he (Dr Miller) must have known that the
disease was confined for many weeks to a small portion of the eastern side of the city,
and that, not a case occurred in any other part of the town, that was not  referable to
that, as its source.  Such Was the statement of the Board of Health, to our citizens,
and, in consequence of which, they forbade intercourse  with the  infected portion of our
 •ity, and ordered an abandonment of that part of the town, etc "
  He  adds,  "a few weeks  after, the infection extended a few  streets  further.   The
Board of Health accurately defined its limits, and again declared, that still not a case
occurred but could be traced to this spot of the city, as its source. Dr.  Miller care-
fully enumerates the cases occurring, and the numerous parts of the city in which the
sick reside,  but as carefully suppresses the observation  of the Board, of which, too, he
was a member, and must have known, that the  persons so taken  sick,  had,  prior to
their attack, been exposed to the infection by frequenting the infected spot."   How
strangely Dr.  Hosack here mistakes the obvious  import or evidence of an important
fact ?  One of the strongest proofs of the local origin of Yellow Fever,  results from the
 circumstance of its beginning, and remaining, almost  exclusively, in particular  spots
or situations.   Of this,  Dr. Miller was very sensible; and, if he omitted to state  " the
observation of the Board," respecting it, he could only  have done so because it appear-
ed superfluous, after he  had so distinctly mentioned the facts to  which it related.  And
 is it, then, possible, that Drs. Hosack and Chisholm can have been so inept as to believe
that these facts could operate in supporting their  opinion of  the importation and conta-
gious nature of this disease ? Do  they conceive, that if it were contagious, it would have
been so many weeks confined to one spot,  and that, when it afterwards " extended a
 few streets  further," those  only would have been attacked by it, who had visited that
identical spot ? This is exactly what  would happen in regard to a disease not contagious,
but arising  from miasmata; because, the soil in which they are produced being immova-
 ble, and its exhalations  incapable of causing disease, at any considerable distance from
 their source, persons to be acted upon by them must necessarily approach that source.
 But contagion having no such immoveable origin will not be thus confined ; persons in-
 fected by it, and sickening in different places,  naturally infect others,  who soon spread
 the disease widely,  so that the spot where  it'first appeared often becomes  less dange-
 rous than most others,  and its atmosphere does not continue to produce disease,  when
 the sick have been removed, and the houses shut up,  as happens in cases of yellow le-
 ver.  With the same fatuity, Dr.  Chisholm, in his letter to Dr. Haygarth,  has pub-
 lished one from Dr. \. Fpthergill,  late of Bath,  who,  writing to the American consul,
 at Bristol, of the Yellow Fever at Philadelphia, iu 1805, and ii.entioning that it had, in
 November, received h check, apparently from the cooler season setting in ;"  adds, " It
 remained for  some weeks a local disease  in the southern suburbs," (adjacent to the 
273
   Dr.  Miller adds, at  p.  53, " It appears, from the  records
of this  epidemic, that there were  thirty-one streets of the city,
most of  which continued to  be crowded with inhabitants,  in
which only a single case occurred in each ; and, in the mass of
six  hundred cases,  reported to  the Board  of Health,  there
were only thirty-five houses in which more than a single case
was found."  " The  great mass of persons attacked with the
disease,  consisted of such as never had approached the sick,
or any other assignable source  of contagion ;  and, on the con-
trary,  as will  presently appear,  great numbers were exposed
to close intercourse with the sick, without injury."
   Further, in regard to this epidemic, the health officer, Dr.
Rodgers, made a long, minute,  and satisfactory  report to the
Board of Health, (dated December 19th, 1805) of every ves-
sel, and  of every circumstance, connected  with the possibility
of an importation of the disease,  which  is concluded in these
words.  " I have now clearly shewn,  as far  as negative proof
can go,  that whatever might  have been the  cause of the late
epidemic, it did not arise from  any neglect of duty at the qua-
rantine ground, nor did it come  through  that channel."*   Pre-

marshy low grounds, at the confluence of the Delaware and Schuylkill) "b it, at length
was communicated to several of the principal streets in the city, as far as Eighth street,
westward,"  (persons who had been exposed to miasmata in other places, happening to
fall sick in these) "but it chiefly infested Water street, Front street," (running paral-
lel with, and next to Water street) "and the margin of the Delaware."  He adds,
" many of the professors and medical practitioners here, deny that the disease is conta-
gious, and in this notion the body of merchants bear them out."  Dr. Fothergill, how-
ever, adheres to the  old notionM contagion and importation,  and no wonder that it
should have adherents, in men who fancy they can see evidence of a contagious quality,
in facts  which decidedly proVe the contrary, to all who are able to  reason with impar-
tiality.
  In the letter first mentioned, Dr. Hosack invited Dr. Chisholm to "visit the United
States," adding, "you would find materials for giving a final blow to your enemies:
three or four months residence here would be sufficient."  Was this a sincere effusion
of intolerant zeal, or did Dr. Hosack intend that his invitation should reach Dr. Chis-
holm on the first of  April ?
  * One motive for this report appears to have been, that " attempts had, as is stated
by Dr. Kodgers, (p. 19) been made by some, to prejudice the public mind against him,
because he," (who had had the best opportunides of observing and judging of the facts)
                                35 
214
 vious to  this conclusion, the health officer had  given an ac-
 count, in detail, of all the early  cases of Yellow Fever, which
 came under  his notice,  in order that the  board  might judge
 whether the disease went from the  quarantine ground to  New
 York, or came  from the city,"  to the Marine Hospital.  01*
 these  cases  a  great  proportion  occurred in  " a  particular
 neighbourhood  in Water Street; which neighbourhood did not
 exceed two hundred  yards from one extremity to the other."
 " The circumstance (says he)  of so many  sickening  in one
 house, and within so  narrow a  compass,  in Water Street,  and
 the disease having appeared in a former year first in that  very
 neighbourhood,  and  in  every  year  of  pestilence,  always first
 shew ing itself  in situations precisely  similar, establish the po-
 sition of a domestic origin.   IN or can it be pretended, (he adds)

" believed in other causes of disease than importation."   These " attempts" seem to
have been connected with a newspaper attack, (which 1 have not seen)  made by Dr-
 Hosack, of New-York, on Dr. Rodgers, in the preceding month, when the latter had
shown some unwillingness to allow the former, accompanied by two other persons, to
inspect the Marine Hospital,  without some  pledge on their  parts, to secure  himself
against a repetition of the ill-treatment or  misrepresentation which he complained of
having lately suffered.  Dr. Chisholm, in his letter to Dr. Haygarth, (pages 72 and 73)
avails himself of this transaction to charge Dr. Rodgers with having "made a most sin-
gular and unexpected attempt to exact from these gentlemen a preliminary stipulation
of concealment;,: and appears to attribute it to guilty apprehensions in Dr Rodgers;
asking, " why have recourse to arts so unbecoming; were there not sinister objects to
be obtained VJ Knowing nothing of this  transaction but the  little which Dr. Chis-
holm has stated, I am but ill qualified to answer his question.   I can, however, easily
conceive, that, as Dr. Hosack had been long known to be a very zealous  advocate for
the supposed contagion and importation of yellow fever, Dr. Rodgers  might well sus-
pect, what seems  to be true, that the former had come to inspect the Marine Hospital,
and quarantine ground, in the hope of discovering something to enable the believers in
impurlation to obviate the tiiumph of their opponents*or, at least, make it a matter of
doubt, whether the disease of that season had not arisen from imported contagion; and,
as this would, of necessity, imply negligence on the part of Dr. Rodgers, and as he
could not well expect candour and fairness from one so much prejudiced, and acting
from the motives just mentioned, it seems to me that Dr. Rodgers might, very ho-
nestly, have wished to secure himself from misrepresentation, and that it would have
better become Dr. Chisholm had he been less eager in  attributing bad motives to Dr.
Rodgers, especially as it appears, that after Dr. Hosack and his friends had seen all they
wished to s. e, they could find no subject of complaint, except Dr. Rodgers's backward--
ness in gratifying their curiosity. 
275
that the communication between quarantine grourid could pro-
duce it here, because this was exactly the place where,  of all
others, the communication  was least:  nay, there could be
none  at all, for there were no stores,"  &c.  " nor had  any of
these thirty-five patients been at the quarantines, at any time
of the summer previous  to their  admission, nor  had any of
them any  connexion with  infected ships or  diseased  per-
sons."
  In order to  bring this view  to a conclusion, I have only to
notice, in a few words, the occurrence of  Yellow Fever at
New London, in  Connecticut.   At Providence, in  Rhode
Island, and at Boston,  in Massachusett's Bay.  At the for-
mer of these  towns, this  disease appeared as an  epidemic  I
believe for the first, and only time, in the months  of August,
September, and October,  1798, in which the summer was in-
tensely hot and  dry, beyond all example ;  the thermometer
having been,  for several days, in succession,  at from  95° to
97°.  The disease  first appeared about the  26th  of August,
and terminated in October.  " The whole number of persons,
whose complaints clearly indicated the pestilence,  or,  as it is
called, the Yellow Fever, did not exceed 246 ;" and, " of the
above number, 231 cases were clearly traced to the spot where
the  sickness commenced; that  is,  the  patients  were conver-
sant, or had been in that part of the city, a few days, before
they were seized.  The part in which the septic gas appears
to  have been so highly concentrated, extended sixty  rods
north  and south," (along the harbour) " and about  twenty
rods west, being  bounded easterly on the harbour."  This  cir-
cumstance clearly manifests the connexion of the disease with
miasmata, proceeding from  the grounds, wharves, &c. imme-
diately adjoining the water;  though the respectable  clergy-
man, by whom (with the approbation of several other gentle-
men members of the committee of health,  &c.) the account on
which I principally rely, was drawn up, appears to  ascribe
the disease chiefly  to exhalations  from a quantity  of salted
 fish then beginning to putrefy,  within the  space where the 
216
 disease began.   He  adds, "we have not even a shadow of
 ground to suppose the disorder was not of domestic origin."
 Dr. Coit, a physician  of New  London,  in a  letter  to  Dr.
 Mitchell, states, that the persons first attacked, (and to whom
 he was called) were an  innkeeper, with  his wife, son,  and
 daughter, living in a street  next and  close to the  Water,
 (Bank Street) and that within a very few  days he was called
 to  eleven other patients  in the same  street,  and  all within
 eight rods of the innkeeper's House. Eighty-one persons died
 in all.  There was  no  appearance or  suspicion of contagion
 from the sick.   See New York Medical Repository, vol. 2. p.
 304-5, and 372 to 378 ;  also vol. 3, p. 229.
   At Providence, the Yellow Fever became prevalent in 1797;
 also in 1800, and again  in 1805.   " It has uniformly made its
 appearance, and committed its principal ravages, in the south
 part of Water Street,  or the lanes and alleys  immediately ad-
jacent; and those solitary cases, which have occurred else-
 where, could,  with very few exceptions,  be traced to this de-
 voted spot."  " The  portion of Water Street which has been
 thus repeatedly the seat of Fellow Fever, is less than  a  hundred
 rods in length.   It has,  in this place, a  south-east  direction.
 The houses on the water side are  built,  as near as possible,
 to the  natural bank of the  river.  The wharves,  of course,
 which are extended in rear of  them, westward to the channel,
 are artificially raised, partly filled with earth, and partly con-
structed  with logs,   covered  with oyster-shells and earth,
leaving vacuities  beneath,  &c."   " The  south-end  of  the
street is bounded by a small cove, or inlet  from tiie river,
 which receives, through a swale,  or ravine, (before noticed)
the wash of an extensive range of meadows;" which, fer-
 menting  in  hot  weather,  afford unwholesome exhalations.
To these  and other  local circumstances,  described  by  Dr.
 Wheaton,  (in his " Brief Account of the Yellow Fever, which
 has appeared, at different times,  in Providence,") he  adds,
that the spot just mentioned is " confined  by hills eastward
 and westward;" and that, by " presenting  a south-western 
211
slope to the water, it gives to the mid-day, and afternoon sun,
an almost vertical power."
  Dr.  Wheaton informs us, that the summer of 1797 had
been remarkable for a long continued drought; but, about the
1st of August, there ensued  " abundant rains," which "were
succeeded by an intensely Iiot sun; the thermometer, in an airy
situation ranging from 86° to 91c." " The Yellow Fever made
its  first decided  appearance on  the  13th  of August," and
" continued to rage to the 30th of September, in which time
it attacked 102 persons, of whom forty-five died.   Its early
disappearance was ascribed to the almost  universal desertion
of that  part  of the town,  and to a " very heavy  rain and
tornado," which occurred on the 8th of October.
  " In  1800, the first case of  Yellow Fever occurred  on
the 15th of August, and the disease continued to prevail  until
the 5th of October." " There were,  this year, eighty-three
reported cases of Yellow Fever, of Which fifty proved fatal."
The sickly district was more " universally deserted than  in
the preceding year; a  circumstance  which may account for
its early disappearance, as the other parts of the towns  were
uncommonly healthy."
  "In  1805, the disease made its appearance as early as the
25th of July, after  a very unusual duration of hot  and dry
weather.  As the  town  council  directed  an  immediate and
complete evacuation of this part of the town, it soon subsided,
and, on the  10th of August, had disappeared.  The people,
however,  being impatient to return to their habitations, se-
veral new cases occurred in September."   " Here, as  else-
where," (adds Dr.  Wheaton) the Yellow Fever  " has not
been propagated by the sick in  situations otherwise healthy;
or, in otlier words, tins not been fmind contagious.   Of a great
number removed to the  Hospital, in an airy situation, south-
west of the  town, there has been no  instance of the  disease
being taken by the attendant physicians or nurses.   See New-
York Medical Repository, vol. 10, p. 329 to 337.
   At Boston, during the prevalence of very warni weather, in 
278
the montli of Augu.st, 1796,  and " at the south-east part of
the town, near  a considerable  extent of flats, which  were
daily exposed, for some hours, to the action of the sun, a fever
began, and spread thence to the neighbourhood of some of the
docks, proving  fatal to  about  thirty persons.   Dr. Warren,
an  eminent  physician there, in a Letter to the American
Academy of Arts and Sciences, then declared that he had,
almost every autumn, seen  at Boston a considerable number
of similar cases, " not excepting the black vomit, nor the yel-
low skin;"  and that it was, " what is properly termed, a
bilious remittent fever."
   " In the year 1798 this fever  recurred in a very aggravated
form, during the prevalence of extremely hot weather,  when
the thermometer was often  above 90", and sometimes at 96°,
of Fahrenheit's  scale.  It  attacked only those who lived, or
passed sometime in the vicinity of a mill-pond,  drained  of its
water, so  as to leave the  mud, and  other impurities, exposed
to the sun's rays; and in the vicinity of several large docks,
into which large quantities  of  refused vegetable and animal
matters were conveyed from the market.
   According to Dr. Brown,  " not one of twenty, and upwards,
who first  took the disease, recovered;" and, in all, about three
hundred died of it.   " The  fever prevailed with much malig-
nity, till about the middle of October, when it was completely
checked by an inundating storm, from the north-east, of three
days' continuance:"  Hfe adds, from the latter part of July,
to  the middle of September, " the  weather was,  perhaps,
never known so uniformly and excessively hot and debilitating."
It is asserted also, " that the fever did not  seem to he con-
tagious :" that there was " no  instance of its being commu-
nicated to the nurses or attendants of the sick, in places  where
the  disease  was not  originally  contracted."  See  New-York
Medical Repository, vol. 2, p. 360 to 363.
   This fever appeared again at Boston, in August, 1802, and
prevailed until the month of October, (in the same parts of the
town as  before,) "  and  with greater malignity than in any 
279
former  year,  equalling the worst species of genuine plague :
yet the  range of the disease was quite limited."  " It com-
menced in debility, which increased with the progress of the
disease,  till it terminated in death,  more commonly on the
third day, seldom so late as  the fifth: indeed, the patient
might be said to be dying from the moment  of  seizure.   The
venous   congestion  was  very  apparent  from  the bloody
suffusion of  the  eye ;  from  the  cadaverous  appearance of
the  countenance,  and  from  the  livid  tinge  of the whole
surface of  the body  and  limbs ; the cuticular vessels, and
those of the  adipose membrane, being loaded  with putrid
blood."  The disease was " wholly confined to houses promis-
cuously situated at the  heads  of wharfs, in  the south part of
the town; and it was remarkable, that if a patient, under the
disease,  was carried out of the range  of the morbid atmos-
phere, into a healthy part of the town,  and  attended by per-
sons there resident, the disease was not communicated  in  a
single instance : but not so if he remained on the spot where
he  took  the  disease."  New-York Medical  Repository, vol.
vi. pages 338  and  9.
  I do  not find that the disease was even suspected  to have
arisen from any importation of contagion.
  Those of my readers who,  by a  love of truth,  may have
been induced to follow me attentively,  in the view which  I
have  now  taken  of the Yellow Fever, in different parts of
America, and  whose  minds  are unbiassed, will,  I  am confi-
dent,  clearly recognize in that disease all the peculiar features,
and characteristic  marks by  which marsh fevers are distin-
guished  in all parts of the world.   And they will naturally
conclude that, though it be the most aggravated and violent
of the fevers  arising from  miasmata,  this  aggravation and
violence are produced only by a greater concentration or viru-
lence in the latter, joined to a greater intensity of atmosphe-
rical heat, acting on persons, but little accustomed to  bear it,  ,
whilst they retained the excitability of cold or temperate cli-
mates, together with an habitual disposition to generate  that 
280
portion of animal heat which such climates require.   They
will have seen that  the  yellow, like other marsh  fevers, is
always exasperated by great heat,  and extinguished or great-
ly mitigated  by cold;  that, between  the tropics, it prevails
simultaneously with the milder forms of marsh fevers, violently
attacking strangers from cold climates, whilst  the natives or
long residents are at  most only subject to  intermittents or
mild remittents:  they will have also  seen, that in temperate
situations, {his disease in the early part of the summer, he-
fore the atmosphere has  become intensely hot, is commonly
preceded hy,  or rather shews itself  in, the forms  of intermit-
ting or remitting fever; and  that when being exasperated by
excess of heat, it has  assumed, and for  some  time prevailed
under,  the appearance of an  epidemic Yellow  Fever, the ac-
cession of cool weather speedily reduces it again to  its milder
forms; and that a freezing temperature  soon puts an  end to
its appearance, even  in those  forms, as  it commonly does to
other fevers occasioned by exhalations from  marshes, and to
no others: And  they will also  have  seen, that  the common
bilious  remittent, of hot  climates, which is universally ad-
mitted to be the effect  of miasmata, differs from the  Yellow
Fever,  only  by  being a  little less violent : that,  at the
utmost, their symptoms vary  only in  degree; and  that, in
truth,  even  this  difference  is  often  so imperceptible,  that
the  College  of  Physicians  of  Philadelphia,  when  anxious
to assign a  distinction between the  yellow, and the bilious
remittent fevers, thought  it  necessary  to allege one which
is not  only invisible, hut without  existence (i.  e. contagion.*)

  * It has commonly happened in places liable to yellow fever, when the cause of that
disease (miasmata) exists, without being sufficiently powerful and  abundant to create an
epidemic, that a few cases of yellow fever occur, intermixed with what are called bilious
remittents and intermittents,  all from the same cause, and sometimes even in the same
families.  In other seasons, when the miasmata are sufficiently abundant and powerful
to produce an epidemic yellow fever, the first cases of it are often accompanied by, and
scattered among, remittents and intermittents ;  and if, as happened at New York,  in
1805,  some of the physicians should believe that  yellow fever can only be produced by
an imported contagion, and no vessel should have arrived from the West Indies, so as 
281
 In fact, there is no  difference between these fevers,  except-
 ing the greater violence, and consequently greater  danger,
 attending  the former,  than the latter; for the Yellow colour
 appears in both, and,  supposing  the fatal  black vomit, with
 profuse  hemorrhages  and  petechia,  to occur only in what is
 called Fellow Fever, (though they are sometimes seen in fevers
 known and admitted to  arise solely from marsh effluvia) they
 cannot  be included  among its  essential  or  distinguishing
 symptoms, unless death be also considered as  essential to the
 disease.*   Nor  can  any exasperation  of  symptoms,  which
 has been preceded by a great increase of heat,  give any rea-
 son to suspect that  a fever, whose  symptoms  are thus exas-
 perated, did not originate from miasmata;  because such an
 eaxsperation  is  invariably produced by that cause, in  marsh
 fevers ;  and by  it they are susceptible of the most dangerous
 and malignant appearances.   Of  this  Sir John Pringle  was
 fully convinced,  when, at p. 324,  of his work on the Diseases
 of the Army, he made this observation, viz.
   " I  shall observe,  upon  the whole, that  the  autumnal  re-
 mitting  and intermitting fevers,  of low  and wet  countries,
 when at the worst, may  be considered as  another  species of
 pestilence, since they have been seen with all the virident symp-
 toms peculiar to  that  class of diseases."
   As a farther  proof of the  identity  of  Yellow and  marsh
 fevers,  I shall remark that, besides  their simultaneous concur-
 to be chargeable with such importation, these physicians have commonly thought it pro-
 per to declare, that these cases were not the yellow, but the common indigenous, bilious
 fever; and thus they have, as is asserted, sometimes hindered the inhabitants from leav-
 ing a noxious situation until it was too late.
  * Dr. Lind, at p. 118, of his Essay on the Diseases of Hot Climates, (5th edit.) treat-
 ing of the yellow fever, says,  " having considered this di-ease with attention, I am now
 of opinion, that the remarkable dissolution of the blood, tiie violent hemorrhages, the
 black vomit, and the other symptoms which characterize the yellow fever, are only
 accidental appearances, in the common fever of the West Indies.  They are to be es-
 teemed merely as adventitious in the same manner as purple spots, and bloody urine,
 are in the small-pox, or as an hiccup in the dysentery ; likr these they only appear
 when the disease is accompanied with an high degree of malignity, and, therefore, al-
ways indicate great danger."
                               36 
282
rence, and mutual interchanges, as before-mentioned,  they are
not unfrequently  converted one into the other,  in the very same
individual.   Of this  there  are  many instances and proofs,
some  of which having been already noticed, I need  only ad-
duce  the following extract,  from  Dr. Rush's  Letter to Dr.
Miller,  dated  October  8th,  1802,   concerning the Yellow
Fever which then prevailed  at Philadelphia,  and  with  more
than common mortality, at least, in proportion to the  numbers
of sick.   " Never (says  Dr. Rush) has the unity of our au-
tumnal  fever been more clearly  demonstrated,  than in our
present  epidemic.   Its four  principal grades,  viz.  the  inter-
mittent,  the mild remittent, the  inflammatory  bilious  fever,
and the malignant Yellow Fever, have all run into each other in
many instances.  A tertian has ended in death, with a black
vomiting;  and a  fever,  with the face and   eyes  suffused with
blood,  has  ended  in a quotidian, which  has yielded  to a few
doses  of bark.   The  Fever, in Baltimore, I have  been in-
formed,  has  put on  the same multiform appearances and
changes."   See  New York Medical Repository,  vol.  vi. p.
249.   Greater proofs  of near affinity than these can  hardly be
desired.*

  * The convertibility of yellow and marsh fevers into each other, was attested, almost
half a century since, by  the late Dr. Muck Saunders, who had become well acquainted
with them, as an army physician  in the West Indies and North America. " It some-
times (says he) depends upon the manner in which a patient is treated in the begin-
ning, whether he shall have a yellow, or only a remitting or intermitting  fever."  See
Pringle's Diseases of the Army, p. 108.
  Dr. Rush, and his associates, who were incorporated as the Academy of Medicine, of
Philadelphia, in their letter to the Governor, December 1st, 1797, say, " by  depleting
remedies,  the most malignant yellow lever may be changed into a common bilious fe-
ver j and, by tonic remedies, improperly applied, the common bilious may be made to
assume  the symptoms of the most malignant yellow fever " Dr Drysdale, writing of
the yellow fever at Baltimore, in 1794, observes, that this fever, in its favourable issue,
would sometimes terminate in a tedious quotidian, or tertian ague."  See Cox's Medi-
cal Museum, vol. i p. 41
  Dr Gillespie, also, in  his "Observations, &c." already quoted, after mentioning the
epidemic fever, which had proved fatal to at least one half of the crews of the Spanish
squacton,  iHpturcdby  Admiral Harvey, at Trinidada, in February, 1797, adds, that
from ♦« the accounts which our medical gentlemen collected at Trinidada," this epi- 
28S
   Finally, the Yellow and marsh Fevers resemble each other
 by attacking the same organs or parts of the body, especially
 the stomach  and smaller  intestines, which  were found to he
 inflamed in  remittent fever, even  at Copenhagen: and  they
 also lay the foundations  of similar  chronical affections.
   With so  many proofs  of identity in their cause, and of the
 nearest affinity in  their  symptoms, and reciprocal  conver-
 sions into each other, as well as in their effects on the human
 body, and  their changes  by heat  and cold,  &c. it would be
 highly unreasonable not to consider them as being only varie-
 ties of one disease.   And  1  think, with  Dr.  Rush, that we
 might  as well  "distinguish the  rain which falls in gentle
 showers, in Great Britain,  from that which is poured in torrents
from  the clouds in the West Indies, by different names  and
 qualities, as impose  specific names and  characters upon the
 different  states  of bilious (or marsh) fever."   See  Medical
 Inquiries, kc. vol. 4, p. 45.
   Among the  points in  which the yellow,  resembles other
 marsh  fevers,  (and whicli, therefore, co-operate in proving
 their identity) I might have included that of its possessing no
 contagions  property: for certainly this fact has been attested
 and demonstrated in so many places, and by so many unques-
 tionable authorities, that no unprejudiced reader, who shall
 have bestowed proper  attention upon the  proofs and  occur-
 rences which have been stated in the preceding pages, can en-
 tertain the  smallest doubt respecting it.  Wishing, however,
 not  merely to convince the unprejudiced, but to reclaim and
 undeceive those of an opposite description, so as to obviate all
 future disagreement on this  important question,  I shall here
introduce a few additional  facts, testimonies,  and arguments,
respecting it.

dcmic appears to have been  " an ardent Yellow Fever, terminating in remittent and
intermittent fevers, in a manner similar to what happened here, (i. e. at Maninico) in
1796," as mentioned by him, at pages 130,1, and 2; and also at page 164, 5. 1 could
easily fill many  pages with similar facts and authorities. 
284
   One fact, which  decidedly proves the Yellow Fever to be
 destitute of any contagious power, is that of its never hav ing
 been  communicated to others by any  one of the many thou-
 sands who, in the  West Indies,  as  well as  at Charleston,
 Norfolk, Baltimore, Philadelphia, New York, &c. were re-
 moved beyond the reach of marsh miasmata, whilst labouring
 under the disease, or after having imbibed its poison; though,
 in many of these, the disease appeared in its worst forms, and
 proved  mortal.   That this  has been the  case  in  all these
 places,  will have been seen in the  view which was lately
 taken of this subject.   Of the importance,  as well as of the
 certainty of this  fact, the late  Dr. John  Hunter was justly
 convinced.   " What may be considered (says he) as an expe-
 rimentum cruris, to  prove the non-existence of contagion is,
 when the sick leave their usual residence,  and go to other
 places which  are healthy,  without spreading  the  disease.
 This (he adds) constantly happens in the remittent fevers of the
 Wast Indies,"  (among  which he includes the Yellow Fever.)
 See Diseases of the Army in Jamaica, p. 322.
  Dr. Miller, in his report to the governor of New York, has
 made a similar statement, in these words : " Many  who had
 contracted the  disease  in New  York, died of it at Boston,
 Albany, and other  cities at a distance ;  many,  likewise,  at
 Greenwich, Brooklyn,  and other villages, in the neighbour-
 hood.  In no instance  did these victims of the epidemic com-
municate contagion."
  To invalidate this statement,  Dr. Chisholm,  at p. 177 and
 178, of his Letter to Dr. Hay garth, refers to another,  said to
 have been made by Dr.  Wistar, respecting a case of Yellow
 Fever, at Germantown, in the year 1798, when " one person,
 who had been  in Philadelphia" four days, and in  a sickly
 neighbourhood, returned home, on the 7th of August, and, on
the 9th, was attacked with Yellow Fever, which terminated
fatally in four days."  " Ten  cases," says Dr. Chisholm,
" are specified of  the disease excited by contagion emanating
from the body of this person."  To specify  such cases is not 
285
difficult for one who acts under  the  influence of party zeal;
hut this is not proving their existence.  We are told, indeed,
that in most  of  the cases the disease appeared to  have been
contracted at the house of a Mrs. Johnson;  that  " one per*
son  received the  infection from  sorting the clothes  of her
deceased daughter,  and another from the bed on  which his
mistress died," and these pretended circumstances, the only ones
of which any mention  is made,  are to serve as proofs, suffi-
cient to  overturn  the evidence of,  probably, fifty thousand
cases, in which this disease has manifested that it possessed no
contagious quality.   Persons who  believed that nothing could
produce the  Yellow Fever except  contagion,  might conclude
that it had been produced in ten persons, from  one who  had
been at Philadelphia;  for they would naturally neglect to in-
quire whether these persons  had  not also been there, or to
some other source  of marsh miasmata, which is a million of
times more probable than that nature should  depart from her
constant uniformity, and render the same disease  contagious
in one instance, and not contagious  in  50,000 others.   Rely-
ing on this undeniable and fundamental truth, I should think
it a waste of  my own, and of my readers' time,  were I to em-
ploy  it  in a further investigation of the cases in question,
given, as they are, without any proof, or even any circum-
stance, but those just mentioned, and which are suited only to
vulgar apprehensions.  If such cases  had really occurred,  and
with such evidence as to render them credible, Dr.  Rush, who
must have heard of them, and who, at that time, believed that
the disease might sometimes be contagious,  would, probably,
have been so  far confirmed in that belief, as to have abstained
from the public  retraction, which he afterwards made of it;
and he certainly would not, in the very letter containing that
retraction, have declared,  as he did, that the Yellow Fever
" has uniformly perished in the  high and healthy  village of
Germantown, when carried from  Philadelphia."   See Medi-s
dal Repository, vol. 6, p. 165. 
286
   The impossibility of spreading the disease in situations re-
 mote from marsh miasmata has been attested, not merely bj
 persons who believed it  not to be contagious,  but by one of
 the  strongest assertors of the contrary opinion,  by the very
 person who appears to have first misled Dr. Rush, and others
 on this subject, (I mean Dr. Lining, of Charleston) more
 than half  a century ago.   His words are these, " although
 the infection was spread with celerity through the town, yet,
 if any from the country received it in town,  and sickened on
 their return  home,  the infection spread no farther, not  even  so
 much as to one in the same house."   See Dr. Lining's Letter
 in the Edinburgh Physical Essays,  vol. 2, p. 373.  This ad-
 mission, of a truth,  of the  most decisive import, from Dr.
 Lining, ought to have opened the eyes  of  Dr. Haygarth, or,
 at least, to have moderated  that overbearing confidence which
 he has repeatedly manifested in his belief of the contagious
 nature of the Yellow  Fever.   That he was sensible of the
 weight of this admission, and  of the evidence afforded  by it,
 I am forced to conclude, from  the circumstance of his having
 very unfairly excluded, and, to the utmost of his power, sup-
pressed it,  when he thought proper  to- fill  the two first pages
 of the appendix to his Letter to Dr. Percival, with  other
 parts of the same Letter, (from Dr. Lining) in  order  to per-
 suade his readers that Yellow Fever was contagious.
  What Dr. Lining  thus admitted,  and Dr. Haygarth sup-
 pressed, was found true  even in regard  to  the fever which
 Dr.  Chisholm supposes to have been imported to Grenada, by
 the Hankey.  For persons  who took that disease from the
 atmosphere at St. George's, and sickened  in the country, did
 not,  as I am well informed,  communicate  the disease  to any
 person there, and of this  Dr. Chisholm cannot, I think, have
 been ignorant.  This was  also the fact at Dominica, where,
 according to Dr. Chisholm, this  malignant pestilential fever
 was transplanted, and prevailed in 1793, 4, and 5.  Dr. James
 Clark, (a writer of unquestionable veracity) states, at p. 64, of
 his Treatise, that—" when patients, labouring under this fever, 
                            £87
were removed to high situations, for the sake of breathing a
cooler and purer air, and who, notwithstanding, fell victims to
it, the  people about them were never infected, nor did the disease
ever prevail afterwards in such places."—But I will  not abuse
the patience of my readers by adducing further evidence  on
this point.
   Another, and, if  possible, a stronger proof, of the non-ex-
istence of contagion  in Yellow Fever, is  derived from the
Hospitals.  If a disease be supposed to possess any contagious
power, however small, there  is no way in  which that powrer
can be so readily concentrated, and rendered manifest, as by
collecting great numbers of persons, ill of that disease, within
the  wards of  an Hospital.   And  it  is  in  those which have
been exclusively appropriated  for  cases of  Yellow  Fever, at
New-York, Philadelphia, &c.  that we ought to find the most
striking and  irresistible evidence of its contagious  quality,
if it does really possess any.  But the evidence which they
have afforded is of a very different  import. And here I will re-
cur to Dr. Miller's (before-mentioned)  report to the governor
of New-York, against which Dr. Hosack, writh  all his eager-
ness to object,  could find no objection but the omission of one
unimportant observation,  favourable to  Dr. Miller,  and un-
favourable to his opponents.   Dr. Miller's words are,—" no
communication of the disease was ever observed  in Yellow
Fever Hospitals, situated  at  a small  distance from the cities
to which they belong.   JVfo exception  to this  has ever occurred
in any of the numerous seasons  of this pestilence at our  Hospital
at Bellevue, the Marine Hospital at Staten Island, that  of Phila-
delphia, or any other in the United States; provided the ma-
lignant air of the city had been  avoided.*  The force of this
  * Dr Chisholm attempts, at page 174 of his letter to Dr. Haygarth, to pervert the
plain meaning of Dr. Miller's proviso, that " the malignant air of the city had  been
avoided." "Then (says Dr. Chisholm) this malignant air could be diffused to distant
and scattered points, and yet could not extend itself to Hospitals at a small distance
from its  origin."  But the Hospitals were not at a small distance from its origin, nor
had Dr  Miller said or admitted that this  malignant air could diffuse itself to distant
and scattered points;—for, though persons occasionally sickened at such points, the 
28S
fact seems never to have been duly considered or appreciated.
The numerous retinue of medical attendants, nurses, washer-
women, servants, kc. which belong to  an  Hospital,  must  be
known  to every  body.  How greatly they are all  exposed
to  contagion,  if it  could  be  supposed to  exist in this case,
is equally known.  The most malignant degrees  of the dis-
ease  are  constantly  found in these institutions.  The expo-
sure of the physicians, and their  attendants, is well under-
stood.   The  duty of the  nurses  leads to  an incessant, and
unreserved,  intercourse with the sick," &c. &c. yet, not only
all these  have invariably escaped the disease, but likewise  all
the persons occupied in the removal of the sick,  from the city
to the Hospital, who, in this service,  went, without reserve,
into the most  pestilential  quarters of the  town, entered the
most filthy apartments, &c."*
   The facts, here stated by Dr. Miller, are of such notoriety
that no farther proof of them can be necessary ;  'especially  as
my readers will have seen the like testimony given by others
in  the view lately taken of this disease ; I find, indeed, that in
taking it I overlooked a Letter  from  Dr. Ramsay, published
in  the Medical  Repository,  vol.  4,  at p. 220, and dated

miasmata might have been exhaled from particular unwholesome spots, very near to
them, and when this was not the case, the persons in question, without waiting for the
miasmata to reach them; might have gone to the places where they were produced,
as was undoubtedly the fact.  Dr. Chisholm tells us, that he has inquired, at p. 274 and
288, of vol. i, of his Essay, "how far the influence of marsh miasms extend," and  this,
by reference to the pages iu question, appears in his opinion to be two miles; and he
thence concludes, that if these miasms existed in  Philadelphia or New-York,  they
'* would certainly affect the adjoining Hospitals." How little he knew, and how much
he was mistaken, on this subject, must have been manifested by the facts already stated,
at p. 162, 3, and at p. 164, 5, and 6, of this volume.
  * Dr. Miller, in a note, explains the escape of these persons, by stating, " that  they
all resided, during the season, at the alms-house, in an elevated and healthy part of the
city; and, consequently, were only, for a short period, at any one time, immersed in
the noxious atmosphere-." But their communication with the sick lasted for a longer
time, and was such as must have propagated the disease, had it been contagious.  Dr.
Miller adds, in another note, that several persons died of the yellow fever in the alms-
house, in 1798, and that, " although the,house then contained about eight hundred per-
sons, no communication of contagion took place.?' 
289
Charleston, November, 18, 1800,  in which he WTites, " that
of forty-one cases of Yellow Fever, which" (in the preceding
months) " took place in the  Marine  Hospital, forty  were
brought there from the shipping in the harbour, with the dis-
order on them, and,  in many cases, far advanced.   Only one
case originated in the Hospital, and that was of an old intem-
perate man.   While  so many patients were dying of the Yel-
low Fever in the Hospital,  there  was  always a  considerable
number of other patients under the same roof, who  all, with
this one exception," (originating probably  in  drunkenness)
" escaped it.  This is the more remarkable, as the greatest
number of them, as well as several of the nurses, were stran-
gers, and  affords additional evidence, that the disease was not
contagious."  He mentions, that the  Hospital is half a mile
out of Charleston.*
   Of  the non-existence of contagion in Yellow Fever,  Dr.
George Fordyce seems to have been convinced,  near the close
of  his life, though in opposition  to  all that  he had formerly
believed and taught on  the  subject;  for, in his fourth Disser-
tation on Fever, the  last which was published previous to his
death, he  states, as the result of all  his inquiries,  and  of the
best information which he had been able to obtain by convers-
ing with,  and cross-examining, individuals, who had  had op-
portunities of observing the semitertian fever of hot climates,
(for,  so he called the Yellow Fever) in those towns where  it

  * My readers scarcely need be reminded of the facts which I have mentioned at
p. 182—3, on  the authority of Dr. John Hume, Dr. John Hunter, Ur.  Walker, &c. of
the  absence of contagion in the different  hospitals at Jamaica,  notwithstanding the
many thousands of patients with yellow fever, admitted into them at different times.
Nor of the opinions of the medical officers of the army under sir Ralph Abercrombie,
on this subject.  I can safely aver, that several thousand cases of this disease fell under
my  own observation in the West Indies, and that I did not find the  least appearance of
a contagious quality in any of them. The fe\ersof the East Indies, though so ex-
tremely violent as sometimes to produce death in a few hours, are equally destitute of
contagion. Dr. Wade, on the diseases of seamen and soldiers in Bengal, asserts, at
p. 3, that, during the course of a long and assiduous practice there, he "had not ob-
served, to the perfect conviction of his own judgment, either in or out of the hospitals,
a single instance of contagion" among fevers.
                             37 
                           290

prevailed, «that in Hospitals where patients  were received
ill of tbat fever, the physicians, surgeons, and  other attend-
ants, were not oftener seized with it,  than the other inhabi-
tants of those towns."
  The advocates for contagion  in America, (who,  though,
pertinacious, are now very few in  number,)  when embar-
rassed  by the well-known  and admitted fact of the disease's
never spreading in the country, pretend that the  air is there
too pure; which is doubtless, true, if by purity they mean that
it is not sufficiently  charged with marsh miasmata to produce
fever; and this  is also true in those  hospitals, in which the
disease cannot be prop'agated.  And if this be their meaning,
it only  amounts to this,  that  their supposed contagion does
not act,  unless there he also present  another very sufficient,
and in fact, the only cause  of  the yellow fever.  But, if they
mean any thing else, or  mean what is commonly supposed to
constitute atmospherical purity,  this  certainly does not exist
in crowded hospitals; and their explanation is a mere subter-
fuge, to which persons will often have recourse, rather than
candidly retract an  erroneous opinion.
  Besides the universal exemption of  the physicians at  New-
York, from yellow fever, during the epidemic of 1805, (in con-
sequence of  their having then learned, in  great  degree, to
avoid the spots infested by marsh miasmata) Dr. Miller, in his
report, mentions the dissection of persons who had died of yel-
low fever, which, if the disease had been  contagious, must
have proved a source of danger.   " Many of the  physicians
of this city," says he, " were frequently engaged in this mode
of investigating the disease, and  minutely examined bodies in
a very advanced state of putridity;  and yet they all continued
in perfect health."   But, besides  the dissections  here men-
tioned  by Dr.  Miller, it appears  that a great number have
been made without harm in other places,  and particularly at
Pbiladelphia:  together with many experiments upon the black
matter vomited in the last stage of yellow fever, calculated to
ascertain whether  it  possessed  any contagious  property. 
                           291

Among  these  may  be noticed  some very remarkable ones,
lately exhibited by Dr. Ffirth, at Philadelphia, in the presence
of several medical gentlemen of good characters.   After some
experiments of less importance, he inoculated himself in the
left fore-arm with the black matter which had been just before
vomited by a moribund Yellow Fever patient; a slight inflam-
mation ensued, which subsided  in  three days, and the wound
readily healed; he then  confined, hy a black sticking plaster,
some of the same matter, immediately after  its ejection, over
a cut in his right  arm, for two days, and then found that  it
had occasioned no inflammation,  the wound readily healing,
without any formation of pus.
  These experiments he repeated above twenty times,  in vari-
ous parts of his body, with  similar black matters ejected by
Yellow Fever patients, in Philadelphia, during the epidemics
of  1802 and 1803.   He also  put it into  his eye, without ex-
periencing any more inconvenience than cold water produces;
he also inoculated himself with the saliva and serum of patients
under  Yellow Fever, and  with as little effect.   He  exposed
himself to the exhalations  of the same black matters, (which
had been recently  vomited) heated in  an iron vessel,  and ex-
perienced no unpleasant consequence, or sensation.  He swal-
lowed  the  inspissated  matter, which  remained after  this
evaporation, made into pills, without finding his stomach in-
commoded thereby; and he, finally, drank  two  ounces of the
recently-vomited black  matter undiluted, and found it harm-
less, after having previously taken without any bad effect,
considerable quantities  of  similar  matter, diluted with water.
These nauseous draughts, and hazardous inoculations, will,
doubtless, be thought sufficient to prove, that neither the blood
nor the saliva of  patients, under  Yellow Fever, nor yet the
black  matter, the* vomiting of which is justly deemed  the
most fatal symptom of the disease,  possess any contagious
property.   (See  Dr.  Ffirth's Dissertation  on  Malignant
Fever;  Also New-Fork Medical Repository,   2d  Hexade,
vol. 2.  p. 70.) 
292
   I have already noticed the  constant  extinction of Yellow
 Fever by frost,  as one of those points  in  which it exactly re-
 sembles the marsh, and only the marsh, fevers.   This instruc-
 tive and highly important fact is. how ever, callable of a more
 extensive application,  for  it not only  proves the  origin and
 nature of all  these  fevers, but it also proves  decidedly that
 the Yellow Fever has  no power of propagating itself by con-
 tagion ; and, consequently, that it never proceeds from it.   In
 considering this fever as  produced by marsh  miasmata,  we
 readily understand why  (like  other marsh fevers) it should
 cease when the atmosphere no longer retains sufficient heat for
 their generation and exhalation ; but  this diminution of tem-
 perature could not extinguish a fever subsisting by contagion.
 Frost has no access to the apartments,  and still  less  to the
 bodies,  of persons under Yellow Fever.  Upon its occurrence,
 fires, with additional bed  clothes, secure them from its ap-
 proach, and from even the smallest interruption to those mor-
 bid secretions,  or actions, by which contagion is supposed to
 be  generated:  and,  therefore,  if contagion were the cause of
 Yellow Fever, new cases of it ought to occur, during winter,
 especially as we are not acquainted with any febrile contagion,
 which  is  liable to be  rendered inactive, merely  by such  a
 diminution of temperature as is sufficient to stop the progress
 of Yellow Fever.   It  certainly  would  have no  such  effect
 upon typhus fever, small pox, measles^ or, indeed, any con-
tagious disease,  within my recollection.  Dr. Chisholm, how-
ever, from the resolution which he seems to have made of re-
sisting or evading the evidence of all  facts repugnant  to his
 promulgated opinions, endeavours to account for this extinc-
tion of Yellow  Fever, (at p. 177) by  pretending that " it is
 admitted that Yellow  Fever is the product of infection, in
 combination with a high temperature"—adding, "  If it is so,
 and of this there can  be no reasonable  doubt,  cold  weather
must have extinguished  it."  By infection, I  presume Dr.
 Chisholm means contagion,  and if so,  I  must deny the ex-
 istence of any such admission as he pretends, except by him- 
293
self, and those who have adopted his peculiar opinions, in re-
gard to the fever alleged by him to have been derived from the
Hankey ; for he has repeatedly and strongly  denied the ex-
istence  of contagion in the Yellow Fever which prevailed in
the West Indies before the year  1793.   But perhaps Dr.
Chisholm,  as the inventor of that fever, or,  at least,  of its
supposed  origin and contagious pow7er, may think  himself
intitled to endow it with any qualities which may suit his own
purpose, and, consequently, intitled to combine febrile conta-
gion, even  with that  high temperature which has always
proved  destructive  of  it;  but, even with   this  incongruity,
which  I am not disposod to adopt, we may reasonably expect
a little uniformity and  consistency in his account of the pro-
perties  and effects  of  this extraordinary  combination;  and
require that  he should not represent it as  necessarily extin-
guished by cold weather in North America after having assert-
ed, as  will  hereafter  be seen, that it  prevailed extensively
among the  British troops in Ireland, in the  winter of 1795, 6.
   As the more violent forms of yellow or  marsh fever have
ehiefly occurred in the  sea-port towns of North America, as
well as of  the West Indies, and from the same causes, those
persons who, in regard  to the former, have chosen to repre-
sent the Yellow Fever as  the  product of an imported  conta-
gion,  have in  several, tlixmgh  not  in all cases, been able  to
discover some vessel, recently arrived from  the West Indies,
about the time when the local causes of Yellow Fever, from
excessive heat, &c.  were become powerful at Philadelphia or
New-York,  and this vessel being placed in  immediate contact
with these causes,  and  some of her crew being, consequently,
soon attacked with fever, the sufferers, or the innocent ves-
sel, to  which they belonged, have been charged with the guilt
of importing  a contagious disease,  and this  under  circum-
stances where  it has sometimes been difficult  to demonstrate
the truth,  in opposition  to  confident statements,  which,  in
such cases,  are commonly made, and which,  with a  few  of
those omissions or misrepresentations, naturally resulting from 
294
party zeal, often  give  an appearance  of probability to  the
charge.  Indeed, statements of this nature have been adopted
and published by the College Physicians, at Philadelphia ;  the
only corporation, I believe, of any kind in the United States.
which entertains similar opinions of this subject.
  But,  as  the existence of a  contagious  quality in  the
Yellow Fever has not only never been proved or made pro-
bable, either in the West  Indies or  North America, hut on
the  contrary,  this  disease  has,  in  many  thousands of
instances,  manifested,   in the clearest  and  most  decided
manner,  that it possessed no such  quality ; and, as  with-
out it,  no importation of the disease, from  the  West Indies,
is possible,  and  propagation  of it in the United States,
such statements can have had no foundation in truth, nor the
smallest  claim to  serious notice.  If the disease were conta-
gious,  the fact must  have been indisputably  demonstrated
more than ten thousand times, considering the multitudes who
have been victims to  it, and there would long since have  been
no more doubt on  the subject,  than there now is of the conta-
gious nature of small pox and measles.  The uniformity  of
nature, and the necessary connexion between cause and effect,
will not  allow us to believe in the fortuitous occurrence of a
few  rare instances of contagion from Yellow Fever,  in oppo-
sition to the immense mass of facts  by which that disease has
been proved destitute of any such quality, and  the probabili-
ties  will always be a million of times greater that these sup-
posed rare instances, have originated in ignorance, error, pre-
judice, or falsehood,  than that effects so monstrous should ever-
have really occurred.*   With this conviction, I cannot resolve
to misemploy my time hy undertaking a particular examina-
tion of the instances in  which the  Philadelphia College sup-
pose the  Yellow Fever to have been  imported, especially as
 Dr. Caldwell  seems to have  sufficiently noticed and refuted
 them all, in his several  publications ; and particularly  in his

   • While it is notorious that the yellow fever cannot be propagated a single mile
  from Philadelphia or New-York, it is completely absurd to suppose, that it can have
  been transported by a contagious quality one or two thousand miles across the ocean. 
                              295
   Essay on the pestilential or Yellow Fever, as it prevailed in
   Philadelphia in the year 1805, subjoined to his translation of
   Alibert's Treatise on Malignant intermittents.
     Believing that  I have done enough, and  more than enough,
K   to prove that the  Yellow Fever has no contagious power, and
   that it arises exclusively from local causes,  such as have been
   described, I shall conclude my Essay in  regard to the United
   States of America, by adducing  the hitherto uncontradicted
   testimony of Mr. Jefferson (their late president) delivered by
   an official message to both houses of congress;  which affords
   a complete  general confirmation,  by the most  unobjectiona-
   ble, as well  as highest,  authority of the facts stated  in the
   preceding pages.  The  message  was communicated on the
   third of December,  1805, and the part, to  which I refer, was
   in the following words, viz :
     " In taking a view of the state of our country, we in the
   first place, notice the late affliction of two of our cities under
   the fatal  fever, which in  latter times has occasionally visited
   our shores.  Providence, in his goodness, gave it an early ter-
   mination on this occasion, and lessened the number of victims
   which have usually  fallen before it.  In the course of the seve-
   ral visitations by  this disease, it has appeared that it is strict-
   ly local,  incident to cities,  and on the tide waters only, in-
   communicable in  the country, either by persons, under the
   disease, or hy goods carried from diseased places; that its
   access is  with the  autumn, and it disappears with the early
   frosts.  These restrictions, within narrow limits of time and
   space, give security even to our maritime cities,  during three-
   fourths of the year, and in the country always."
     Having thus established the origin and non-contagious na-
   ture of the Yellow Fever, I might here finish this inquiry did
   it not  seem expedient, for many reasons, to extend it to the
   violent and very destructive fevers  which, within a few years,
   have prevailed epidemically in the south of Europe, and  more
   especially in Spain, and at Gibraltar,  in order, by compar-
   ing them  with the Yellow Fever, to ascertain their identity, 
296
which,  however manifest to my conceptions,  has been denied
by many, and even hy some who  have had  opportunities of
becoming acquainted with the former,  at least.
   And here I regret extremely, that, having determined to
confine  this publication to a single volume, I am under the
necessity of laying aside a  great mass of facts, which I had
collected,  with no inconsiderable trouble, respecting the pre-
valence and different forms or gradations of marsh fevers,
not only in Africa,  and the East Indies, but  in various parts
of France, Italy, Sardinia,  Sicily, Malta,  Greece, kc.  and
which, had I room, would greatly  illustrate the subject,  and
confirm what I  have  already  written, as well as what  I am
about to write of the Yellow Fever at Cadiz, Gibraltar, kc.
I must,  however, introduce  what  I have to say in regard to
the latter, with a few observations respecting liochefort, Bour-
dcaux, and Lisbon.
  The former of these cities is nearly surrounded cither by
salt, or fresh-water  marshes,  so   that,  in  summer and au-
lumn, strangers  can seldom reside  there a fortnight,  without
an attack of marsli fever.   On the South-east side, in parti-
cular, are extensive  fresh-water marshes,  which, when the
wind blows over them upon tiie city, in very hot dry weather,
produce violent and dangerous  fevers,  and render them epide-
mical at Rochefort.  This was the case to a  remarkable de-
gree in  1694, when,  according to Sir  John Pringle, (Dis-
eases of the army,  p.  323)  " a fever broke out in Rochefort,
in France, which,  on account  of the uncommon symptoms and
great mortality, was  at first believed to  be  the  plague.   But
M. Chirac,  who was sent  by the  Court to  inquire into its
nature,  found ,the cause to arise from some marshes that had
been made hy  an inundation of the sea: and observed,  that
the corrupted streams, which  smelled like  gunpowder,  were
carried to the town  by  the wind that had long  blown from that
quarter.  About  two-thirds  of  those who were  taken ill died.
This  fever raged in June, July, and August,  and then ended
upon a great fall of rain, wiiich purified the air, and refresh- 
                          297

ed the stagnating water."  Sir John Pringle refers to Les
QSuvres  Postbumes de M.  Chirac,  for an  account of this fe-
ver.   In the Eloge of  M. de Chirac, printed in the Hist. &
Mem.  de L'Acad.  R. des Sciences," for the year 1732, at
p. 121, this  fever was designated  as a " Maladie Epide-
mique, qu'on  appelle de Siam,"  (an Epidemic  called Siam
fever)  doubtless from its resemblance of the Yellow- Fever, to
which that name had then been given at Martinico.  Mr. Chi-
rac is stated to have dissected the bodies of nearly 500 persons
who died of it, and he mentions  his  having generally found
the stomach greatly inflamed, and, in some parts,  mortified.
  Violent fevers, which were considered as pestilential,  for-
merly  prevailed very  often in  the  summer  and autumn, at
Bordeaux,  and frequently  compelled the  parliament  to re-
move to other places. % The Cardinal  de  Sourdis, having
formed a just opinion of the cause of these fevers, under-
took to drain a very offensive marsh, which then existed on
the west side of the  city.—Accordingly,  two great canals
were dug by his orders, and at  his  expence, to convey the
stagnant water into the  river, and a fine causeway being
erected over  the infecting spot, and planted with rows of
elm trees,  the plague, so called, ceased to appear.  " L'on
eleva dans  le lieu ou etoit un Cloaque infect, une belle Chaus-
see, que l'on borda d'Ormeaux.   La Peste n'a point reparue
depuis cette epoque."  See Memoires de la  Societe Royale de
Medecine, torn. viii. p. 272 and  seq. where,  also, a very
interesting report  to the Society will  be  found, of the dif-
ferent parts of France in which marshes abound, and of the
fevers,  intermitting, remitting,  and sometimes apparently
continued,  which prevail in their neighbourhood, with greater
or  less malignity  during  summer  and  autumn.   It seems,
however, that though  Bordeaux has  been,  in a considerable
degree, relieved from these fevers, since the work, executed
at the expence of Cardinal Sourdis, yet the very hot, as well
as dry, summer and autumn of  1804, (which occasioned the
Yellow Fever in many parts of Spain, Gibraltar, &c.)  assist-
                            38 
298
ed by some new attempts at draining, begun at an improper
season at Bordeaux, produced in this city a malignant epi-
demic  fever, which Dr.  Gal way,  a physician of eminence
there,  states to have had v cry short remissions, and to have
often terminated fatally, before  the fourth  paroxysm.  The
daily mortality from it is said to  have exceeded fifty for
some time.  It prevailed chiefly in the quarter  called the
" Departement," where  the ground is lowest, and the streets
narrowr:  and  this  quarter  was  deserted  by  all persons in
easy circumstances.   See New-York Medical Repository,
vol.  4, of 2d Hexade, p. 263, 4.
  Lisbon, since the earthquake, in 1755, has been, in a great
degree, exempted  from marsh fevers; which, however, was
not previously  the  case, especially in the  lower  part of the
town between  the bottoms of the hi{ls and  the river; a spot
where the streets were narrow, dirty, and, as I believe, un-
paved.   In the eloge of Mr. Sanchez, formerly first physician
to the Empress of Russia,  (Anne Ivanowna,) inserted in the
4th volume of  the " Hist. De la Societe Roy. de Medecine de
Paris,  it is stated, (in a note, at  p.  215) that he had witness-
ed the ravages made at Lisbon  in  1723, by a very mortal
epidemic; and that Dr. Bertrand, a physician, who had dis-
tinguished himself during the plague at Marseilles, in 1720,
being consulted by the King of  Portugal, declared the latter
to have been a different disease fnom the epidemic, at Lisbon,
in which black vomitings were the most alarming symptom :
(" des vomissemens noirs etoient le Symptome le plus effray-
ant.")   Mr. Sanchez is  also stated to  have observed, that
this epidemic rarely attacked women, and that the negroes of
both sexes completely escaped it.  These  facts were obvious
indications of the Yellow Fever; hut I found others more de-
cisive,  In the library of the British Museum,  M. S. 4376.
Plut. II. J.  is  a  letter, dated Lisbon, October 30th, 1723,
signed William Cayley, (apparently the British Consul there)
and  addressed  " to  Dr. Kennedy, Physician to  the British
Factory  at  Lisbon," in which,  after mentioning " the sick- 
                            299

iiess," whicli had prevailed for some time, without any abate-
ment ; " still continuing to take off numbers of its inhabitants,
some of whom die suddenly, and in such a manner as has given
cause  to suspect the disease to be  attended with pestilential
symptoms," he calls on  Dr. Kennedy for his " opinion" re-
specting it, " and the observations he had been  able to make
in the  course of his practice;" to the end that he, Mr. Cayley,
might, according to  his " duty,  transmit the same to his
Majesty's  Principal  Secretary of  State, in order  that,  if
deemed contagious, due precautions  may be taken to prevent
the same from being introduced  into  his  Majesty's Domi-
nions," &c.
   To  the  preceding letter is  subjoined  an answer, signed
Gilbert Kennedy, and dated, the 31st of the same  month,  of
which the following is an extract,  viz.:
   " The  heat  last  summer  began  late,  but continued very
violent, and much longer  than usual,  so that the grapes,  whicli
were more  plentiful this year  than many  years past,  were
burnt up, wThen pretty ripe.  All the summer was sickly, but,
about the middle of  August,  there  appeared the fever whicli
now i'eigns, accompanied with a pain of the head and loins, a
great  sickness at the heart  and stomach, with reachings  to
vomit, very contagious in the lower parts of the city, going
generally through a family, and very few families escaping  it,
especially in the close, narrow streets.  The high parts are
much freer  than the low parts, and the  villages and country
fwuses  about town are entirely free from this distemper, notwith-
standing the great communication.  The recovery is generally
accompanied with  the  yellow jaundice.   The only mortal
symptom in this epidemic is the vomiting black choler, but this
symptom is so rare, that  I have met with it but twice in above
a hundred I have seen with this distemper."*

   • It seems probable, from sevei-al circumstances,  that the worst cases of this dis-
 ease occurred among the poorer inhabitants of Lisbon, and that Dr Kennedy's prac
 tice being nearly confined to the British Factory, who were in better circumstances,
 he saw  fewer  cases of black vomitings than the Portuguese physicians.  1 ought 
300
   " By his Portuguese Majesty's order, there have been three
bodies of persons dead of this distemper opened in the public
Hospital, in all  which the blood  appeared dissolved  like the
thin lees of wine; and  in  one of them, who had  the black
vomit,  there appeared,  besides,  black spots upon  the skin,
which were only superficial;  the  gall bladder  and intestines,
with a small quantity of black gall in them, and the stomach,
with a large quantity of the same."
   " The reasons why great numbers have died of this distem-
per are;  firstly, the many poor who live here most miserably;
and before they can procure any assistance, are carried off by
the force of the disease, which is extremely violent for the two
or three first days, having rarely any crisis that is  usual in
other fevers;—Secondly, the Portuguese method of treating
all fevers by bleeding, morning and evening, while they  last;
which has generally  been pernicious in this epidemic.   From
all its appearances,  hitherto, it seems very clear,  that  it is
contagious only among tlwse  wtiose  bodies  are predisposed by
living in a close, noisome air, and abound  with bile, or labour
under some error in the  non-naturals.  Strangers, who drink
wine,  (i. e. are intemperate)  are more universally  attacked
with  it than the Portuguese: among the  latter no  man of
fashion has had it, nor has  it yet entered  any convent, except
the Irish, although they all assist the sick."
   With so many facts, decisively proving that the disease was
not communicated by the sick to the well, and that it only at-
tacked persons who had been exposed to the influence of marsh
effluvia, we might well wonder that Dr. Kennedy had not dis-
covered the truth, did we not  recollect  the general dispo-

 further to observe, that Dr. Kennedy mentions, in his letter, that the weather had
 " changed several times to rain and cold," without any abatement in the distemper.
 It may, however, be presumed, that these changes were not very considerable, and
 they obviously were not lasting; and, therefore,  not likely to produce any sensible
 benefit.  Moderate showers of rain, occurring with some intervals, have been found,
 in America, rather to promote than diminish the progress of yellow fever; probably,
 by favouring the extrication of miasmata; and at  Lisbon, in the month of October,
 nogreat diminution of temperature is likely to have been thus produced. 
301
sition which then prevailed to believe in the supposed contagion
of fevers,  without discrimination or consideration.  To those
who have  formed correct ideas on this subject, it must now
appear absurd, to represent a fever as being " very contagious
in the lower parts  of the city," very little so in the " high:"
and  as  having no existence in " the  villages and  country
houses about the town,  notwithstanding  their great commu-
nication."
  1 will now proceed to Cadix.  This eminent maritime  city
has frequently been afflicted by violent and destructive  epi-
demics.
  Dr. Felix Pascalis, who lately travelled over a great part
of Spain  to procure information, and ascertain facts, on this
subject, mentions on  the authority of Dr. M. Gonzales,  (au-
thor  of a " Dissertation Medica sobre la Calentura maligna
contagiosa," or Yellow Fever, which prevailed at Cadiz, in
the year  1800,) that, "  during the seventeenth century,"  this
city " had been four times visited  by horrid pestilences, of
which there are monumental indications,  and  religious festi-
vals,  instituted to commemorate their duration, cessation, kc.
There are, however, no such discriminating accounts of these
epidemics, as  will enable us to decide,  whether they arose
from  marsh miasmata, like those of the last and present  cen-
turies at the same  place, or whether they were  the plague,
properly  so  called ; but, considering how frequently  and
loosely the latter appellation was given to very different  dis-
eases, when attended with great mortality, the form is highly
probable.   Dr. Pascalis, however,  asserts,  that  the Fellow
Fever prevailed at  Cadiz in 1730, and that the physicians  sent
from  Seville, and who critically examined the disease, " did
not omit to notice the (yellow) colour of the  patients, and the
vomito prieto:" and for evidence of this he refers to  " Cadiz
Illus  trada, lib. 6."  He asserts, also, that  this disease  pre-
vailed there at other times in the last century, particularly in
" 1736, 1744,  1746, and 1764."  As authorities for the three
first of  these  epidemics, he refers to the writings of Dr. N. 
302
 Rexano, Dr. Gregorio Condemina, and El Vicario Ecclesias-
 tico de la Isla de Leon."
   Of the epidemic, in 1764,  an account has been written, in
 Latin,  by Dr. Salvarez,  (or Salvareza) then a principal phy-
 sician at Cadiz, by  which it appears to  have exactly resem-
 bled  the  Yellow  Fever of America.   He, indeed, calls  it
 Vomito Frieto, because black vomitings, as well as yellowness
 of the  skin, frequently occurred.   Dr.   Lind,  also, in his
 Essay on the Diseases of Hot Climates,  at p. 122, after men-
 tioning, that Fevers,  similar to Yellow Fever, have appeared
 " in some of the  southern parts of Europe, during  a season
 when  the air was intensively hot and unwholesome,"  adds,
 " this happened at Cadiz, in  Spain, in the months of Septem
 her and October, 1764, when excessive heat and want of rain
 for some months, gave rise to violent epidemic, bilious  disor-
 ders, resembling those of the West Indies, of  which an hun-
 dred  persons  often died in  a day."   He afterwards gives a
 particular  account of the symptoms, and then informs us,
 that " the dead bodies having been examined by order of the
 court of Madrid, the stomach,  mesentery,  and  intestines,
 were found covered with gangrenous spots, the  orifice of the
 stomach appeared to have  been greatly affected, the spots
 upon it being ulcerated."  He also informs us, that the dread
 of this disorder forced many people of fashion to retire into
 the country, where they remained in  perfect safety from it."
 Reverting, again to this epidemic, at p. 161, he says " it did
 not extend its influence to any ship which lay at  a  distance
 from the city;  as  I am informed by Dr. Maguire, an eminent
 physician of that place.   His Majesty's ship, the Tweed, was
 then at anchor in Cadiz bay;  an officer, and several of her men,
 who had been on shore, were seized with this fever; but all
 those who were  sent on  board the  ship recovered, no had
 symptom  appearing in  their fever, whilst a disease, similar
to black vomit,  and  the Yellow Fever,  and equally mortal,
depopulated that  large  city."  From these accounts, it ap-
pears that the disease was not propagated in the country, and 
303
 that  seamen, who had imbibed miasmata on shore, and be-
 came  sick, did  not  infect others when sent on ship hoard:
 and, consequently, that the disease was not contagious.—Nor
 does  it appear that any suspicion then existed  of  its having
 been imported from any other place.
   In  the  summer of 1800,  this fever  again appeared as a
 most formidable epidemic, not only at Cadiz,  but in almost
 all the sea port towns of Andalusia, particularly Seville, St.
 Lugar,  orLucar, Puerto-Santa Maria,  Puerto-Real, Rota,
 and L'lsla; occasioning the deaths, as is computed, of nearly
 eighty thousand persons.  It also prevailed, at the same time,
 on the coast of Barbary,  particularly  at Tangiers and  Tc-
 tuan.  On this melancholy occasion, the government of Spain
 (which, some years before had dictated certain  prescriptions,
 written by the king's physician, Dr. Masdevall, to be exclu-
 sively employed  by the Spanish physicians  in  fevers similar
 to the present, and certain opinions to  be also  subscribed by
 them  on the subject,) thought proper to order a long and cir-
 cumstatial  publication to  be made as a supplement to the
 Madrid  Gazette  of  the  28th of October, 1800,  under the
 title of a  " Description of the Epidemic Disease which began
 at Cadiz,—its origin and  propagation—the different symp-
 toms and effects of it, and the method of cure, &c.  Publish-
 ed hy order of government, for  the instruction  of the public,
 and  particularly for the  notice and regulation of the prac-
 titioners  of physic, kc."    (See  Medical  Repository,  vol. 5,
p. 103, kc.)
  In this publication  it is stated, that the preceding  winter
had been long and wet, the  rainy  season having been pro-
longed  till the month  of May; after which the summer  be-
came  intensely hot, and the thermometer, from  the middle of
July,  rose  to  85° of Fahrenheit's  scale;* that an easterly

   * Soon after the epidemic in question had ceased, a pamphlet, written by Don
 Rodriquez Armesto, an officer of the Spanish navy, and entitled " Reflections on the
 Epidemic which prevailed in Cadiz, and the neighbouring towns,  in the autumn of
 1800,"  (" Iteflexiones sobre la Epidemica padecida en Cadiz," &c.) was published, 
304
wind  succeeding,  lasted forty days, and being (as  is  usual
there)  very  hot,  subjected  the inhabitants  to extreme  heat,
with sweatings so profuse that they could obtain no relief but
by  bathing.   That, about the 8th of August, bilious fevers
began to appear; and, from the 10th to the 15th of that mouth,
many people in the  quarter  of Santa  Maria  were attacked
with what proved  to be the epidemic in question.
   Among the more  general  symptoms of the disease,  those
are mentioned which occur in other marsh fevers—Those  of
the more violent cases are stated to have been Subsultus ten-
dinum,  Delirium  or  alienation of mind, Hiccough,  convul-
sions, hemorrhage at the nose, bloody  vomitings,  bloody and
black  stools,  yellowness  of  skin,  petechia,  and, finally,  black
vomitings, similar to those  which, at  certain  seasons  of the
year,  are endemic at  Vera  Cru%,  Honduras, kc.  (" La he-
morrhagia de narices, la vomicion sanguinolenta por la hoca,
la melena, deyecciones de  Sangre, la ictericia,  las petechias,
y ultimamente el vomito atrabiliario, a que han querido Ilamar
vomito prieto, semejante at que es  endemico en ciertas est aciones
del  ano, en  Vera Cru%, Honduras,  &c.)   These  symptoms,

 after having been licensed in the usual manner. The author was, however, soon ar-
 rested on a charge of having diffused false,  dangerous, and seditious opinions, and
 compelled to subscribe a formal retraction of them,  so far as they were at variance
 with the creed which the court thought proper to adopt respecting the supposed im-
 portation and contagious nature of the  fever in question.  More than fifteen hun-
 dred copies of this pamphlet were publickly burnt; a few, however, escaped de-
 struction, and Dr. Pascalis, going afterwards to Spain, found means to procure two of
 them, and has given an  abstract of their coot nts in the New-York Medical Reposi-
 tory, vol. v. Hexade 2d, p.  131,  etc.  By this abstract,  it appears that the author
 endeavoured to prove that the epidemic had been produced by atmospherical and
 local causes ; and that lor this purpose he adduced accurate meteorological observa-
 tions, demonstrating, among other things, the extreme heat which had then pre-
 vailed."  " These," says Dr. Pascalis, " were official, as he was, by royal authority,
 keeper of the royal observatory of the Isle of Leon :" and by these it appears, " that
 the thermometer marked 95 degrees,"  (instead of,85°) a degree of heat "equal to
 that of Senegal." 1 presume, however, that we are not to consider 95 degrees as
 the constant temperature of that season, but onh as that which  it sometimes attained
 in the shade, for in the  sun he states it to have often been at 112 degrees, even in
 very damp places. 
305
  and especially those of which the  original  description is  re-
  pealed in1'Spanish, can leave no room to doubt concerning the
  nature of the disease.
    It is added that the most  fatal symptoms were coldness of
  the extremities, feebleness of the eyelids,  vomiting of matter
  like coffee-grounds,  hiccough, convulsions,  and  coma.  The
  account  of the methods  of  treating the disease, and  of  the
  reasonings of the  Spanish physicians, respecting its  causes,
  are not sufficiently interesting for the space  which they would
  occupy,  were  1 to  give  even  an  abstract of them.   It is
 stated, however, as  a fact, that persons, who had lately  ar-
 rived from the West Indies, owing to their being accustomed
 to the like seasons, did not suffer an  attack  of this  epidemic,
 and  that even those who had  been long resident in that part of
  Spain, were, in a great  degree, exempted from  it;  and,  on
 tbe other hand, that persons  from Canada, and other  (north-
 ern) countries,  were extremely liable to it, which are circum-
 stances clearly manifesting its resemblance to Yellow Fever,
 and its want of contagion.  The physicians  are  also stated,
 not to have observed pestilential buboes,  carbuncles,  or an-
 thraces,  in any of their  patients: and,  we are told  that,
 though several were afflicted with phlegmonous tumours, end-
 ing in gangrene, others with  erysipelatous vesications of like
 tendency, and some with parotids,* yet they  were not of that
 kind  wiiich appertains to the  true plague, and which had been
 described hy Chicoineau,  at Marseilles, and Samoilowitz,  at
 Moscow.
   In  looking  for adequate  causes of this epidemic,  we shall
readily find them in  the  situations, and local circumstances
of Cafiiz,f  and the other  towns of Andalusia, in which  it

   * Parotids have been repeatedly mentioned by Lancisi, and others, as occurring in
 the marsh fevers of Italy, and they are sometimes observed in the yellow fever of the
 West Indies and North America.
   f The town of Cadiz is upon a point of land, which, by advancing into the sea,
 forms within itself a spacious harbour. Tbe external ;>:irt of the city, or that which is
 nearest the ocean, is chiefly built on a rock, and is a little elevated.  But the part
                             39 
306
 prevailed.   About the  end of July,  the epidemic  made  ite
 first  appearance  in the  Barrio of  Santa  Maria,  inhabited
 chiefly by New Castilians, who  were generally poor and  la-
 borious,  and  it soon   extended  itself to the  low  and damp

 which is eastward, and adjacent to the harbour, is placed on very low, damp ground,
 contiguous to marshes.   Indeed, almost the whole country round the Bay is flat, low,
 and swampy, and the sides of the harbour are, moreover, covered by salt pans.   An
 intensely hot easterly wind blew constantly in  1800, for six weeks, over the har-
 bour,  and over the other sources of miasmata just mentioned, conveying the latter
 directly upon the adjoining quarter of Santa Maria,  at the  south-eastern side of  the
 town,  where the streets are narrow and filthy, and where the epidemic appeared
first, and continued longest.  Thence it extended itself westward,  exactly in the di-
 rection of the wind.
   Puerta Real, Puerto Santo Maria, Rota, and the town of Isla,  (which last is sur-
 rounded by  salt pans) adjoin either the  hr.rbour or the bay of Cadiz, and they all
 partook of the epidemic, as might be expected, from their  low situations,  and other
 circumstances.
   Not far from  Rota is the river Guadalquiver, on whose left or northern bank is
 placed the city of Seville, round which the country, to a considerable distance, is so
 low, that, as Mr. Townsend has observed, (Travels through Spain, vol. 2, p. 353)
 " it is frequently overflowed, and, upon some occasions,  the water has been eight feet
 high, even  in their habitations.  He adds, p. 356, that " the soil is rich, and being,
 at the  same time very deep,  its fertility is exhaustible," p. 357.  That,." in conse-
 quence of vapours  and  miasmata, occasioned  by stagnant water, and by frequent
 floods,  the inhabitants of Seville are subject to tertians, and putrid fevers,"  (mean-
 ing the more violent marsh fevers.)   What Mr. Townsend  has mentioned of the
 soil round Seville  is true,  also of the whole countiy  along the Guadalquiver,  be-
 tween that city and S. Lucar, a space of  twenty leagues; and, therefore, we need
 not wonder that the towns and  villages contiguous to this river should, in all  ages,
have been noted for  the prevalence of autumnal marsh fevers,  called  by the Span-
iards, TavardiUos,  or Tabardillos, and resembling what,  in the West Indies, are
 commonly named  bilious  remittents.  These  Tabardillos, indeed, were, in some
extraordinary? seasons, so much  aggravated in this part of  Spain as to be deemed
the plague.   (See  Kay's Travels, p' 416.) Don Uodr. Armesto informs us, " that
 Seville is proverbially offered as an instance of annual (autumnal) plagues, where
it never was thought necessary  to establish rules of quarantine  on  any  description
 of vessels."  (Medical  Repository, 2d  Ilexade,  vol. 5, p. 131,  and seq.)  In an
ancient work, by  Doctor Juan  Ximenes  Savariego, printed at Anteguera,  in  1C02,
and  entitled  Tratado de Peste,  I  find the authour mentioning,  at p. xvii. as  the
cause of the fever which he calls Tavarditto, pools of stagnant and corrupted water,
like that of lagoons  and  inundations  of rivers,  such as those of the Guadalquiver,
 at Seville, these late years.   (" Estangucsde Aqua estanqua, y corrompida, como
 de lagonas, y inundaciones de Rios, como las a  avido de Guadalquibir en Sevilla es-
 IQS anos passados.")  He adds, that persons ill  of this fever  do not generally give 
                            307

streets of Sopranis and Boqueta,  (near the  sea gate) and
thence to the quarters of Ave  Maria,  and St. Antonia; and
having,  by this  time,  attracted the notice  of government, a
meeting of physicians  was convened, who,  after consulta-
tion, unanimously  agreed in  reporting the  disease to be a
simple synochal fever, and not contagious.   Indeed, the epi-
demic was  so mild  (as often happens at the early appearance
of  marsh   fevers without  the tropics) that even at a third
meeting of the physicians, several of them declared they had
not lost a  single patient by the reigning  disease,  and many
asserted, that of two or three hundred cases, not  more than
one or two had terminated unfavourable.  At this meeting,
however,  a student  of  the  College of Medicine,  at  Cadiz,
Friar Juan de Acosta,  belonging to the Convent of St. Juan
de Dios,  who had seen  most of  the  sick brought into  the
Hospital  of this convent,  (adjoining the Barrio  of  Santa
Maria,) declared the fever to be  very acute, and  of  a very
bad sort,  but concurred with the  others in  thinking it  not
contagious.*
   Some days after this,  says Dr. Arejula,  " we, physicians
in Cadiz,  began to observe these fevers more seriously  and
attentively.   It was natural that, having called  them gastrico
bilious fevers, void of contagion,  we  should  also believe the
 cause of them to be general, existing in the town; we recol-
 lected, according to the text of tbe great Hippocrates, and the
 observations of succeeding physicians, that much rain  in win-
 ter and spring, followed by great heat in summer, like  that
 which had been experienced at Cadiz, was the cause of fevers,

  it to their  attendants.  When we consider how  unusually the rains  were pro-
  longed throughout  this part of Spain,  in  the spring of 1800, and the inundations
  which must have been thereby produced, together with the intensely hot and dry
  weather, which succeeded and lasted for a long time, we certainly need not  be at
  any loss  respecting the cause  of this epidemic.
    • See "Breve Descripcion de la Fiebre Amarilla padecida en las Andalusias,"
  fecc. or a Brief Description of the Yellow Fever which prevailed in the Andalusias^
  Stc from 1S00 to 1804 inclusive, by Don Juan Manuel de Arejula, printed in 1800,
  at the Royal Press in Madrid, 8vo. pages 154. 156. 318. 
SOS
 epidemics, and  the  plague.  We thought, moreover, that we
 had found another powerful cause in the kennels (Canerias)
 occupying flic middle of our streets,  and receiving all  the
 foul water, and excrementitious matters, which we considered
 as sources of  carbonic, hydrogenous, ammoniacal, sulphuret-
 ted-hydrogenous, and other unwholesome gazes."  It seems,
 however, that, notwithstanding these opinions, the physicians
 of Cadiz, (as  those of  other places have often done)  soon lost
 sight of the effects of miasmata, or rather ascribed these effects
 to a supposed  contagion, extending from the bodies of the sick
 to the well.  They observed, says Arejula, " tiiat the person
 nearest the sick was commonly the first attacked with the dis-
 order, and that, if it got into a house, all had  it in a few days ;
 that it proceeded from one to the next house,  and thus extend-
 ed the length  of  a street;" and this course, which,  however,
 was neither constant nor uniform, they considered as a deci-
 sive proof of  contagion ; though,  supposing what must have
 been  true, that  where the disease  made this progress,  tiie
 houses and persons wrere within the reach  of miasmata, the
 facts in question might be as well explained without,  as by the
 operation of a contagious influence.
  At p. 248,  Arejula  endeavours farther to account for the
 spreading of the disease, by stating that the New Castillians,
 among whom the fever began, and who, being greatly attached
 to the second person of the trinity, and members of  a frater-
 nity, bearing his  name, and  believing that their devout and
 fervent supplications to him,  would stop  the  epidemic, deter-
 mined upon making a solemn procession, with his image, and
 obtained  permission for that  purpose,  from the magistrates,
 though not until they had had recourse to menaces, which in-
 timidated the government.  The procession accordingly took
place, about  the 5th  of August, an immense concourse  of
the people joining therein, and it lasted seven hours; during
which time, these unfortunate people were exposed to the rays
of a burning sun, and, under great fatigue, to all the mental
agitations which religion  or fear  could produce;  and thi% 
309
 chiefly in those parts of the town  where the marsh miasmata
 were most powerful. That a procession, in such circumstances,
 should produce a great extension of the disease can hardly be
 doubted; though  not in the way which Arejula, and others,
 have supposed; for, as the well, and not the sick, joined in the
 procession, personal contagion was not likely to  be present
 and  active among them.   Similar processions were continued
 almost daily, and, undoubtedly, with very mischievous effects,
 until Don Tomas  de Morla, as Captain General of Andalusia,
 assumed the government, and put an entire stop to'them; but
 the disease had then nearly reached its full  extent.*
   At Seville the fever first appeared in the low, unwholesome
 suburb of Triana, consisting chiefly of narrow unpaved streets,
 adjoining the  Guadalquiver, but  on the side opposite  to the
 city.  It next appeared in another unwholesome suburb ;  that
 of Los Humeros, also adjoining the river, and  only separated
 by it from Triana;  and thence by the  middle  of September,
 it had extended nearly over the whole city, occasioning, be-
 fore it terminated, the  deaths of fourteen thousand, six  hun-
 dred, and eighty-five persons therein.
   When the physicians at Cadiz had mistaken the effects of
 miasmata for those of personal  contagion, (a mistake wiiich,
 in that crowded city, and with  its numerous processions, &c.
 it  might have been difficult to avoid) the  next step was to
 ascertain its origin.  I do  not find that, on any former appear-
 ance of Yellow Fever, in that city,  its introduction, from any
part of America, had ever been suspected, or that any precau-
tion had ever been  employed for its exclusion : though,  if it
had been a contagious disease, such precautions would have
  * Don R. Armesto says  the evil was augmented  by making public fires in the
 Streets of Cadiz to purify the air, and thus producing an artificial heat, which pre-
 cluded the salutary effect that might have sometimes resulted from a slight refresh-
 ing breeze: that it was augmented also by the dread and panic of reported conta-
 gion, and by numerous acts of religion, e. g.  by the funeral processions which suc-
 ceeded every death ; by  the " holy images, relics,  and sacramental objects which
 were incessantly offered  to the eyes of a dejected  people," and by  " thundering
 preachers solemnly warning every one of his approaching dissolution." 
310
been highly  expedient,  considering  how often  the  galleons,
and other ships from Porto Bello, Havanna, and other parts
of the West Indies, had been attacked by the disease, in  re-
turning thence to Cadiz; as happened to  the  squadron, &c.
under Don Lopez Pintado, mentioned at p. 337.
   But in the summer of 1800, the government,  as well as the
inhabitants, of Cadiz, appear to have adopted the belief of an
importation  of the  supposed contagion from America, and  a
ship,  called  the Dolphin, belonging to Baltimore, was gene-
rally and decidedly selected and accused as having been the ve-
hicle of this  mischief: and reports were  fabricated,  by which
three persons were stated to have died of Yellow Fever onboard
the Dolphin, during her passage, and what had been supposed
to be the first cases of the fever at Cadiz, were declared to have
occurred in different individuals, who had all directly communi-
cated with the Dolphin,  or some of her crew;  and other sai-
lors belonging to the same ship were said  to have found their
way  up  the  Guadalquiver,  through St.  Lugar,  (in which
town however, the  disease did not appear  until the middle  of
September)  and,  by lodging  in the  suburb  of Triana,  at
Seville,  to have produced  the Yellow Fever there,  some days
before its appearance at  Cadi*.  These stories, in point of de-
tail and seeming accuracy, were such as Dr.  Haygarth, by
his letter of  the 23d of May,  1799,  solicited Professor Water-
house to procure for him respecting the importation of Yellow
Fever into Philadelphia, &c.  and they were circulated  gene-
rally, and with great  confidence,* so that Don Pablio Vali-
ente, Intendant of Cuba,  who had  chartered the Dolphin,  to
bring himself and his family to Spain,  was, notwithstanding

   • These stories were adopted, and most of them published, in substance,  by Pro-
 fessor J. N. Berthe, of Montpellier, who was sent  by the French government,
 with two other physicians (M. M. Pierre Lafabrie, and Victor Broussonet,) into
 Spain, to ascertain facts and collect information, respecting the epidemic of Anda-
 lusia, in 1800, of which he has given a Precis  Historique, in  a large volume, 8vo.
 printed at Paris, in 1802.  Some account of the stories, relating to the ship Dol-
 phin, may be found at and between p. 52 and 59. 
311
his rank and connexions, arrested upon  a criminal charge,
tried before the Royal Audienza,  at Seville,  and, after a full
investigation, and eleven  months  imprisonment,  fully  and
honourably acquitted of having introduced the Yellow Fever
at Cadiz ; and he was,  probably, as a compensation for the
injustice he had suffered, afterwards promoted hy the govern-
ment.   In the course of this prosecution, it w as juridically
proved, that the Yellow Fever had not appeared at the Hava-
na, whence the  Dolphin sailed in May, 1800, until some time
after her departure; and though she touched at Charleston on
the 2d of June, and sailed thence on the 10th of that month, it
was, (in consequence of an application from the Spanish govern-*
ment,) certified unanimously, at  an extraordinary meeting of
of the Medical  Society of South  Carolina, on  the 5th  of
April, 1801, (twenty-two respectable physicians being present)
that " to the best of their knowledge,  no Yellow Fever  had
existed in that town, or in the Port of  Charleston, prior to
the 20th of June, in the year  1800."   They also declared, on
the ground of specified facts,  their conviction that the disease
in question Jiad never been propagated by  contagion.   It was
also proved, and particularly by the testimony of  Don Jose
Caro,  a Spanish physician, who had returned as a passenger
on board the  Dolphin,  and was  examined, on oath,  by the
judges at Seville, that  the diseases,  of which the  three  sai-
lors*  had died on  board of that ship, were not of the nature of
Fellow Fever,] but different  diseases,  of which  an account
was given.  It was, moreover proved, that no symiitoms of
the Yellow Fever had appeared in any person on  hoard the
Dolphin,  and, consequently,  that the  disease could not have
been  introduced  by that ship.  Dr. Arejula has,  therefore,
deemed it proper to reject the stories concerning the Dolphin,
and to confess that it was impossible to ascertain whence the

  • Professor Berthe, at p. 340 of his volume, has multiplied these deaths to three
times three, or nine.
  f See Dr. Pascalis's  Account of this Prosecution, &c. in the  New York Medi-
cal liepository, vol. 9 p. S86, 7, and 8. 
312
 epidemic was derived.   He, however, represents it as having
 been spread  by contagion from Cadiz, to the  other places
 where  it prevailed, and,  as having been exactly similar to the
 Yellow Fever of America, (seep.  153) in which his opinion
 agrees with  that  of Professor  Berthe,  Dr.  Gonzales, and
 other Spanish physicians, by most of whom it is now called,
 " la Fiebre Amarilla," or the Yellow Fever.
   After the treatment which Don R. Armesto and his publica*
 tion underwent,  it can hardly  be expected that  any Spanish
 author  would openly  profess to disbelieve the contagious na-
 ture  of this  epidemic, or  that I should be able  to adduce
 Spanish authorities to support my own opinion on that point,*
 and I  shall, doubtless be  thought to have done enough,  if,
 availing  myself of the  facts  asserted or admitted (for other
 purposes)  by  those who  represent the disease as being  con-
 tagious, I demonstrate the contrary from these very facts.
   Among the  facts in question, one which has been much in-
 sisted upon by the contagionists, and particularly  by Professor
 Berthe, is what may be  called the  Geographical Progress  of
 the disease, which,  though readily explained, by  supposing it
to proceed from miasmata generated  in  particular  situations,
 and wafted  in one direction by a  long-prevailing wind,  is
utterly  inexplicable upon the supposition of its resulting from
personal contagion, because, in great cities, men do not al-
ways communicate, in  the slightest  degree, with their  next
neighbours,  and  they never communicate exclusively  with
these, hut very often with persons at considerable  distances,

  * Don Armesto is not the only person  who has been punished in  Spain for ex-
 pressing  his sentiments on the subject of  Yellow Fever. Doctor, now Sir James
 Fellows,  who went from Gibraltar to Malaga and Cardiz, in order to procure in-
 formation on this subject, after mentioning, in a letter to me, (dated Algesirus
 Bay, February 27, 1806) the obstacles which he had encountered, says, the great-
 est " was the mystery and secrecy with which all the information I obtained was
 enveloped."—I found the Spanish physicians very willing to afford  me information,
 but I could not  get them to tell me all they knew ,■ for, in  this country, Doc-
 tors, who give their opinion too freely, about the nature of a disease,  are banished,
 as was the case of one at Malaga, and another at Carthagena." 
313
 and in various directions, by whom  the  effects of personal
 contagion would soon be  felt, and spread on all sides.  " It
 was distinctly observed, says Professor Berthe, at p. 74, that
 the malady affected to seize, with scarcely any interruption,
 all the houses which were situated on the same side of a street,
 and that it rarely passed over to the other side, where  the
 streets were wide, and well aired.  In some parts of the town,
 (he adds) the distemper has been seen to stop, as it were,  for
 a time, as soon as it had reached to houses standing  in a pub-
 lic square, and even to retrograde, with respect to the direction
 in which it had previously advanced, by appearing in the  ad-
joining houses, rather than in those which were separated by
 the breadth of the square."  These Mr. Berthe has strangely
 conceived to be clear indications of the contagious nature of
 the disease;—as if the next neighbours, on the same side of a
 street or square, had been  the only persons  in  all Cadiz who
 visited, or approached, each other.   And here I must remark,
 that, though the professor represents his supposed contagion,
 as so feeble  and inert that it could not make its way from one
 side of a street or square to the other,  he has most inconsist-
 ently described it in several parts of his work, and particu-
 larly in his Letter to the French  Ambassador,  at Madrid, as
 possessing an incalculable  activity.  And it is by this, and  the
 supposed rapidity of its extension, that he endeavours to  ac-
 count for the nearly simultaneous appearance of the disease at
 places so distant as Cadiz, Seville,* and other towns and vil-
 lages along the river Guadalquiver; an  effect which could*
 have been produced only by miasmata becoming abundant in
 those  low  situations, and acquiring  maturity nearly at the
 same  time.
   Another proof of the non-contagious nature of this epidemic
 is derived from the fact,  (admitted  by Professor Berthe, and
 all the contagionists) of its not having spread in the towns or
  * Dr. Pascalis asserts, that the  epidemic  first broke out " on the 23d of July,
 in the suburb of Triana, in Seville, a little before it was noticed at Cadiz."  See
 Medical Repository, vol. 9, p. 389.
                             40 
314
 villages, which are at a small distance from the low grounds
 of the Guadalquiver, particularly the elevated village of Al-
 cala de  los Panaderos,  which is  distant only three or  four
 miles from Seville, and takes its name from the occupation of
 its inhabitants, who are Bakers, and make  all the bread  con-
 sumed in Seville.  " There  was,  consequently," says  Mr.
 Berthe,  (see p. 157,  8.) "  a daily  communication  between
 Alcala and Seville, through  a considerable number of indivi-
 duals, and this communication  was  never  interrupted,  not
 even during the time when the distemper was committing the
 greatest havoc in the town;" and when, out of a population of
 80,000 persons in  Seville, above 76,000 were attacked by the
 Yellow Fever.*   He adds, that, according to the report of
 the physician at Alcala, twenty-four persons had  had the dis-
 ease in that village, who all brought it thither;  ("Pont ap-
 porte du dehors") that eighteen  of these had  died;  and yet,
 that in no instance had  the fever been communicated there,
 from one individual to another.f   Professor Berthe also men-

   * When Sir James Fellows returned to England, in 1806,1 mentioned to  him,
 what Professor Berthe had stated respecting Alcala, and  he  confirmed the  state-
 ment, as a  tact, of which he had been informed, on good  authority, in Spain ;
 adding, that the like had happened, in 1804, at two villages near Malaga, prin-
 cipally inhabited by Bakers,  who  supplied that city with bread;  the  persons
 who brought and delivered the bread at Malaga, sometimes remained there all
 the following night, and,  in that case, were afterwards very commonly attacked
 with the Yellow  Fever, at their own houses; but the fever was never propagated
 by them to any other person. He made a visit to one of these villages,  (Tnrriano)
 situated upon the declivity of a  hill, westward of Uie Agual Medina,  about five
 miles from Malaga—a situation  which, being like Alcala, removed from all pro-
 bable  sources of marsh effluvia, may account for the non-appearance of contagion
 in those who sickened there, much better than a supposition mentioned by Sir
 James, of its having resulted from the burning, in the Bakers' ovens, of certain
 aromatic herbs, collected in the  mountains.   Had they burnt all the spices of the
 Molucca islands, I,am persuaded they  would have proved as useless, for any  such
 purpose, as the fires made  in the  streets of Cadix were found to be,  in 1800.
  f M. Berthe endeavours to account  for the non-communication of the disease at
Alcala, by supposing that the fires of  the Bakers', ovens had produced a greater
ventilation in that  village, though, in another place, he acknowledges that the fires
made in Cadiz, to produce  a similar effect, were not of the least  benefit; and, in
towns where the  true plague has become epidemic,  the Bakers, instead of being 
315
tions  the small town  of Scipiona, as  one in which the fever
did  not  appear, though but  a few  miles  from San Lucar,
where a sixth part of the  inhabitants died of it.   Scipiona
had, however, the advantage of being higher and at a greater
distance from the low grounds adjoining the river.  M. Berthe
also mentions the large elevated town of Medina Sidonia,
between Cadiz and Gibraltar, at  the distance  of eight  miles
from the salt pans of La Isla de Leon, as another to which the
epidemic did not extend.*
   Another fact,  stated by  M. Berthe (at p. 69) on the autho-
rity of a principal magistrate at Cadiz, (Le Procurador Mayor
Don Miguel de Irriharen) is, that, on  the day  after the great
procession, which I have mentioned at p. 309, the number  of
sick was increased by between five and six thousand  new at-
tacks: and these are  supposed to have been the effect of con-
tagion received during the procession.  But it is utterly impos-
sible  that  any contagion  yet known, should have operated so

 exempt, have been found the greatest  sufferers. This is mentioned, in regard to
 the  plague at Toulon, in 1721.  See Traite de la Peste, 4to. p. 49, 50   In my
 copy of this work, there is a marginal note to this part of it, in the hand-writing of
 Dr. Russel, in which he states, that  "Bakers were  remarkably subject to the
 plague at  Aleppo, not from any peculiarity in the contagion, but from circumstan-
 ces favourable to infection."
   * It ought to be mentioned, that in the  following year, 1801, when the Yellow
 Fever  is understood not to have appeared in any sea-port town of Andalusia, it
 prevailed, to a considerable extent, in a particular quarter  of the inland town
 of Medina Sidonia, and as may be presumed, from the agency  of marsh miasmata,
 rendered active by  causes  which I am not able to explain,  not being sufficiently
  acquainted with the local circumstances of the place, and the state  of its atmoS*
 phere, at that  time.  There was, however, no suspicion of any new importation, of
 contagion, and  even if the epidemic of the preceding year at Cadiz, &c had re-
 sulted from contagion, and that contagion had been capable of subsisting in a dormant
 state,  over the  winter, and becoming active in the following  summer,  the effects ol
 its activity would, doubtless, have been manifested in the places where there had
 been  most of it, and where its ravages had been greatest in the year 1800, and
 not in a town where it had not existed.  On that  occasion, however, guards were
 employed to  obstruct all communication with the sickly part of Medina Sidonia,
 and as the miasmata could only reach to a certain extent, the fev«-r did  i.ot pre-
 vail in those quarters  which were too remote, and the guards naturally had the
 credit of having kept the epidemic within certain limits. 
316
suddenly, though it has been ascertained that marsh miasmata,
in  particular  situations, do sometimes  produce fever within
even less than twenty-four hours ,• and that these new cases,
as  well  as the  epidemic, generally resulted from the latter
cause is  abundantly manifest from  its similitude in every
respect to what have been heretofore noted and ascertained to
be  the peculiar  characteristics of marsh and Yellow  Fever :
especially the  following:
   1st. Its having been preceded by that stateof weather which
notoriously renders marsh effluvia most abundant and noxious.
That this was the case, to a  remarkable degree, is admitted
by  all: and Professor Berthe was  so  sensible of it, that, at
p. 366, he does not scruple to  admit, that if no contagion had
been introduced at Cadiz, in 1800, the causes of disease there,
and in other  parts  of Andalusia,  were such  that a violent
bilious epidemic, or marsh fever, must have been produced by
them, similar to that which was, at the same time, produced
by  these causes at Cette, and other places along the Mediter-
ranean coast.   He is, indeed, not willing to consider the fever
at the latter places as exactly similar to the epidemic of Cadiz,
&c. because he wishes to have it believed, that  contagion had
co-operated with the other  causes  in producing this epidemic,
and he represents the fever at Cette, as  not having been con-
tagious.  But, after attentively  considering his own descrip-
tions of both, it is evident that, at the utmost, they could  only
have differed in (a small) degree, and not in their nature.*
  2d. By the  greater prevalence and  mortality  of  the dis-
ease, in situations nearest to the sources of marsh miasmata.f
  •Don Rodr. Armesto considers the Mediterranean fever as resembling that  of
Cadiz, and  says, the same epidemical constitution of the atmosphere extended along
the Mediterranean, as far as Leghorn and Genoa, adding that, in the latter, " where
150 persons died every day of Yellow Fever, no American vessel could be accused
of importing it, as Genoa was, long before, closely besieged by  land, and blockaded
 by sea."
   fDr. Berthe, for himself and his colleagues, makes a general admission of this
fact at p. 161.  " The epidemic, (says he) was singularly rapid in its progress, and
always most destructive, in low and humid situations."  " I might, (he  adds) cite
on  this subject the ravages committed by the distemper in several  villages built on 
317
 This was strongly manifested in the Barrio of Santa Maria,
 which is stated, even by Mr. Berthe, to have been " le pre-
 mier Foyer," of the  disease, which, (he  adds) in that spot,
 produced " une mortalitt effroyable," (see p. 162.)  The ma-
 lignity   was,  indeed,  such, that  the proportion of deaths
 among  those  who were  attacked, exceeded, by ten  times,
 that of some other situations.   Here the  disease not only be-
 gan first, but  lasted, after it had ceased  in all other parts of
 Cadiz.   A  similar   difference, in  respect  of situation, was
 observed at Seville,  where, according to M. Berthe,  (p. 103)
 only one in eighteen of the sick died in  the  wider and more
 elevated streets,  while, in those  wiiich were  damp  and low,
 as in Triana, and Los Humeros,  the mortality  amounted to
 one-third, and even  to  one-half; and this difference  was ob-
 served,  not only in  regard to  streets,  but to  single houses, in
 some of which,  from .their situation, the  disease was much
 more fatal than in  others.  Such wide  differences would  not
, have accompanied a disease produced by contagion.
    3d.   By the influence of extreme hot  weather, in exaspe-
 rating  this  epidemic,  and  of cold weather,  in  mitigating,
 and finally  producing a  cessation  of it.    These  effects were
 generally observed;  and Professor Berthe  has mentioned
 them distinctly,  and  in  very strong terjns,  particularly  at
 p.  154 and p. 324.
    By the marked severity with which it universally  attacked
 all strangers from colder climates, particularly  those from

  the banks of the Guadalquiver, and compare  them with the very different results
  which it had in other villages at a small distance, but farther from t/te river, or stand-
  ing on rising ground, at a greater or less elevation.  We have procured the most ac-
  curate accounts in this respect, which it is useless to mention in detail, as they all re-
  semble each other."  This is in exact conformity with  the  experience of former
  times.  Dr. Lccaan, who, in the reign of Queen  Anne, was physician to a British
  army sent to Spain, in his " advice" to that army, p. 5, says," It is»generally obser-
  ved, that all over Spain, dwelling houses or towns built near any river side are al-
  ways unhealthy, and much worse  near a marshy ground, where fevers or agues are
  very common, and more frequently mortal or difficult to cure thanin any other part
  qf the world." 
S18
England, Germany, and Prussia,  as specified by M. Berthe,
at p.  175, 323, and those from Canada, as mentioned in the
publication made by the Spanish government.   And, on the
other hand, by its invariably sparing negroes, Creoles,  and
persons  who, after residing for some years  in situations be-
tween the tropics, had recently come from them, as is men-
tioned by Professor Berthe, at pages 166, 7, 8, and 9;  also
p. 323.
   With  all these prominent features, it is impossible  not to
recognise  in  this epidemic,  a marsh  or  Fellow Fever, and
consequently, a fever destitute of contagion.
   A  similar fever less violent,  and  much  more limited in its
attacks, occurred again at Cadiz and Seville, in the months
of August and  September, 1801, and, for some weeks, excited
considerable alarm ;  but the  weather proving to be neither so
hot nor dry as in the preceding year, the fever did not increase,
and was finally deemed  a Tabardillo,* or bilious  remittent,
such as occurs  to a greater or less extent, almost every year,
in the southern parts of Spain, as well  as  on the coast of
 Barhary.
   Though the Yellow Fever  had,  in the year 1800, prevailed
 at Malaga, and some other  Spanish  towns  on the Mediter-
 ranean coast,  it  was with  much less violence  and  mortality
 than in Andalusia.  It recurred, however, at the first  of these
 towns, with great malignity, in 1803,  so  as to occasion the
 deaths of 12,000 persons :  and, in the following year, it pre-
 vailed there again with almost unexampled violence  and fa-
 tality ;  it being computed that more than twenty-six thousand

   * If I am not mistaken, the Tabardillo (though often Used in a  more general sense
  strictly means the fever, which Burlet, (in his Dissertation sur les Maladies des Es-
  pagnols, Ann. 1714,) has named Tritseophia Syncopalis j having paroxysms which re-
  turn every day, but correspond alternately with each other,  as in the double tertian.
  Riversius calls it Tertiana maligna pestilens.  It is said not unfrequently to prove
  mortal at the second or third paroxysm.  Dr. Pascalis says that, during the epidemic
  of 1800, the Spaniards, not being aware of the absolute unity of the disease, consider-
   ed the milder cases of it asTaberdillos.  See Medical Repository, vol. 9, p- 379. 
319
 of the inhabitants  of Malaga, died in that summer and au-
 tumn, of this fever.
    In  1804, as well as in  the preceding year, this epidemic
 appeared first, and prevailed most generally and destructively
 in a low Suburb, called the  Barrio de Perchel,*  and in other
 contiguous low parts of the  town, liable to great humidity by
 inundations, and percolations of water from the river Guadal-
 medina.   And, as  the summer of  this year,  in  the south  of
 Spain, France, and Italy, resembled, and even surpassed that
 of 1800, by its excessive heat, and great want of rain, so the
 Yellow Fever prevailed, not only in Malaga, but  Cadiz,
 Gibraltar, Carthagena, Alicant, and even as far eastwards  as
 Leghorn, and in all  nearly at the same time.
    It  seems, however, to have appeared a few days earlier  at
 Malaga,  than at any of the  other places,  probably because,
 from local circumstances, the  heat of this city (and especially
 with the Terra!,  or land wind) is  often greater than  in  any
 other part of Spain.  (See  Carter's journey from Gibraltar
 to Malaga, vol. ii. p. 406.f)

   * Malaga is situated at the ftnt of a  mountain, and in a very low valley, through
 which a stream passes,called the Guadel-Medina.  This is properly a torrent, which
 is sometimes nearly dry, but sometimes is so full as to overflow its low banks, aud
 inundate several parts of the town on ono side,  and the whole of the  suburb called
 the Barrio  d' Perchel, situated on the other side. I have  been informed by Sir
 James Fellows, who visited Malaga in  1805, that the sites of  the houses  in this su-
 burb, and in many parts of the town, are from two to three feet below the bed of the
1 river;  aud that, when the stream is full, the water enters into all the lower apart-
 ments copiously.
   f '.le tells us at the  next  page, that in 1637, " 20,000 inhabitants of this city died
 of the plague, which visited them again twelve years after and carried  away the
 greater part of the citizens" Probably  this plague  was an epidemic Yellow Fever,
 like that of 1804.  The only objeotion  to this supposition is, that Mr. Carter men-
 tions the plague of 1637, as appearing in the month of May, which according to the
 old style then used, would have extended to the 10th of June.   But an extraordina-
 ry concurrence of circumstances has, in that part of Spain, sometimes produced in-
 tensely hot weather, even at an earlier period.  The like happened at Charleston,
 South Carolina, in the year 1732, when a most violent and destructive  Yellow Fever
 appeared there in the month of May, though that disease commonly does not begi
 to prevail epidemically in that city till August. 
320
  Early in August, the deaths had become very numerous at
Malaga, and had produced great alarm : but a diminution in
the heat of the atmosphere having lessened their number; the
physicians, on  the 14th of that month, subscribed a certificate,
declaring that " no epidemic then existed in Malaga,  and
that the disease which had appeared, was only a sort of inter-
mittent fever of a malignant character, similar to that  which
prevailed  in other parts of Spain ;  and that its malignity  was
already so much abated that only five out of twenty then died,
though, at its commencement, it had proved  fatal to  fifteen
out of twenty \" (a strong proof,  indeed,  of malignity!) It
bappened, however, that almost  immediately after this certifi-
cate, the weather again became  intensely hot, and  the deaths
increased so rapidly, that, on the 21st, they amounted to  148
in that single day.   The fever wras then deemed not only con-
tagious, but pestilential; and effectual measures were  unfor-
tunately taken to cut off  all  communication between the city
and the country, by which the  miserable citizens were com-
pelled to  remain exposed  to  the  morbid exhalations,  whicli
caused  the disease,  and  ultimately to perish  by  it, (as the
greater part of them  did) and, in the mean time, they were
depriv ed of the necessary  supplies of food.
  As the  disease had made its first appearance this season at
Malaga, and as  no  body  ventured to doubt of its contagious
nature, all the other Spanish towns (fifteen  in number, besides
villages)  where  it soon  began to rage,  were presumed to re-
ceive the  contagion from the former city ;* and (which  is per-
haps, still more  extraordinary)  Arejula, who  admits (p.  153)

  * Dr. F. Pascalis mentions (Medical Repository, vol. 9. p. 391) that the physician
 who, at the beginning of the epidemic, in Malaga, in 1804, first  announced its true
 character, " became so disgraced as to be compelled to exile himself.  In three days
 he arrived in Cadiz, where his servant soon  died with Yellow Fever."  This happen-
 ed exactly at the lime when other sufficient causes had rendered the miasmata ac-
 tive at Cadiz, and, the Yellow Fever soon becoming prevalent, as in 1800, it was as-
 cribed to this servant, and, of course, to contagion, not miasmata, received by him at
 Malaga. 
321
 that this was the true Yellow Fever of America, pretends that
 the contagion of it was introduced at Malaga, by twobri°s which
 entered that port, not from America,  but from Marseilles, on
 their way to St. Domingo ; so that the deaths of 120,000 per-
 sons by this disease, during that year, in Spain only, are thus
 derived from a  French  port,  where quarantine regulations
 are executed with tiie great exactness, and where no such dis-
 ease existed.   But, after having so  often proved that this fe-
 ver is void of contagion, and incapable of importation, I shall
 not be  expected  seriously  to examine  tins  charge against
 Marseilles, nor the allegations respecting other places said to
 have become infected by sommunicating with Malaga ; all of
 them,  so  far  as  I have been able to ascertain their local cir-
 cumstances,  having had within  themselves  such sources of
 marsh miasmata, as  in such an extraordinary season might,
 with  the  experience of  former years, have been expected to
 prove highly morbific*   Instead,  therefore, of exhausting the
 patience of my readers, by  describing sources  of marsh mi-
 asmata  in  Spanish towns,  where their  existence  has  been
 proved by the frequent recurrence  of marsh fevers, I will pro-
 ceed  directly to a place where these sources are less obvious,
 I mean
                         GIBRALTAR.
  And here it is to me  a matter of regret, that in describing
the situation, and local  peculiarities of this interesting spot, I
I am,  in regard to many circumstances, compelled  to rely  on
my own observations,  made at times, when, not  foreseeing

  * Carthagena, besides other sources of miasmata, has within about a quarter of a
 mile of its bastion, a very extensive swamp, called the Mmojar.  Mr. Townsend, at
 p 137, of the  3d volume of his Travels in Spain, says of the diseases of  Carthagena,
 that "the most endemical are intermittent and putrid Fevers. These arise from
 the proximity of t/ie extensive swamp, already mentioned, containing many hundred
 acres, which  might easily be drained, so as to produce the most luxuriant crops "—
 He adds, " in  the year 1785, during the three autumnal months, they lost '2500 per-
 sons, and, in the succeeding year, 2300 more; yet the Almoja;  lemainsundrained."
 To  th<se deaths may  be added 14,940 others,  produced in 1804 only, by the same
 marsh fever, aggravated into the form of Yellow Fever.
                              41 
322
 their connexion with tin's subject, my examinations  and in-
 quiries were not so minute and particular as they would other-
 wise have been.
   The town of Gibraltar is built upon a narrow strip of nearly
flat ground, extending along  the foot and western side of a
 stupendous rock, (in some places between 2000 and 3000 feet
 high) which, at its summit, is very sharp, and runs as a, longi-
 tudinal ridge, nearly a mile and a half from north to south.
   This rock,  on its eastern side, forms an abrupt and almost
 perpendicular descent, from top to bottom;  but, on the western
 side, towards  the town, its  declivity is but moderately steep,
 presenting,  according to my best recollection,  an inclination
 of about thirty-five degrees.  So that all the rain discharged
 from the clouds, attracted and arrested by  the  summit of the
 rock, and falling  upon a declivous  surface  of, I believe, at
 least 400 acres, excepting what escapes  hy evaporation, or is
 absorbed by  the scattered palmettos,  grasses, and plants
 which find means to grow on  the rock,  must descend to the
 town in addition to that which  falls directly upon  its own sur-
face.   But a part of this rain water is intercepted at the bot-
 tom  of the  declivity by a large ancient  stone Aquseduct, five
 feet deep, and covered by an arch ; having on that side, which
 is nearest to the acclivity of the rock, a considerable number
 of apertures, called weep holes, through which the descending
 water, after percolating through the sand, enters the Aquse-
 duct, for the  use of the garrison.   This Aquseduct begins
 about half way between the south portgate  and the new bar-
 racks : and  is continued close  along the side  of the road, into
 the middle of the town.   It, however, now  receives less water
 than formerly, because General O'Hara,  to form  a parade for
 exercising the troops, caused a ridge of sand which ran paral-
 lel with the  Aquseduct, and  through which  water was perco-
 lated into it, to be levelled and covered by a mixture of slate,
 hard clay, kc. which have formed an impenetrable surface, so
 that a considerable portion of the falling water, which used
 to find its way into the Aquseduct, now  runs over it,  into the 
323
town. How far this change may have contributed to increase
the quantity, or virulence of  the miasmata, in the summer of
1804, I am unable to decide.
   The whole Peninsula of Gibraltar  consists of a rock, co-
vered more or less, in  particular  spots, with earth.   Conse-
quently, the town itself is  placed  on the  rock which extends
even to the water's edge ; and this being nearly impenetrable
by water, must, in that respect, produce the effect of a  sub-
stratum of hard clay, and hinder the escape of moisture, ex-
cepting only those excesses of it, which the soil cannot absorp
or retain, and which must, consequently, descend to the ocean,
whose level is,  I believe, thirty or forty feet below that of the
streets, running generally with a small descent towards it.
The town, therefore,  though  elevated  in  regard to the sea, is
very low when  compared with what may be called the moun-
tain behind it:  and,  as the great quantities of vegetable  and
other matters constantly brought into  the town, to supply the
various wants of the garrison, and the other numerous inhabi-
tants, must  even  from  their refused or useless parts, afford
matters sufficient (with water) to produce abundant miasmata,
especially when assisted by the fragments of vegetables growing
upon, and frequently washed down, from  the mountain,* we
might, I think, very reasonably  expect in that climate, and in
such  a situation,  that marsh fevers would  sometimes become
prevafent.f  It is, however, I believe,  true  that agues do not
often occur in- the town of Gibraltar; probably, because in
ordinary seasons,  the quantities  of rain water which either fall

  * Sir John Pringle, in his work on Hospital and Jail Fevers, (p. 46) says, " I
 have observed, in a fixed camp, that the rottenness of straw concurred to affect the
 health of the men, as was v\s\b\ef>y' ^.general convalescence\i\>on changing the ground."
  • I have already  referred to Dr.  M'Lean's testimony  that fatal miasmata arise
 where there are no veiy  certain appearances of marehy soil, and to the instances
of this which he adduces from the fevers at Cape Nicholas Mole  and St Mark's.
Many others might be  added to these, if necessary.  Even Dr Chisholm, at p 122,
of his second volume,  has  mentioned a production of Yellow Fever, in 1798, at
Fort Edward,'in Martinico, by percolations of water, through the sides of a bankj
 lodging under " the floox1 of the barrack." 
324
directly upon the town,  or find their way into it, from the
declivous surface of the rock or mountain, are so great, as to
wash into the  sea, the decomposing  organized matters con-
tained in  the soil, before  they have had time to form noxums
miasmata; and it seems  to  be  only in seasons when there  is
but little rain  for  six or eight weeks,  that  such miasmata
can,  in Gibraltar, acquire maturity  and force sufficient  to
manifest themselves extensively.
  But, besides  the materials necessary or conducive to the for-
mation  of miasmata, there is, at  Gibraltar,  sometimes a co-
operation of causes suited to render them extremely powerful
and virulent, especially when, as in 1804, an intensely hot le-
vant or easterly wind prevails during a great part of the sum-
mer,  with no rain  excepting a  few slight showers, just suffi-
cient  for the extrication or evaporation  of these miasms in a
state the least diluted, or most concentrated with such a wind
intercepted by  the perpendicular  acclivities  of the mountain
on its  east  side, the  atmosphere  of the town of Gibraltar
would remain nearly stagnant,* and the exhalations from the
earth, instead of being blown upon the ocean, would be left  to
accumulate in  the narrow streets,  and produce the most  vio-
lent form  of marsh fever.  To  these causes,  we may add the
great augmentation of temperature, occasioned  by the rays of
an unclouded summer's sun, reflected upon the town, during
the hottest part of  the day, from the acclivities of the rock.—
Even the ordinary temperature  of the atmosphere in this town
appears to be  very  great.  Dr.  Lind  (on  Preserving the
Health of Seamen) says, " the heat at land, in  Gibraltar, ex-
ceeded that in the ship upon the water, by eight or ten degrees
and also that of Oran in Africa, by six degrees;" and he adds,
" that the  common heat,  during the summer,  in the garrison

  • Dr (Lind, on Preserving Health in Hot Climates, p. 117) writing of Port Vlaho,
which is almost surrounded by high mountains, in the Bay of Mexico, says, "the
stagnated  air thence becomes so unwholesome, that men, after being there  a few
days, are suddenly seized  with violent vomitings, head-aches, delirium, &c and, in
two or threa days more, the dissolved mass of blood issues from every pore." 
325
of  Gibraltar, is from 79°  to  87 degrees.   See p.  168.  We
need .not, therefore,  wonder,  that though agues do not often
occur  at  Gibraltar,  the more violent forms of marsh fever
frequently prevail there, during  the summer and autumn, as
is well known to be the case.
  The  late  Dr.  Donald Monro, in his Observations  on the
means of  preserving the  Health of  Soldiers, vol. 1,  p.  23,
says, " at this place (Gibraltar) June,  July, August, and Sep-
tember,  are  constantly  hot, and the two last sultry ;  and  in
these months the garrison, and  inhabitants, are subject to bilious
and putrid* ^ disorders ; but new comers seldom escape, and
have them in a violent degree.
  This statement by  Dr. Monro, having been shewn by me to
Sir James Fellows, on  the  3d  of June, 1806, was by him con-
firmed, on the ground of his own experience, at Gibraltar,  in
the preceding year,  and also  on that of documents which he
had collected there respecting the state of health of the garri-
son in former years.
  Mr. Pym, Garrison  Surgeon at  Gibraltar, and long a resi-
dent there, mentioned to me on the  27th of November,  1808,
that, during the hot months, persons died  there every year of
fevers, which, by his description,  resembled the bilious remit-
tent or  Yellow Fevers of the  West Indies ; the patients often
becoming yellow before death ; and, it appears from the 3d
volume of Dr. Trotter's Medicina Nautica, (p. 420 and seq.)
that a similar  fever prevailed, to a  considerable extent, at
Gibraltar, in the autumn of 1799.f

  • The words  " bilious and putrid," as here used, were apparently intended to
signify fevers resembling the Yellow Fever of the  West Indies, though, perhaps,
less exasperated.
  f In the year 1766, orders from his Majesty being sent to the governors and com-
manding officers at Gibraltar, Grenada, Antigua, Jamaica, Senegal, and North Ameri-
ca,  " to transmit a report of the most eligible season for landing troops in each of
their respective districts, so as to avoid, as much as possible, the inconveniences of the
climate," 'Answers were returned to this  requisition by the several governors, under
their signatures, after proper  consultations and inquiries: and a copy of these an-
swers having been transmitted, by the Adjutant-General, on the 29th of May, 1809, 
326
  With such evidence of the morbid effects of marsh miasmata
at Gibraltar, there can be no  doubt that, however produced,
they often exist in that place, during the summer and autumn ;
and  when,  by the  unprecedented heat, and drought of these
seasons in the year 1804, the marsh fevers of Cadiz, Malaga,
and other towns, but little removed from Gibraltar, had been
converted into the most violent epidemical Yellow Fever, can
it he surprising that this should also have happened at the lat-
ter of these  places ?
  Many stories,  contradicting and refuting each other,  were
confidently  propagated  respecting the supposed introduction,
at Gibraltar, of the contagion  to which this was by many at-
tributed.
  Among these stories, one derived it from Cadiz, hy means
of a Spaniard, named Sancho.  Another from Malaga, by a
different Spaniard, named Santos.  Others designated indi-
viduals, with different names, from these places, as having
done the mischief.   That some persons arrived, and sickened
at Gibraltar, after having imbibed the noxious exhalations of
Cadiz, and  Malaga, may he true, and, also, that this happen-
ed about the time when miasmata, similar to those which had
occasioned the epidemic  in those cities,  were beginning to op-
erate at Gibraltar,  may also be  true ; but this is all that can
be said with truth.
  The accounts are almost as contradictory,  in regard to the
particular time and spot at which the first case or cases of
this fever appealed in the town of Gibraltar.   This contra-
diction, which  could  not have  happened, if  the  disease had
originated  from an imported  contagion,  would naturally oc-
cur in  regard to an epidemic arising from miasmata, which
beginning to act,  often at several places, and always in dif-

 to the army Medical Board, for the re-consideration, I copied the following ex-
 tract, relating to  Gibraltar, (which has also been noticed by Dr. Monro) viz.
 " Gibraltar, from the middle of November to the latter end of MarcH, the best
 time for landing ; June, July, August, and September, the worst; the garrison
 being very subject in these months to bilious and putrid fevers." 
327
ferent  persons, ahmit the same time,  and producing in them
diseases  of various degrees of violence, it must have been
difficult,  (as  it has been found to be in New York,  Phila-
delphia,  &c.) to draw a line of separation, between the com-
mon bilious remittent, and that which, by being a little more
severe, were mistaken  for  a new fever; especially  as these
marsh epidemics  commonly begin  w7ith the milder  forms,
and  increase by  almost insensible gradations.  Hence some
accounts represent the  epidemic in question  as  having first
appeared at Gibraltar about the tenth of August, and others,
as having  begun  about the 8th  or 10th of September, and
this in different individuals, as well as places.
  It appears, however,  that the  fever began to  attract par-
ticular notice in several houses  near the governor's parade,
a little before  the middle  of September,  and soon appear-
ed in so  many  others, that it was found utterly  impossible,
as might be expected, in  an epidemic from such a cause,  to
trace any sort  of connexion, in regard to its progress; and
though most of my information has  been obtained from gen-
tlemen who had  believed in the existence of contagion, yet
that information warrants me in asserting, that no  one fact
has been substantiated,  to prove that there wras a single in-
stance, in  which  the disease  had  been  communicated from
one  individual to another: Indeed,  it must  have been dif-
ficult,  in a place so confined and crowded as  Gibraltar was,
to have  distinguished between  the effects of miasmata and
those of  contagion, otherwise than by the greater rapidity
with which fevers, from  the  first  of these causes,  general-
ly appear to  spread within certaia limits, as then happened
at Gibraltar.   But I do  not  find  that any  experiment was
devised,  or pains taken,  for the purpose of ascertaining the
truth,  had  it been practicable, on  this point.   Dr.  Nooth,
an army  physician, of great experience, as well  as learning,
who was then at the  head of  the  medical  department  in
Gibraltar,  had, during his long services  in  different  parts
of America, become  well acquainted with marsh fevers,  in 
328
 their  several  forms,  and  he  was  soon  convinced  that an
 exact similitude existed between the  most violent of these,
 and the disease then prevalent at Gibraltar, and, consequent-
 ly, that the latter was  void of contagion; and, though  per-
 sons less acquainted with  these  fevers, and, therefore, less
 qualified to decide  respecting  that  of  Gibraltar, very gene-
 rally, concluded the latter to be contagious; and, probably,
 for no better  reason than  the fallacious  one of its spread-
 ing epidemically,  Dr.  Nooth, as  I am  informed,  did not
 see any cause to change his opinion on  this subject.
   In regard to the symptoms  of this fever,  they were, in
 every  respect, similar to those of the epidemics then  and
 lately prevailing at Cadiz,  Malaga, kc. and, therefore, all
 my observations on the latter will be applicable to the former.
 It began at the time when marsh fevefs are commonly most
 prevalent, and was preceded by that intensely hot and  dry
 weather, which renders them most  violent, and which would
 have destroyed a typhus  or contagious fever: and it was ex-
 tinguished like other  marsh fevers, by the rains and  cool
 weather of December, wiiich would not have extingnished any
 contagious fever yet known : like the yellow and  other marsh
 fevers, it attacked, with  the  greatest violence  and mortality,
 persons from cold climates;  and either did  not  affect, or af-
 fected but slightly, persons who had resided for  a  long  time
 between the tropics,  and  had but lately quitted that residence.
 Thus it appears, by the official returns, that the 10th regiment,
 lately arrived from the East Indies, by the way of Egypt,
 though 748 in number, besides commissioned officers, lost only
 twenty-eight men during the  epidemic; and  of these,  the
 greater part were unseasoned recruip sent to Gibraltar from
 England : whilst, on the  other hand, the regiment of De Roll,
 consisting principally  of Germans,  who had  not previously
 served in any hot climate, lost 187 out of 605 men : almost a
third of their number.   The mortality  was greatest on  the
2d  of October,  when nearly  150 died.  After the 1st of  No-
 vember, it diminished greatly. 
$29
   Strangers arriving at Gibraltar, while the fever prevailed,
 were most  commonly attacked with it on  the  2d, 3d, or 4th
 day, after their arrival ,• a space much too short for the opera-
 tion of typhus contagion.  Mr. Pym, Surgeon to the garrison,
 and now Deputy Inspector of Hospitals,  who  had  read and
 believed Dr. Chisholm's account of the alleged  introduction of
 a new and highly contagious fever  at  Grenada, by the ship
 Hankey, imagined  the epidemic at  Gibraltar to   resemble
 that  fever; and he endeavoured,  in  a  conversation  with
 me, to explain how it might be distinguished from the or-
 dinary bilious fever of Gibraltar;  and this was by an ag-
 gravation of symptoms similar to that which Dr.  Chisholm
 has mentioned as having distinguished the supposed Hankey
 fever  from the ordinary Yellow  Fever of the West Indies.
 Expecting, as I do, to demonstrate, in my seventh  appendix,
 that no fever, of any kind, was derived from the Hankey, and
 that no such contagious fever as is supposed, ever existed, it
 cannot be necessary that I should here discuss  that subject.
   In the year 1810, a state of weather, similar to that of 1804,
 in regard to  heat and  drought, subsequently  to  a very wet
 spring, occurred  at Gibraltar, Cadiz,  Carthagena, &c. and
 re-produced the Yellow Fever at all these places ,•  but, as this
 state of weather began  later, and lasted a  shorter time, than
 in 1804, the disease  was not,  in  many cases,  so violent, nor
 did it  prevail so extensively, or so long, as in that year.  The
 worst cases at Gibraltar appeared in a few transports, upon
their arrival from  Carthagena, where  their crews had been
 exposed to more virulent miasmata than those at Gibraltar.*

  * Most of these cases fell under the care of Mr. M'Arthur, Assistant-Surgeon of
 the th Veteran Battalion, who, in giving an account  of them, dated  October 29,
 1810, writes as follows : " After carefully observing the symptoms and progress of
 the fever that lately raged here, and comparing h with the accounts of the malignant
 Yellow Fever that prevails in the West Indies, I am clearly of opinion, that it is ex-
 actly the same disease.  In its symptoms and character, it almost accurately corres-
 ponded with the description of that disease given by Mosely.  N B  Dr. Moseley's
 description was written long before the Hankey was built, and is generally well suited
 to the severer forms of the Yellow Fever in America.
                              42 
330
   In the tow n of Gibraltar, some persons died of the fever in
three or four days, but many of tbe cases were milder, and so
much like the ordinary bilious remittent,  that  some doubted
whether it was similar  to the fever  on board the transports.
Others imagined that there were two sorts of fevers  in  the
town,  one contagious,   and introduced  by  some means or
channels unknown, from the transports; and  the other, an
indigenous, marsh, or bilious fever.   Nearly the same varia-
tion, in the degrees of violence, occurred in the fever at Cadiz,
and  would naturally occur to marsh  fevers, and to no others
in such a  season.  The following is translated from  a  decla-
ration, dated Cadiz, November 2, 1810,  and signed hy Sir
James Fellows,  and nine Spanish physicians, viz.:
   "  We, the undersigned physicians, having deliberated on
the questions proposed to us  by the  Supreme Junta, relative
to the nature and symptoms of the disease now prevalent,
have agreed that it is the same  in kind as that which raged
here in 1800 and 1804, but that  it is less frequently malignant
and  contagious; we having observed, in many of the sick,
disorders  of  a different  character, which cause the  reigning
fever to be less intense and infectious."
   How a  contagious fever, in one set of patients, should be-
come less  contagious and intense, because others had different
disorders  at the same time, I do not  understand—probably
these other disorders  were remittent fevers, or  Taberdillos.
These Spanish physicians, however,  seem to have become less
confident  than  formerly,  in the supposed  contagion of their
epidemic; and I am well informed, that but a day or two be-
fore  the date of this declaration, Sir James Fellows had de-
cidedly expressed  his  belief, that it was not contagious, though
he formerly entertained  a different opinion of  the epidemics
in Spain and at Gibraltar.*

   * Whether Sir James Fellows would ever have entertained such an opinion of
these epidemics, had he been left, by Dr. Haygarth and others, to the unbiassed con-
 clusions of his own reason, may, 1 think,  be questioned. And 1 think it right to
 mention, as an instance ot Dr, Hay garth's confidence in his own judgment, respect 
331
   Probably my readers will  agree with me, that my view on
 this  subject may now be closed with propriety.  I might, in-
 deed, have  taken into  it  hundreds  of facts,  in addition to
 those which have been recently noticed, and of  similar import;
 hut I think  too  highly of their understandings  to suppose that
 such additions can be necessary.
   There are but few things  more obscure or  fallacious  than
 the subject of  febrile  contagion.    The  matters,  (whatever
 they  may  be)  which  produce  contagious fever,  being  like
 marsh miasmata, imperceptible by our senses,  and  like them
 applied to the body   through the medium of the atmosphere,
 we can  never  directly  trace  either  of these morbific  agents
 backward  to its  source,  so as,  by that  means, to  ascertain
 whether it had  emanated from a person labouring under fever,
 or from the earth.   Fortunately, however, the  fevers, occa-
 sioned by  these several causes,  are distinguishable from each
 other by certain  characteristic  marks and peculiarities, with
 which,  by  long experience,  and numerous observations, we
 have been made acquainted,  and thereby enabled,   with cer-

 ing a disease which he had never seen, (and of which his notions were most errone-
 ous) and of his solicitude that others should adopt and act exclusively upon his opin-
 ion, that,  in a letter  to a member of the late Army  Medical Board, and dated De-
 cember 16, 1801, he wrote as follows, viz.:   " Can you think it proper to leave up-
 on the medical staff, a single person who doubts whether this pestilence, (the fever
 at Gibraltar) and all the calamities which it has occasioned, were solely produced by
 contagion ? Every donbt of this kind will hinder the vigorous measures which will be
 required for the thorough  cleansing all the houses, boxes, furniture, and clothes,
from every particle of the infectious .poison.  Every hint suggested  to discourage the
necessity and utility of such purification,  will destroy the salutary confidence whieh,
in truth, ought universally  to  prevail."  I hope, and, indeed, believe, that Dr.
 Nooth's retirement from active service was with h'nn  a matter of choice, and not an
 effect  of this letter ; but I must think that Dr.  Haygarth ought at least, to have
 had some Jierso/ia/knowledge of the disease in question, and of the facts connected
 with its origin, before he attempted, on that ground, to deprive the public of the ser-
 vices of gentlemen who did possess that knowledge,  together with as much intellect
as himself,  and who were therefore, better qualified and entitled to form opinions an
the subject.  I certainly do not impute to Dr. Haygarth  any other than  benevolent
intentions in this exercise of his zeal; for I believe  such intentions  have often actua-
ted the most violent zealots, whilst persecuting others, even to death, to compel their
 assent to articles of faith. 
                                 332

tainty, to refer each of these fevers to its separate cause.   We
are,  moreover,  often enabled, in  some degree,  to ascertain,
by a proper attention to facts, which of these different causes,
or rather which of their  sources, has been sufficiently ap-
proached by an individual or individuals, for the production of
disease; and thus to discover the father, by the features of  the
child, and by the exclusive  opportunities  of access which  the
father has enjoyed.
   My  readers will recollect, that all these  means have  been
employed by me  in  regard  to the yellow, and its  kindred marsh
fevers, especially  in the view which has been just closed,  by
which it has been clearly seen,  that they are all the offspring
of one parent;  and a solid  foundation has been thus  acquired
for presuming,  that  the yellow,  like other  marsh,  fevers is
void of any contagious  quality.*   It has also been  seen  that,
in many thousands of instances, the Yellow  Fever has clearly
manifested and proved itself to be completely destitute of contagion.

   * Those who have imagined that  marsh fevers might become contagious, have,
 probably, never reflected upon the monstrous effects which, in that case, would ne-
 cessarily have ensued.  If the small-pox, measles, &c. had not been rendered con-
 tagious,  these  diseases would have existed only in the persons first attacked by
 them and  the  purposes, which they were intended to fulfil  among mankind, must
 have failed. But the cause of marsh fevers exists to such an extent, and so  perma-
 nently, that, probably, the loss of human life occasioned by it, without any aid from
 contagion, exceeds that of all other diseases incident to mankind : and if fevers pro-
 duced by marsh miasmata could acquire  a contagious power, and thereby produce
 other fevers, in addition to those which their original cause will, doubtless, continue
 to produce abundantly, and witlwut end,  such enormous additions, to the  widely-
 extended and powerful mischiefs of marsh miasmata, would  long since, in the ordi-
 nary course of things, have exterminated the human race. For the coldest habitable
 regions  would  not,  in that case, have afforded an asylum to  mankind, as they now
 do, from the evils of marsh miasmata.  Because that monstrous production of fever,
 from the contagion of marsh fever, would be enabled to reproduce itself as a con-
 tagious fever,  even in Lapland. And of what description can  we suppose such a
 fever would be ?  Does any one conceive that a fever, resulting immediately from the
 action of marsh miasmata, would resemble one produced by a different cause, i. e.
 the contagious quality which had been acquired by a marsh fever ?  This, and many
 other absurdities, might have been avoided, by attending to one great fundamental
 truth ; viz. that no disease is  ever contagious, unless it has originated from contagion.
 And that contagious diseases can only be produced by their respective contagiom. 
333
And, as truth  is invariable, and the same disease, in suitable
circumstances, is always or never contagious, we may safely re-
ly on this immense mass of evidence, and conclude, that the few
instances of a  contrary appearance, (and there are but very few
which have not already been shewn to  be founded in error or
misrepresentation) were observed and reported imperfectly,
or under tiie influence of prejudice, or deception.*   This con-
clusion will, I hope, produce important  benefits  to  mankind,
notwithstanding the outrageous  criminations  hy which Dr.
Chisholm  has endeavoured to obstruct all  free inquiry,  and
frighten or overwhelm his  opponents on this subject.   (Letter
to Haygarth,  p.  159.)  Great as the evils may be, of mis-
taking a contagious for a non-contagious disease, those pro-
duced  by  the  opposite error, are,  at  least,  of equal  magni-
tude : though, under  the influence of terror, the former have
been seen with  microscopic eyes, and the  latter,  in a  great
degree, overlooked.
   Without insisting npon  those expensive delays and  embar-
rassments, by whicli useless quarantine laws shackle the com-
merce, and naval operations of a great maritime country, I
   • I have already given instances of very erroneous inferences in favour of the sup-
 posed contagion of Yellow Fever, from facts  which, rightly understood, were capa-
 ble of proving :it to be nora-contagious.  The following is an instance of such an
 inference, from a fact which at the utmost, is but equivocal, viz. Dr. Dancer, of
 Jamaica, in a note to his « Observations on  the Contagiousness and Importation of
 Yellow Fever, in the New York Medical Repository, vol. 7, p. 253," says, " agree-
 ably to  the  information I have received, from several  country practitioners, the
 crews of ships stationed at the ouUports are generally healthy until one or more
persons fall sick."  A truism which seems applicable to ships at the in-ports also.
 He adds, " but, as soon as a  single instance of Yellow Fever occurs, the  disease
 spreads from one person to another, till it goes through the whole ship, and after-
 wards from ship to ship."  But this, which Dr. Dancer mistakes for a proof of conta-
 gion, is only, what might be  expected from miasmata, among  ships lying within
 their reach.  From various circumstances, their morbid  effects appear  sooner in
 some persons and situations than in others.  Some will,  therefore sicken earlier
 and others  later; and Dr. Dancer's mistake  consists in supposing that the  person
 who first was attacked, gave the fever to the second, &c. while, in fact, they all
 drived it from one common source.  The like mistake has been made by many
 others;  and even by Dr. Lind, at p.  184, 5, of his work on Preserving Health in
 Hot Climates. 
334
 may ask,  if it  be an harmless error which misleads mankind
 respecting  the cause of an  epidemic, and  not only  induces
 them to employ vexatious precautious to guard against imagi-
 nary dangers, but also to  neglect  the only proper means  of
 future  preservation,  by  meliorating  the  condition   of  the
 places they  inhabit ?   Dr.  John  Hunter has well observed
 that,  " by supposing a fever produced  by marsh  effluvia to
 be the effect of contagion,  an army may be left to perish,  iu
 an  unw holesomc  situation,  which might have been saved by
removing  to one  where such effluvia did not  exist."   (Dis-
eases of the Army, p. 320.*)  And it  is notorious that, dur-
ing  the late  epidemics  in the south of  Spain, an unfortunate
exercise of civil authority,  occasioned the loss of many thou-
sands of lives, by  compelling  the  inhabitants of the towns,

  • It is not always in  the power of a general to choose or change his situation, es-
 pecially when his army is weaker than that of the enemy.  But when this is the
 case, there is good reason to believe that the morbid effects of marsh miasmata may,
 in a very considerable degree, be obviated, by administering the Peruvian bark, with
 apsicum, or ginger, allspice,  and bitters,  copiously to those who are in  apparent
 health. In September, 1809, when an application was made to me by the Surgeon-
 General, with the sanction of his Majesty's ministers, to join Dr. Blane in the mission
 then proposed for Walcheren, I fully intended, if possible, to procure a fair trial  of
 these prophylactic means, upon the British troops there.  And when I  was  hin-
 dered from joining in that mission,  by causes which it would be improper to men-
 tion here, I communicated my ideas and wishes on this subject to the Secretaiy of
 State for the War Department; in whicli, however, a change was then taking place;
 and from that, or some other cause, my communication remained without effect.  It
 would have been my desire that each soldier should take night and morning a drachm
 of the bark in powder, with half as much  of powdered ginger, or allspice, or an
 equivalent portion of capsicum, in a moderate glass of rum, brandy, or gin, or half a
 pint of porter,  'or the space of a fortnight; and this I would have  repeated, after
 the interval of a  week, again and again, till the  beginning of December, when the
 noxious influence of marsh effluvia would have ceased to operate, until the  month
 of May, and  then I would  have recommenced a similar course, but with smaller
doses of the bark, etc. which would, I think, have been sufficient, if begun so early
 in the  year. By such means I certainly should  have expected to save many lives,
 and obviate the necessity of abandoning that island. And this expectation would
have been founded upon several facts published by Dr. Lind, Dr. Itobertson, M. Al-
 phonse Le Roi, &c. and upon others not published, which have  either  occurred
within my own knowledge,  or been communicated to me, upon unquestionable
 authority. 
335
 where it prevailed, to remain in their morbific atmosphere,
 lest, by quitting it, they should  infect others.
   These, however, are hut part of the evils resulting from a
 dread of contagion, where it has no existence.  Few in this
 country have heard or can conceive how often, and  to  what
 an extent,  the strongest and best ties which unite and benefit
 mankind, have been  cruelly  broken,  within the last twenty
 years, in some  parts  of America and Spain, by persons act-
 ing under  the  terror of imaginary dangers;  and driven by
 it, to abandon  their homes, their occupations, and even their
 nearest relatives and dearest friends, in the hour of sickness;
 and, by this desertion of the duties of humanity, this denial of
 that assistance, and  those consolations  which might  have
 been afforded,  without the smallest danger, to render  these
 visitations  of disease incalculably  more  afflicting and  fatal
 than they otherwise would have been.  Don  R.  Amesto, in
 the work heretofore mentioned, asserts that the barbarous and
 anti-social  belief of the  importation and contagion of Yellow
 Fever, has, from its baneful influence in Spain, caused many
 unfortunate victims to be abandoned, and left to starve in their
 beds.  That others have been slwt at the  very doors of houses
 in which they endeavoured to Jind an asylum ;  and that many
 others were carried alive to their graves."  Let the zealots,
 who have contributed to this monstrous  inhumanity, reflect
 upon it,  and if  their intentions have, as I  hope, been good,
 let  them,  at least, maturely examine  and  re-consider the
foundations  of their belief, before they  again endeavour to
 carry it into action.  It neither requires, nor indicates even a
 mediocrity  of understanding, or learning,  to  adop  the com-
 mon notion of contagion and foreign derivation, in regard to
 epidemics;  nor does  the facility,  with  whicli these notions
 are propagated, afford the smallest presumption in  their fa-
 vour.  By  much the greater part of mankind do not possess
 either sufficient industry or knowledge for the due examina
 tion of a subject so intricate,  and complicated, nor have they
 so much of  tHc power and habit  of close, and  accurate, rea- 
                            336

soning, as is necessary to decide respecting it.  Every one,
however,  can believe, and the belief of contagion affords  a
ready  solution of all  difficulties, without the  trouble of in-
quiry or even of thought; and we need not, therefore, won-
der that contagion, like witchcraft, should have been univer-
sally believed, (though as little understood)  and often with as
little foundation.
END OF PART IV. AND OF THE ESSAY ON YELLOW FEVER. 
PART  FIFTH.
CHAP. I.
    OBSERVATIONS ON  TYPHUS, OR CONTAGIOUS FEVER.

Though the Greek noun Tt>p«s (stupor,) was applied hy Hip-
pocrates to several diseases, all of  them very unlike the fever
in question,  (which probably was unknown  in Greece,)  I
shall not object  to  the  name, as distinguishing those fevers
which  accord  with Dr. Cullen's  definition of this  genus.*
But  I think there is great  reason to object to the vague and
loose application of it,  which is  now become frequent,  to
designate generally all low or slow fevers, arising frem great
fatigue, cold,  and damp habitations, unwholesome, or insuf-
ficient food, anxiety, grief, fear,  and  other depressing pas-
sions,  and debilitating causes, which have no  connexion with
contagion, nor any  power  of producing a contagious  disease.
I believe in the existence of a fever, sui generis, strictly con-
tagious,  (unconnected  with  any  of the exanthematous dis-
eases,) and,  therefore,  according to my  view of the  subject,
derived exclusively from its own specific cause,  or  contagion.
In this, which I consider as the only  contagious fever, there
are,  I think,  some varieties ; but without any  differences
sufficient  to form  more than one species.—The  facts and

  * Cullen. Gen. Morb. p. 71.  " Typhus morbus contagiosis ; calorparum auctus;
pulsus parvus, debilis, plerumque frequeus ; urinam parura muiuta ; sensorii func-
tiones plurimum turbatss ; vires multum iinmitiutse.''
                         43 
338
  reasons wiiich have led  me to this belief, will have been seen
  in the   second part  of this volume,  at p. 89,  and seq.  and
  they  arc  sufficient,  in my judgment,   to outweigh all  the
  great authorites  to which  they  are  opposed, and render it
  absolutely incredible that  any inanimate matters, even those
*  excreted by living animals, should by any natural, or artifi-
  cial decomposition  and  recomposition,  ever require a  power
  strictly contagious, or in other words, be enabled, like liv ing
  animals and vegetables, to  assimilate  other matters to their
  own nature, and  thus multiply and perpetuate their existence.
  Some writers of considerable reputation, sensible, perhaps,
  of this difficulty,  have made a distinction  between contagion
  and infection, and have  ascribed  the  production  of typhus
  fever, and  some  other diseases,  to  the  latter.   One of these
  writers, Dr.  Adams, (in the  quarto  edition of his  Observa-
  tions on Morbid Poisons,  at p.  6,)  after adopting this dis-
  tinction, says of " infectious diseases,"  that they " do  not
  require for their production  matter  similar  to their effects,
  but may at any  time be generated, by  crowding  together the
  sick or wounded,  of  any  description."*   He  then  mentions

    » Scores of justly distinguisheiraulhois have made similar assertions, without any
  decisive fact or evidence in support of them,  so far as I can discover ; probably rely-
  ing on the authority of those who had written antecedently.  Had this assertion
  been true, the sick and wounded at Walcheren  ought to have produced at least as
  many cases of typhus fever, as had previously occurred in  the same year, among the
  British troops at Corrunna, by actual contagion.  The sick, at least, if not the
  wounded, atthc former place, having been more numerous, and in many cases more
  crowded.  But, contrary to general expectation, not a  single instance of typhus fever
  appears to have been thereby occasioned. That such a production of typhus fever
  might  have been expected, according to the common opinions, will appear from a
  letter written to the Deputy Secretary at war, by the Physician General, Sir Lrt-
  cas Pepys, (after lie had visited the hospitals in the Eastern District,) dattd, " Army
  Medical Board Office, September 14,  1809."  in which he says, <• the disease- afflicting
  the troops returned from Holland, is the bilious remittent, and intermittent fever
  liable to degenerate into typhus  and contagious fever; but it has not, so far as I have
  witnessed, that character at present, nor is there any dysentery."  See Military Pa-
  pers, letter K. p. 52.
    Other  eminent physicians have not only  believed  this liability of marsh fever t*
  degenerate into contagious fever, but imagined Uiat such degeneration had actually 
339
♦• hospital,  prison,  or  ship fever,  camp  dysentery,  and  some
peculiarly  malignant  ulcers,"  as being  infectious  diseases;
adding,  that " though these diseases when formed,  may pro-
duce their like effects  in otliers, yet we  can always trace their


 begun to take place.  Thus Dr. Blane, in his letter to the Physician General, dated
 Middleburg, October '6, 1809, says " the fever known by the name of typhus, with
 which armies in ordinary circumstances are chiefly affecttd, has been rare,"----" as
 yet, among the troops here  I am sorry to say, however, that both diseases begin to
 shew themselves, particularly at Flushing, where the accommodation  is far inferior
 to that at Midd leburg."  Military Papers, E.  p. 103.  And in  another letter, dated
 the 6th, he explains the causes  which render the situation of the sick at Flushing
 "much worse  ;" adding, " they are  also over crowded and dirty."  E. p. 98.  After-
 wards, iu a joint letter from Dr. Blane, Dr. Lempriere, &c. to the Secretary at War,
 dated October the  10th, 1809,  we find this observation, viz.  " The malady is not
 contagious in itself, but liable to assume that new form of fever, wherever  ventilation
 is defective, the patients crowded, or where other local causes of impurity prevail.—
 This  has  been strikingly proved in some instances, particularly  at  Flushing, where
 we found the  accommodations too confined and  crowded."  E. p. 107.  That these
 gentleman in  this iastauce mistook a few cases of low, or slow nervous fever, for a
 contagious or  typhus fever, (as has been done thousands of times,) was manifested af-
 terwards, by the facts stated at p. 215—19 of  this volume.  And certainly if the gen-
 eration of  contagious fever in the way, and by the means in question, had been pos-
 sible,  the  supposed instances of it would not have been confined to Flushing ;  other
 places haying been very sufficiently crowded,  as is proved by a letter from the gener-
 al in chief, Sir Eyre Coote, to Lord Castlereagh,  written on the 17th  September,
 1809, immediately after a personal inspection of the different regimental, as well as
 general  hospitals.  " Middleburg, (says he,)  from the size of its building,_ affords the
 best accommodations,  but even in that town the sick are so crowded, as to lay (lie)
 two in one bed,  in several places, and have no circulation of air."—" At Veer, a large
 church contains about 400 patients, the other places are miserably small, and exces-
 sively crowded   At Armuyden the accommodation for the  numerous sick is wretch-
 ed."
    I have admitted at the begining of this note,  that the number of wounded men at
 Walcheren,  was greatly  disproportioned to that  of the  sick.  But there is suf-
 ficient evidence to  prove, notwithstanding all that has  been written  and believed to
 the contrary,  that patients of the former description  do  not generate contagious
 fever any more than the latter.   Dr. Blane, who was physician  to the fleet under
 Lord Rodney, mentions that the  battle of the 12th of April, produced an addition of
 810  men  to the list of wounded.  But though the whole  fleet was  detained at sea
 until  about the end of that month, and the last division of it did not  reach Port
 Royal, in Jamaica,  until the 25th of May, and though the discharges from so many
 severe wounds, must in that climate  have become  highly fetid, "yet" says Dr.
  Blane,  (p- 76) "  the; c was less sickness and less dealh from disease in this month 
340
origin in  causes different  from  their  effects."   That  Dr.
Adams,  who is  accustomed and qualified to reason,  should
have believed any thing so unphilosophical, and incongmous,
would have  been incomprehensible to me, if so many others
had not  discarded common sense on the subject of contagion.
To represent  a disease which is  notoriovzbj contagious,  and
propagated  by contagion, as  capable of heiitg also produced
by  other, and those  very different means, is to multiply causes
unnecessarily, and, therefore, unjustifiably;  and it moreover
destroys the natural,  and just influence of causes upon  their
effects, hy making the same disease result from very dissimi-
lar causes.    In this  way,  the  infectious  diseases of Dr.
Adams are supposed to acquire all that is wonderful in conta-
gion,  I  mean  the power  of reproducing, and perpetuating
themselves,  without deriving any thing  from that  original
product of  divine wisdom and power, to which  I am forced
to  refer the beginning of  all  strictly contagious diseases ;
and while thus enabled to  multiply themselves, ad infinitum,
similar  diseases with the  same  reproductive powers,  are
sirpposed to originate  from  time to  time,  in  thousands of
other persons, without any legitimate or suitable cause, or,
in  the  language of Dr.  Adams,  by  the agency  of matter,
dissimilar  to its effects: and these monstrous products,  of an
equivocal  incomprehensible generation,  are to be considered
as  similar in their natures and effects, to those resulting from
specific  contagions.   Were it possible for. typhus thus  frc-

 (April), than in any of the former 2.3 months, in which I kept records of the fleet,
 and less than in any subsequent month, till the fleet got to the coast of America/'
 And that an accumulation of wounded men is no more productive of fevers of any
 kind in cold weather, than in hot, as just mentioned, I need only copy what Dr. Lind
 has stated at p. 213 of his work tm the Health of Seamen, concerning the Magna-
 nime, ship of the line, viz.  '' She was seventeen weeks at sea,  and for a whole
 month of that  time, during very bad and stormy weather, had on board the men
 wounded in the general engagement on the 20th of November: notwithstanding
 this long  continuance at sea, and the violent storms she encountered, yet of 700
 men, 5 persons only were reported to us to be sick, besides the wounded, and these
 chiefly in  chronic disorders.1"          / 
341
qucntly, and  easily,  to originate without  contagion,  and  at
the same  time  acquire and multiply itself, by a contagious
quality, who could ever hope to escape that disease ?
  If Dr. Adams had  supposed typhus fever to be not conta-
gious, his opinion that it might be produced by a great accu-
mulation  of sick  and wounded,  in close  or  ill ventilated
places, would  not to me  appear,  a piiori, improbable; as
the atmosphere may become unwholesome, either by not con-
taining a  sufficient portion of  the vital part of it, or by the
addition of  noxious v apours  dispersed therein; and it might
be very naturally  expected that fever would occur among the
disorders  resulting from  such  a deficiency  of oxygenous  gaz
on one hand,  or such noxious  additions on the other;  though
we are not entitled to believe that  this really does  happen,
without some  evidence of the  fact,  and of this  (as has been
observed  at p. 89 and seq.)  there  is none within, my know-
ledge,  excepting that  whicli relates to  fevers produced  by
exhalations  from the earth, and excepting that connected with
specific contagions.
  Though  contagious  fever has probably existed  for many
ages  in this, and some other northern countries, its history is
involved in great obscurity,  because it  was not, until very
lately, observed and  distinguished  with any tolerable accu-
racy.*  Even Sydenham  did  not consider this fever  as pro-
  * One of the most early and unequivocal accounts of typhus which I have met
 with,  is in the first volume of the  "Acta Medicorum Berolinitnsium," of which 1
have  the 2nd  edition, printed at Berlin, in 1719-  The first article,  the title ol
which is "Anni praeter  la'psi, 1716, Status epidemicus  speciatim historia febrium
 petechialium, tunc temporis grassantium,"  containing an  account of a contagious
 petechial fever prevalent " in Pomerania citeriore," p.  10  " Ultra fluvium Pene,
 Grypswaldae, Stralsundse atque in insula Rugia, (Rugen) magnus incolaruin nu-
 merus, hac maligna febre afnictus fuit.  Regnavit dirum hoc contagium per totam
 fere hyemem  anni  prseterlapsi 1715, ultimumque suum non ante effudit impetum
 quam sequinoctium vernale, anni 1716 superaverat, solstitiumque eestivale plenius
 attigerat."  This account, or, as it is called " Methodus, fktheses practicse, secun-
 dum  quas febres accutse petechiales, anno, 1715, post  solstitium hyemale St deiu
 porro in nosocomiis castrensibus & alibi tractatse fuerunt," was written by the Ar-
 chiater regius ; and to these, " nonnihil desuisquoque addidit, Doctor Schwartzius."
  It is  stated at p. 18, that both these physicians  died  of this fever; the treatment 
342
 ceeding from  contagion, but  as  depending on  a particular
 state, or constitution of the atmosphere.   Huxham and Prin-
 gle, as I have formerly mentioned, were the first who gave us
 distinct and just  notions of  contagious  fever, though  Dr.
 Ebenezer Gilchrist,  of Dumfries, had previously written two
 papers on it, under the name of " Nervous Fever," one in the
 fourth volume  of the Edinburgh Medical Essays and Obser-
 vations, printed in 1737 ;  and the other in the fifth volume of
 that wrork,  printed in  1744.  And though he was  silent con-
 cerning its contagious nature, his descriptions, separated from
 the theoretical reasonings  adapted to his time,  are generally
 correct.  He states " this fever to be very different in its na-
 ture  and changes, from other fevers," and to  have "some-
 thing pecidiar  in it which neither the ancients nor moderns per-
 haps  had described, if at all thought of."  Vol. 5, p. 507.   He
 adds, at the next page, " as our fever seems to be peculiar to
 this age, it is not a little surprising that much  more had not
 been  said upon ft.   Some scattered hints are to be found in
 late authors, both just and ingenious, but not sufficient to make
 out a system of the disease."  He did  not, however, mean to
 represent this as a new disease, because in the preceding vo-
 lume, at p. 348, he  had stated it to have " been these many
 years fatal in Britain."  He appears to have treated the fever
judiciously, and to have formed just opinions of the effects of
 opium, bark, and wine, in certain circumstances.
  Typhus is properly the disease of cold climates, and in this,
 as in almost every other particular, it is  in direct opposition
 to the yellow fever.   The late Dr. John Hunter, in a paper on
 the gaol, or hospital fever, (Medical Transactions, vol. 3, p.
 348,) says, " I have never seen the fever earlier than the month

 which  they chose for themselves, is also mentioned ; and, it is not surprising, that
 bleeding and emetics,  repeated at advanced stages of the disease, should  have
 brought on hiccuping and petechia?, and have occasioned death.
  The description  of the symptoms, and of the effects of some of the rcmedu-s
 employed, which will be chiefly found between pages 10 and 25, are Judicious, and
 ^fford  unquestionable proof of the existence  of this fever in the army, and lower
 classes of the people, in certain parts of Pomerania. 
343
 of November, and I believe it seldom appears so soon.   It be-
 comes  frequent about  Christinas,  and  increases  during the
 months of January and February.    If  March and  April are
 warm,  it grows less frequent; but  if they are  cold, it con-
 tinues  nearly as common as in the preceding months,  which
 was the case in the two last winters, both of which were unu-
 sually  cold.   When the weather begins to grow warm, it gra-
 dually disappears."  P. 350.   He adds,  (p.  366,) " I would,)
 observe, that for upwards of two years,  that I remained in Ja-
 maica,  I never saw  one  instance of the hospital fever, though
 the military hospitals were often as much crowded as they are
 in .Europe."  "The heat  proves a prevention of the disease,
 as much as cold forwards its production."*
    The influence of heat in  mitigating,  and finally extinguish-
 ing contagious fever, was very fully manifested in regard to
 the  troops which  sailed from  Cork,  under  the command of

   * Numerous facts might be mentioned in confirmation of this general assertion.  Mr.
 Howard  has repeatedly noticed the greater prevalence of jail fever,  during winter,
 than in summer;  and Dr.  Trotter, in the first volume of his Medicina Nautica, .
 197, observes  that " as cold weather, and a whiter season, favour the action of ty-
 phus infection, we know that warm weather, and a summer season, assist in its extinc-
 tion."   And of this he gives several decisive  instances and proofs.  Dr. Blane had
 previously made a similar observation, at p. 233 of his work on the Diseases of Seamen,
 Dr. Lind  also has mentioned facts,  in which heat  produced similar effects, though he
 appears not to have  understood the cause; at p. 319 of his volume on Preserving
 the Health of Seamen, he observes,  that "this infection (of typhus fever), after every
 method used to destroy it  has prmed ineffectual,  will often of itself, gradually abate,
 and at length entirely vanish." This he adds,  " I often observed in our prisons, during
 the last war, where,  after  committing great  ravages among the French prisoners,
 the infection often stopped of a sudden, and  they were sometimes so entirely free
 from it, that iu the month of September, 1762,  when I was employed by the govern-
 ment,  to  muster the prisoners of war in the castles of Porchester and Winchester,
 which  in the preceding year had  suffered  much by the jail distemper, I did not find
 oiie person labouring under that distemper,  among  7000 prisoners, many of whom had
 been confined for several y£ars." (See Lind on the Health of Seamen, p. 320, 321.)
 11 ere there is good reason from the month (~September J in which this entire cessation
 of the disease was found to  have taken place, to conclude that it had been  produced
 by the heat of the preceding summer months, though Dr. Lind assigns no cause for it
 "which seems indeed to have been an extraordinary oversight and omission, especially
as at p. 233 of the same volume,  he had inferred from several facts, " that a cold damp
 air increases the power and vigour of contagion ;" meaning that of typhus fever. 
344
 major-general  White, for St. Domingo, in February, 1796.
 Two hospital ships, in which I had embarked, and sailed from
 England with the army, under sir Ralph Ahercrombie, hav-
 ing by storms been rendered unable to  continue the voyage,
 and the last of them having landed me on the south-west coast
 of Ire, I embarked on board a very large  hospital-ship, the
 Bridgewater, (formerly an Indiaman,) destined to receive the
 sick of general White's division, among wiiich a severe typhus
 fever had prevailed to a great extent, and with great morta-
 lity, previous to our sailing from Cork, where most of the sick
 were left at our departure;  but  many of the soldiers,  appa-
 rently well, being exposed to the contagion which existed in
 many of the transports,  or having imbibed it  previously,
 whilst detained at Cork, fell sick on the passage, and were
from time to time removed into the Bridgewater, which soon
 became full of patients, under typhus fever, which was com-
 municated to several of the orderly men,  and nurses, to some
 of whom it  proved fatal.  It became evident, however, that as
 we reached, and proceeded in the warmer latitudes, the cases
 of fever gradually diminished in number, and became  much
 milder; though, from the shortness of our passage,  and the
 cool season in which it was made, the full effect of heat in ex-
tinguishing contagious fever,  could not have  been produced,
 and, therefore, it  was not surprising that a  few patients with
 the same fever,  in a  milder form, and apparently divested of
its contagious power, were sent on shore to  the hospitals, im-
mediately after our arrival at Barbadoes.   These had proba-
 bly imbibed the contagion before our arrival within the tro-
pics, and its effects, though moderated, were not wholly pre-
vented hy a change of temperature.  One of the  last persons
 attacked, was my own  servant, who had  indeed been suffi-
ciently exposed to the contagion  on board  the Bridgewater.
But in his case, as well as in all the others which occurred be-
tween the tropics, the fever was slight, and not being commu-
nicated in any instance,  at least  after our arrival at Barba-
does, it there terminated. 
345
   In voyages to the East Indies,  ships remain for a  much
 longer space of time between the tropics,  and being also ex-
 posed to an higher temperature, the  power of heat in destroy-
 ing typhus fever, is in them more decisively manifested; an
 entire cessation of the disease, (however prevalent) commonly
 taking place before they can reach the Cape of Good Hope.  It
 has indeed never been known, as I am informed, that a single
 case of this fever had  occurred on  either side of the Indian
 peninsula.
   But without going  from home,  or farther hack than the
 year  1809, we may find strong evidence of the power even of
the moderate summer heat of our climate, in extinguishing ty-
 phus fever.  It is well known that the contagion of this dis-
 ease, had been  imbibed hy many of the soldiers who returned
 from Corunna, in the beginning of that year; who, being at-
 tacked either on board of the transports, or soon  after landing
 in this country, the disease was communicated to nearly 10,000
persons belonging to the army, (including those in the artillery
and ordnance departments,) and this  within little more  than
two months.  I had a short time before obtained leave to re-
tire on half-pay ; but finding that there vv as no army physician
in the western  district, I offered my services there, and ob-
tained by doing so, an opportunity  of observing the influence
even of our vernal  warmth,  in  mitigating  and  checking the
fever, which ceased I believe completely, at least in regard to
new  cases, before the end of May, and even sooner in the
western and warmer districts.
  Whether heat interrupts or suspends the influence of typhus
contagion,  by dissipating the corpuscles, of wThich it consists,
or by rendering the body less susceptible of their impressions,
or both, I will not venture to decide;  but certainly, those who
by birth and residence, have been  long habituated to  inter-
tropical climates, are, when they remove into the cold, parti-
cularly susceptible of the action  of typhus  contagion, if* ex-
posed to it; and this has been found to be the case of Negroes,
to a  remarkable degree,  particularly in the New England
                           44 
346
states, and in Nova Scotia, where  the people of that race,
who were exported at different times to Sierra Leone, had
been very extensively  attacked with  contagious  fever; and
indeed many of them  were ill, and some died of it, in their
passage to Africa; but in all  cases it was very soon  extin-
guished after their arrival at Sierra Leone, if not previously.
Dr. Trotter has observed, at p. 205, of the first volume of his
Medicina Nautica, that the natives  of Africa "  are very-
liable" to the fever in question; adding, that " in ships they
are commonly  the first sufferers."   So that in this respect
also, the yellow and typhus fev ers are directly the reverse of
each other; as they are moreover in the following particulars,
viz.  Typhus is aggravated by that degree of cold which ex-
tinguishes yellow fever.   It never prevails epidemically.  11
commences much less violently than yellow fever, and is pro-
tracted to a greater  length.  It manifests  no disposition to
remit, unless the patient  has imbibed marsh miasms, whilst
even in the violent forms of yellow fever, there is generally
about the 3d or 4th  days, a very sensible,  and often a very
delusive cessation or abatement of the  febrile commotion, and
of all the inflammatory symptoms.   In both, however, it is of
high importance towTards the cure, that the patients should he
removed to, or kept in  a pure wholesome atmosphere.
   In  regard to their effects on the human  body,  Typhus is
generally accompanied with less mortality, and the derange-
ment which it occasions in the system, is much less permanent
and mischievous, than that which accompanies or results from
even the remittent fever of Europe.—Witness the events pro-
duced hy the former disease in the British Army, subsequent-
ly to  the return of the troops from Corunna, in  1809, and,
those which attended, or followed the expedition to Zealand,
in the same  year.  In regard to the former, it appears that
the deaths did  not exceed one in ten  of  the sick, though the
accommodations were in many situations but ill suited to that
disease; and a considerable number of the medical persons
employed by Mr. Knight, were but ill qualified to direct the 
34T
treatment of the sick; the whole were, moreover, restricted
by his  parsimonious regimental hospital system, from direct-
ing those allowances, and indulgencies, in  regard to nourish-
ment, wine, porter, &c. which are highly important to patients
under Typhus fever.  On the Zealand expedition,  however,
and without these advantages, the  deaths were but a small
fraction less than one in eight, the recoveries were much more
tedious, relapses, perhaps,  one hundred times more frequent,
and very often followed by permanent obstructions, or morbid
alterations of the Viscera, ending in  Dropsy, or other chroni-
cal affections;  which rarely occurred as  the  consequence  of
Typhus, in the troops  from Spain;  who were in general  fit
for duty in six or  eight weeks after becoming convalescent,
which was never the case with those from Walcheren.
   Whilst I was employed with the troops from Spain labour-
 ing under Typhus, I thought it very desirable that so good an
 opportunity of ascertaining  the  time which the  contagion
 thereof  may remain latent after its  application to the human
 body, should not be lost, as so many other opportunities had
 been; and I therefore obtained, chiefly through the kindness
 of Mr. Grant, deputy inspector of Hospitals in  the Western
 district, returns of the orderlies and nurses who had attended
 the sick in question, and had been  afterwards attacked with
 the same  fever;  and also an account of the  time when  the
 attendance of each began, and of the interval which succeeded
 previous to the attack.  I found, however, that it was neces-
 sary in these returns to make a distinction between the order-
 lies and nurses, who had returned in the transports from Co-
 runna,  and, consequently, had, at least in some instances, been
 exposed to the contagion, previous to their  attendance  on  the
  sick  here, (as was proved hy the different  results in these
  cases, from those  of the persons who had not left England.)
  And, accordingly, this distinction was  made in most of the
  returns.   In  all of them, however, there  was au omission ot
  the persons who had only been temporarily employed;  though 
                           348
their  number exceeded that  of  the  regular orderlies  and
nurses ; hut in regard to their cases it was difficult to ascer-
tain dates.
  Having selected such of these  returns as  appeared to be
most  correct and  suitable,  I  found  that they  produced  the
following results;—viz. of  thirty-five orderlies  and  nurses
who had returned from Spain, and, therefore,  might have
been previously  exposed  to  contagion, it appeared that  one.
was attacked on the  first day  after beginning  to attend  the
sick;  one on the 2d,  one on the 6th,  two on the 7th,  one on
the 8th, one on the 9th, two  on the 11th, one on the 14th,
one on  the 15th, one on the 16th, three  on the 17th, one on
the 18th, two on the 20th,  one on  the 21st,  one on the 22d,
two on the 23d,  two on the 24th,  two on the 25th, one on the
26th, three on the 27th, one  on the 28th, one on the 36th,
one on the  38th, one  on  the 40th, and one on the 44th days.
Of ninety-nine  orderlies and  nurses  who had not been out of
the kingdom,  nor, as  far as  was known, exposed  to febrile
contagion, it appears  that one was attacked on the 13th day,
one on the 14th, two  on  the 15th, one  on the  16th,  four on
the 18th, two on the 19th, three on the 20th, six on the 21sf,
four on the 22d, four on the 23d, two on the 24th,  six on the
25th, four on the 26th, four  on  the 27th, eight on the 28th,
five on  the 29th, three on the  30th, three on the 31st,  two on
the 33d, three on the 36th,  four on the 37th,  one on the 38th,
four  on the 39th,  one on the  40th, two  on the 42d, three on
the 44th, one on the  45th, five on the 47th, one on the 48th,
three on the 52d,  two on the 54th,  one on the 58th,  one on
the 60th, and one the 68th  days. It results,  therefore, from
tins statement, that among the ninety-nine orderlies and nur-
ses, who had probably not been exposed to the contagion be-
fore  their attendance on the sick commenced,  the  earliest
 attack was on the 13th day,  and the latest on the  68th; but
 these returns were made up about the 20th of April, and it
 appears that some who had escaped till that time, were after- 
349
wards attacked ;*  and, therefore, though there may be rea-
son to conclude that febrile contagion does not remain inactive
so long after being received into the body,  as marsh miasma-
ta, I  see  none  for  believing that an  interval of five  or six
months, may not sometimes elapse  before the  actual produc-
tion of fever by it; especially if the summer should intervene
previous to an attack ;  in which case the occurrence of fever
would, I think, almost always he postponed until the following
winter,  and often  completely  obviated :| and  I  cannot help
strongly suspecting, that such a postponing of the disease hap-
pened to some of the troops from Corunna, in 1809. It wiil be
recollected that sickness prevailed to a very uncommon extent
in the army at home, during the early part of the preceding
year ; and though it did not consist exclusively of contagious
 fever, that disease made a considerable part of it, until it became
 extinct  at the approach of summer.  It will also be recollected,
 that many of the regiments in  whom  this  sickness occurred,
 were, after its  cessation,  employed  under Sir John  Moore,
 and Sir David Baird, in Spain, where  Typhus fever cannot
 exist in the Summer, and  where,  I believe,  it never  appears
 even in Winter, unless  by  an  extraordinary  introduction  of
 it.   Such an introduction took  place in that year by the Spa-
 nish army  under the Marquis de  Romana, which had  been
 removed from Holstein and  Denmark, (where Typhus is a

   * Ivftny circumstances or causes may accelerate the actual production of Typhus
 fever in persons who have imbibed a sufficient portion  of the contagion; particularly
 the  effects of Cold, Drunkenness, excessive Venery,  deficient nourishment, and in-
 deed of every tbing occasioning debility, especially, in slender, feeble constitutions,
 in which  the disease will also commonly prove most severe : and hence, contrary to
 what happens with Yellow  Fever, those who are  in the decline of life suffer more
 from it than the young, and females more  than  males. On the other hand, a robust
 young man, who after exposure to  febrile contagion, prudently avoids all debilitating
 accents, or excesses, may, by the strength of his constitution, and of its conserva-
 tory energies, not only resist for a long time, but finally overcome, such a portion of
 infection  as in most cases would have soon occasioned disease.
   f In «ase heat would produce, in regard to Typhus contagion,  an effect analogous
 to that of cold, upon marsh miasmata, when  the morbid action of the latter is  sus-
 pended,  until the following SpriDg or summer. 
350
 frequent disease) back to their own country in British trans-
 ports ;  and though this  fever did  not appear  in  that army,
 after their arrival in Spain, until the Autumn and Winter, it
 certainly began then  to prevail  therein to a considerable ex-
 tent.  It will be remembered that in the latter part of that
 campaign, the British army, twice  crossed that of Romana,
 and on  both occasions  Mr.  Warren,  Deputy Inspector of
 Hospitals, informed me that he had  observed a considerable
 number of the Spanish Soldiers  to be labouring under Typhus
 fever.   He added that the disease afterwards appeared among
 the French troops, as might well have been expected from
 their having occupied the barracks,  quarters, and hospitals,
 which,  in  a long line of inarch, had just  before  been  used,
 as well by Romana's as  by the  British  army under Sir John
Moore.  This fact  Mr.  Warren stated, on what  he thought
good information, and particularly  that of a British medi-
cal officer, who had  remained with the British Hospital left
at Lugo.
  Whether at either of these crossings the British army re-
ceived  any febrile contagion from the  Spanish, or whether
they found any  of it  on hoard  the transports in which they
returned from Corunna,  some of which had, as I understand
been employed in removing the Spanish army from Denmark,
is not,  1 believe, well ascertained; but I think it highly pro-
bable that in many cases, the cold,  rain,  and excessive fk-
tigues  to  which the British soldiers were exposed, during a
considerable part of Sir John Moore's retreat, and  after their
embarkation, might have brought into action the latent infec-
tion of the preceding  spring, the morbid influence of which
had been suspended by the summer ;  and I believe that typhus
fever has, on some former occasions, suddenly made  its appear-
ance from similar causes.*  Circumstances to be explained in

  * The learned and Reverend Stephen Hales, D. D. in his treatise on Ventilators,
 (8° 1758) states at p. 106, that the convicts from Newgate often carry the Gaol dis-
 temper with them, " to Virginia, before it breaks out''' As Dr. Hales, had some
 time before taken great pains to introduce the practice of frequent Ventilation iu 
351
another place,  compel me to  desist from any farther observa-
tions on  this subject, and to  conclude the present chapter, by
subjoining extracts  from two letters,  written  to me by  Mr.
Grant, dated Plymouth  Dock, the 24th and 27th of April,
1809, viz.
   " Before the arrival of the troops from Corunna, this gar-
rison was extremely healthy.  Typhus did not  exist in it, nor
were there scarcely  any sick in the hospitals, confined to bed;
but the  effects of contagion very speedily developed  them-
selves amongst the orderlies, and others,  employed in fatigue
duties, connected with the hospitals.   They seem, however, as
speedily to have disappeared, as we have scarcely a do%en febrile
diseases now in the garrison,  and these are orderlies who have
been taken ill since collecting the inclosed returns.  The disease
also became latterly very  slight in its attack.   In answer to
your question, respecting the  yellowness of skin,  I have not
seen many instances of it  in  this garrison;  the proportion
not exceeding 2 to 100 :  scarcely an hospital that has had two
or three  cases.   One of  the  medical officers who  died,  Hos-
pital Mate Williams, was of this description."
   Extract trom the  second letter,  viz.—
   *' It may be also aiding your enquiries to  remark, that in
the naval  hospital  here, where some of the sick from Spain
 the ships employed in transporting criminals  from  Newgate to America,  and had
 collected good information on the subject, it is to be regretted that he did not men-
 tion this fact more circumstantially, and especially that he did not inform us, wheth-
 er this complete suspension, for probably two or three months,  of the action of Ty-
 phus contagion, after it was received  into the body, happened in cold or hot weath-
 er  That  it was not always suspended so long, is ewdent by a fact which the same
 respectable author had mentioned in the preceding page, of the breaking out of this
 distemper, " in Mr. Keid's convict transport  ship  the Laura, notwithstanding the
 ship was frequently refreshed by  Ventilation." The Convicts (says he) were put ou
 board, the latter end of April, in seeming good health, and continued so until they
 anchored  in Stromncssf Bay, in the Orcades, when between the 11th  and filteenlh
 of May, a great part of the people fell sick of the Gaol distemper, in the compass of
 two days." He adds in the next page, that the contagion was in that ca;e supposed
 to have been brought on board the Laura by  the convicts  from Newgate.  But we
 have no means of ascertaining how long they had imbibed it before they  were remov-
 ed from that prison. 
352
were  accommodated, 24 nurses, and seven labourers,  wer
taken ill of fever, in attendance upon them ; of which number,
four nurses, and three labourers have died.   Previous to this
occasion, I am informed by the medical officers of that estab-
lishment, that it was a rare occurrence for the servants of the
hospital to be taken ill with fever, in attendance  upon the
sick.
  " At Pendennis Castle, Falmouth, where some sick  from
Spain also debarked,  the progress of contagion was  more
rapid, extensive, and  fatal, (in proportion to its field of ac-
tion) than in any of the other hospitals in this district.   All
I he medical officers  and servants stationed there, (the North
Hants Militia,) were  speedily taken ill, and  one-fifth of the
regiment, viz. 103, of which number,  11 died." 
CHAP. II.
              OBSERVATIONS  ON DVSENTE11V.

By the Greek name of this disease, (Awrtneix) signifying  a
pain,  or griping of the bowels, Hippocrates intended to de-
signate both ulcerations and hemorrhages from the intestines,
and every kind of flux,  with, or without blood, from them.
After his time, however,  this name seems, in its application,
to have been restricted to an  ulceration, or supposed ulcera?
tion, of this part of the alimentary canal, with gripings and
tenesmus, producing or attended by mucous, or bloody stools.
Now,  however, an  intermixture of blood with  the  stools,
though of frequent occurrence, is not deemed a characteris-
tic of dysentery, nor is ulceration of the intestines; hut when
the disease has been of long continuance, they are  often found
after death, to have been ulcerated, and even sphacelated.  A
spasmodic  constriction of the colon,  retaining the natural,
but hardened, faeces commonly attends this disease; and Dr.
Cullen superadds,  as a  part of character  " contagious  py-
rexia," though this  addition  seems objectionable, in  regard
to contagion, wiiich I am convinced is not generally,  if ever,
connected with dysentery.  Sydenham, when treating of the
dysentery  of  1669,  says,  " After  having  attentively  con-
sidered the various symptoms of this disease, I discovered it to
he a fever, sui generis,  turned inwards upon the intestines."
Dr.' Balfour, in his  account of this disease, as it occurs in
Bengal, has called  it an " intestinal  remitting fever;" and
Dr. Hush,  who supposes it may he connected with jail fever,
                           45 
354
  as well as with the fevers from marsh effluvia, omits the word
  remitting, and calls it  " the intestinal state of fever." (Medi-
  cal inquiries, kc. vol.  iv. p.  167.)   He moreover  contends,
  that  after a  fever has  been thus  thrown upon  the intestines,
  to as  to  occasion dysentery, it may,  by  a retroversion, be
  translated to the skin,   and there produce rash, prickly heat,
  and eruptions of various kinds.*
    Dr.  Akenside, in his  Commpntarium  de Dysenteria,  in-
  stead of Sydenham's belief that this disease was a "febris in-
  troversa," seems to consider it as an introverted  rheumatism,
  or, as Dr. Rush would call it, the intestinal state of rJieuma-
  tism;  and with this notion, the  former supposes that like or-
  dinary rheumatism, dysentery  may be either accompanied
  with  fever,  or divested of  it.   He supposes, also, that it al-
 ways begins with  the  smaller intestines,  and  gradually de-
  scends  to the rectum,  and that rheumatism and dysentery  are
  frequently converted into each other.
    Sir John Pringle considers  " all the epidemic dysenteries,''
 as being '* of the same nature;"  (see p. 223,) and in support
  of  his own opinion on  this  subject, he appeals to  the experi-
 ence of the late Dr. Huck Saunders; " not only in Germany,
 but in  Minorca, America, and  the  West Indies;"  in all of
 which,  notwithstanding the  differences of climate, this disease
 appeared " with the same  symptoms,  (though with more or
 less violence,  according to  the heat,) and yielded  to the sam *

  * If such a translation of dysentery to the surface of the  body can be effected by
 art, it should, I think, al ways be attempted, as speedily as possible, because the attempt
 will be  more likely to succeed while  the disorder is recent, and because the danger
 of a disease in  the skin, is much less than of one in the intestines.  In a case of severe
 diarrhea, with which I was  partially acquainted, and which  was suddenly stopped by
 opium,  Peruvian bark, and sudorifics, near a dozen large biles were produced on
 different parts of the body, within three or four days ; and when these had suppurated,
 others supervened  in succession, for  several months, but gradually diminished in
 size, though not in number, until near the Ume of their total disappearance ;  since
which, the patient, though  more than sixty years  of age, has for six years enjoyed
 better health, than in any former part of his life.  I barely mention  the fact, leaving
others to judge, whether this improvement in the patient's health, resulted in any de-
 gree from the biles, which to him were a new, as well as a troublesome occurrence. 
355
medicines."  That  this is true of epidemic dysentery, I can
readily believe; being convinced that this disease never pre-
vails epidemically, unless it proceeds, from  marsh miasmata,
whose morbid influence is then, from particular circumstances
or causes,  directed and exerted upon the intestines, rather
than upon the heart and arteries.
  This connexion between dysentery and marsh fevers, has
been suspected and believed,- by several respectable authors;
but I do not recollect that the identity of their  causes has
been any where so decisively manifested, as it was at the town
of Sheffield, in the state of Massachusetts, during the summer
and autumn of 1796,  according to a very circumstantial and
apparently accurate statement, made by William Buel, the
principal physician of that  town, who  had previously given
an account (published by Mr. Webster) of the febrile disorders
whicli prevaled there, during the three preceding years.  The
statement regarding the year 1796, may be found in vol. 1, of
the New-York Medical Repository, p. 439—459, and the fol-
lowing are extracts from it,  viz.:
  " The part of the town in which the sickness prevailed, is
almost a perfect level.  The river Housatonak, whose width
is generally between 30 and 40 yards, runs through it in  a
serpentine direction, and with a very gentle current."—" On
each side of this river, there is a considerable extent of luxuri-
ous meadow-ground,  whose surface  is  generally overflowed,
when the snow melts in Ihe spring, and sometimes by freshets,
at other times in the year.  This meadow-ground is all much
interspersed with coves or pools, which are left after the sub-
siding of the  flood, full of  stagnant water;"—and this " is
in the course of the summer evaporated from some to dryness,
and from others nearly so."—" Beside the meadow adjoining
the river Housatonak, there are several other streams, which run
through large tracks  of flat, and very marshy land.   On one
of these streams, towards the north part of the town, there is
a mill-pond, which appears to have been the common centre
of the sickness in 1796, and  the preceding  sickly years." 
/
356
 '• This pond overflows a large track of  land, whicli was for-
 merly covered with a luxuriant growth of timber, and other
 vegetable productions, which are all now dead, and in a state
 of dissolution, in consequence of the action  of air  and water
 upon them:"—" whenever a  dry season occurs,  the water
.recedes from almost tbe whole of the land  last flowed,* and
 leaves the whole mass of dead animal and vegetable substan-
 ces, lying on its surface, exposed- to the action of a scorching
 sun."
   " The fsetor which arises from this drowned land, when
 made bare by dry and hot weather, is extremely disagreeable,
 and offensive to all who approach its borders."—" The stench
 is smelled hy the inhabitants at times even to the  distance of
 half a mile: an exposure to the eftects of this noxious effluvium
 contiguous to its source, not unfrequently in  the  year 1796,
 produced immediate nausea and vomiting."  The writer, after
 observing that the spring of this year had been uncommonly
 wet, adds, " we had such an excess of rain even through the
 month of June, that all  our streams, ponds, coves,  and marsh-
 es, were kept full, and even our dry est land  was  highly sur-
 charged with water."   But from  the beginning of July for-
 ward, we began to suffer from  the  other extreme; we very
 seldom  had rain,  and uniformly the weather w as intensely hot,
 particularly in the month of  August:"—" the drought was
 so great, that vegetation was much injured ; grazing grounds,
 particularly, were parched almost to dryness."
   After these explanations, the writer gives a particular ac-
 account of a considerable number of cases of dysentery, which
 occurred before the 20th of July, within what he afterwards
 describes  as  *' the  sickly circle;" adding, that within a few
 days other persons, within the same limits, were attacked
 with bilious  or marsh  fever.  " From  this  time, (says he)
 instances of this fever frequently occurred, so that it was ap-

  * By the  «land last flowed," the writer means a large extent of ground, over
 which the mill-pond had recently been extended, by raising the mill-dam seven feet
 above its former height 
357
parent both  disorders were endemic."—" In a  short time,
both prevailed to a degree truly calamitous and alarming."—-
"Let (says the writer) an imaginary circular line be described,
from a point on the south-eastern side of the above-mentioned
mill-pond, whose  radii shall be  one and  one-half mile in
length ; this circle will embrace about 100 families, and about
600 inhabitants; it would comprehend the whole territory in
wiiich the  sickness prevailed, with so much exactness, that
there would be  considerably short of 10 families without  its
limits in which  there was  sickness, and  there certainly were
not 10 within which were exempt."  Of about 450 persons in
the eastern half of this imaginary circle, " at least 250 were
affected with sickness ;  of the 150 who dwelt nearest the pond,
there were not 10 who escaped."*
   "The dysentery frequently  came on while the patient was
affected with bilious fever.  In this case the type of  the fever
soon became obliterated,  and the accompanying febrile symp-
toms were similar to those in original dysentery.  The change
of the  fever into dysentery, did not, however,  secure the pa-
tient from  the tendency to relapse,  so peculiar to that disorder.
But the convalescence of those who had simple dysentery on-
ly, was generally short,  and the recovery perfect.
   "  Sometimes  the fever  came on upon tiie dysentery.  The
type of the fever was not in this  case easily ascertained,  un-
til an  abatement of the dysentery took place, when, as the
dysentric symptoms subsided, the fever would appear in its pro-
proper form.  The two  disorders  appeared to  be complicated;
that is, they both seemed to exist  at  the same  time, rather
than to act in alternation.  The fact is certain, that  in cases
of accession of dysentery upon the fever,  the latter disorder
always showed  itself in its true form, after the symptoms of
the other had subsided.

  •It is not to be supposed I hat marsh miasmata, arising from the mill-pond, exclu-
sively produced disease at the distance of a mile and an half; other sources of them
were interspersed throughout the whole circle here imagined. 
358
   (t In the sickness which makes the subject of this communi-
 cation, there is every reason to ascribe identity of cause to Vie
 two disorders.  They were circumscribed in  a very striking
 manner,  hy precisely the same limits.   They both  began and
 ceased to prevail at the same time.  Neither disorder occurred,
 (except in a few instances of both disorders about the  pond,
 at the south part of the town,)  at any considerable distance
 from the limits, but in persons who had previously resided
 within them.  There  were instances of both disorders affect-
 ing persons in different parts of the  country, who  had  resid-
 ed within these limits.  A stay  of only one night in  the cen-
 tral part of the sickly territory, in some instances produced
 these disorders.
   " The  facts which I have stated, prove sufficiently, that
 neither of these  disorders was propagated by specific conta-
 gion, at least beyond certain  boundaries,  otherwise they must
 have extended, for there was  no interruption of communica-
 tion.   I have remarked before, that I  was myself convinced
 that neither disease  was  propagated  by specific contagion.
 teen within  these boundaries.   In all cases which came under
 my observation of sickness  without the limits,  and acquired by a
 residence within them, there was no instance of either com-
 plaint being communicated from  the person  affected."   Here
 it should be observed, that the town in which these disorders
 were produced, is situated  near the northern boundary of Mas-
 sachusetts, where the summer heat  is commonly much  more
 moderate  than in Pennsylvania, and other states, in  which
tiie yellow fever has often  prevailed.
   This  connexion  of dysentery  with marsh fevers has been
 also noticed, in different parts of the  United States, and  in
 many other parts of the globe.*   Dr. John Vaughan mentions
 the former disease, as prevailing over certain low  districts,

  • Dr. Cleghorn (Diseases of Minorca, p. 134,) says, " Sometimes a tertian is
 changed into a dysentery, or a dysentery becomes a tertian ; and when one of these
 diseases is suppressed, the other often ensues." He adds, that it is not uncommon
 for " the fits of tertians to be regularly accommpanied by gripes and stools." 
359
 adjoining the Delaware, and evidently resulting from marsh
 effluvia.—See N.  York  Med.  Rep. vol.  iii. p. 223.   Dr.
 De Rosset, also, in giving an account of the Bilious Yellow
 Fever, of 1796, at Wilmington, in North Carolina, (which
 I noticed at p. 248-9 of this volume) mentions it to have been
 preceded in July  and  August,  after excessive  heat,  by the
 dysentery,  which  "soon became general,  proving fatal in
 many instances."  He adds,  " towards the  close of August,
 when  the first  cases  of bilious fever occurred to  me, the
 dysentery began to decline; and scarcely one new case of it
 occurred  after the fever became more prevalent.  It may be
 here remarked, that every person  who  had laboured under
 the dysentery, without an exception  within my knowledge,
 escaped the fever."
   It is remarkable that here,  as well as  at  Sheffield, the
 morbid influence of marsh miasmata first  manifested itself in
 the form of dysentery. •  This, I  believe, does  not always
 Jhappen.  Dr. James Clark, in his Treatise on the Yellow
 Fever at Dominica, says, (page 103) that " the dysentery
 generally prevails at the same time that the  remittent and in-
 termittent fevers do, in the West Indies, and probably from
 the same cause."   Dr. Trotter observes, that on the coast of
 Africa and the West Indies, dysentery " is joined with inter-
 mittent and remittent fevers."  (Med. Nautica, vol.  i. p.
378.
  Of the East Indies I have no  personal knowledge; hut it
 is notorious that marsli fevers  and dysentery are there Com-
 monly produced  by the same cause,  and at  nearly the  same
 time :* that both often occur in the same person, and they are
 said to be not unfrequently complicated with chronic inflam-
 mation of the liver, to  whicli the greater heat of that climate
 seems  to  dispose  the  inhabitants  in  a remarkable  degree.

  • Dr. Ffirth says, that of the crew of the ship in which he went to Batavia, 76 in
 number, all, except eight, had either marsh fever or dysentery ; that " the fever ap-
 peared to alternate with dysentery ; when the weather was bad, the latter prevail-
 ed ; when,§-0OT4 the former." 
                           3G0

But,  without leaving Great Britain, we may find evidence of
the influence of marsh miasmata in producing dysentery, from
its appearing in those places, and at those seasons, in which
they  were known to be  morbidly active.   Even London,
though now almost exempted from their effects by a change of
circumstances,  was  formerly  very  much infested by  them;
and Sydenham  remarks, that the dysentery never prevailed
until the latter part of summer,  and that it disappeared at
the approach of winter,  resembling  marsh fevers in  these
respects.  He has, indeed, omitted to  notice those peculiari-
ties of the season which render marsh effluvia most powerful,
because he ascribed diseases not so much to  the sensible as to
the ocadt qualities of the air, which he  called its constitution.
Dr. Willis, however, has (as Sir John  Pringle observes) sup-
plied this omission, in regard to  the dysentery which prevail-
ed in  London in the  autumn of 1670,  by mentioning  that it
began after an  exceeding hot and dry summer; " post sesta-
tem impense calidam  &? siccam."   (See Pharma. Ration, sect.
iii. chap.  3.)  Sir George Baker, also, (de Dysenteria Lon-
din. an. 1762) mentions  that this disease,  in the latter year,
appeared as an epidemic, about the end of July, after very hot
and  dry weather; and that it raged until  November.  Sir
John Pringle also observes, (p.  251)  that in this year 1762
" the  summer heats and drought were of a longer continuance"
than he ever observed in this country,  and that in the autumn
more cases of dysentery " occurred, than in all  the  sixteen
years that" he   "had  resided  here."—And Dr. Huxham,
without appearing to suspect the influence of marsli effluvia,
has remarked the prevalence of this disease  as a consequence
of hot summers.  " Post fervidam sestatem, constanter fere
sequunter  cholerse, dysenterise, alvi fluxus."   (De Aere &
morbis epidemicis, t. ii. p. 176.)
   But that I may not unnecessarily extend  these quotations
I shall content  myself with referring  to Sir John Pringle's
" Observations on the Camp Dysentery," among which arc
the following, viz. 
361
  " I  have never known the  dysentery epidemic, unless in
summer or in autumn,  when tiie primse vise are most liable to
be disordered."   (Diseases of the Army, p. 224.)  He might
have  added, and when marsh iniasmata are  most powerful.
Again, at p. 226,  " Frequently the beginning of a flux will
have all the appearance of an autumnal fever; for the patient
will be feverish,  with  disorder in his stomach and bowels, for
two or  three  days before  the purging conies on; but  after
that,  the fever  sensibly gives  way."  And again, at p. 253,
" Hitherto we  have seen how  similar the causes are, of the
remitting  and  intermitting  fevers, and  of  the bloody-flux.
Nay,  the affinity extends even  to  the occasional or exciting
causes ; such as when, in the end of summer, or in autumn,
the men are exposed to night damps* and fogs, especially after
a hot  day, or lie upon wetvground, or in  wet clothes, part of
them will be seized with that kind of fever, and part with this
flux; and perhaps some  of them will have a disorder com-
pounded of both.   Add to this, that those fevers begin to be
frequent in camp whilst the dysentery still subsists; that the
first symptoms  are often similar, such as the rigors, and disor-
der of the stomach; that the remitting and intermitting fevers
of  a bad kind have sometimes ended in a bloody-flux ; that such
countries as are most subject to  those autumnal remitting fevers,
are likewise most liable to the dysentery ; and that the analogy
continues even to the method of cure, in so far as the principal part
of it consists  in clearing  the primse viae.  Upon the whole,
the nature of the two distempers appears so much alike, that, at
first sight, Sydenham  seems to have expressed himself justly,
when he called this flux " the fever of the season turned upon
the bowels."  But upon a  nearer view  we shall find this no-
  • It is  remarkable  that,  notwithstanding all that Lancisi anil others  had written
of the influence of marsh effluvia in producing fevers, Sir John*seems to  overlook
their effects,  aud ascribe  them to cold and moisture. Hence, though  he considers
dysentery, and remitting or intermitting fevers, as having similar causes, he makes
no mention of marsh miasmata as occasioning either, eve,n where they prevail most
extensively, as in Flanders, &c. It is, indeed, true that he supposes the moisture to be
rendered more hurtful by the effects of putrefaction in marshes.
                              46 
362
 tion more ingenious than solid,  since the circumstance of Wt*
 hems; contagious, shews that the dysentery is essentially differ-
 ent from those fevers."
   Here we find  that this justjy-distinguished physician,  alter
 stating facts  and reasons the most forcible, for considering
 marsh fevers  and dysentery as produced hy the same cause,
 gratuitously assumes the latter disease to be contagious, and, on
 that assumption, in opposition to these facts and reasons, in-
 fers that the latter disease " is essentially different from those
 fevers."   We shall, however,  soon find reason to think that
 contagion is not a quality belonging to dysentery, unless it be
 in cases which are occasioned by, or complicated with, typhus
 fever, if,  indeed, such cases  ever exist;  and we  may there-
 fore conclude, that marsh miasmata,  acting in a particular
 direction,  are a frequent cause of dysentery; indeed, there is
 good  ground  for believing that it never becomes an epidemic,
 without their  co-operation.
   The causes  which determine tiie morbid influence of marsh
 effluvia towards the intestines, so as to excite the disease in
question,  rather than intermitting or remitting fevers, do not
seem to be yet well understood.  Dr. Blane thinks, when per-
sons are pre-disposed to that morbid action which may termi-
nate cither in  fever or  dysentery, that the latter disease " is
more  likely to arise from an irregularity  in  eating or drink-
 ing :—a  fever from being exposed  to  the weather,"  &c.
There can, however, be  no doubt, but  the latter of these
 causes, (supposing  it to  include  the application of cold and
wet to the skin,)  is  often productive of dysentery, either
alone, or  in  conjunction  with miasmata  and other  causes.
 Indeed, there are but fewr persons who have not some time been
made  sensible of the sudden effect of  such applications,  in pro-
ducing diarrhoea at least; though I am far from thinking that
improper food, by irritating  and disordering the bowels, does
 not also co-operate  in exciting dysentery ; and under the head
 of improper food, I would  include sharp,  acid fruits, when
 eaten to excess, such  as pine apples, whicli  Dr. Moseley 
363
   mentions  as having caused the  disease.   I  think, however,
   that in this,  as well as other cases of dysentery,  which were
   chiefly in  his  contemplation, marsh  effluvia must have  been
   the principal cause; for at p. 214  he notices  the stools,  as
   being " more frequent, and all the symptoms more aggravat-
   ed, at those hours when the current fevers are in their exacer-
   bations,  and the reverse wiien those fevers are in their  remis-
   sion ; besides the alternate succession of one disease to another,
   which (says he)  I have frequently  observed:" and  this,  to
   my apprehension, clearly  indicates  the influence  of  marsh
  miasmata,  though he adds that it cannot " be  doubted but
  this fever of the intestines, like most others, is caused  by ob-
  structed perspiration."*
    But besides the production of dysentery by the operation  of
  wet and  cold, conjointly with miasmata or other causes, this
  disease has, in many instances, been apparently occasioned by
  their operation  alone.
    Of this  Sir John  Pringle gives a remarkable  instance, at
  p. 19 of his Observations on the diseases of the Army, viz.—
  " On the 26th (of June, 1743,) in the evening, the tente were
  struck, the army marched all night, and next  morning fought
  at Dettingen.  On the night following, the soldiers lay on the
  field of battle without tents, exposed to a heavy rain.   Next
  day we moved to Hanau, and encamped on good ground  in an
 open field;  but  it was then wet,f  and  for  the first  night or
 two, the men  wanted straw.   By these  accidents,  a  sudden
 change  was made in the health of the army; for the summer

  • An obstruction of perspiration,  to with  (in conformity  with the principles
of the Humoral Pathology) the dysentery  is here ascribed, probably is not a cause
of it, as occasioning a retention of matters  which ought to have been excreted (and
for which  nature has provided other outlets when  wanted,) but as  being generally
accompanied with a morbid distribution of the blood, and an improper determination
of the living power inwardly to the intestines, followed by increased, or inflammatory
actions in their vessels.                                             *
  | Dr. F. Home  (at p. 26 of  his Medical Facts and Experiments,)  says there were
"two rainy nights, after the battle of Dettingen," wiiich " produced the  bloody
flux." 
364
had begun early, and the weather had been  constantly warm,
kc."—". Now the pores were suddenly stopped, the body was
chilled, and the humours tending to resolution from the pre-
ceding heats,  were turned  upon the bowels, and produced a
dysentery,  wiiich continued a considerable  part  of tbe cam-
paign.  In eight days  after the battle, about 500  men were
seized with that distemper,  and in a few weeks nearly half the
men were either ill, or had  recovered of it."
  Dr. Trotter  mentions a  lamentable dysentery, which was
produced on board the  Berwick, ship of the line, in October,
1780,  in consequence  of the  hurricane  on the 5th of that
month, by which the clothes and bedding of the  seamen, and
indeed every part of the ship  " were soaked in water," and
many of the men " slept for nights together on the wet decks,
overcome with fatigue, and  debilitated from the want of food."
In seven  weeks thirty of the best men died of this disease, in
some  cases complicated with  scurvy, and " near 300 of the
ship's company were  ill," when she arrived at Spithead.
(Med. Nautica, vol. i.  p.  378, kc.)  Dr. Mosely  says, " it
has often happened that hundreds of men in a camp have been
seized w ith the dysentery,  almost at the same time, after one
shower of rain, or from lying one night in the wet and cold."
(See his Treatise on Tropical  Diseases, 3rd edition, p. 268.)
I suspect, however, that in such cases, the  disease is  not ex-
actly  like that which principally results from marsh effluvia;
that it has a greater similitude to diarrhoea, and  if accompa-
nied with fever, that this is  nearly related to that of catarrh.
  Another supposed cause  of dysentery has been alleged  by
so many respectable authors, that it would be improper in me
to reject it, though I have never seen any decisive or convinc-
ing evidence of its operation in this way : wiiat I  mean is
typhus fever, or its contagion.   Dr. Blane,  at p. 394  of  his
work on  the Diseases of Seamen, says, " when this (typhus)
fever  prevailed on board  of  any ship  that  arrived  from a
northern climate, it was soon after succeeded by, or converted
into,  a dysentery ; for the ships that arrived either from Eng- 
365
land or North America, with the greatest stock of feveiish
infection, were the most subject to fluxes, after being two or
three months in the West Indies."   Dr. Trotter asserts that
typhus fever was combined with  dysentery in the transports
which conveyed the army under Lord Moira to Ostend,  in
the year  1794;  (see p. 378)  and Sir John Pringle says, (p.
227) " The most fatal sort of fever, which  so  often attends
the dysentery of the army, though not essential  to it, is the
hospital  or jail distemper."—" This fever (he adds) com-
bined with the bloody flux, was generally mortal."  But sup-
posing, as I am willing to do, that Sir John Pringle has com-
mitted no mistake concerning the true nature of the fever in
question,  it may, notwithstanding, become a matter of doubt,
whether the dysentery in these cases, was the consequence of a
typhus fever inverted or thrown upon the intestines, or whe-
ther the patients had been exposed both to marsh effluvia and
febrile  contagion  at  different times, and that  each having
produced its effect  separately, the  fever and flux were thus
accidentally combined ?  In  either of these cases, however,
we may understand, and perhaps believe what the same author
asserts at p. 103, i. e. that " the putrid effluvia of the dysen-
teric fseces, are  not only apt to  propagate flux, but likewise
to breed  the jail or hospital fever, with or without bloody
stools:"  for the excretions of patients under the action of con-
tagion, may reasonably be expected to  become contagious ;
though I cannot believe that dysentery  ever possesses that
quality, when it is not derived from, or  connected with that
 cause.
   G. Fabricius Hildanus, in his Treatise de Dysenteria, cau-
tions  persons in  health  not to approach the places  where
 dysenterical excrements  are deposited, lest they should he
infected; adding,  that the exhalations  of such  excrements
 affect the bowels of persons in health, by some  occult quality.
 Afterwards, Sennertus mentioning the dysentery, which oc-
 curred in 1624, after great heat and drought,  says that  one
 person was infected by another, and that whole families died 
366
  of it.  But there seems to be good reason for  believing, that
  the disease here mentioned was occasioned by  marsh effluvia,
  and that their effects were, as they have been on so many oc-
  casions, mistaken for those of contagion ; and this was proba-
  bly the case with Sir John Pringle in Flanders, whenever the
  disease prevailed as an epidemic, which was always at a time
  of the year when  febrile contagion must have been nearly
  inactive, and  when marsh effluvia  were most powerful.  Sy-
  denham  no where  intimates  that his epidemic  dysentery was
  contagious, and Willis distinctly asserts that it  was not.  Even
  Sir John Pringle  admits (p. 235) " that this disorder is not
  so catching as most others of the contagious kind;" hut adds
  that he " always found it in some degree infectious, especially
  in military hospitals," whenever it was "  epidemic;" and this,
  according to his own explanation in other places, was'always
  in the summer and autumn,, when  marsh effluvia were most
  abundant and active, and when febrile contagion must have
  been least so, and therefore when it was most easy to confound
  their effects.   It is  moreover  absolutely incredible, that marsh
  effluvia should  produce contagion, when they disorder the
  bowels, and not produce it when  they occasion intermittent
  and remittent fevers.   Mr. Boag doubts whether dysentery is
 ever contagious in the East Indies ;* and  all the  medical
 gentlemen from  that climate  with  whom I have conversed,
 have entertained similar doubts, or rather believed it not to
 be so.  Dr. Mosely says, " as to contagion from infection in
 dysentery, I must confess I never saw an  instance of it; nei-
 ther do I believe  there is any such  thing."  (p. 267.)  M.
 Bruant, physician  to  the French army in Egypt, says the
 dysentery was  not contagious in  the great  hospital (the house
 of Ibrahim-Bey,) at Cairo,  where  he  officiated with three
 other physicians, though it had long been  crowded with sick."
 See Hist. Medicate  de L'armee d'Orient, 2de partie.  And in

  * See Medical Tracts, &c.  vol. iv. p. 13.  He thinks the climate of that country
unfavourable  to the production and propagation of contagious diseases,—observing
that even the small pox  gradually disappears as the summer advances. 
367
regard to my own experience, I have no hesitation in declaring,
that with thousands of soldiers in that disease, under m^ care
at different times, and  often much crowded in hospitals, bar-
racks, and transports,  I never have been able to discover any
sufficient reason to believe that the disease was communicated
by any of them to any nurse, orderly man, or other person.*
  I shall conclude this chapter by a very few general obser-
vations on the treatment of dysentery.
  As in  this disease there is manifestly a morbid determina-
tion of  febrile or inflammatory action upon  the intestines, I
think, and  have always found it beneficial, speedily to coun-
teract this  disposition,  and  produce  an  opposite  determi-
nation ;  so far at least as  to create a salutary distribution of
the blood, and of the living power, throughout the body, and
especially upon  its surface, by suitable diaphoretics, combin-
ed  with  opium  in small  doses;  by  the application of flan-
nels, immediately to the skin,  and more especially round  the
abdomen; and in urgent cases by the warm bath, (continued
for the space of an hour, if tiie patient can hear it  so long,)
warm fomentations, and  especially  blisters  upon the belly,
taking care at the same time to promote sufficient evacuations
by stool, to relieve the intestines as much as possible from all
irritation and uneasiness,  which they might suffer by a reten-
tion of hardened faeces, or scyhala, and other matters.  For
this last purpose, the  neutral purging salts, with manna,  are
proper, or a mixture of the oleum ricini, with the juice of a
ripe orange, and a little mucilage of gum-arabic, which will
agree better with most stomachs, and prove equally effica-
cious; emollient purgative clysters  may also  be employed.
Should the disease be  attended with  considerable  fever, care

  •I have  now before me a statement which I made on the 5 th of May,  1806, of
aertain facts communicated to me on that day, by Dr. Macdonald, who was a staff
surgeon with the army in the Netherlands, under the Duke of York, in 1793 and 4,
decisively proving, that a dysentery which prevailed to a great extent, and in the
worst form  among the French prisoners, accumulated at Ghent to the number" of
nearry 4,000, did not manifest the slightest contagious property 
368
must be  taken not to increase  it by the  too frequent use of
diaphoretics and opium.  When the disease, by long protrac-
tion, has occasioned ulcerations of the intestines, and more
especially when it is complicated with  an affection of the
liver,  calomel should  he preferred  as a purgative, and  it
should also be employed with opium, so as to excite a  sore-
ness of the mouth.
  The food in dysentery oifght to be light, and easy of di-
gestion ;  indeed, tbe stomach  will commonly bear no other.
The amilaceous matter of the  Maranta arundinacea, or In-
dian arrow-root, boiled  with milk, barley, and chicken-wa-
ter, salop, tapioca,  &c. are generally the  most acceptable,
as w ell as salutary.  But if the patient should have any par-
ticular craving, it may almost  alwys be safely indulged.
  The best means of obviating this disease, especially in ar-
mies, deserve consideration; and, among these means,  there
is, I believe, none  which  would prove more generally effica-
cious,  than  constantly wearing flannels round the belly, and
next to the skin : the allotment  of muscular fibres to that part
of the body is very sparing, and so is its power  of  resisting
cold.   In Germany, Italy, Spain, and  Portugal, people of the
lower  order,- very generally  wear  sashes of woollen  stuffs
round their waists;  and I have observed a  similar practice
among the Turks and Arabs,  whicli,  however it began, has
probably been continued from  a conviction of its beneficial ef-
fects  in  preventing disease.  Dr.  Grainger, at p.  36 of his
Essay on the more Common West India Diseases,  (2nd edi-
tion)  makes  the following just observation.  " One  should
imagine it would  he hardly necessary to advise to  cover the
 bellies of the diseased (under " fluxes" with warm blankets ;
 and yet  for want of this simple precaution, I  have known ma-
 ny negroes lost." 
CHAP. III.
             OBSERVATIONS ON THE PLAGUE.

Upon my return from Egypt, in 1802, I employed some time
in reading, and making extracts from, such scarce books, and
manuscripts, relating  to the plague, and  sweating  sickness,
as I could find in the British Museum, the libraries of Uni-
versities, (particularly  that of Oxford) and other collections,
partly for my own satisfaction, and partly with an expecta-
tion of publishing something on these diseases, they having
previously engaged my attention in some  degree.   This  ex-
pectation, however, has not been fulfilled ; because, though
my researches  were not unproductive of  curious matters,  I
have doubted whether they would prove so generally interest-
ing, or so practically  useful, as to  render a  publication of
them  desirable ; and in regard to what I  had either seen or
thought of the plague,  I hoped that  Drs.  Buchan and Price,
army Physicians, who underwent the disease in Egypt, would
render any contribution from me of  no importance, by giving
to the public the results of their own more extended expe-
rience on that subject.  But as  this  hope is now almost extin-,
guished,  and as opinions which I think erroneous have been
extensively  propagated by high authorities, some  of which
confound the plague with Typhus,  and  others  with  yellow
fever, I cannot allow the present volume to go into the world,
without adding some facts and conclusions, tending, as I hope,
to stop the progress of error; and founded, not only on a con-
                           47 
                             JS70

 sidcrable share  of reading,  and some personal observation;
 but on valuable communications, with which I have been fa-
 voured,  by medical  gentlemen, who  were employed  in the
 Pest-houses of Egypt, and  some of them for a longer time
 than  myself.
   In regard  to the history of plague,  I shall  here introduce
 hut a very  small part of what I had collected and written on
 the subject.  In the Hebrew, Arabic,  Greek, Latin,  and  all
 other Ancient  languages, with  which  we  are  acquainted,
 words are found signifying generally,  (like the English word
 Plague) an extensive  and destroying  malady, when  applied
 to diseases; and Galen, who was for many centuries the oracle
 of  medicine,  has sanctioned this application of the term ; for
 he expressly says* that epidemic and plague, arc not names of
 any particular disease ;  but  that the former  designates a dis-
 order attacking many persons in a district; and that when it
 proves mortal  to great numbers, it then  becomes a plague : and
 with these vague  significations the words in question  were
 long used.  But in modern times,  writers who aimed at more
 accurate  discriminations, have appropriated the word plague,
 and its correspondent terms in other languages, to signify ex-
 clusively  a  peculiar and very fatal  disease distinguished by
 symptoms, to be hereafter mentioned, among which Glandular
 swellings in the groin, axillae, and neck, are the most constant
 and remarkable.
  I am convinced, by facts the most indisputable, that the dis-
 ease just mentioned,   and  to which alone I shall  apply the
 name  of  plague, is not only distinct from all others, (or sui

  * Ou' yeip $V voe-v'fietTos  yc tivo$ ovopui ifiv Ivtfti/M*  jj'  Xotp.SS'ts, «AA"
 ori me «v  3-oAAfl<; £v tvi  ytvtflxt %apiai, toZto liri$i)[*.ov ivoftct^eTai. veo-
 TiXBovroi S'tcureo  too weAAoi/? aitiigeiVy Aojftoj ylvtrut.  Vid. Foesius (Eco-
nom.  Ilippoc. p 638.
  1 am informed by Mr. Brown, the African traveller,  that Koubeh, and Webe, or
Vebe, are terms now used by the Egyptians to designate the plague. The formei
signifies a great mortality from disease, and the latter a grave ; and conjoined these
woids imply a disease wiiich sends many people to their graves. 
371
generis) but  that it  is, morever, specifically contagious, and,
consequently, incapable of being any where  produced, except
from its own  contagion; and I think it highly probable that
this  disease has subsisted  almost from  the commencement of
human existence, and been continued from generation to gene-
ration, by  its peculiar contagious quality;  though,  from the
want of proper  discrimination, which is found in  all the an-
cient medical writers, and  which might  well  be expected in
regard to  those diseases,  which were ascribed  to supernatural
causes, there is, I believe,  no clear, definite, and certain des-
cription of  the plague,  anterior to that which Procopius* gave

  • Procopius, a Greek Byzantine historian, was secretary to Balisarius, and attended
him in the wai-s  of Persia, Vfrica, and Italy, after which he became prefect or governor
of Constantinople.  It is in the second  book of his History of the  Persian War,
(Chap. 22,) that he gives an account of  this plague.  I have made the following trans-
lation of those passages in which he describes the disease, viz.  " Persons were seized in
this manner:  they suddenly became feverish, some whilst asle -p, and others, in their
ordinary occupations.  The body did not change  colour,  nor grow hot, nor inflamed,
even with the fever, which was so moderate from the beginning, and until evening,
that neither the patient, nor his physician, by feeling the  pulse, apprehended any
danger ; for no one could have suspected  death  from  it: A tumor rose, in some on
the first, and in others on the second day, but sometimes later, not only in the groin
but also within the  axillae, (armpits) and sometimes behind, or under the ears, or
in some  other part as might happen   These symptoms have hitherto appeared very
constantly, in all who were attacked by the disease;  other symptoms were less con-
stant.   I cannot say  whether from any differences in the bodies of the sick, or from
the will of him who sent the disease."   " In some there was a profound coma, in
 others a violent delirium." " Some died very speedily, others lived several days. 1'he
body was spotted with black  pustules of the size of a lentil, in some who did not live a
single day ; but died immediately : others were  carried  off* by a spontaneous vomiting
of blood. This I can declare truly, that the most able Physicians often prognosticated
the deaths of numbers who shortly after  recovered surprisingly ; and, on the other
hand, they have pronounced the recoveiy of many who were doomed to speedy death:
 so that in this distemper there was no reasoning which could assist human judgment;
no one being able, in most cases, to foresee the event.  Bathing was beneficial to some,
 but toothers it did harm.   Many died who were  left without attendance, while others
 in the like circumstances unexpectedly recovered. Again,  all  methods of treatment
 succeeded with, some, though, in short, no certain means were discovered, either to
 cure or prevent the disease."   To pregnant women the disorder was certain death,
 for those who miscarried died, and those who were delivered perished with their off
 spring."  " Itgenerally happened that those whose buboos grew large and  suppurated,
 recovered from the disease, which seemed to spend its violence upon these tumors ;— 
372
  of the great plague that began about the year  542,  and lasted
  more than  half  a century,  destroying a great part of man-
  kind,  as  far  as  the world  was then known.   But  there is, I
  think, great  probability, that this disease was  known to the

  whilst in thuve whose buboes remained without suppuration, it had an unfavourable ter-
 mination." "  i'hisdisease lasted for four months at Byzantium, (Constantinople) though
 it raged most during three only. In the  beginning few  died beyond the  usual number;
 but the evil soon increased to such an extent, that the deaths amounted to 5,000 daily, and
 at length to 10,U00 and upwards. At first, care was taken to bury the dead in the vaults
 of their families, but afterwards they were thrown into the sepulchres of others,  some-
 times from ignorance, but  often by violence.  In the end an universal confusion pre-
 vailed ; servants being  left without masters, and masters, once very opulent, deprived
 of servants by death or sickness.   Many houses became desolate,  and  bodies some-
 times remained in them unburied, because none of their inhabitants had survived."
  Agatluas,  another Greek historian,  who lived about the  same  time,  and wrote an
 history of Justinian's reign, beginning where that of Procopius ends, mentions another
 violent eruption of the plague at  Byzantium, where, he says it had  never entirely
 ceased, from  its commencement in the 5th year of  that Emperor.  He says, it de-
 stroyed myriads,  and with symptoms  like those which at first  distinguished it   Sec
 the  Greik edition,  with  the  Latin version, and  notes by  Bonaventure Vulcanius,
 printed at Leyden, 1594, (4°) Lib.  V. p. 148.
  A farther account of  this plague  was given by Evagrius Scholasticus, an ecclesiasti-
 cal  Greek historian, who lived in the  same century.  He calls it, the inguinal plague,
 and says it began  two years after the taking of Antioch, by the  Persians  (under  Cos-
 roes,   V. D  540,)  and that whilst he was writing  it had invaded  that  city for the
 fourth time,  having then lasted 52  years, and almost depopulated the world.  The
 following is a  translation of his description of the disease ;  viz.  "In some persons,
 seizing-the head, it rendered the eyes sanguineous, and  the face tumid ; then falling
 on  the (elands of the)  throat, it put an end to life, in all who  were  thus seized.*—
 Some were afflicted with discharges  from the bowels ; in others an  abscess formed
 in the groin,  and, being followed by a raging fever, the patient died on the second or
 third day with his body and mind apparently sound.   " Some were seized  with deli-
 rium and expired.  Carbuncles arising on the body, extinguished life in many.  Oth-
 ers recovered once, and afterwards died of the  same disease.  The  modes of con-
 tracting the disease v» ere various, and baffled all calculation.  Some perished by once

  * In modern times, patients under plague have been speedily suffocated by such  an
 affection of the sub-maxillary glands.
  Orrseus, at p. 96 of his Descriptio Pesti s, after nentioning  parotid swellings  adds,
 " Atq-otquot submaxillaribns obnoxios vi.lerv- inihi contigit ob enormem  intumescen-
tiam partiuin laryngi  proxiraarum, et inde productam  suffocaiionem omnes e vita mi-
grarunt  llorrendum sane aspectum, a tumoiv vastissimo  deformes oribus hiantibuset
lingua exserta anxio anhelantes, prcebuerunt miseri*" 
S7S
 Jews  at an early period of their history, and that it was the
 disease mentioned in 1st of Samuel, chap. v. verses 6 and 9 j
 and ch. vi. v. 19,  under  the  name of "Emrods"  (or He-
 morrhoids)  according  to the  English  translation;  which
 seems entirely  gratuitous; the Hebrew word being (Aplwlin
 or Apholim)  and its  root  (Apol.) signifying  an  eleva-
 tion, eminence, or hill, it properly denotes a tumor, or swell-
 ing,  in  some secret part; and I believe, there  is no sufficient
 authority  for referring these tumors to the anus,  rather than
 to the groin, where they would  constitute buboes,  and indicate
 the plague; a disease which is much more likely than the
 piles to have spread  extensively and destructively among the
 Philistines  at Ashdod,  and  to have been communicated by
 them,  when they restored  the ark to the Israelites, at Beth-
 Sheinesh, and have there caused the deaths of 50,070 men;"
 who were thus afflicted, as is said, " because they had looked
 into the  ark of the Lord."   These swellings would have been
 as much in the " secret parts"  of men wearing clothes,  when
 placed in the groin,  as if placed in the  other situation.  It
 may indeed be  alleged as  an objection to this construction,
 that,  among the dreadful curses denounced in the 28th Chap-
 ter of Deuteronomy,  v. 6, the Hebrew  word  which denotes
 Pestilence (Deber) is  different from that which in the 27th
 verse, has been translated Emrods.  But there is no force in
 this  objection, unless it can be  ascertained, that the  word
 Deber then signified  the  true  plague,  and if  that be ascer-
 tained, it will  prove this disease to have been known to the
 Jews at an earlier period,  or soon after they left Egypt.
   From several passages  in the writings of Hippocrates, it
 seems prebable, at least, that the true plague had fallen un-
 der his observation.   He mentions, at  the 55th  verse of the

entering into infected houses" "Some by only touching the sick-" "Many who
remained with the sick and freely handled tl.em as well as the dead bodies, wholly
escaped the malady."  Hist. Eccles. lib. iv. c> 29. 
374
 4th book of his  Aphorisms,* that  fevers  accompanied  with
 buboes are all  dangerous,  except  ephemeralf fevers;  and  this
 passage  is repeated in the  7th section of the  2d book of Epi-
 demics, with this addition,^  " and  buboes occurring  in fevers
 are more dangerous, especially if  in fevers which are acute,
 they subside soon after their appearance:" and these observa-
 tions may be considered, as correctly applicable to the plague.
 It is  also probable, that  the disease  which is  described  as||
 prevailing  among the fullers  in  the  5th  book  of Ms Epide-
 mics; 7th Section  (page  1155 of Foesius's edit.  E.)  and also
 in the 7th book of  the same, 7th Sect. (p. 1229. H.) was the
 plague : and  this probability is heightened by this considera-
 tion,  that,  if the plague  existed  in the  country,  no class of
 men would be so liable to  be  infected  by it as fullers,  who
 were  then very  much employed   in cleansing the woollen
 clothes almost universally worn  in  those days.

  * Hippocrates Aphor. 1. iv. 55.  Ol inri GuSaoi wvpeToi  -xuvitq   xxxe) lrX<»\
 tvv ttpTt/neptiv.
  \ iiy the exception here made in regard to ephemeral, he  appears to have meant
those short and mild fevers, of one  paroxysm, which so frequently attend the suppu-
rative process in buboes, caused by absorption.  These buboes are well described by Ga-
len, in the 15th book of his Methodus Mcdendi;  of which description the following is a
translation.  "Thus also, ftoiti an ulcer coming on a finger, either of the foot or of
the  hand, the glands in the groin and  tbe axilla,  swell and inflame, upon first receiv-
ing the blood returned from the extremity of the limb : and about the neck, and the
ears, glands have often swelled from ulcerations ekher upon the head, or the neck, Or
some of the neighboring parts.  They call glands thus swollen buboes."
  | Ol tTt QaSac-i  irvetTo)  kukov zrXqv t#v itpniptipm, xxt ox  iiit  rrvee-
 roitri  Cy£«v£? Ktxy.t'ovts ii rolnv o%i<rii i%etg%r,s irtzgaxftti'o-eiyTts.  Hipp.  Epid.
 Lib. 2. Sect. 7. Fos. p. 1025.
  || " Among the fullei-s tubercles arose in the groin, which were hard, and not  pain-
ful; others also of the same size about the pubes, and in the neck.   There was fever,
at first attended with coughing.  On the third or fourth day the bowels were affected
with diarrhce ; heats supervened, with dry tongue, and thirst.  The alvine discharges
were very bad ;  they died."  In this translation I have taken the liberty of altering
the passage, Tf/rji  ftijvj tctu^toj.  which is obviously defective, into  T£»T?J  (*-*> 1
 T£t«»t>i, which I conceive to be the only proper reading. 
375
   These are the parts  which favour most the supposition that
Hippocrates was acquainted with the plague.  Galen,, indeed,
mentions (in lib.  de Therm,  ad Pison.) that Hippocrates put
an end to the plague at Athens,  hy lighting fires; but,  after
the definition, before  quoted,  of the plague by this author, we
can have  no certainty that the disorder then prevalent  in
Athens was the true plague.
   It does not appear,  however,  that Hippocrates knew either
the peculiar nature of the plague,  or its contagious property.
I have not indeed met  with any passage in his writings which
clearly shows, that he  was aware even of the existence of such
a quality in disease as contagion.*
   In  regard to the description given by Thucydides of  the
plague at Athens, in the Peloponnesian war,  I  must observe,
that whatever  its merits  may be in other respects, it is too
vague and inaccurate for any medical purpose; for it does not
unequivocally designate any known disease.   The parts of it

  * Galen was manifestly convinced of the contagious qua!i'.y of the plague when he
used these^xprtjssions, c-wdtxTeiZeiv rate, XoittarTovtriv i-rio-pxXis, x7raXxv<rxt
yx» x.i'vS'vvas aTxep ^fue^i "r'»»5 l" itpixXftixs  Lib. I.e. 2. de Different.  Fe-
brium   The last observation respecting the contagion of Opthalmia is become remark-
able, since this quality has been ascertained to exist, in that species of it which has been
imported from Egypt.  Galen morever acknowledges that he left Rome and returned
to his own country ( Pergamus) to avoid the contagion of plague. Aristotle also believ-
ed the plague to be contagious ; for he  asks.
  Prob. Sect. 1. prob 7  A<«  TiVoTf  o  XotfMS y.ow tuv vio-uv pciXtfX  rove,
TrXtio-idptvTXi ro7i  fcexirebofievoic, TrporxiXTiftirXrio'ti.  »i on /ttovjj t»v yoTcti
x.ouij' eV/v  xztxo-i a?t S'ix rouro -zTxtriv ewtfaegti tov  Xoi/u.ov  oa-ot (frxoXuc,
t%o*Tts ir*8zrxp%vri, %x\ yxp efix to uzreKKXVftx  rrTi vao-n rr> s wxgee run
GepxsrevoiAtvu* ytvo/AtvKS TX%e&>s Jsro too ■zrpetyf*.XTe$ xXitmitxi   Also,
  Probl Sect. Vll 1.  Aict r) xtso fnXt voo-uv ivim  voo-ouTit ot TrXtjTix^evrti,
k&o oe uyuixi; oufets  oyiec^erxt; which is  a plain mention of contagion, though
not applied to any particular disease.
  Aretseus, in the last chapter of his second Book of Therapeutics, observes,that ele-
phantiasis is as contagious as plague.
   " Aioi h \vi&ioZi ti, xxi l;vv2'txtT*$tci, ou  pem j»"  Awjtw,  **xvw,
y«g «'? fttTtiSbio-ii  pyjio^if) £«^>?'." 
376
 most applicable to the plague are the alleged contagious  pro-
 perty of the disorder, and tbe mention of small pustules and
 sores, as marking the bodies of the sick.   *ai/*t*i'»*s< ^^xic, *«j
 tXKto-ti ^6^.  There is, however, no intimation of any glan-
 dular tumours, which must have occurred in the true plague ;
 and all  things considered,  the  disease seems most likely to
 have been a marsh fever, combined with scurvy, modified and
 aggravated by an accumulation of eight times the usual num-
 ber of inhabitants,  afflicted by famine, despair, and  all the
 calamities of war.  It is remarkable, that tbe disease began,
 and prevailed most, at  those seasons when marsh miasmata
 are always most powerful; and though said to have been con-
 tagious, it was not communicated  even to the  neighbouring
 towns of Peloponnesus and Bceotia: a plain indication of its
 having been produced, and propagated by local causes.
   Among the definitions of plague given by nosologists,  that
 of Dr. Cullen* seems  to  he one of the least  objectionable.
 But even this is faulty, by including typhus fever,  which pro-
 bably never occurs  in this disease, and is as  distinct frem it, as
 from small  pox or measles.  It may indeed be possible  that a
 person who has been exposed to the contagion, both of plague
 and typhus, should be attacked by  both diseases  together;
 but in this case, the infection of  each would doubtless remain
 distinct, and only be able to propagate  its peculiar disease ;
 because one is communicable by  immediate contact only,  and
 the other, so far as we can judge, exclusively through the me-
 dium of the atmosphere.
   The definition of Pestis,  by Sauvage, accords w ith that of
 Cullen, and is liable to a similar objection.   Linnseus, substi-
 tutes a most acute  Synocha Typhus fever; a  substitution which
 will often be at variance  with fact,  as in most cases no such
 fever is present.   Vogel errs in a greater degree, by arrang-
 ing plague among  simple continued fevers, stating it to be epi-

  •  Pettis.  " Typhus maxime contagiosa, cum suniraa debilitate."—" Incerto morbi
die eru^tta Bubonum vel Anthracum." 
377
 deinic and most acute; and superadding  a great number of
 symptoms, neither essential nor constant to the disease.   Sa-
 gar's definition is less exceptionable than Vogel's, but it is at
 least objectionable, as including typhus fever.
   Orrseus, wrho was  sent with superior  medical authority,
 by the late empress, Catharine  of Russia, to advise and assist
 during the plagues at Jassia (or Yassy) and Moscow,  has re-
 fused to  admit fever of any kind among the characteristic dis-
 tinctions of plague; and assigns his  reasons  for doing so.  at
 pages 71, 2, and 3, of  his  Descriptio  Pestis,  (4°, printed  at
 Petersburgh, 1784,) where, though he  acknowledges that feb-
 rile  symptoms occur in most cases of plague, he  maintains,
 that fever does not essentially belong to the disease,  nor con-
 stantly attend it.   And  that it would he  just as reasonable to
 give the name  of fever to that acceleration of pulse, and  other
 effects of morbid  excitement,  occasioned  by  acrid  poisons,
 fumes of charcoal, &c. as  to  the febrile symptoms which often
 attend the plague.  And  certainly fever,  properly so called,
 does not  constitute the disease,  nor is  it in all cases percepti-
 ble,  even as a symptom;* but  the latter part of  this observa-

 * In very mild cases of  plague, buboes arise and suppurate nr disperse, and  the.
disease  terminates  without any manifest febrile symptom. I  saw some such cases,
in the pest-houses at \bnukir,  in 1801,  and a greater number have been ob served by
 others in different  situations.  The like happens  sometimes in the mildest cases of
 inoculated small-pox ; on tbe other hand,  I believe (though  such cases did not fall
 under my observation) that the morbid impressions from the contagion of  plague are
sometimes  so powerful as to extinguish life, before any such reaction of the system
can take place, as would produce an appearance of fever.  In general however,  and
excepting these extreme cases, there is so much of reaction, or of effort, by what has
been called  the vis medicalrix  naturse,  that febrile symptoms,  more  or less  violent,
as well  as variously modified, do  (as in  small pox) occur to persons attacked by the
plague, during a part of its continuance. See Waleschmidt de siq;. Pest. Holsat. 1712.
Haller (Disp. ad morb. Hist, et Curat, v. 5. p. 555.)  "Pestis, proprii loquendo febris
vocari nequit; est  enim  ssepissime sine febre,  et sub varia  larva sua ludit   dra-
 mata."
  Diemerbroek observes  (de peste, p. 12) " Pestis sine febre paucis  incipiebant et
finitur ; pluribussine febre quidem incipiebat, s';:I c[ i e i-.i-i ■ i mil diu p i,.;  inse<ri>»ba-
tur," &c  He adds, in a  note, " Pestem esse qu'-d iffveisum a feb:v, et febr m  eju9
essa symptoma, durante hac pestilente  c> lstitutioue  multoties  observavimas,  ac
                                48 
578
  tion would apply to every other symptom of the  disease, no
  one of which invariably and manifestly occurs to every pa-
  tient ; so that if, in defining the plague, we were to reject all
  the symptoms which are not  constant and inseparable,  we
  should have none left to denote the  disease;  fever, therefore,
  though of no particular form or  species,  may perhaps be ad-
  mitted as part of the definition,  and this with a swelling of
  some of  the lymphatic glands,  or with exanthema, including
  carbuncles, may serve  generally to  designate the plague, if
  accompanied by that particular contagion which  is its  cause
  and essence, and rvithout which  there can be no plague.
   The limits prescribed for this publication,  will not allow me
 to describe the several  forms,  modifications,  and degrees  of
 ,fever  whicli accompany the plague in different seasons, situa-
 tions, and individuals.   They are in fact as numerous and va-
 rious  as the human constitution is  capable of exhibiting.  In
 the young,  robust, and plethoric, we find synocha, or ardent
 fever,  with the  usual inflammatory  appearances,   and  in
 feeble or debilitated constitutions  we have  the  appearance
 of low nervous fever.   The intermediate  degrees and  com-
 binations are,  however, much more frequent than either  of
 these  extremes;  indeed, the  cases  of   ardent  fever  com-
 monly bear a  very small proportion to  the others,  perhaps
 because the action of this contagion is found generally to de-
 press  or diminish the  living power.   In  all  these cases the
 patient's  constitution and circumstances have a great, if not an
 exclusive influence  upon the  febrile and other  symptoms;
 with this exception,  however, that  in persons who have pre-
 viously been sufficiently exposed to  marsh effluvia, the  fever
 to which  this contagion acts as an exciting cause, generally

proinde nonnulli pestem male per febrem definiunt, cum febris no;> sit de ip: ius es. eriti •,
 ut infra probabitur cap. 12. :inn:>t. 2"
  Dr. Sotira, at p. 3. of his M inoir sur la  Pe.-.tc,observ'ie en Egyptc, in describing
the varieties  of that disease,  s:ivs, " Finalement, il yea avait quelques-uns att:tque<<
d'un leger mal de tete, avec un degnut passa^r,  s, >;.» fevre, qui suuffraient un pici.-
temeut sous l'aine, a l'en<lroit o i le bubon  |>e,lil ntiel s- muniles.."   P.-u a peu le-
bubon se prononcait, pour disparaitre, on pour suppnrer longtems iipres," Sec. 
379
takes on the form cither of a quotidian  intermittent,  or of a
double tertian."*
   I have assumed this disease to he essentially and specifically
contagions, and I  shall presently mention sufficient proofs and
grounds for the assumption.   But I think it expedient first to
offer  some observations,   concerning  the  channels through
which its contagion is received by the  human body;  because
the production of buboes,  in  my  opinion, depends entirely on
this fact,  that the contagion  after being applied hy contact to
the skin,  is exclusively received  through it, and conveyed by
the lymphatics into the blood vessels,! as in the case of  inocu-

  * Dr. Price informed  me that in all or nearly allthe Sepoys or other East  Indians
attacked by the plague, who had fallen under his care in  Egypt, the accompanying
fever was of  the intermitting form ; that the paroxysm  began with cold and shivering;
and it was during the cold stage that most of these blacks died.  They had probably
all  been exposed to marsh  miasmata, in the neighbourhood of Rosetta;  and  to
this  circumstance  I should ascribe the occurrence of this form  of  fever  among
them.
  ■J- The facts which prove the necessity of actual contact  with some infected person
or thing to communicate the plague, are so numerous, and many of them  so notorious
that it must be unnecessary for me to enter upon a detail of  them, after what Dr. Kus-
sel and others have published, and after the experience of the British army in Egypt,
which invariably demonstrated this necessity, by shewing that all those who  avoided
contact invariably escaped the disease, whilst those  who did  otherwise in suitable condi-
tions, were very generally  infected.   Nor was there,  so far as I  have been able to dis-
cover any instance, in the French Egyptian army, of a communication of the d.sease
without contact, though the Physicians to that army,  who have written on the subject,
do not,  I believe positively assert the impossibility of  such communication.  But M.
Des^enettes, the chief Physician to that army, at p. 248, when writing upon th.s con-
tagion, savs, « on a vu un simple fosse, fait en avant d'un camp, en arreter les ravages ,•
 et c'est sur  des observations de ce genre, que est fonde Visohment avantageux des
 Francs dont la pratique a ete suffisamment, detaillee par divers voyageurs."  And Dr.
 Pu-net, one of the physicians of the same army, (whose experience in  this disease was
 very extensive) at p. 130 of his Memoires, sur  les Fievers Pestilentielles,  kc. du Le-
 vant, not only supposes the necessity of contact, but adds that even this wi.l not suffice
 without an aptitude in the receiver of the contagion.   He indeed afterward, inUmate.s,
 that from the crowded and confused state of the army, he had not been able to ascertam
 « si le contact de la personne malade,  ou de ce qu'il a louche est indispensable, pourj
 donner la  maladie," &c.  It is apparent, however,  that he did not know of any other
 way in which the disease had been communicated; and  the physicians employed at
 Moscow, duringthe plague, which destroyed nee -ly 60,0' »0 inhabitants of that city, ,n 
380
 lation  for the small pox;  and  hence we  may account for the
 morbid state  of the  lymphatic system,  which  has  been  ob-
 served, in the few cases of dissection,  where proper attention
 was paid to its condition.  The effects of morbid poisons, and
 other  noxious  matters when absorbed, upon  the glands con-
 nected with the absorbents, have  been  sufficiently manifested ;
 and it  is from  this  cause  that  the  axillary glands of one or
 both arms, when the small pox has been introduced by inocula-
 tion, become swelled about the  time or a  little before the com-
 mencement of the eruptive fever;  and (as is well known) it is
 also by an absorption  of venereal poison, through a particu-
 lar organ,  that the  inguinal  glands, to which  that poison is
 directly conveyed by the absorbents, become affected ;  and it
 is I ecause the contagion of plague  is  not commonly  applied
 and communicated through the same organ, that pestilential
 buboes near  the groin are not  often,  if  ever,  formed  in the
 very  same glands as the  venereal, but  in the  femoral  and
 1771, appear, by abundant experience, to have left no room for doubt on the subject.—
 Dr de Merlens, in the English  translation of his account  of that calamity, says, " the
 contagion was communicated  solely by contact ofthe sick, or infected goods."  " It was
 not propagated by  the atmosphere."  He adds, " when we visited  any of the sick we
 went so near them that frequently there was not  more than a foot distance  between
 them and us ; and though we used no other precaution than that of not touching their
 bodies, clothes, or beds, we escaped infection."  M. Samoilowitz, who was surgeon to
 the great  military hospital,  where the plague in question first appeared, and who be-
 sides the most extensive experience in Moscow, had been greatly  employed for that
 disease, in Poland, Moldavia, and Wallaehia, asserts, in the preface to his " Memoire
 sur la Peste,"&c. that " il est certain que la peste  ne se develloppe, et ne se  propage
 que par le contact ainsi que  je le demontre dans  mon memorie;" which indeed
 he afterwards does, by numerous facts.  But after all  these observations,  I would
 not be  understood as  maintaining that  the air expired from the lungs of a  pa-
 tient under  the  plague, and loaded  with humidity,  may  not contain  some
 contagious matter, capable,  if immediately received into  the mouth and lung% of
 another peason (by a very near approach of their  faces to each other) of being absor-
 bed, and taken up by the lymphatics spread over these internal surfaces, or perhaps
 by the lungs, so as to produce the disease : This would, I think, be nearly equivalent
 to  contact, and attended with no more difficulty than  there is in an absorption by the
skin.  Orrseus says, p. 151, " communissimd affectionis via  per contactum oliscrvata."—
 He thinks, however, that the disease may be  taken  by the breath ; but if this were true,
the other would not be the most commonway, because people frequently can and do avoid
contact but cannot avoid breathing with the sick. 
381
other glands which are connected with the lymphatics coming
from the lower extremities.  Orrseus, indeed, mentions a fact,
which, without his  appearing to  be sensible  of it, demon-
strates the production of pestilential buboes by absorption.
He says,  p.  154,  " In  quibus  escharse  carbunculorum, post
superatam pestem acutam, diutius neglcctae restitarunt, partes
adjacentes valde  intumuerunt, et in non  nullis  bubones de
novo  suscitabuntur."    These  secondary,  or   new buboes,
could  only be caused by an absorption from the protracted
and neglected carbuncles.*
   While the  lymphatic system and its uses were but very  lit-
tle known,  and  pestilential buboes  were  considered  as an
effect of the vis medicatrix naturae,  and as being intended to
facilitate a critical separation and discharge of the pestilen-
tial virus from the blood, we need not wonder  that a  morbid
absorption was not suspected to have been their cause.  But
it seems extraordinary that in recent times, and with modern
discoveries, not only Samoilowitz should suppose buboes to be
formed by the contagion of the plague thrown outwardly from
the  blood, (See  his Memoire, p.  112,)  but  that  a  similar
opinion should have seemingly been entertained by M.  Desge-
nettes, the chief physician of the French army  in  Egypt.  I
conclude at least that this must have been his opinion, because
he states buboes to have been produced by an inverted action

  * Platerus  had also observed the production of buboes, by the  influence of carbun-
cles, though he probably did not suspect  the way by which that influence was exerted.
He says (Praxeos Medicx, t. ii. p. 79) " Seel et fit ut bubones in peste correptis, non
semper, a venenata ilia vi" (veneni pestiferi) "in corporis emunctoria excussa, verum
oh carbonis vicioi ardorem doloremque influxum hunc in adenes coinmoventis, uti in
aliis quoque inflamationibus accidit proveniant"  He afterwards mentions the forma-
tion of carbuncles, particularly in pestilential fevers; adding, " a quo anthrace ah in-
itio lineani rubram ad bubonem, qui pleruraque ilium comitari solet" " porrigi sxpe
observavimus." The red lines here mentioned are now known to proceed from
an inflammation of the absorbents ; and they were observed, even by Galen; see the
note to page 556. He adds,  concerning these buboes, "cernitur autem aliquaudo
Ipsa quo que vena per totum membrum rubra et calens, et  distenta."  &c.  But
though  secondary buboes may be produced by an absorption from carbuncles, the
latter can never produce them on patients in whom carbuncles do not occur, or only
 /(.cur subsequently to the buboes, as is often the case. 
382
 of the absorbent system,* contrary  lo  every tbing analogous
 with which I am acquainted. And in the very next paragraph,
 after mentioning carbuncles as being eminently contagious, he
 says (that in opposition to  buboes)  they arc produced by di-
 rect absorption:—"par absorption  directe, c'est a dire dans
 Pordre ordinaire, et par la voie la plus courte,  et le plus sim-
 ple contact."  To me, however, it seems most probable, that if
 either buboes or carbuncles  result from any thing thrown out-
 wardly by arterial action, or by any effort of nature, it must
 be the latter, rather than the former,  wiiich are so produced.
 I  have insisted  the more on this subject, because  the  truth
 concerning it seems to be of some importance in regard to the
 prognosis, as well as treatment of the disease.
   Dr. Trice  informed  me  that  in all  the bodies of persons
 who had died of plague, which he dissected  in Egypt, the
glandidar  system was  morbidly affected;! and Dr- Sotira,
 who was physician  to the French army there, observes, that
 according  to his information, those who died  of that disease,
 and had been examined by the French medical officers, besides
 a morbid state of the brain and spinal marrow, were found to
 have " tout le systeme des glandes lymphatiques engorge."
 See Memoire sur la Peste Observee en Egypt,  &c."  p.  8.
   With these, and  other proofs of morbid absorption hy the
 lymphatics,  it is not  surprising that buboes  should he the
 most frequent of all the symptoms which  occur in this multi-
 form disease.  On a general computation, I think it would ap-
 pear that glandular swellings  have been  observed  in nearly
 three-fourths of those who were supposed  to have had plague,

  * " Les bubons pestilentiels sont des engorgements des glandes lymphatiques, qui
s'operent evidi ment par un mouvetrent inverse  du systeme absorbant." Hist. Me-
dicale de L'armee d'Orient, p. 109.
  f Dr. Price informed me, also, that in all  the  bodies which he had  dissected, the
liver was greatly enlarged: but these, excepting one, had all been born in the East
In.lies ; and on my asking, whether he did not think it more likely that an affection of
that viscus should have existed previous to the attact of plague, than that such enlarge-
ments should have been so suddenly produced by that disease, he answered intheaf-
 fli-mat'iye. 
                          S83

and many are erroneously  supposed to have had it, when it
prevails  extensively and destructively, and as no sufficient
examination  takes  place in many of the more violent cases,
where buboes often do not appear till the approach of death;
and there are others,  where the rudiments,  or germs, are dis-
coverable only after  death, and by such applications of the
fingers as are both  dangerous and unpleasant,  it may he in-
ferred, that but very few if any persons have  undergone this
disease,  who  either had not glandular swellings, or in whom
they would not have occurred, if life had not been extinguish-
ed, before there was sufficient time and  reaction of the sys-
tem  for  their production.  I do not, however, think it im-
possible that so much of the contagion of  the plague as will
suffice to produce  the disease,  should find its way into the
system by the absorbents, without producing  a swelling of
the glands,  though facts prove  that this does not commonly
happen.  Whether  in any of those mild cases, where buboes
have appeared without fever, and which have been supposed
to be most liable to re-infection,  the contagion had affected the
glands, without finding its way into the blood vessels,  I am
unable to determine.   I am also unable to explain why the
fermoral or inguinal  glands, should he much oftener affected
than those of the axilla; a fact which has  been generally ob-
served, and which  seems to make it probable, that the conta-
gion of the plague  has  been more frequently taken up by the
absorbents Of the lower extremities, than by those of the
hands and  arms.   This might well be the case with persons,
who, like the inferior inhabitants of warm countries, seldom
wear shoes  and stockings , but there is some difficulty in un-
derstanding how it could  happen to others, unless stockings
by absorbing and retaining the contagion, favour, rather than
obstruct, its approach to the skin.
   When the disease  is likely to prove mild, its  commence-
ment is commonly  first indicated by hardness of the  glands,
and  in many cases this occurs  with, or soon after, tbe first
febrile or other morbid  symptom :  often, however, and rspr- 
384
 ;ially in cases of great debility,  no glandular affection is  dis-
 coverable for several  days, nor even until the near approach
 of death.   So much has been written by various authors (and
 particularly Orrseus,  at  p. 95 and  6,) in regard  to  buboes,
 their appearances,  situations,* numbers,  sizes,  kc.  that  as I
 am not giving a treatise of plague, I  may be  allowed to pass
 over these topics.
   For similar reasons,  I shall offer very few observations re-
 specting the anthrax or carbuncle,  of  which Orrseus seeing to
 have given the  best account.f   Their occurrence is, I  believ e,

  * " Des qu'un bubon parait soi t aux aines ou aillieurs il se place tousjours de cote, au-
dessus ou au-desous de la glande et jamais sur la glande meme comme  les bubous ven-
criens. Ceux des aines prominent ordinairement deux.doigts  au-dessous des glandes
inguinales."  Meipoires ur la Peste, par M.  D. Samoilowitz,  M.  D. he. p  138.
  f Orrseus p. 98. " Carbunculi nihil aliud sunt quam siderationes partiales cutis, et
eiproximx  celhilosie,'' (membrana;) " anigredine crusta;  mortuse sic  nuncup-iti."
  He makes a distinction  of carbuncles into the moist and dry,  which I do not recol-
lect to have been made by any other writer,  though it appears a  very proper and ne-
cessary one.  The former is that which seems to agree  best  with what authors have
described as the pestilential carbuncle. Orrseus describes it thus:—" Febre pestilen-
tiali jam oborta, vel interdum simul cum  ea, pars qualiscuriqiie corporis, nunc ltiajo-
ris,  nunc minoris ambitus ardere, dolere, rubescere, et tumescere incipit: (in aliis non
nisi macula rubra, vix supra supeifciem cutis  prominens, conspicitur,)  non diu post, in
medio tumoris Una vel plures, hand procul a se invicem di.->tantes  pustules,  quasi
capitula acuum," (pins'  heads)  " majuscula, altitudincm lineae," (1-12 of an inch)
" raro superantes, pallidiusculse  &  sanie turbida replete exsurgunt, quae  post  breve
 intervallum crepant; cutis vero subjecta livescens & mox ingrescens sphacelum jam
factum indigitat  Nigritieshxc paulatim in omnes  dimensiones  ulterius serpit, cum
peripheriasemper inflammata.   Sape ex carbunculo  in  variam directionem prsesertim
ad tractum majorum vasorum& tendinum, vibicessat insignesprotenduntur."  Samoilow-
itz (p. 142) says, that the only parts in which the carbuncles do not happen are  "les
parties recouvertes de poils, ainsi que celles ou se manifestent les bubons."  He is pro-
bably  wrong with respect to the latter for Orrseus (p. 98) says, that  sometimes
the  moist carbuncle  "bubonibus implantatur;"  Samoilowitz  is  incorrect,  too,
as to the progress of the  carbuncle;  for after saying, (p 143)  that  "les pestiferes
eprouvent  deja une douleur ties vive a  Vendroit ou ils  doivent se  placer :"—He
mentions, that "il hut ausitot visiter Vendroit qu'il  indique.  Ony  trouvera d'abord
un  tres  petit  bubon,  ou pustule  rempli d'une serosite jaunatre, sans ouciai
signe   dHnfammation."   Now this is  what  I believe never  takes  place, for
the  excessive pain  felt at the part is only  the effect of very considerable inflam-
mation existing in it, which  usually arises to such  a degree of violence, as at last
to destroy the vitality of the  part: this progrpss, too. through tbe  various de-
grees of inflammation and mortification is in the 7noist bubo by no means so rapid as is 
385
totally unconnected with that of buboes,—I mean that buboes
have no  influence on  their  production.   When they  appear
very early,  they assume a dark brown or black  colour, and
remain  forty-eight hours or  more,  without  being  circum-
scribed  by an  inflamed margin;  they generally  indicate  the
greatest danger.
   Exanthemata are of several  species :—one is  a vescicular
eruption,  sometimes of the size of a pea, or larger,  appear-
ing without any  determinate  situation, of a yellowish  or li-
vid colour, and with an inflamed margin ; they were formerly
known to the people of England by the  name of Mains:  when
three or four of them arise near  to each other, they often be-
come  confluent, and, by uniting, produce what Orrseus calls a
dry carbuncle, to which  from the  first  they have great  affini-
ty ; those which  are  of a livid  colour, flabby, and confluent,
may be  considered as a very unfavourable symptom.
   Another exanthematous eruption attending the plague, may
be considered  as  petechial;   it  renders the skin  spotted,  and
assumes different colours, sometimes reddish, but it more fre-
quently approaches' to blue,  purple, or brown.   The dark co-
loured spots were  in  this country called,  and deemed  to be,
tokens or signs of death,  and  found to  he such in Egypt.

commonly supposed ; for the inflammation of the carbuncle may proceed to a cer-
tain height, and then stop before any mortification has begun, and this after the
inflammation  has existed for a day  or two.v  Thus  Orrseus (p. 112) " Quam pri-
jaum febris," (accompanying the plague,) "funditus sublata fuerit, rudimentum car-
bunculi inflammatum dissipatur„• interdum (uti in me ipso accidit) humor  purulen-
tus quasi sub vesiculd grandiori derepente obortd colligitur, & evacuatione per incisi-
onem facta, fundus cutis ruberrimus,  & minime sideratus per suppurationem levio-
nem sanationem facile admittit."
  The dry carbuncle (says Orrseus p.  97) " e contra  sine ullis inflammationis indiciis
e maculis" (petechiis) " latioribus confluentibus enascitur,  quse scepe ante febrem
aderant: hac vero" (febre) "jam accensd,  cutis nigerrima facta arescit, corruga ur,
et  . • • vicina depascitur;"  rubor " marginis" "fere nullus est."  He adds, " Per-
iculossisimus est & vix multi eo affecti ex naufragio vita emergunt, dum  exhumido"
.  . .  " maxima segrotorum pars convalescit,  nisi in partibus nobilioribus .  . .locatus
fuerit," &c. or unless it  shall grow to a vast size, and produce suffocation, or exhaust
the patient's strength.  This dry carbuncle  is not  very painfuK
                                 49 
38b
These petechial spots do not change their term or character
like the vesicular eruptions.  Orrseus mentions, at p. 113, a
case in which these spots made  their first appearance in great
numbers, immediately after death.
   Of the contagious nature  of the  plague, I should hardly
have tbought it necessary to adduce any proofs,  after all that
has been experienced, and written  of its dreadful effects, had
it not lately become  fashionable to entertain doubts, at least,
en the subject, without any other foundation or reason, so far
as  I  can discover, but  that of the escapes of persons  who
sometimes  are seemingly exposed to this  contagion, suffici-
ently for the production of disease.  I have certainly  not
been inattentive to facts  of this nature, nor unwilling to al-
low  them their full  force;  and the opinions and modes of
reasoning,  which I  have entertained in regard to yellow fe-
ver, have  led me to endeavour, as far as possible, to ascer-
tain how far the multitudes of opposite facts could  be explain-
ed, by supposing the operation of any local or atmospheri-
cal cause, distinct from personal contagion, and particularly
that of marsh miasmata,  to  which plague has recently been
ascribed by writers whose opinions are justly of great weight:
I have however, found  insuperable  difficulties in  the way of
every supposition which does not admit the influence of a spe-
cific contagion.
  When  I  took charge of the pest houses at Aboukir,  in
1801, Dr. Buchan, my predecessor,  and every other medical
officer employed in that dangerous service, had already caught
the disease ;  and of these officers,  twelve in number, seven
had died, besides a considerable number of nurses, and other
attendants on the sick ;  though  if  there be any spot  on earth
exempt from  the operation  of  marsh miasmata, it would, I
think, have been  that upon which  these pes? houses were pla-
ced, together with the surrounding dry, barren sands, within
which, those  who took the  plague in  this manner,  had  in
effect been  confined.  The cause  which had  thus created a
specific disease iu every medical officer  exposed  to its action. 
                                $87

must  have been  pecidiar  and powerftd,  and there was  not*
the  smallest reason  to suspect the  presence of any  n.orbid
influence,  except that of  pestilential  contagion, nor  could
marsh effluvia,  had they been present, have occasioned such
a  disease,*  nor,  indeed,  could  any thing else  within  our
knowledge, other than its own specific contagion.
   The medical  officers of the French army had previously
experienced the effects of  this contagion  to a  much  greater
extent.  Dr. Sotira,  one  of its physicians, after expressing
his astonishment that  there should  be men " assez  bizarres
pour ne  pas croire  a la contagion  do la peste," among other
proofs of its possessing that property, mentions  the loss which
was sustained  from  this disease by that army in  the  seventh
year  of what  was  called the French Republic,  "  d'environ
quatre vignts officiers de  sante" of about eighty medical  offi-


  » There are many irresistible proofs, that the cause of plague is perfectly distinct
and unconnected with that of yellow, and other marsh fevers. Were  it the same, we
should certainly find the former disease most prevalent between the tropics, instead of
being, as it notoriously is,  totally excluded from so great a part of the globe ; and we
certainly should not find its progress suspended  in Egypt during  the hottest months,
when marsh miasmata are most active and  powerful; nor should we find the nat ves
of Africa and of the East Indies, who are  least susceptible of morbid impressions from
tlje latter, and in whom marsh fevers,  when they do occur, are mildest, not only ta-
king the plague frequently, but dying of it in far greater  proportion than   any other
race of men ; as was found to be the case by the British East Indian army in Egypt, and
as Desgenettes, Pugnet, Sotira, and  the other French physicians, declare to have hap-
pened to the negroes who fell under their observation  Dr. Sotira, indeed, asserts,
that all of them who had the disease died  of it very soon.  The circumstances which in-
fluence the production of marsh  miasmata appear to have no share in causing the
plague j its ravages being as great in the high, arid and barren parts of Syria, as among
the canals, and upon the rich soil, of Lower Egypt ; and  indeed, it prevails least in
those parts of Lower Egypt which are most productive of marsh effluvia ; and particular-
ly the Delta.   I havesaid nothing of the very important and essential differences which
must always subsist between the plague and yellow fever, notwithstanding all the inge-
nuity and labor which have been employed to give them an apparent sim.htnde. Nor
have I noticed the certainty with which the Franks secure themselves from plague by
shutting *A provided the known precautions  are not neglected  or transgressed, as
somet mes happens.  Would such precautions exclude marsh miasmata, or would a
ditch wa-d off their morbid  influence, and as  Desgenettes  asserts, have  secured an
army from the plague ? 
388
 cers; a loss which, he says, was the more deplorable, because
 it could not be repaired.   He adds, that in the two following
 years, it was thought expedient to employ Turkish barbers, to
 dress buboes, carbuncles, and blisters, as well as to bleed and
 apply frictions of oil, under the inspection of French physici-
 ans and surgeons,  and that by these means only twelve medi-
 cal  officers  died in  twice the former space of time.*   As the
 deaths of the first year afforded a strong proof of contagion in
 the  disease, their great subsequent diminution manifested the
 probability  of escaping it, by abstaining from the actual contact
 of infected persons and things.
   When the plague re-appeared in the  British Indian army,
 during the autumn of 1801, and the succeeding winter, more
 precautions were used by the medical officers employed in the
 pest houses, to guard against contagion,  and a greater  pro-
 portion of them  escaped:  hut still a majority of these gentle-
 men took the disease, and to more than half of them it proved
 fatal.  I could fill  volumes with valid and well-attested proofs
 of  the contagious  nature  of plague.  But I must refer those
 who may entertain doubts on this subject to  the facts publish-
 ed  by  the  French physicians  who were  in Egypt,  and  by
 Orrseus, Samoilowitz,* and others,  who saw the plague in
 Russia, Moldavia, Wallachia, Poland, kc.

  • See Memoire sur la Peste observee en Egypte, etc. par Gaetan Sotira, Docteur
en Medecine, Medecin del'Arme d'Orient, fcic. p. 5.  He also ment ons, that more
than half of the Turks,  who were thus employed to asist the French surgeons, took
the plague, which in several instances proved mortal ; though ;;mong a considerable
number of other Turks employed at Rosetta by the French, to bury the dead, only
one  caught the disease.  This is one of the many facts which indicate that there is
much g»»ater danger  in  handling the bodies of infected persons whilst alive, than
after death.
  f Or Samoilowitz, who for many years officiated as  an  army surgeon in places
where he had numerous  opportunities of  seeing persons under the plague, and who
when that di ea^e was so destructive at Moscow, in 1771, was most extensively em-
ployed there, has filled  nearly one hundred pages, in the early part of his volume
" Sur la Peste," with proofs of its contagious influence ;  and, among these, he men-
tions, that having successively volunteered  his services as chief surgeon, in three of
the principal hospitals at Moscow all the assistant surgeons who were employed under 
389
   Though nearly two thousand deaths, by plague, occurred to
the French army whilst in  Egypt, it was thought expedient,
for a time, to deny the existence of the disease; and both the
general, Buonaparte,  and  the chief physician, Desgenettes,
exposed themselves to  some dangers, in order to  allay the
general  apprehensions  of the soldiers on  this  subject;!  an<*
among  other expedients, the latter, after dipping  the point
of a lancet in the pus of  a  bubo,  on one  of the convalescents,
slightly pricked his groin and his arm, near the axilla, taking
care, however, to  wash  himself immediately with  soap  and
water, which, as he says, were brought him for that purpose;
a small inflammation was  produced  in  the  spots which  had,
been thus  pricked, which lasted three weeks, but produced no
worse consequence.   Whether the disease of the convalescent,
from whom the pus was taken, had passed beyond the stage in
which it is contagious, as is probable, or whether the pus was
applied in too small Quantity, or washed off too soon, I will not
decide. Desgenettes, indeed, acknowledges,( p. 89) that this ex-

him, fifteen in number, took the disease, and of these all died, excepting three ; whilst
the physicians who walked  among the sick,  but carefully avoided all contact with them
or their clothes, &c.  generally escaped.
  Samoilowitz was  himself  three times attacked by  the disease, a circumstance
which he ascribes to the dispersion of his buboes without  suppuration, the first and se-
cond times.—See p  39, 40, &c. also p. 35.
  Dr. Pugnet, among other instances of pestilential contagion, says, "Huit Francais
a  Caipha, se sont successivement  communique le germe de cette maladie, en se trail
mettant une pelisse  ; cinq sur six, a Gaza, en se disputant un habit de drap, la de-
pouille d'un de leurs compatriotes; quatre a Jaffa en mettant a  leur usage des mou-
choirs de Col qu' un Pharmacien de troisieme classe, mart, avait apport6 d'ltalie.  Ces
quatres heritlers, furent en  meme temps, atteints de bubons a  V entour du Col et
perient du troisieme au sixieme jour." See p.  229,  230. These four  instances of
persons becoming infected by tying  round I heir necks handkerchiefs which had im-
bibed the  contagion, and all getting buboes round the neck, are strong proofs of the
production of glandular swellings  by absorption through the  lymphatics, leading
to the glands which thus become affected, as I have lately mentioned.
  j- Desgenettes, as  an explanation of the motive by which he was actuated  in regard
to the plague on this occasion, and also • in refusing ever to give  that name to the dis-
ease,  says,  " Je crus devoir dans cette circonstance traiter l'armee entiero comme un
malade, qu'il est presque toujours inutile and souvent fort dangereux, d'cclairer sur
sa maladie, quand elle est tres critique." 
390
  periment proves nothing against the transmission of contagion,
  which, says he, has been demonstrated by a thousand examples.
  " Elle n'-infirme point la  transmission  de  la  contagion, de-
  montree par mille  exemples;  ille  fait voir seulement  que les
  conditions  necessaires  pour qu' elle ait lieu, ne sont pas hien
  determinees."  Whether Dr. White, who entered the  pest
 house of the Indian army, at  El Hammed, early in January,
  1802, was  misled by this experiment, I know not;  hut, from
 a persuasion that the plague was not contagious, he immedi-
 ately rubbed some pus, taken  from a pestilential bubo, upon
 the inside of his left thigh, and the next morning inoculated
 himself in the wrist, with matter running from another bubo.
 Four days, however, had scarcely  elapsed from bis entering
 tbe pest house, before he was seized with  shiverings, followed
 by febrile heat, &c. which he flattered himself would prove to
 be an intermittent.  But he died of the plague before the end
 of the third day; and thus, unfortunately, added another to
 the proofs—alas !  too many—of the contagious nature of this
 terrible  disease.
   We  probably do not know so much of the facts and circum-
stances which either favour or retard the transmission of pcs-
lential 'contagion from  an infected  person (or tiling) to those
who are uninfected, as would enable us,  in all cases, to assign
the true cause, why persons often escape harmless,  whose ex-
posure to contagion has  seemingly been such as ought to have
subjected them to the disease; much seems to depend on the un-
fitness  of the atmosphere to become a vehicle of this contagion,
and on the necessity of an actual  application of it to the human
body,  and  of a subsequent absorption  through the skin, all
which must  render its introduction into the system more diffi-
cult and precarious.  Volatile contagions, particularly  those
of small pox and measles,  will  necessarily be taken into  the
lungs of one who breathes the  air in which they are diffused  ;
and the lungs, being peculiarly  fitted to  imbibe a  vital part
from the inspired air, they, in doing this, may probably imbibe
contagion also; and  therefore  we might naturally expect, 
391
 what seems to happen,  that persons who have never been at-
 tacked by these diseases should seldom escape, when suffici-
 ently exposed to their contagion :  whilst, on the other baud,
 we find that those morbid poisons which being fixed, can only
 be received  by  contact,  through the  skin, very  often fail in
 producing their effect; this is particularly true of the virus of
 rabid animals, that of syphilis, &c. which are not  always of
 the same force, nor are the absorbents equally disposed to re-
 ceive them  in all men, nor  at all times even in  the  same man.
 Dr. Pugnet, though he  is justly convinced  that nothing  will
 produce the plague but its peculiar contagion, thinks the suscep-
 tibility of the human body for it is greatly increased by a moist
 and moderately warm atmosphere—that children, females, and
 persons of delicate, feeble constitutions, are most apt to become
 infected ; and that those who are naturally robust and vigor-
 ous  seldom take the disease, unless weakened by excessive fa-
 tigue, or by excessive indulgence with women, or intoxicating
 drinks.  See p. 205.  Dr. Sotira entertains nearly the  same
 opinion.  Desgenettes remarks, p. 248,  that the plague seem-
 ed more particularly to  attack those who were exposed to sud-
 den  transitions from a hot to a cold atmosphere, and vice ver-
 sa :  such as bakers, cooks, and blacksmiths ;  and  that men
 addicted to excesses with women, and spirituous liquors, ve-
 ry seldom recovered from the disease.
   It has been supposed by  Orrseus, Pugnet, and others, with
 some probability,  that abundant transpiration through the
 skin, may hinder the absorption of pestilential contagion, and
 even wash  it outward from the pores ;* and on this supposi-
 tion, the former has strongly  recommended the taking of exer-
 cise sufficient to produce a copious discharge of sweat, after a
 real or supposed exposure to  the contagion ;—and it seems to

  • If the contagion of plague he thus washed outward upon the skin, might it not
descend to the legs or thighs, and after the sweating has ceased, be there taken up by
the absorbents, and in this way, render inguinal, femoral, or crural buboes more fre-
quent than those in Uiempper parts of the body ■ 
892
 have been on this supposition, that Desgenettes,  after his vis-
 its to the pest houses, always mounted his horse, and rode un-
 til he found himself in a free prespiration.  See p. 90.
   Another probable  cause  of unexpected escapes from  pesti-
 lential contagion may be the short time which persons under
 the disease continue  in  an infectious  state.   Our knowledge
 on this subject is very deficient.  It has been ascertained that
 variolous patients do not infect others, at soonest, until their
 pustules begin to maturate, and they are probably most infec-
 tious when these are  in  a state of desquammation;   whilst
 persons who have the measles, to  my knowledge, have com-
 municated the disease before any eruption was  discoverable.
 It has not, however, been sufficiently ascertained when patients
 under plague first acquire the power of  infecting others, nor
 to what stage of the disease they  retain this power.   I w as
 confidentially informed, when at Aboukir, of an instance in
 which no infection resulted from a most intimate connexion
 with a  female,  a single hour before she was attacked  by the
 plague.   Dr. Sotira thinks the disease is most,  if not  exclu-
 sively,   communicable during  the  existence  of fever; and
 Pugnet thinks the disease  ceases to be contagious so soon as
 the fever terminates.*   Dr.  Desgenettes, in his Resume, p.
 248, says the body whilst warm, and  especially  in the febrile
 state, seemed to  give out  contagion  most  easily.   Orrseus,
 however, at p.  151, represents  the disease  as  being  infec-
 tious only when at its acme :—" Contagium  ab iis solum, qui
 in acme pestis constituti sunt propagari v idetur."  And by the
 account which Sonini has given of  his own case,  (See Essais
 Philosophiques, &c. p.  177, and seq.)  it seems probable that
 wrhen the disease has so  far adv anced,  as that the buboes sup-
 purate, the  body ceases to give out  contagion.

  * If the contagion of plague depends exclusively upon the febrile action which most
frequently accompanies it, those cases of the disease in which there was no fever, (such
as that of a cook at the pest houses of Aboukir,) may be supposed to have been in-
capable of giving the disease to others-. 
393
  But besides all these impediments to  the communication of
disease by persons ill of the plague, (and which will  account
for many of  the  supposed  extraordinary escapes,) there arc
others arising from the influence  of atmospherical heat  and
cold, which, in their extremes, either  render the contagion
dormant, or suspend that susceptibility  or affinity of the hu-
man body,  without which it cannot produce disease in ordina-
ry circumstances.  Pestilential  contagion probably  exists at
all  times  in  Lower  Egypt, Syria, and many of the great
cities of the Levant, ahd it is frequent  on hoard Turkish and,
Greek vessels.  It appears to have been first introduced  into
the Britisli hospitals  at  Aboukir, by  the carpenter of the
Dictator, of 64 guns, who  was sent in a boat to visit a Greek
vessel at sea, and thus caught the  disease.*   This was about
the beginning of May, and the disease  was readily propagat-
ed,  and prevailed with its usual mortality, during the whole
of that and the following month, after  which it was  commu-
nicated with  greater difficulty, and when communicated, the
disease was much milder, though  one  case fell under my ob-
servation,  towards the end of July, which proved fatal.   The
disease was,  however,  this year protracted in Egypt several
weeks beyond the time when it  usually  disappears,  which is
commonly supposed to be about the 24th of June, the Nativity
of St. John  tiie Baptist,  and its cessation at that time, is by
superstitious christians  ascribed to his  benignant interference.
On this occasion the effect of heat in lessening the susceptibi-
lities of individuals, or their aptitudes  for taking the disease.
was most evident in those who had  lately  arrived from cold
climates,  and who  wrere  comparatively most affected by the
summer's heat.  This was my case, and my escape from the
disease is doubtless attributable to my being in that condition,
for  I employed no unusual precaution, nor ever avoided feel-
ing  the pulse of  a patient having the plague, when my doing
so could be of any benefit.
  * I afterwards  discovered the plague on hoard a Greek ship employed by the Bii
fish government in the Bay of Aboukir, and reported the (act to Lord Keith,.
                            50 
391
   There were, however, persons in Egypt who had been long
accustomed to greater degrees of heat,  and who were there-
fore not rendered insusceptible of the disease, and some few of
these caught  it, after it had  become extinct in  the  British
army,  and when  a person  recently  landed from England
would not receive it, though he slept in an infected bed;  and
it was  from this cause, that in  the autumn of the same year,
tiie disease began  at Rosetta nearly  two months before the
usual  time, i. e. on the 13th  of September, when I first dis-
covered it in two natives of the East  Indies, attached to the
Indian army; and  it was propagated with some rapWity for
six or eight weeks, among persons who were either born in, or
had just come from, a'climate much hotter than Egypt, whilst
the British troops directly from England did not receive, and
probably  could not have been made to take the disease.
These facts are in perfect concord with what I have mention-
ed of the influence of heat and cold upon the human body, at
p. 115 and seq.  It has indeed been alleged,  as a reason why
the plague first appeared in, and was afterwards confined to,
Rosetta,  in the autumn of 1801, that it was the only open
port to wiiich vessels from Turkey and Greece resorted,  and
that by some  of these the disease probably had been imported,
because it did not,  as is pretended, occur during the preced-
ing season at  Rosetta, or at least that if any  case of it did
occur there,  it wras concealed.  This  is, however, certainly*
erroneous; for to my knowledge, several persons at Rosetta
had been attacked  by the plague previously  to the arrival of
the Indian army,  and  had,  without any concealment, been
sent to the pest house near the town.
   It is -by this effect of heat,  that the plague seldom appears
in Upper Egypt, and never farther south than the Cataracts,
(as I was  assured hy Mr. Brown, the African traveller,) and
that it ceases  earlier at Cairo than at Rosetta.   Indeed, it was
this effect which  hafl enabled  the Indian army  to escape the
plague until it reached Rosetta. 
395
  The cold in Egypt is never sufficient to stop the progress of
the plague, and it is therefore commonly most prevalent there
some weeks before and after the vernal equinox:  but in Russia
Poland, and even in Great Britain, the winter has commonly
produced an almost complete cessation of it.   This happened
to the great plague at  Moscow in 1771, though the manner
and extent in which the houses are there warmed, and the cold
air excluded,  counteracted the effects of  severe frost, so far,
ihat some cases of the disease occurred during the  whole
winter.  De Mertcns tells us,  however, that after the month
of October, there was a great diminution in the number of at-
tacks,  and of their mortality ; and this is more accurately pro-
ved, from the statement given by Orrseus at p. 48, by which
it appears that the deaths in September were 21,404, in Oc-
tober  17,561, in November  5,235,  in December 805,  and
in January 330.  Samoilowitz also informs us, that though
the hospitals then contained many persons who had been newly
entered for the  service  of the sick, as barbers, nurses, &c.
scarcely any of them had  the disease after  the month of No-
vember, and  never but in its mild forms.   Desgenettes has al-
so observed of the plague in Egypt, at p.  248, that " les vents
du nord, lex extremes du froid & du chaud, la font cesser pres-
que  entierement."
   These facts will enable us, in a great degree, to understand
why, notw ithstanding the contagious nature of the plague, an
exposure to its contagion is frequently harmless; and it is for-
tunate for mankind that divine providence has  made its com-
munication to depend  upon  the  co-operation of so many fa-
vourable  circumstances,  and particularly that  of a  suitable
temperature; that of its application  by actual contact proba-
bly  continued for some  time ; and  that of  certain  aptitudes
and susceptibilities in the human subject; for without such re-
quisites,  or such obstacles to the propagation of this  disease,
the earth might have long since become desolate.
   The contagion of plague, like the poison of rabid animals,
varies considerably in regard to the interval  between its ap- y 
                             396
 plication to the human body, and the  manifest production of
 disease : three, four, or five days,  seem most commonly to
 intervene.   Samoilowitz states the interval between  infection
 and sickness, as extending from two to fifteen days inclusive-
 ly ; but in one or two instances which occurred at Aboukir,  I
 was  inclined to believe that the  disease had been  produced
 within 24, or at most, 36 hours after the contagion  had been
 applied to the body.*
   In regard to the means of obviating the disease, by those
 who cannot avoid touching infected persons,  or garments,  &c.
 I have not much to  propose.  Pugnet says, that in the plague
 at Damietta, he used no other precaution than that of immedi-
 ately washing his hands, after they had been applied to an in-
 fected person, or thing, and taking care that his  own  clothes
 should not touch those of the sick, or any thing likely to im-
 part contagion : in other respects he breathed  the atmosphere
 of the pest houses^freely, both with an empty and a full stom-
 ach.   Desgenettes  says  (p. 90^ that  he lived as well as his
 situation would permit, and used spirituous liquors in small
 quantities at a time ; that on leaving the pest houses, he care-
 fully washed his hands with vinegar and water, or  soap  and
 water, and galloped home to excite a moisture on his skin; that
 he then changed his linen and clothes entirely,  and washed his
 body  all over with luke-warm water and vinegar.   In addi-
 tion to these precautions, it might, perhaps, be well to cover
 the hands with gloves of oiled silk, or oiled fine linen, or with
 a thin coat of bees-wax, softened by oil, during the time in
 which  they are likely to  come  into  contact with-the  in-
 fected matters.   Mr. Baldwin has asserted, that dealers in
 oil generally escaped the  plague; but Orrseus asserts, (p. 59)
 that those whose  occupations were much connected with  ani-

  * Diemeibroocck, p. 52, col. 1, quotes a passage from Franciscus  Valleriola, in
 which that author says that he has frequently seen persons falling down with the plague
 a few hours after having been exposed to the contagion of it:—" cum aliquis integre
 sanus accessu ad peste correptuni (liominem) peste quoque inficitur, atque paucis post
y7ioris concidit, quod fieri  s«pe videmus.'' 
397
mal fats, such as candle and soap makers,  curriers,  &c. were
the most liable to be infected.
  When the  pestilential contagion has been received into the
System, it seems in a peculiar degree to exert its morbid influ-
ence upon the brain and nerves, producing  (the slighter cases
excepted,) shiverings,  tremors of the limbs, and affections  of
the head, such as stupor, vertigo, coma, or delirium, with  sud-
den and excessive prostration of strength, and depression  of
mind ; and it is by this mode of action, that it renders the bo-
dies of those who die of plague, remarkably soft,  flaccid, and
variously discoloured,  with a permanent flexibility  of the
limbs,  as in those who are killed by electricity, or  by any
cause which destroys, or exhausts the excitability or living
power.   The prognosis, therefore, is always unfavourable,  in
proportion as the  symptoms denote a greater degree of  mor-
bid affection in the brain and nervous system.
  It is not my intention to enter upon a particular account of
the various  symptoms  of  plague, for which, indeed, my own
observations have been too limited;  but I cannot avoid notic-
ing  that peculiar  appearance of the eye,  which Dr. Russel
has  called the  muddy didl eye, mixed with  something (not
very intelligible) of lustre; an appearance wiiich has also been
noticed by Orrseus, (p. 109) and others,  as being peculiar  to
this disease.   Dr. Price informed me, that by minute exami-
nations he had satisfied himself, that this appearance of the
eye was occasioned by the different  colours of the fluids  con-
tained  in,  and distending the vessels of its  external  coat,
which fluids were sometimes bloody,  at others  yellowish,
bluish,*or dark coloured,  and caused the vessels to appear as
variously shaded  streaks,  or lines, which  sometimes  were
circular, at other times diverging like radii from a centre, and
in some cases  by running together, they produced irregular
spots,  the ultimate effects  of all  which,  he  thought,  aptly
enough expressed  by the term of a muddy eye.
   Dr.  Price also mentioned a peculiar appearance of the
tongue, which sometimes occurs  in this disease, and which 
                             398
 has been called the streaked, 01 fiery tongue, as produced by
 alternate streaks, or patches of white and red.
   In regard to the proportions of death from  plague, it varies
 greatly in different seasons and temperatures ; but I am afraid
 that when the disease prevails extensively,  and  with its usual
 violence, more than  one-half  of those attacked by  it, have
 commonly died, under the most judicious modes of treatment,
 and with the best accommodations.  De  Mertens  says, (p.
 45) that until the disease was mitigated by frost, at  Moscow,
 in  1771,  scarcely four  patients in a hundred recovered:  but
 this must have beep a  most uncommon degree  of mortality.
 Desgenettes says  that  the French  Egyptian army  lost 700
 men of this  disease,  during their  expedition into  Syria, in
 the year seven ; and  that in the year  right,  about  one-third
 were cured;  and he  expresses great satisfaction in  recollect-
 ing, that of  700  men  under  this disease,  in the citadel of
 Kairo, in the year nine, more than  one-third had escaped.*
   The deaths from this disease generally  occur between the
 2nd and  5th   days;  those who survive the 7th day,  are sup-
 posed to  be  in the way of recovery.  Orrseus describes an
 acute inflammatory form of  plague which produced  apoplexy
 or  suffocation, and terminated  fatally in  24 hours.   (In this
 bleeding might probably have been useful.)  Savaresi, one of
 the French physicians  in Egypt,  says the disease sometimes
 occurred there with a  fever, which he calls  a  synochus, and
 killed the patient in  24 or 36  hours, before  any buboe, car-
 buncle,  or eruption  had manifested itself.   Some cases  oc-
                                                       •
  * Desgenettes Hist. Medicalc, &c. p. 250, says  L'an ix, ou nous avons eu dans la
citadelle du Kaire  jusqu' a 700 pestiferes, nou avons en le douce satisfaction d'en voir
guerir au dessus du tiers, 8c dans quelque  circonstances pies de 1* moitie : les jennet
neghes & les Syrians au service de  la republique ont particu-lierement souffert de
la peste.
  Small as this success may be thought, it is great, compared with the results of the
treatment, when sweating was  practiced in the fullest extent. Hieron.  Mcrcurialis
de Pestil, p. 11,  says,  " Qui versali sunt  in curandis segiis hoc tempore,  (| lague of
1576,) facile cognoverutit, ex centum oegris etiam decern et plures fuisse servalos." 
399
 curred in the British and Indian armies, in which tiie powers
 of life seemed to he suddenly overcome by the disease,  and in
 which death took place within a few hours,  without any ap-
 parent effort or reaction of the system.  I believe, however,
 that when persons  are said to have suddenly dropped down
 dead from an attack  of the plague, that the disease had com-
 monly subsisted some hours at least, though not avowed, or
 perhaps known; and in those cases where persons supposed
 to be convalescent suddenly expire, it is probably from some
 over exertion, too great for the exhausted state of their  excita-
 bility  by  the previous disease.
   Two cases of re-infection, or second attacks of plague,  fell
 under my observation in Egypt;—oue occurred in Mr. Web-
 ster, then an Assistant Surgeon, and the  other in a suldier of
 the 27th regiment, each of whom had a buboe; they were, how-
 ever,  but slightly indisposed, the weather having become hot.
 Dr. Buchan had a second attack, hut with only a small car-
 buncle, as he informed me; Dr.  Price also had a second at-
 tack without either buboe or  carbuncle, but, according to his
 account, with a violent affection of the head and nervous sys-
 tem.   In general, I think, second attacks are milder than the
 first, though Dr. Price informed me of his having seen a lad,
 who under such an attack,  died on the second day.   Pugnet
 says,  p.  140, that  reinfections,  when they  occurred, were
oftencst in persons who  had been mildly treated by the first
 attack ; and that several of these had the disease very violent-
ly the second time, immediately after using the beds or blan-
 kets of persons who had died of it.
   Having, as I believe, already at pages  61 and  387-8 suf-
 ficiently shewn the impropriety of attempting to assimilate
 the plague with yellow fever, it seems expedient that I  should
do the  like in regard to the endeavours which  have been made
to confound the former disease,  at least as it has appeared in
this country, with typhus fever.
   Sir John Pringle,  at p. 319 of his work on the Diseases of
 the Army, says, «I shall  not enter upon the distinction to 
100
 he made between a pestilential fever and the true plague ;*  th«
 ancients are not clear upon this  head,  and those of the  mo-
 derns who contend for  a real  difference,  have  not  been  abte
 so to ascertain it, as to end the dispute-!   I  shall,  therefore,
 only remark, that though the jail and hospital  fever may dif-
 fer in specie from the plagucv yet  it must be accounted  of the.
 same genus, as  it proceeds from a similar cause, and is attend-
 ed with the like symptoms." J I I  Where this distinguished
 writer  could imagine that he had observ ed any likeness in the
 symptoms  of these  diseases,  or  any  ground for  considering
 them as the effect of a similar cause, I  am unable to conceive.
 The late  Dr. George Fordyce, however, believing that Sir
 John Pringle had not done enough, in considering the plague
 and typhus fever as diseases of one genus, has strongly  inti-.
 mated  that the former  disease never existed in this country,
 and that the latter was  always mistaken for  it.  In his  Dis-
 sertation on Simple  Fever, this  author makes the following
 observation respecting the plague,  viz :—
   " This infection has sometimes been brought into Europe,
 as was the case at Marseilles; but  that  disease  called  the
 plague, wiiich ravaged  this country, on considering the histo-

  • The connexion,  real or supposed, between a particular state, or  constitution of
the atmosphere, and the extraordinary prevalence of plague, has induced persons, in
different ages,  to consider fevers  which either preceded, or followed such an event,
s.s partaking of  the nature of the plague ; and hence, fevers  which had  neither the
characteristic symptoms, nor the contagion of plague, have been denominated pesti-
lential fevers. Sydenham, on the ground of this connexion, has  not only  described a
pestilential fever of 1665 and 1666, but also a  variolus fever, (of 1667, 8, &c.) as he
called it,  because in his opinion,  it " depended upon that epidemic constitution of the
air, which (as he says) a?  the same time produced the small pox,-"  though this fever
was not attended with  any eruption, nor with any of the symptoms connected with an
eruption; and though it did not possess that peculiar contagion, which is essential to small
pox.  I n regard to the production of_any disease, specifically contagious by any " constitu-
tion of the air," it ean only have  been imagined ; and,  therefore, those appellations
of pestilential, and variolous, were highly improper and fallacious.
  | A little common sense,  according to my conceptions,  would easily " end the dis-
pute."  A disease is the plague, or it is not the plague.—If it be the plague, it should
receive that name ;—and if not  the plague,  it should not be called  pestilential, by
those who would attach correct and precise meanings to words. 
401
ries of the disease, seems to have been a fever produced by in-
fections of the first class which have been enumerated.   (" In-
fectious matter produced in  the body  of a man afflicted with
fever, or produced by & number of men  living for a certain
time in  a small space." p. 121.)  For the inhabitants of this
country, (he adds) it is undoubtedly of great moment to de-
cide this point, but  it  would make too  great a digression.
The author may perhaps lay the evidence before the public in
an appendix."  Unfortunately,  however, the author is dead,
and  no  publication of this evidence has been made, or is, as I
understand, ever likely to he made ;  I must, therefore, con-
clude, that the judicious editor of the posthumous part of Dr.
Fordyce's work, either  did not find the evidence in question,
or did not think it worthy of publication ; for otherwise, con-
sidering the importance of the subject, we may presume that
it would not have been suppressed.  But another physician,
respectable by his owrn  talents, character,  and  rank in our
profession, as well  as by  those  which  his father possessed
when alive,  has adopted,  and endeavoured to  support this
opinion,  that the  destructive  plague which  formerly  com-
mitted  such ravages at various  times in London,  and for the
last time in  1665,  was no other than our ordinary typhus or
contagious fever;  an opinion for which I am unable to disco-
 ver the smallest foundation.   Those  who believe the physi-
 cians of the 17th century to have been so egregiously mistaken,
 must necessarily suppose they were unacquainted  with the
 true plague, or that this disease  has so much  similitude with
 typhus fever, as to make it difficult to distinguish  one from
 the  other: that  the first of these suppositions is at  variance
 with the truth, must be evident  to all who will  refer to the
 descriptions of the plague,  given by medical writers in those
 times,  and more especially to the instructions  prepared by
 the College of Physicians, and given to the Searchers at the
 beginning of the plague of 1665, in London,  which point out
                         51 
402
 most  clearly  and  distinctly those  symptoms  and appearances
 which characterize the true Egyptian, or Levant plague ;* and
 which, without the grossest inattention, would have rendered
 it impossible even for  the most  ignorant, to have  been  mis-
 taken in regard  to  the disease generally, though they might
 have been liable to err in a particular case,  where, from the
 causes heretofore  mentioned, the appearance of glandular swel-
 lings, exanthemata, &c.  was either obstructed or  retarded.
 And  in  regard to the supposition of a similitude in the  two
 diseases, I am not a little surprised  that it  should  have been
 entertained by any  one who  had ever  read  even  a tolerable
 description of  the two diseases ;  and I  should be  astonished
 if it were countenanced  by one who had actually seen them.
   That the plague, as it formerly  prevailed in London,  was
 not  a typhus  fever, must be  evident from  the  notorious fact
 of its having  always been  most extensive  and fatal in the
 summer 'months,   particularly August  and  September, when

   * The searchers appointed by authority in 1665, were required, by  the College of
 Physicians, " to take notice,  whether there be any swellings, risings, or blotch, under
 the ear, about the neck, on either side,  or under the arm-pits of either side, or the
 groins; and of its hardness, and whether broken, or unbroken ?"
   2ndly, " Whether there  be any blains, which may rise in any part of the body, in
 the form of a blister, much bigger than the small pox, of a straw  colour,  or livid
 colour, which latter is the worser ; either of  them hath a reddish circuit, something
 swollen, about it  which circuit remains  after the blister is broken, encompassing the
 sore ?
   3dly,  " Whether there be  any carbuncle, which is something like the blain, but
 more fiery and corrosive, easily  eating deep  into the  flesh,  and  sometimes having a
 black crust upon it,  but always compassed about with a very fiery red or ttvid flat, and
! hard tumor, about a finger's breadth more or less; this, and the blain, may appear in
 any part of the body >
   4thly, " Wb.Ptb.er there be  any tokens, which are spots arising upon the skin, chief-
 ly about the breast and back, but sometimes, also, in olher parts;  their colour is some-
 thing various,  sometimes more reddish, sometimes inclining a little towards a faint
 blue, and sometimes brownish, mixt with blue; the red ones have often a purple circle
 about them ; the brownish,—a reddish ?
   5thly, " Whether the neck and the limbs are rigid or stiff,  or more flexible and lim-
 ber, than in other dead bodies  ?" 
                             403
 there is a cessation of typhus fever :  and the fact of its having
 been rendered nearly, if not completely, extinct, by the cold of
 winter, when typhus is commonly  most active and prevalent;
 for  though  intertropical heats  exterminate or  exclude  the
 plague, and the summer heat of Egypt suspends its progress,
 the  warmest weather in our country, is  not too warm for the
 greatest ravages of the plague.
   That other  diseases prevailed in London during the summer
 and autumn of 1665, and were confounded with the plague, I
 am  disposed to conclude, because it was then commonly be-
 lieved that this  disease, when raging so extensively  and de-
 structively, had the power of converting all other diseases to
 its own nature; and with this  notion, fevers which had none
 of the  distinguishing marks of the plague obtained that deno-
 mination ;  but  there  are  numerous facts and reasons which
 warrant a belief that these  were marsh, and not typhus
 fevers.   It will not be expedient  that  I should here adduce
 proofs  (now well known) of the frequent and extensive preva-
 lence of intermitting and remitting fevers,  in asd about Lon-
 don, before the sources of miasmata were removed, or rendered
 unproductive, as they have been, in a great degree,  for near
 a century.   Morton affirms, that remittents were very destruc-
 tive from  1658 to 1664; and that sufficient  causes for their
 recurrence existed in  1665, may be presumed from the long
 continued  dry and hot weather which took place in the sum-
, mer of that year, though neither  Sydenham nor Hodges have
 distinctly mentioned it.* The fever accompanying the plague

   * At page 13 of Loimologia, &c. Hodges observes, « the whole summer was re-
 freshed with moderate breezes, sufficient to prevent the air's stagnation and corrup-
 tion," kc and " the heat was likewise too  mild to encourage such corruption and
 fermentation as helps to taint the animal fluids," &c.  It is probable, however,
 that, by  these loose expressions, the author only  meant, that the air did not
 stagnate,  and that  the heat was not so excessive as to  produce the corrup-
 tion,  &c. which  are here  mentioned;   for, at page 20, he thinks it proper
 to advertise his  readers,  " that  this year  was most luxuriant in  most  fruits, 
404
 of that year was very commonly a remittent.   Hodges, whose
 authority  on this  point  is better  than any  other within my
 knowledge,  mentions,  at p. 49  of his Loimologia, that in this
 pestilence  "persons  frequently died without  any  preceding
 symptoms   of horror,  thirst,  or  concomitant  fever;"  and of
 this he gives two instances,  in wiiich the disease undoubtedly
 was the  true plague, adding,  that  although sometimes  "  no
 appearance could  be discerned, even of a lurking fever, yet,
 for  the most part some  fever did shew itself."   (p. 50.)    And,
 at p. 51,  he observes,  that "  the  fever  accompanying this
 present pestilence was  of the worst  kind, both on account of

and especiallly cherries  and  grapes, which  were at  so  low  a price  that  the
common  people surfeited with them;"  which, in regard to grapes at  least
would not have happened in this country without a summer of more than common
heat.  It is, indeed, mentioned as such,  distinctly, by Mr. R. Hooke, in a letter
to the Honourable Robert Boyle, dated July  8th, 1665,  in which, after noticing the
adjournment of the Royal Society by roason of the plague, he says,  "I cannot,
from any information I can learn of it, judge what its cause should be,  but  it seems to
proceed  only  from infection  or contagion, and that  not catched,  but by  some near
 approach to some infected  person or stuff; nor can I at all  imagine it to be in the
 air, though  there is one thing which is very different from  what is usual in other hoi
 summers, and  that is a very great scarcity  of flies and insects." See Boyle's works,
 (1772) vol.  vi. page 501. And in regard  to the stagnation of the atmosphere,  and
 want of rain, Dr. tidward Baynard, (Physician in Bath) in page 252 of Sir John Flay-
 er's  " Ancient iLvyfoXxo-ix revived," (printed in 1702) writers, " I was at Chiswick,
 and  sometimes in London, in  the time of the great plague in the year 1665, and I
 very well remember," " during the time  of the plague, there was such a  general
 calm and serenity of weather, as if wind and rain also had been banished the realm,
 for many weeks together, 1 could not observe the least breath of wind, not enough
 to stir a  weathercock or fane;  if any, it  was southerly."  That there was an unusual
 drought in  that year is farther  manifested,  at page 256 of the History of this Plague,
 by the following observation :  " It pleased God to send  a very plentiful year of corn
 and  fruit, but not of hay  or grass; by which  means  bread was cheap, by reason of
 the  plenty  of corn; flesh was cheap, by reason of the scarcity of grass ; but butter
 and cheese were dear for the same reason ;  and hay,  in the market just beyond White
 Chapel Bars, was sold at 4/ per  load." In several places of the same work, (suppos-
 ed to have been written by Defoe) particularly at pages 145 and 146, the weather,  in
 that summer, is stated to be " very hot " And in the then state of London and its
 vicinity,  this hot and dry weather might well be expected to occasion more than th*
 ordinary proportion of intermitting and remitting, but not of typhus, fevers. 
                           405

its state  and  periods;  sometimes imitating a  quotidian,  at
others a tertian ; sometimes seeming to retreat,  and at others
attacking again,  with redoubled fury.   There was never (he
adds) a  total cessation, hut sometimes  a remission for an hour
or two, although every exacerbation was worse than the for-
mer."  All this  is very similar to an  epidemic  marsh remit-
tent,  and  as  unlike  typhus fever  as  possible.    The   same
author, iu a letter addressed to a person of quality, and sub-
joined to his  Vindicise Medicinae k Medicoriim, printed in
London,  ann. 1666,  after mentioning the  irregularity of the
fits, or paroxysms,  of the fever, in those who were ill of the
plague, adds, that " they  seemed most to resemble a double
tertian;" and that " in many, when the virulency was ex-
pelled and spent, these fits did keep and  observe their types,
and became either pure or bastard tertians."—Or, in  other
words, that after the contagion of  the plague had ceased to
operate in the body, the influence of  marsh miasmata, pre-
viously imbibed,  continued to produce its usual  effects.
   In  regard to the treatment of the disease, I shall offer but
a few observations.   It appears to have been a very early and
general opinion among the physicians of this and other neigh-
bouring countries, that those who were attacked  by the plague,
small pox, and other contagious diseases,  had imbibed a mor-
bid poison, and that it was necessary, above all things, to assist
nature in expelling that poison from the body, and this princi-
pally hy sweating, which Morton called,  i(regiam  viam" or
the king's highway.  In " certain rules, directions, or adver-
tisements,  for this  time  of pestilential  contagion,"  " first
published for the behoofe of the city of  London,"  in  *' the
 visitation of 1603,"  " by Francis  Herring, Doctor in  Phy-
 sick, and Fellow of the College of  Physicians," and re-pub-
 lished, upon the recurrence  of the plague in  1625, copious
 sweatings  were  directed to be excited  by strong sudorifics,
 With warm beds and bed  clothes, " so  soon as any of them 
406
 (" the poorer  sort  of people")  apprehend themselves  to  be
 taken with the plague,"  and these  were to be  repeated  every
 eight hours;  and they  were  to " continue this course for four
 or five  days;" and  whilst sweating, it  was   enjoined  not  to
 " let them rest,  or sleep."*    The same opinions,   or modes of

   "To discover the motive for this strange injunction,  w 3 must recollect that pati-
 ents in the plague  are  often comatose, or  morbidly disposed to  sleep;  and as those
 who were so affected had commonly died, it was conceived that the  poison of the dis-
 ease was enabled to exert its pernicious influence, more powerfully in a sleeping than
 in a waking state ;  and,  therefore, that it was  of the greatest importance to hinder
 sleep,  especially while attempts were  making to dislodge the enemy by sweating, and
 also when nature was supposed to have endeavoured to produce a  similar  effect by
 buboes.  In an old work entitled,  " De la manierc de preserver de la pestilence, et
 d' en  guerir, par  Benoit Textor, Medecin,"  printed at Lyons, in 1551,  the author,
 at p. 130, makes this observation : " C'est un accident de grande importance, et per-
 petuel  ou  inseperable de cette maladie, que  le long et profond dormir, contre lequel,
 pour cette cause, il est necessaire de soigneusment batailler, taut s' en fault qu' on le
 doive  mepriser."  And he  afterwards  explains  himself more  on this subjeet, at page
 150, in these words :  " Quand le bubon and le charbon sortent, le dormir est fort
 dommageable, d' autant qu' il retire au  dedans la malice du venin.  Et neantmoins c'est
 alors que les malades y s jnt plus enclins, et qu' il y ha plus a faire a les empescher de
 cela."   " Or en ce cas quand ces enflures se font, veu  que par un tel  moyen nature se
 efforce  de  poulser ceste matiere aux parties  extericures, alors  pour luy ayder, le veil-
 fer est requis au raalade, s' il le fut onques.  A eel a on taschera par paroles recrea-
 tives,  par jeux,  par bruits, par crys.   On  criera bien hault aux  aureilles du mal-
 ade mesmes,  par voix aigue, on sojinera des  bassins, et  dautres  choses aupres
 deluy,  on cornera,  on frappera oikc  des bostons, on ouvrira et fermera les portes,
 ou  quelque cofire et armoire a lestourdie, on usera de pinsemens rudes,  de ligatures
fortes es extremitez comme es doigts, ce quon  appelle bailler  le moyne, on ployera
 doloureusement ces parties,  on luy tirera  les clieveux, la bar be, et principalement les
poilz des parties honteuses, on luy tirera bien  fort le nez et les aureilles, ou luy ouvrira
 les yeux par force,  ou y jettera du vinaigre, on  les gratignera asprement, on le
frappera, on le  scourra, on I'exposera a la lumiere,  on le tourmentera en  toute
 maniere, on  rovandera  en  la  maison ou procedera  prudemment  par toutes ces
 faconsde faire selon  le personnage.   U'autre  part pource que par le trop veiller les
 esperils vitaux «e dissipent,  dont souvent s'ensuit grande debilitation,  pour eviter ce
 danger, si les malades demeurent trop  longuement sans pouvoir  dormir, ou y pour-
 voyera, kc    Certainly nothing but the most extravagant apprehensions of danger,
 from sleeping in the plague, could have iuduced  a physician  of  good character seri-
 ously  to advise  such violent,   extraordinary, and indecent means to produce watch-
 fulness, knowing as he did how much  it contributed to exhaust the powers of life. 
407
 trcalment were  adopted in  the  " advice  set downe  hy the
 College of Physicians, by his Majesties speciall  command,"
 which was printed  in  1630, along " with certaine statutes"
 concerning the plague in that year.  By this it was directed
 " that there be good fires kept in, and about the visited houses,
 and their neighbours;" and "to make fires rather in pannes,
 to remove about the chambers,  than  in chimneys, the better
 to correct the ayre of the houses."   After which directions
 are given for the repeated administration of the most powerful
 sudorifics, upon the ground of opinions delivered in  the fol-
 lowing  sentence, viz.—" For as  much as  the  cause of the
 plague,  standeth rather in poison,  than in  any putrefaction of
 humours,  as other agues doe, the chief est way is to move sweat-
 ings,  and to defend the heart by some cordial thing.
    On the 13th May, 1665,  the College of Physicians were re-
 quired by " a Committee" of the Privy  Council,  appointed
 by the  king, " for  prevention of the spreading of the infec-
 tion of the plague," to  inspect the  " Rules given by the Phy-
 sicians of former times, and imprinted for  the public benefit,"
 and to make such alterations as  they should " find the (then)
 present times and occasions to require and to cause such their
! directions to be as speedily prepared and printed as possible;"
 and the College in their answer or address to the said Com-
 mittee,  on the 25th  of May, signified  that they had  done as
 was required of  them.  And  among  the directions  then pub-
 lished by the College, after the mention of bleeding,  purging,
 and  vomiting, they say " tliese  three great remedies rarely
 have place in the plague, but are generally dangerous,  and most
 of all purging, by any strong medicines;  and are therefore
 not to be used, but  upon some extraordinary urgent indicant,
 or just occasion, and with the greatest caution,  whicli  only
 an able physician can judge of."  They afterwards deliver it
 as their opinion,  that " the poison is  best expelled  by sweat-
 ing, provoked by posset ale," (i and  London treacle" to the 
                               408

 quantity of 3ij mixed; the Patient to " he put to bed to sweat
 well covered  in a blanket, without  his shirt, for  twenty-four
 hours,  every fifth hour renewing his cordial, but in half the quan-
 tity''  first taken, " between whiles refreshing him with posset
 drink, oatmeal caudle, or thin broths, made jelly wise, or harts-
 horn jelly," and, if necessary, warm  bricks, wetted with vine-
 gar, and  wrapped in flannels, were to he  put to his feet,  and
 care was to be taken that he " sleep not till the sweat be over."
 Blisters were at the  same time to be  applied,  "behind  the
 ears,  about the  wrists, near the armpits,  on the insides of
 thighs, and near the  groin,"   to  " draw forth the  venom."
 The buboes, or swellings of the lymphatic glands, were to he
 " always drawn forth, and'ripened, and broke with all speed."
   I have mentioned these facts to illustrate the motives, as well
 as the  means,  by which persons,  were as I fear, often sweated
 to death in the plague, small pox, miliary fever,  and above
 all, in the  sweating  sickness,*  and  with so little suspicion of

  • I may at some aiture time endeavor to dispel the obscurity  in which the cause and
nature of the sweating sickness seem to be involved, but at present I shall only observe
that the  efforts to produce sweat, and the mischiefs thereby occasioned in this disease,
were probably greater even than in the plague ; and to throw some light upon the ef-
fects of that treatment in the latter disease, I  venture to introduce a paragraph, which
 with others, I have  extracted from a curious  manuscript, part of Sir Hans Sloane's Li-
brary, No 349, now in the British Museum  It is intituled " Aoiftoygxpix,  or an
 Experimental relation of what happened remarkble  in the last Plague in the City of
London," by " William Boghurst, Apothecary," etc.  He was also the author of Lon-
 dinologia, sive Londini Encomium MS. also in the British Museum;  and his epitaph,
at Meereworth, states, that he " was an honest just man, skilful in his profession, and
 in the Greek and Latin  tongues, delighting in the study of antiquity," Sec.
  In chapter 21, at page 121,  when going to  treat of the cure of the plague, Mr. Bog-
hurst says, "Before I  begin this, I  must needs say  something concerning a  doubt
 which hangs in my mind,  which I  have hinted at a little once or twice before,
 viz. x whether  strong sweats often  repeated be  an authentical,  canonical  rule,
which will serve for all sorts of people or cures.  I wish somebody of more skill would
 resolve the doubt: that which makes me doubt and stick concerning this, is that I have
 seen so many this year of strong, lean, raw-boned, nervous, (sinewy) people, of much
 spirit and little humour, that have been very laudably sweated, and scarce one in twenty 
409
the mischief, from a violent excitement and expenditure ©f the '
living power, produced hy stimulating cordials, heated rooms,
excessive  covering, deprivation  of sleep,  kc. that  all  who
escaped death under  such treatment, were supposed to have
been saved by it.
   Opinions equally erroneous were entertained of the nature
and treatment of buboes, and exanthematous eruptions, which,
being considered as critical  eruptions,  though often occurring
at the commencement of the disease, it was thought necessary
to bring them as speedily as possible to a state of suppuration,
by the most stimulant applications, in order, as was imagined,
to extract the morbid poison, and even to employ scarification
or excision for the carbuncles.  Sydenham was indeed so fully
convinced, that buboes and  carbuncles were intended by na-
ture  to produce salutary evacuations, that he considered an
attempt to discharge the morbid poison by artificial sweating,
as an endeavour to force it into other outlets, than those  which.
nature had selected for this purpose.  It seems highly proba-
ble, that the  buboes which accompany the plague, are no more
the effect of  an  effort  of nature to  evacuate morbid matter,
than  those which  occur in the venereal disease, or, after the
introduction of variolous contagion by inoculation; and it has
been proved, in a multitude of instances, that no harm has re-
sulted from the spontaneous resolution  or dispersion of pesti-
lential buboes  without suppuration.  Such instances have been
often seen, and attested,  by the most accurate and respectable
writers on this disease; and though it may be proper to pro-

ofthem liave lived, but dyed all within two or three days ; and the sooner, by how much.
more freely  they sweated, and were worst after sweating ; being much more subject to
lightness of head, staggering, faintness, bleeding at the nose, quinzies in the throat; and
some had the tokens come out presently, which made me desist from much  sweating
such persons, and then I had many patients lusty men, who lived and never sweat at all,
and are living to testify the same; and Iobserved that they that sweated freely of their
own accord seldom lived" The spontaneous sweatings here mentioned were doubtless
the effect of a morbid predisposition to that discharge, connected with debility, which fre-
quently occurs in this disease, though in many patients, who have the plague, there is
an unusual  dryness of skin, and indisposition to perspire. 
                              110

 mote their suppuration by emollient, and moderately stimulant
 cataplasms,  kc. where a natural disposition to that issue is
 evident;  there can,  I think, be no  danger in  favouring their
 dispersion, or resolution, hy the usual  means,  when we  ob-
 serve a spontaneous tendency to such a termination.*  I know
 that the sudden retrocession  of buboes,  previous to suppura-
 tion, and  whilst other symptoms indicating danger, subsist un-
 abated, is often followed hy  death.   But this mortality is not
 in such cases produced by any change in the  buboe itself, or
 by the retention of any matter which  ought to be discharged,
 hut by  such  an extreme diminution of  the living  power, or
 other injurious  effects of tbe disease,  as is  incompatible with
 the continuation of a suppurating process, and  also  with the
 patient's  recovery; and therefore, this retrocession is to be
 considered not as the cause of death, but as an indication,  and
 consequence  of that condition of the patient, from which death
 necessarily resulted;  and on the other  hand, when these glan-
 dular swellings rise,  and suppurate favourably, they indicate
 such a state of the living power, and of the system, as is likely
 to overcome tbe disease, without the  supposed  benefit of an
 evacuation of morbid poison by that suppuration.   The same
 reasoning appears applicable  to  carbuncles, though in their
 gangrenous  state,  and when  not surrounded by concentric
 inflamed rings,  they require hot stimulant applications,  and
 afterwards such as will promote a suppuration, and a separa-
 tion of the carbonaceous crust.f

  * Mr. Boghurst, at p 111 of the before mentioned MS. says, " Though many bu-
boes after they came to be very  big, never come to break at  all, but sink away again,
anil by degrees wear finite away ; yet doth the patient grow well, and continue so, not-
vAthstanding their not bieaking .- yet you must not make iiyour design to repel, divert,
or discuss tliem, but only to suppurate them ; and it you see\hem not more forward, or
digest so last as is convenient, then you may apply a vesicatory, just underneath them,
that so the pernicious icliorous matter may  have vent ; and these blistering plasters had
better success always, than cupping, or burning, or potential cauteries "
  f Boghurst mentions, at p. 146 of his MS. that in the year 1665, some persons used
to make incisions round each carbuncle, and apply vinegar and salt to the fresh wound ;
lf but to what purpose, (says he) I know not unless they delighted to toriucut people ; for 
                            411

  In regard to the treatment of the disease, generally, I have
little to offer; and, until we know more of the ways and means
by which nature endeavours to overcome it, I am afraid we
can do but little for her assistance, otherwise than hy restrain-
ing all violent and  dangerous  symptoms,  all  excessive and
debilitating evacuations, and supporting, when necessary, the
powers of life,  by a moderate use of wine, sether, opium, vola-
tile alkali, and Peruvian bark.  The instances of persons who
have strangely recovered from the plague,  after having wan-
dered alone about the country, particularly in Egypt, exposed
to cold and wet,*  seem to  indicate, that even the most mode-
rate sweating is,  at best, useless:  hut on the other hand, the
unsuccessful trials made by Dr. Price, of the cold hath, afford
no encouragement to repeat such applications to the surface.
In some few cases,  where the disease occurs in the vigorous
and  robust, and  is accompanied  with  highly inflammatory
symptoms, bleeding might, I think, prove beneficially, if em-
ployed within a few hours from the attack; though in general,
very had effects appear to  have resulted from this evacuation.
Mild emetics are  said, in some cases, to have  proved benefi-
cial, given at the  very beginning of the disease.
  Mercurial preparations were tried in Egypt, and probably
thought not to have been previously employed in any other
country for the plague.   Diemerbroeck, however,  mentions,
at p.  268, their having been long before  employed by Am-
brose Pare,  who  bestowed  some commendations  upon them,
(lib. 21, cap. 29,) with what justice, I will not decide.   But
during the plague at Marseilles, 1720,  Diedier states, that he
employed mercurial frictions, and pushed them as  far as pos-
sible,  "ausi loin qu'on les  peut  porter," without producing
any good effect.  See Traite de la Peste, p. 522.

it put them to as much pain as if they had been on the rack." He adds that a French-
man, after cutting round the carbuncles, used to pluck out the eschar with pincers, be-
fore it was " ripe" for a separation.
  * Desgenettes mentions two remarkable cases of this kind, at p. 149, 150, and they
are not the only ones which have been well attested. 
412
   Orrseus also asserts, p. 154, that he had employed mercu-
 rials in various forms and doses,  both  internally and exter-
 nally, and that they did no good.  "JNec minimam utilitatein
 praestarunt."   Pugnet, likewise, as he states, employed the
 same medicine, both internally and externally,  without the
 smallest benefit, even  in the  cases  for which  it seemed most
 suitable, excepting a few instances where buboes were degene-
 rating into cold indolent tumours,1 and appeared to be improv-
 ed  by applying mercurial ointment along the course of the
 lymphatics leading to them.  He adds, that it did not obviate
 infection, as several  persons caught the plague, whilst under
 salivation for venereal  complaints.  Sotira  also declares, that
 he  employed salivation in three persons ill of the plague, and
 that two of them died.   Dr. Price, who probably  tried saliva-
 tion to a greater extent than any other person in Egypt, seems
 to have formed a better opinion of its effects ; and for  the same
 fallacious reasons which have  induced many  persons to con-
 sider it as beneficial in yellow fever,  viz. the recovery of some
 patients, in whom he was able to excite a salivation, and the
 deaths of all those in whom he attempted to excite it, without
 success.  He admitted, however, in a conversation with me,
 that he  had always found it extremely difficult to affect the sa-
 livary glands of persons under the plague, and was never able
 to do it by mercurial inunctions alone:  and when I  observed
 to him that a considerable time  would be necessary to produce
 salivation by the means wiiich he had employed : i. e. unction,
 and calomel internally, and that it seemed probable, that those
 who lived long enough to be salivated in this way, must have
 previously passed over the dangerous part of the disease, and
 have been therefore likely to  recover, if no salivation had ta-
 ken place;—he admitted that my observation was  probably
just,  and that the deaths of those in whom a salivation was
 not produced, had alway$ taken place before the time which was
 commonly required to affect the salivary glands.   I have,
 therefore, no difficulty in believing, that the supposed benefit
from salivation in the plague, depends upon fallacy similar to 
                           413
that respecting yellow  fever, wiiich  I  have stated  between
pages 74 and 80.
  In regard to the frictions with oil, which were  strongly
recommended  by Mr. Baldwin,  I am afraid  that but  little
benefit is to be expected from them in  this disease; like mei-"
cury, they appeared to  be an old and discarded remedy,  re-
produced as a new one.  Benoit Textor, in the publication
lately mentioned, so long ago as 1551, says at p. 33, in re-
gard to sweating for the plague :
   " Celuy qui ha besoing  dc suer doit estre fort  frott£ par
tout le corps,  principalement avec huilc  de camomille, ou avec
camomile & huile ou avec Phcrbe  dite  nepeta, &c."—" Que le
personnage se face bien couvrir & chauffer des quarreaux ou des
briques aux piedz, ou appliquerdessouz les aixelles & es aines,
vessies remplies  d'aue chaude."  Riverius also recommended
frictions over the whole body, with oil warmed, night and morn1
ing, in the plague.  See Prax. Med.  lib. xvii. cap. 1.  These
frictions were, however, tried extensively by the French physi-
cians in Egypt, and with very little, if any, benefit;  though in
a few cases  they seemed to give temporary ease and  relief,
Pugnet, indeed, says they were not  only useless  but caused
anxiety and disturbance to the sick, that of 15 patients to whom
 these frictions were applied under the  French physician Carrie,
 one recovered with difficulty, and all the rest  died; and that
 where  they  seemed to  do good, the disease was always mild.
 See  p. 261.   With so  much reason  to doubt of their utility,
 there is a strong objection to their use; arising from the very
 great danger of  communicating the disease to the unfortunate
 person by whose hands they may be applied, and   thus de-
 stroying many lives, without much probability of saving one.
END OF THE FIFTH AND LAST PART. 
 
APPENDIX.
No. I.
   The following is Dr.  Physic's communication,  which I promised
 at p. 24 to insert in this appendix: viz.—
   " Some Observations on the Black Vomit,  communicated by Dr.
 P. S. Physic, of Philadelphia,  to Dr. Millar."  Extracted from the
 5th volume of the New-York Medical Repository, 1802,—page 129.
   " Having,  in the  years 1798 and 1799 had  frequent opportunities
 of dissecting the bodies of persons who died of the yellow fever in the
 City Hospital, I had thoughts of publishing a  circumstantial detail of
 the several appearances in each case.  On perusing, however, the
 descriptions given by late authors, I find but little  to add to them, ex-
 cept some  observations  respecting the black vomit, which do not ap-
 pear to have been particularly noticed.
   " The common opinion was,  and for any thing  I know to  the con-
 trary is, at  the present time,  that this black matter is poured out by
 the liver. The dark-coloured appearance of  the bile in its accumulated
 state, approaching more to the colour of the  black vomit, than any
 other secreted fluid,  would very readily induce a person to conclude
 that they were the  same, if he did not  compare  and examine them
 carefully; and, likewise, attend  to several other circumstances."
   By such  an examination the following differences have been ob-
>served.—
   " First,—If the darkest-co-oured bile be spread thinly over a white
 surface, such as the skin, it loses the colour it had in its accumulated
 state, and appears of a yellowish-green colour; but, if the black vomit
 be treated  in the same  way,  it retains  its  black, or dark-brown ap-
 pearance.
   " Secondly,—The bile  in the gall bladder  has its common bitter-
 taste, but the black vomit is insipid, or nearly so.  This fact has been.
 ascertained by  several persons; and among others, by the  late Dr.
 S. Cooper.   I have  inquired of a number of patients just after they
 had vomited it, they almost all  declared it to have no taste; and tbe
 organs of taste were proved to be perfect in these people, by  trying
 whether they could  distinguish between different tastes.  It  occasion-
 ally happens, that violent efforts made in vomiting,  will force some
 bile out of the gall bladder into  the stomach, and then the black vomit
 will have a bitter taste like bile.  Dr. Cooper twice found it intensely 
416
 bitter owing to this circumstance, which, how ever, is' a rare occur-
 rence.
   " Thirdly,—The black vomit differs very  much from any  mixture
 that can be made of the dark-coloured bile, with any of the fluids
 found in the stomach, or intestines.   If bile be mixed  with the mucus
 of the  stomach, or, if some of it  be added to the  black  vomit,  it
 mixes with  these uniformly, and imparts a yellowish-green  tinge to
 them.   The nearest resemblance to black vomit that could be made,
 was, by mixing some of the mucus of the stomach, a little blood, and
 some bile, together; but the difference was still very obvious.
   "Fourthly,—The  stomach has been  found full  of black vomit,
 when,  in the same subject, the  fluid in  the gall bladder and biliary-
 ducts,  was very different from it in its colour and appearance.  I have
 found the gall bladder filled with a fluid of a brick-dust colour; in
 some  others it  contained  a fluid  of a  light green  colour;  and, in
 others, a transparent and colourless fluid, resembling the white of an
 egg, only that  it was  of a thinner consistence.  In some  instances,
 again,  a purulent-coloured fluid was  found in them.  Some of the
 same kind of fluid which the gall-bladder contained in these last-men-
 tioned instances, was generally found in the  duodenum; the stomach
 in the same body containing black vomit.
   " Fifthly,—The pylorus, in several instances, has been found closely
 contracted,  and yet, the stomach  contained black matter.
   " The above observations have  appeared to me to overthrow the idea
 of the black vomit being secreted by the liver. The question, however,
 still remains;—from whence is  it  derived?  I believe it to be  a secre-
 tion from the inflamed vessels of  the stomach and intestines;—and for
 the following reasons :—
   " First,—It is found in these viscera, when it cannot be detected in
 any other organ, or cavity connected with them.
   " Secondly,—It is often found of  so thick a consistence, that it doo-,
 not mix with  the fluids of the stomach : in such cases, it adheres to
 its inside, forming a black coat of  considerable thickness; and, when it
 is once scratched off, it cannot  be made to adhere again in the  same
 manner.
   " I have, in one instance,  observed this black substance in two al-
 most circular patches,  each about two uiehes in diameter, adhering to
 the stomach; and all the other parts being free from it.  In this case,
 there was no black matter loose in the cavity of the stomach nor intes-
 tines.   On scraping it off",  the  spots which  had been covered by it,
 were found inflamed,  and  these  spots only.   Now,  it can hardly be
 possible for this black  substance to have got into such a  particular
 situation, had it been  secreted by  the liver; and some of it, in that
 case, would have been observed in the gall bladder, gall ducts,  or
 duodenum.
   " It must not  be conjectured, that the black vomit  irritated the sto-
 mach, and  produced the  inflammation: on  the contrary,—Dr. May
 frequently  repeated an  experiment, which proved it to be very bland.
 He dropped it into his  eyes, and ne,ver experienced any more incon-
 venience from it than if water had been used. When the hands have
"been irritated in  dissecting, which once occurred to myself, I  beilevs it 
417
has arlocn from some acrid substance having  been swallowed by tlip
patient just before death, as elixir vitriol, volatile alkali, &c.
  " Fourthly,—I  have  seen the inside  of the inflamed  stomach as
black as the black vomit,  resembling it in colour exactly.  In most
of these cases, no black matter  was found in the,cavity  of the sto-
mach.   Tbe vessels only which were inflamed were distended with it.
This colouv-differs very much from the dark purple of a part in a state
of gangrene;  and I never observed any  putridity  attending it.  This
blackness has, in some stomachs, been  universal, in some in  spots
only ; the other spots being in a state of high inflammation, giving the
inside of the stomach a chequered appearance.  These spots, in one
instance, were seen resembling each other in shape and figure exactly;
and were, in every respect alike,  except  in colour; the one being red,
the other black.  Here  some of the inflamed vessels only had gone
into the act of forming black matter, but did not excrete it.
   " The secretion of  black vomit appears to be one of the  most
common modes in which violent inflammation of the stomach has a
disposition to  terminate.  Death, however, in genera^ takes  place
before it entirely disappears.  I  hare seen many cases, which shew
that ,the  inflammation  is diminished by the secretion;—of which, it
will  be  sufficient to  mention the following.  On  opening a stomach,
one-half of it  was coated with adhering black matter, while the  other
half was free  from it; on  scraping it off clean,  and comparing the
part underneath with the other  half of the stomach which had not
secreted any black matter, the  difference  in the degree of inflamma'-
tion was very striking, being much  the least in  tire part which had
been covered  with the black substance.
   " In some cases, where the vomiting of black matter had been con-
siderable in quantity, or continued foi several  days, the inflammation
was found very faint indeed; and in  some, the inside of the stomach
appeared as if covered over with a vast number of small glands, like
mucuous folicles  crowded together."
   The author had also promised at p. 40, to give "  the substance  of
another Memoir  concerning the Black  Vomit, written by Dr. Isaac
Cathrall, of Philadelphia; which, however, by reason of  the  room it
would necessarily occupy, the editor of thu latter parts of this volume
has  been forced to omit;  preserving, however, the following extracts,
from an inaugural Dissertation on Malignani  Fever, by Dr. Stubbins
Ffirth, (now, or late, of Philadelphia,) relating to the appearances on
the dissections of a considerable number of persons who had died of
the yellow fever: viz.—
   " The brain was generally found in a  diseased state, the meninges
being considerably inflamed, the  dura mater beinj sometimes aggluti-
nated to the pia mater, in consequence of the increased action  of the
arteries thereof.  Tfee  blood vessels were turgid with blood, appearing
us though  they had been  injected; the substance of the brain was
harder  and firmer than usual; the ventricles frequently contained
water, sometimes to  the amount  of several ounces; in some cases, the
rupture of a small vessel had taken place, and an effusion of blood waa
found between the pia and dura mater. 
418
    " The  stomach was always  found diseased;  great  inflammation
  being observable throughout, and erosions of the villous coat frequent,
  nay,  in a number of cases, whole portions thereof, of the size of a
  dollar, were  detached, and  found floating in the  black  vomit.   The
  blood vessels were, in general, very much distended; and, in one case,
  their smaller extremities filled with a fluid  similar to the black  vomit
  in appearance,  taste,  and smell.  This inflammation was  frequently
  continued to the small intestines;  the  duodenum was the most affect-
  ed, but the jejunium and ilium also suffered a part;  nay, the large in-
  testines by no means escaped free, for I have often found them  consi-
  derably inflamed.
    " The spleen and pancreas were generally  found in a healthy state;
  the kidnies were also generally sound; but the bladder was, in a num-
  ber of cases, inflamed; and in  some so contracted,  that  the  cavity
  would not hold  four ounces.
    " The  liver was generally, I  might say  almost always found in a
 healthy and natural state."—" I  do not find amongst my papers any
 1 evidence of its having been diseased, except in three of the patients
 that I examined, and, in two of them it had been of a chronic nature."
 " The gall bladder was always found in a healthy  state, containing its
 usual quantity of bile, and of a natural colour.  I have preserved spe-
 cimens of black vomit, and  of  bile,  taken from the same patient,
 shewing the difference, which is obvious from first sight.   From eve-
 rycircumstance, I feel myself authorised to, and  I  do positively, as-
 sert, that black vomit is not an altered secretion of the  liver;  is not
 changed bile; and does not come from the liver, whatever others "may
 assert to the contrary."  To prove this, he  says, 1st.—" It is  never
 found in the gall bladder,  the hepatic,  or the cystic ducts, or the duc-
 tus choledochus communis."  2ndly.—The bile  is found natural in
 the gall bladder, when the stomach is distended  with black vomit."
 3rdly.—" I have found the stomach distended with black vomit,  when
 the pylorus valve completely obstructed all  passage from the duode-
 num to the stomach, or vice versa; at the  same time, the liver was
 perfectly free  from  disease, and the bile in the  gall bladder natural in
 colour, taste,  and consistence."   4thly.—"I have  seen arteries of the
 stomach distended with a fluid similar to black vomit, and  not to be
 distinguished from it by any means whatever :  a portion of the villous
 coat of the stomach separated from its  adhesion to  the others, and the
 space  filled with black vomit, poured  forth by the termination of the
 small arteries."   See Dr. Cox's  Medical Museum, vol.  1st. p. 116
 — 118.
   In some few cases of mortality from the yellow fever, the stomach,
 after death, is said to  have been found without marks »f inflamma-
 tion.   But I do not recollect that any of these were described so par-
 ticularly as  they ought to have been,  or with such  explanations as
 could  enable us to ascertain either the  accuracy of the observers, oi*
 the causes of such  deviations, if real, from the condition in which,
 according to my bestJnformation, that viscus has been seen in at least
 49  out of 50, of the bodies of persons dead of yellow fever, which
 have been examined.   In support of this observation, I could adduce
 numerous proofs; but thinking them unnecessary, I shall only sub-
join a few lines from an official statement, published in the  Moniteur 
419
" du 17nivose anxi," (7th of January, 1803,) concerning the death,
See. of the Captain General Leclerc, (brother-in-law of the then First
Consul of France,) at St.  Domingo, who is therein declared to have
been attacked with fever " le 8 Brum aire an xi."—" Et le medecin a
declare ce meme jour, que e'etoit la maladie de Siam, dans toute son.
intensite,"  &c.—"Le  10, le vomissement a ete filus frequent, & est
devenii noir."  During the vomitings, it is stated that the  skin ap-
peared black, with a yellow tinge; and that blood escaped by the eyes.
He died in the night between- the 10th and  1 Ith, " Brumaire."  This
statement is signed " Peyre, Medecin en Chef."  The medical offi-
cers who examined the body after death, declared that they had found
" Vestomach extremement fihlogosr, la tuniqueinterne sfihacelee, e^ en-
duite d'une humeur noirdtre et visqueuse"  (The stomach very much
inflamed; its inner coat sphacelated, and covered with a blackish vis-
cid fluid.)
  We are  informed by Dr. Caldwell that " the  existence  of intro-
suscefitio intestinalis,  was the  only actual  discovery made  by the
knife of the anatomist,  during the epidemic (at Philadelphia) in 1805.
This affection was confined to the small  intestines, and was found  to
exist in several cases of the disease.  I believe,  (says Dr. Caldwell,)
the discovery was  first made in  private practice, by Dr. Stuart, and
afterwards by Dr.  Parish, at the  City Hospital."—"The course of the
intro-susception was always from above,  downwards  the upper por-
tion of the intestines being the receiver, and the  lower portion the re-
ceived."   Dr. Caldwell's  Essay on the Pestilential or Yellow Fever
at Philadelphia,  in 1805, p. 179.
   Probably these intro-susceptions were  produced by violent strain-
ings to vomit.  How frequently  they happen  in cases where the dis-
ease proves mortal, wUl deserve, as far as possible, to be ascertained. 
APPENDIX
NO  II.
»Thr author, at p.  98,  after giving decisive proofs "that if putrefy-
ing  animal  matters are  not completely harmless, they are, at  least,
innocent of  the charge of producing contagious fever,"  has referred
those who might desire farther evidence on  tins point, to his second
appendix, which was intended to contain " rather a redundancy, than
a deficiency of such proofs."  But  as the present volume is already
extended beyond the author's  expectation, and as the facts allotted for
this  appendix appear almost superfluous after those formerly stated,
the editor ventures to omit by much the greater part thereof.
  The following statement  is extracted fjjom a letter written to the
author by Mr. Lawrence, Anatomical  Demonstrator  at St.  Bartholo-
mew's Hospital; whose character, talents, and professional acquire-
ments, have already, at an early part  of his life, greatly and justly
advanced him in the road to eminence.  It was  dated  February 21,
1809.
  " In a constant attendance at the dissecting room of St. Bartholomew's
hospital for more than ten years,  I have never seen any illness produc-
ed by the closest attention to anatomical pursuits, except such as might
be expected to follow from  a  similar confinement and application to
any other employment.   When it is  considered that most of the stu-
dents come from the country,  and that  many spend much time in dis-
section, being employed also in writing, reading,  8cc.  during the rest
of the day;  it will not be a matter of surprise that their health should
occasionally suffer:  but the indisposition has never appeared to derive
any peculiar character from the  exposure of  the subject to putrid  ef-
fluvia.   Of  course, you will except from this observation, the effects
which may arise from the absorption of noxious matter from wounds
received in dissection.   It has not appeared to me, that ill consequen-
ces of that description,  follow more frequently  from the  dissection of
the most putrid,  than from that of recent bodies.   The following par-
ticulars will  afford the most  complete proof, that the exhalations from
decomposing animal substances are not necessarily injurious to the
human body.  John Gilmore, together with  his  wife, and two  sons,
lived for ten years  in a room under the anatomical buildings of St.
Bartholomew's.  The whole family slept,  as well as spent the day, in
this apartment, which received a very small quantity of light,  in con-
sequence of its single window opening against a high wall.  The room
was at the end of a passage, in which several tubs containing bones in
a stat* of maceration were generally placed, and with  which other di-
visions of the cellars communicated, containing large excavations for 
421
receiving the refuse of the anatomical rooms.  The latter were not
separated from the general passage by any door.
  " The  animal matters thrown  into the receptacles just mentioned,
are,  I believe, converted into adipocire, and the fetor is consequently
not so offensive as if they went through the putrefactive process; but
the whole place was constantly filled with a  close cadaverous  smell,
very disagreeable to any  persons who went down from the fresh air.
During  the  whole day, Gilmore was employed about the dissecting
room, in removing the offals, in  cleaning macerated bones;  in short,
in an almost  constant  handling of the most  putrid matters.   He  al-
ways enjoyed good health, was fat, and possessed very great  bodily
strength.  He left his situation in consequence' of an apoplectic  at-
tack, and died lately,  at the age of 69, after two other similar affec-
tions.  His wife survives, enjoying a good state of health.  Neither
of his sons appears to have suffered from any  unvvholesomeness of
their abode.  They are  both hearty and strong, although they have
been employed some years in attending the dissecting room.  But the
whole family left the cellar soon after the father's first attack."
  During the time  that our  very numerous  fleet of transports,by in
the bay of Aboukir, many bodies of sailors  who had either died, or
had been drowned,  were  washed on the shore, where they remained'
unburied, exposed  to the heat of the sun.  In riding to  Rosetta, it
was necessary to keep  along the shore;  and I passed 18 or 20 corpses
in this situation.  They  were in various states of putrefaction; but
the stench from them all was offensive in the highest degree, and often
extended to  more than 100 yards.   My curiosity led me to approach
close to  most of them,  that I might examine the  changes  they had
undergone.   Some were swelled  up to an enormous size, and the skin
seemed  so distended, that it appeared ready to burst.  These were
often of a dark-brown  colour; some had not yet come to that state;
others had passed it;  and the skin having burst in several places, the
air had escaped, and they had become more or less desiccated,  and of
a black colour.  Every person  who had  occasion to pass from the
camp to  Rosetta, was obliged to come  within reach  of the vapours
emitted by these bodies.   There were  orderly dragoons  constantly
passing;  yet, neither myself nor any one else, so far as I could learn,
was attacked with fever, in consequence of our exposure to these va-
pours; and my professional situation would probably have enabled me
to learn if any such consequence  had followed.
  Orrseus Descriptio  Pestis, Sec. p. 47.   After stating that towards
the decline of the plague in Moscow, in February,  1772, the College
of Health received information  " hinc hide in domibus emortuis &  in-
fectis.....cadavera clanculum  inhumata vel aliter occultata repe-
riri;"—and that they ordered all the houses to be searched, offered 20
roubles  to informers,  ? et quae (cadavera) in locis spatiosis  non sat
profunde inhumata fuerunt, eorum  6epulchra terra multa  contegere,
e.aetera vero  nuda  reperta in  camcleria  transfiortare."   He says,
" Hac ratione circiter  mille cadavera in habitationibus, ipsis reperta
fuerunt.   JVofabile  omino fuit neminem ex vesfiillonibus,  vel aliis in
negotio  hoc  periculoso versantibij,* i?ifectutn} nedum morbo  aliquo 
m
corrufitwn fviisc, quamvis tanta ab omni infectione incolumitas vix ac
ne vix quidem sperari posse videbatur."
  The good health commonly  enjoyed by tallow chandlers and  soap
makers,  is now too well known to require any evidence from me in
confirmation of it, notwithstanding the very offensive and putrid exha-
lations to  which they, and  particularly the former, are exposed.
Glue and catgut makers are  exposed to vapours equally corrupt and
disagreeable.  When riding on the Uxbridge road,  near the 4th mile-
stone,  on the 14th of August, 1810, I was assailed by an offensive
smell of putrid animal matters, which I soon discovered to have come
from a set of works near the  road, employed hi the making of glue;
adjoining to which wore several huts belonging to the labourers and
their families, most  of  whom  I  saw,  and they all, both adults and
children, had the appearance, mid, as I vyas informed, the  enjoyment
of good health.   I have heard the same of catgut manufacturers.
  In the Edinburgh  Medical  and  Surgical  Journal of October  1,
1810, may be seen an account, given by Dr. Chisholm, of amanu:
factory (of which I  had some knowledge from  the time  of  its first
establishment,) at Conham, near Bristol, destined  for the conversion
of animal flesh into a substance resembling spermaceti, by  cutting up
dead horses,  asses, dogs, &c. and putting their muscular parts into
boxes  with holes for the admission of water, and afterwards  placing
tliem in pits  filled with  water,  while the  entrails and useless  parts of
many hundreds of carcasses, were left to putrify on the surface of the
ground.  And  it appears from Dr. Chisholm's statement, as well aa
from other information  which was given to me on the subject, that
though the effluvia of these putrefying animal matters were highly
offensive to the  overseer of this  manufactory, and  to the workmen
employed under him, as well  as to others within their reach, no injury
was done by them to the health  of any person, during the two  years
in which these operations were continued.
  In regard to the morbid effects supposed to result from the putre-
faction of fish,  they  appear, so far at least as regards fever, to have
had no existence, but what was derived from the indiscriminating cre-
dulity of such writers as Forestus.  That a large whale was formerly
cast ashore, and suffered to putrefy on the sea coast, near Egmont, in
North Holland, (a place nearly surrounded by marshy or low grounds,)
I am willing  to  believe ; but that the  fever which is said by Forestus
(tome  1, lib. 6)  to have followed that event, was  produced by the
whale, rather than  by  marsh miasms, I cannot believe;  because
whales have not been found capable of producing  such effects in later
times,* and because  fevers from marsh effluvia constantly fall under
our observation.

  * See the account given by Dr. Gordon of a whale which putrefyed very harmlessly  at
the island  of Santa Cruz, published  in the appendix to Dr. Chisholm's Letter to Dr.
Haygarth, p. 251—253. The same appendix contains an account of the putrefaction of
1,000 barrels of salted beef, at the same island, which were finally ordered to  be  thrown
into the sea : and were thus disposed of without having occasioned sickness  to any person
in the house, store, or neighborhood where this putrefaction had taken place and sub-
sisted. 
42$
  About the year 1788, a whale was stranded on the coast of France,
near Havre de Grace, andM. Baussard, in an account of it, published
in Rozier's. Journal de Physique, for-March,  1789, says,  « Pendant
que j' etois occupe a dissequer ce gross animal, une Lueur Phosphor- .
iq'ue exhaloit de l'interieur de son corps, et une odeur tres fetide de la
tete."  " Les  exhalaisons m'ont occasionne  des  inflammations aux
narines, et a la gorge et certains parties huileuses  de la  tete m'ont
mis les mains dans un etat pitoyable."
  No mention is, however, made by M. Baussard,  of any febrile af-
fection occasioned either to himself or any other  person by the putre-
faction of this fish; and that no such affections do, in fact, result from
that cause was farther proved  by the information which I obtained on
the 2d of October, 1807, at the Greenland Dock, where the late pro-
prietor, Mr. Ritchie, (who had just sold his property to Sir Charles
Price and his associates for 35,000/.)  informed me that  for a consider-
able time all the Greenland ships had been used to boil their blubber at
this place* for which purpose five coppers,  with proper coolers, &c.
had been erected.  Mr.  Ritchie had lived more than 50 years in the
neighbourhood of this dock, was well acquainted with'the boiling pro-
cess, and assured me, repeatedly, that though the blubber is often in a
very offensive state, emitting an highly putrid  smell, neither himself,
nor his people, nor the crews of the Greenland ships, who perform the
whole boiling, &c. nor the neighbours, have ever, to his knowledge,
suffered in their healths from that operation;  that his people, and him-
self, have always been healthy, and that he believes no crews are more
healthy  than those of  the Greenland ships.    This  account was
confirmed by the master of a  Greenland ship then in the dock, who
said he had been employed in  the whale fishery for the last 22 years,
excepting one year, and had been used to boil down the blubber for 16
or 18 years of that time.   He said besides,  that the Greenland ships,
on their return home, often smell very offensively to  strangers, though
to  themselves the stench is  imperceptible; that the casks in which
they carry out their water are those in which they have brought home
 the blubber; aud that the water generally is  found extremely offensive
for some hours  after the bung is taken out; in which state,  however,
the men are accustomed to drink it;  and, that notw ithstanding all this,
he does not conceive that any men are more healthy than the creVs of
those ships.   That the stench from  the blubber is universally admit-
ted to be greatest when it is  boiling; and that these  effluvia, so far
from being at all unhealthy, are, on  the  contrary, reckoned so whole-
some that it is very common for sick persons to come to the copper, as
soon" as they  rise from their  bed, and to hold their heads -bver the
steam, as close as they can.
   Mr. Ritchie informed me, that what remained of  the blubber, after
tbe  boiling was  finished, was now very commonly bought  for agricul-
tural purposes;  that it was usually taken away by the  purchasers just
 after the boiling, and was allowed to lie by a certain time, till it was in
 a proper state to be used as manure; when it vv as laid upon the ground
 and found to be very useful. 
424
   The use of fish as manure is no new invention :* herrings, pilchards*.
and mackarel, have been long employed for this purpose in those part9
of  Great Britain where they are caught in the greatest abundance, and
so are the various species of mollusca.  In some parts of Cambridge-
shire,  &c. a small fresh-water  fish called stickle-back,  (gastyrosteus
aculeatus, Lin.) becomes so plentiful, that, leaving their native ditches,
they form vast shoals in the rivers, and being  caught in nets,  or bas-
kets,  are strewed over the ground, in the proportion of twenty bushels
per acre.  No morbid effect, however, so far as I can discover, has
ever been known to result from  the putrefaction of fish, or other animal
matters  employed  in  this way, though fevers ought to have resulted
from it, if producible by the natural decomposition of animal substan-
ces.
  Putrid human excrement  seems equally incapable of producing le-
ver. A nightman, who had been extensively employed for thirty years
in this metropolis, assured me, that though  his  labourers frequently
fell into  asphyxia, or died  off,  as  he called it,  they had always reco-
vered on being brought  into the open air; that no fever had ever en-
sued from such Occidents,  nor, as he believed, from this kind of occu-
pation; that sometimes, from  intemperance,  and  getting cold, they
had feverish indispositions, but not more so than other labourers;  and
that, v\ hen steady and sober, he  thought them  remarkably healthy;
that their eyes were sometimes affected, so as  to produce temporary
blindness, from which, however,  they commonly recovered in a few
days;  and that this, with asphyxia, were  the only  disorders to which
he considered them as particularly liable from the nature of their occu-
pation.
  The receptacles of human  ordure beloiiging to the great hotels in
Paris,  being commonly very  capacious,  and very  seldom  emptied,
those mephitic exhalations which here produce  asphyxia, and are there
called  "filomb," seem to be highly concentrated, in these receptacles,
because they produce death to the nigbtmen not unfrequently,  but, in
other respects,  their effects resemble those which are produced in this
metropolis,  as  may  be seen by a report,  entitled, " Observations sur
les  fosses d'aisances et moyens. de prevenir les inconveniens de leur
vuidange,"  par M. M. Laborie, Cadet de  Vaux, et Parmentier, (who
had been employed by the French government  to  ascertain facts on
this subject) published in  the Journal de Physique, Sec. An. 1778, p.
444.-—See also Ramazzini de morb. artific. cap. xiii.


  *  In the " New English Canaan, containing an abstract of New England," written by
Thomas JVlovton,  " upon ten years knowledge and experiment of the Country," and
printed at Amsterdam Ann. 163V, arc these  passages; viz. (1* 86,) " The Coast aboun-
deih with such multitudes of coilcl, that the inhabitants of New England doe (lunge their
grounds with codd." P. 89-  " There is a fish (by some called shadds, by some allizes)
that at the spring of the year passe up the rivers to spawn in the ponds, and are  taken  in
such multitudes in evmy river that hath a pond at the end, that the inhabitants dunge their
ground with them.  You may see in one towneship a hundred acres together set with
these fish,  every acre taking 1000 of them : and an  acre thus dressed will produce and
yeald so much come as 3 acres without fish."  This practice has been mentioned by sev,
eral other writers. 
APPENDIX
NO. III.
The purpose of this  appendix has been stated, at pages  108 and 109
of this  volume.  It will contain a faithful abstract of Mr. Holwell's
narrative of his own sufferings, and those of his unfortunate  compa-
nions in the black-hole, at Calcutta, and more especially of the facts
connected with the supposed production of fever by the crowding and
suffocation which occurred in that situation *
  Fort William,  at Calcutta, had  been surrendered to the Suba of
Bengal, in the afternoon of the  20th of June; and,  between 7 and 8
o'clock of the  same  evening, Mr. Holwell, who  had then  become
ehief in council,  with the other civil and military officers of the India
company, their servants and soldiers, amounting in all to  146 persons,
were  forcibly driven into a prison, called the black-hole,  which was a
cube of about eighteen feet,  " shut up  by dead walls on the east and
south, (the only quarters from which the wind  could reach them) by a
wall and door to the north, and open only to the west, by two windows
strongly barred, from which they could scarcely receive  any the least
circulation of air."   In this state, these unfortunate persons,  previ-
ously exhausted by fatiguing exertions to defend the fort, and with only
standing room, (i. e. 26£ inches by 12 inches, to each  person, upon the
average) in a very sultry night, soon fell into an excessive  perspiration,
which was followed by  extreme thirst; and this  became  the more in-
supportable, as their bodies were more and more deprived of moisture.
  To gain more room, they stript oft' all their  clothes; and, to relieve
the fatigue of standing upright, they all sat down on their hams, or rose
up at given signals :  but they were so  wedged up  while  sitting down,
that it required considerable efforts to  rise, and several who were too
weak to make such efforts, were either trodden to death or suffocated.
"Urinous  effluvia" soon pervaded the  interior of the prison, which at
last became very powerful, and, to use Mr. Holwell's words, " affected
them as if they were  forcibly held with  their heads over a bowl  full of
strong volatile spirit of hartshorn,  until suffocating." (p.  26.)   In the
mean time, also,  the  atmosphere was gradually more and more vitia-
ted; so that (p. 15,) "before 9 o'clock  every man's thirst grew  intole-
rable, and respiration difficult.  In this distressing situation, the pri-
soners cried loudly for water ; and when water was at length  brought

  ♦ See " A genuine Narrative of the deplorable Deaths of the  English Gentlemen
and others, who were suffocated in the Black Hole, in vort William,  at Calcutta, in
the  kingdom of Bengal, inthe night succeeding the *20fh  June, 1756. Ina Letter to a
f-'rie.id, by J. Z. Holwell, Esq. London, printed for A. Millar, in the Str.md, 1758."
54 
426
 by some of the guards, with such eagerness did they struggle to get it,
 that not only the greatest part of the water handed in hats through the
 bars of the prison was spilt before it reached any one's lips, but many
 were trampled down  and suffocated, while others, particularly those
 who stood near the windows, were pressed to death.  It was soon, how-
 ever, discovered, that draughts of water were of little service towards
 quenching a thirst produced and kept up by  such causes; they now,
therefore, became clamorous for air,  and endeavoured to force the
 door of the prison;  but finding their attempts vain, and, preferring an
 immediate death to the lingering extinction which they apprehended as
their doom, they grew outrageous, and abused (p. 25,) the Suba and
his officers, and their own guards, by the most opprobrious names, " to
provoke  the latter to fire in  upon them; every man that could, rushing
tumultuously towards the window, with eager hopes of  meeting the
first shot. .Then a general prayer to heaven to hasten the  approach of
the flames to the right and left of us, and put a period to our misery."
After such violent exertions, they whose  strength and spirits were
quite exhausted, laid themselves down, and expired quietly upon some
of their companions; others, who had yet some strength left, made a
last effort for the  windows, and several succeeded by leaping  and
scrambling over the backs and heads of those in the first  ranks, and
got hold  of the bars,  from  which there was no removing them after-
wards.  In this manner, which is more easily  conceived than describ-
ed, was the remainder of the night passed;  and when, at  the dawn of
day, an order was brought for their release, dnly 23 persons remained
alive out of 146, and these were so weak that it took more than 20 mi-
nutes to remove the dead piled up against the  door, so as to procure a
passage out for one at a time.  Of all those who survived, Mr. Holwell
probably  suffered the most in the course of that night, and certainly he
had the narrowest  escape* from death; being one of the first who en-
tered  the prison, he had placed himself at  a  window, and continued
there  more than three hours, until his  " legs were  almost broken with
the weight against them," and he was " at last so pressed and wedged
up by those who were clinging to the bars over him,  as to be deprived
of all motion."  Unable to endure this torment, he begged the people
about him, " as the last instance of their regard,"  " to make way that
iie might retire from the window to die  in quiet," and with difficulty he
passed through them to the platform on the opposite side of the  room.
Here his  distresses rapidly augmented, and,  "in less than ten minutes,
he was seized with a pain in the chest, and palpitation of the heart, both
in the most exquisite  degree."  " He retained his senses, however,
and not willing to bear any longer so much pain, without attempting to
obtain the relief which he knew fresh air alone would afford, he pushed
towards a window, and by an effort of double the strength he had ever
before possessed, he  found means to seize one  of the bars, and to
fix himself in the  second  rank of those who were  standing at it.—
The relief now felt was counterbalanced by new  evils; for as others,
in like manner, climbed and strove to get air, he  presently had to
sustain the weight of a heavy man, whose knees were  pressing on
his back, with the  body resting on his head; a Dutch Serjeant  had
also seated himself on his  left shoulder, and a black  soldier on his 
427
right, all which nothing could have enabled him long to support, but
the  props and pressure  equally supporting him all  around."-
In this position did he remain from  half after 11 till about 2 o'clock,
when, being exhausted by the repeated exertions he had made to dis-
lodge these incumbrances,  and finding that he must either quit the
vvmdow, or sink were he was, he resolved on the former, having tru-
ly,  for the sake  of others,  suffered  infinitely  more for life, than the
best of it is worth.  With great labour he forced his  way from the
window, (several,  in the  inner  ranks, appearing to him dead,  while
standing, and only prevented,  by the throng  about them, from fall-
ing) and having gained the  platform a second time, he lay down on it,
and in a short time lost all  sensation.  Here he remained until near
six o'clock in the morning, when the Suba, having been informed  of
the  suffocation of most of the prisoners,  sent to inquire if Mr. Hol-
well had survived: and  being  told that there was an  appearance  of
life  remaining,  and that he might recover if the door were  opened
very soon, an order came instantly for the release of  the prisoners.
In  the mean time, Mr.  Holwell had been brought to the  window,
where he revived in a few minutes, and was shortly after restored to his
senses.  As we have no information respecting the circumstances and
consequences of this transaction, excepting that which  was published
by Mr. Holwell, and as his account of those consequences of neces-
sity relates principally to his own case, (for he was immediately sepa-
rated from all but three of the survivors,)  I have thought it proper to
describe minutely his sufferings, that the reader might  the better un-
derstand and decide, how far Dr. White,  (in the Philosophical Trans-
actions,  vol. lxviii.) and Dr. P.  A. Wilson, (in his treatise on febrile
diseases, vol. i. p. 407)  were justly intitled to adduce this transaction
as an  instance and proof of the generation,  of " a most malignant
and infectious fever,"  (these are Dr.  White's words) by  " the crowd-
ing  together of a number of men in camps,  hospitals, jails," &c.
It is true that Mr. Holwell,  at p. 31 of his narrative, mentions his be-
lief  that very few of his companions  had  retained their  senses during
the  tune in which he  was  senseless, or  if they" did, that they  " lost
them soon after they came  into th«open air, by the fever  they car-
ried out with them:" he also mentions, at p.  34,  that when taken out
of prison he found himself  in " a high putrid fever," and so weak  as
" not to  be able to stand;" and he  informs us, at p.  38, that  in the
ensuing night, he was " covered from head to  foot with large painful
biles^" which he considered as  " the first symptom of his recovery;
for,  until these appeared, his fever did not leave him."  During the
next night, his three companions, also, ".broke out  in biles all over
their bodies ; a  happy circumstance, (he adds) which, as  I  after-
wards learned,  attended every one who came out of the black hole.'"
From these expressions,  it  has been pretended that the atmosphere
of the prison being contaminated by the respiration, and perspiration,
of so many persons,  and  by "the intolerable  stench arising from the
dead bodies,"  (as is mentioned by Mr.  Holwell, at p. 32) had  gene-
rated contagion, and that this had produced in all the  survivors that
formal disease which is properly denominated fever.  But, on a close
examination  of Mr.  Holwell's  statement,  this will not  be found  to 
428
 have happened,  even though suffocution, from  a  want of the vital
 part of the atmosphere, breathed  by these unfortunate persons,  had
 been superadded to the other evils of their situation, and had irreco-
 verably  destroyed  nearly six in seven of  their whole number;  for,
 with vital air enough to obviate suffocation, crowding, with all its con-
 sequences, would not have  caused any of their deaths.   That they
 should have lost their senses by being suddenly brought into a. pure,
 open atmosphere, can surprize no one; such  a transition might well
 produce even greater changes upon men in  their  situation, without
 the aid, or existence, of fever, properly  so called.  And it appears
 evidently,  from Mr.  Holwell's statement, that he,  and probably the
 others, very speedily  recovered their senses : for he being carried im-
 mediately  before the  Suba, (or viceroy) who  had heard or suspected
 that his prisoners had buried  or concealed money and valuable effects,
 in the Fort, and wished, by violent threats,  to  extort a  confession
 thereof from  Mr. Holwell,  the latter manifested  such presence of
 mind, and power of reasoning, as  could not  have  been expected of
 one who had been so recently brought back to  life, even  if no  tem-
 porary suspension of  intellect, or any other disorder than debility, had
 occurred.   We are informed, however, that the Suba, giving no cre-
 dit to Mr. Holwell's  denials, ordered him to  remain confined under
 the care of Mhir Muddon, general of his household  troops,  and he was
 consequently removed  that morning, with his three companions, in a
 common carriage of the country, drawn by oxen, to  the camp, " above
 three miles from the fort:" and  soon after loaded with fetters; and it
 was here that he passed the night,  and was covered with biles, which
 put an end to his supposed fever, in less than 24 hours from its com-
 mencement.  That  Mr. Holwell, who had suffered so greatly, and in
 so many ways, during the  preceding night, should have found him-
 self exhausted, disordered, and  feverish, the  following day, appears
 very natural;  and perhaps  it was not unnatural that  using the  word
fever in a loose, and fiofiular sense, he  should describe  himself as
 having been in one.   But  that his  disorder was not strictly a fever,
 and much less what has been understood by the term  oifiutrid fever,
 will,  I am confident,  be readily admitted by every physician of ordi-
 nary  candour and discernment.  •Indeed, Mr. Holwell may be pre-
 sumed to have had no other  reason for giving the name of "fiutrid"
 to the febrile commotion which took place in him,  than a supposition
 that any disorder occasioned by the heated and  putrid atmosphere of
 the black hole, must necessarily partake of putridity.   But if a putrid
 fever had really occurred,  it is not credible that he could have been
 removed above three miles, exposed to the unclouded sun in that cli-
 mate, and yet relieved  from  this fever in less than  twenty-four hours.
 It appears also (at p.  38) that Mr. Holwell and his companions were
 marched  back to Calcutta the next morning " in their fetters,  under
 the scorching beams of an intensely hot sun," which certainly would
 require exertions too  great for men, of whom one  had been in  a pu-
 trid fever but a few hours before, while the others  were not then re-
 lieved from that with which they were said to have been attacked, and
 which only left them upon the occurrence of biles in the evening, after
 Ws fatiguing march.  And certainly if Mr. Holwell's disorder, and 
429
that, of his companions, had amounted  to fever properly so called,
such fatigue, if, against all credibility, they were capable  of enduring
it, must have been followed by consequences very different from any
which  appear to have been produced.   Two days after  this march,
these gentlemen were embarked in a large open  boat, and sent as
prisoners  up the river, to  Muxadabad, then the capital  of Bengal;
this voyage lasted 13 days,  and, during the whole of it, they were ex-
posed  to one regular succession of heavy rain or intense sunshine,"
with no defence against either; and their only  food during  most of
the time, was rice  and the muddy water of the  river : they were be-
sides "so distressed for room,  that they could not stir without bruis-
ing their own or each others biles;" moreover Mr. Holwell, on a par-
ticular occasion, was forced out of the boat,  and made to walk in the
scorching sun about noon,  more than a  mile and a half  from the ri-
ver ; " his  legs running in a stream of blood, from the irritation of his
irons,  and  himself  ready to drop at. every step  from excessive  faint-
ness, and unspeakable pain."  " By this cruel travel" he became so
exhausted, that his guards were forced to carry him part of the way
back, and  support hhn the rest of it.  All these sufferings, however,
did not produce fever.  Mr. Holwell, indeed,  tells us, (p.  47) that
five or six  days after this, " he  was attacked by a fever on  the night of
his arrival"  at Muxadabad, attended with considerable inflammation
of his leg  and thigh; yet he adds that u. all terminated the next night
by a regular fit of the gout in  his right foot and ankle ;" a  sufficient
indication of the laxity and incorrectness with which Mr.  Holwell has
used the term fever.
  Such are the facts relating  to this singular transaction, and to me
they prove decidedly, not that febrile contagion may be generated, by
crowding many persons into a  small space,  without sufficient ventila-
tion, but the reverse.  For certainly the few who were recovered from
the combined efforts of crowding and suffocation, escaped with  less of
Indisposition than could have been reasonably  expected, considering
the cruel treatment which some, and probably all of them, afterwards
sustained: and it cannot be fairly pretended, that  this   indisposition
amounted, in a single individual, to that disease which is strictly de-
nominated fever; much less to contagious  fever, of which, indeed,
there was not the slightest vestige or appearance.  In none of the in-
•stances where  crowding has been supposed to  have generated febrile
contagion, was it  ever  carried to the  extent  of  suffocating,  I will
not say the greater, but even  a small  part  of  those subjected to it:
and as in this  case, (where, out of 146  persons, 123 were thus  de-
prived of life)  neither contagion, nor even a fever,  without contagion,
was produced among the survivors, notwithstanding the concentrated
exhalations from so many dead bodies, running speedily into putre-
faction, (as their various excretions had done before) we may consi-
der this as a most decisive proof that febrile contagion is not capable
$f  being generated by qauses of this description. 
APPENDIX.
No. IV.
The  subject of this Appendix, viz.—The  Black Assize at Oxford^
anno  1577, and that of the Old Bailey, anno 1750, are mentioned  at
pages 110 and 111.
  Though I have taken considerable pains to throw light upon these
remarkable events,  the  former,  I  fear, must always remain in great
obscurity.  The best account of it which I have been  able to find,  is
that given in  " The History and Antiquities of, the University of  Ox-
ford," by Anthony  A. Wood, M. A. of Merton College, first  pub-
lished in English, from the original MS. in  the  Bodleian Library, by
John  Gutch, A.M. printed at Oxford, &c. 1796.  At p. 188 of the
2nd volume of this work, we are informed by the author, that at this
time,  i. e. the I9th-20th of Queen Elizabeth,—" lived in Oxford a cer-
tain book-binder, named Rowland Jencks,  who, in his familiar dis-
course, would not only rail against the commonwealth, but the religion
now established, and sincerely by the generality  in the  university em-
braced :" that " he made it his chief employment to vilify the govern-
ment  now settled;  profane God's word; speak evilly of the ministers,
8cc."—" In this course  of life, he continuing for some time, taking
glory, as it were, in it, the university to whom the said person belonged,
(because privileged) took cognizance of him and  his  actions;" and
" a convocation  of doctors, regents, and non-regents being held, May
1st, it was ordered that  he should  be seized on, and  sent to London
to be  examined by the Chancellor of the University, and the  Queen's
Council."—Which was  done.  " But after he had been examined  at
London, he was sent to Oxford again  to be committed to prison, and
stand  to  a  trial the next assizes  following," Sec.
  " The assizes, therefore, being  come,  which  began the 4th  of
July,  and continued two days after,  in  the  Court-House at the Cas-
tle  yard;  the said Jencks was arraigned, and condemned, in the
presence of  a great number of  people,  to  lose his  ears. Judg-
ment  being passed, and the prisoner  taken away, there arose  such
an  infectious damp, or  breath among the  people, that  many  there
present,  to the apprehensions of most men, were  there smothered;
and others  so  deeply  infected, that they lived not many hours after."
Here  Mr. Wood introduces an old  ditty  written upon that event,
and printed in black  letter, in which death is made to boast of his
feats  on  that occasion.  " The  persons (continues Mr. Wood,) that
then died,  and were  infected by the said damp, when sentence was
passed,  were  Sir Robert Bell, Chief Baron of the Exchequer; Sir 
431
Nicholas  Barham, Sergeant at  Law;  both stiff enemies to the  Ro-
man  Catholic  religion/;—Sir Robert  Doiley,  High-Sheriff;  Hart,
his Under-Sheriff;  Sir William Babington,  Knight;  with five Jus-
tices of the Peace;" and a  considerable  number of  gentlemen who
are named,  " besides most  of the  jury, with  many others that died
in a  day or two  after.   Above  600  sickened in  one  night,  as  a
physician*  that  now lived at Oxford attesteth; and the day after, the
infectious air being  carried into the next village, t sickened there an
hundred more.
   " The  15th,  16th, and 17th days of July sickened also J  above-300
persons,  and within 12 days space  died an hundred scholars,  besides
many citizens.   The number of persons that died in five weeks space,
namely, from the 6th of July to  the  12th of August (for no longer did
this violent  infection continue,)  were 300 in Oxford, and 200 and odd
in  other places, .so that tbe whole number that  died at that time
were 510 persons,  of whom many bled till  they expired.   The time,
without doubt, was  very calamitous and full of sorrow; some leaving
their beds, occasioned by the rage of their disease and pain, would beat
their keepers or Burses,  and drive them from their  presence; others,
like madmen, would run about  the streets; markets,  lanes, and other
places;  some  again  would leap  headlong  into deep waters."—
" The physicians fled,—not to  avoid  trouble which  came more  and
more upon them, but  to save themselves and theirs.fl  The  doctors
and heads of houses, all, almost to a man, fled, and not any college or
hall was  there, but had  some taken away by this infection."   Those
who thus died, he  says, " were troubled with a most vehement pain
of the head and stomach, vexed with  the phrenzy, deprived  of their
understanding,  memory, sight,  hearing, &c."—" At the time of their
 deaths, they would be very strong and vigorous, but if they  escaped
it they were to the contrary."§—" That which is most admired is, that

   • Dr. George Ethryg  is the physician here alluded to.  He practiced  at that time in
 Oxford, and in the second book of his « Hvpomnemata  qusedam in  aliquot Libros  aiili
 JEginata;," &c. printed in London anno 1580, he states, that on the night m which the
 disease first made its appearance, about 600 were attacked by it, and m the  next nigbt
 100 more in the neighbouring villages.
   + The carrying of the air to the neighbouring villages, seems to be a mistake. Those
 who sickened in  them, had all been exposed to the cause of the  dr™,  *'"^ver it
 was, in the Court House, or in the CasHe, as is stated in the renter ot Merton College,
 of which  an extract was published in the Philosophical 1 ransact.ons vol  50. P-6^-
 70 >,  and in  which, at  p. 701, are these worfs:-" Nam tffi _^im cthscet a&fadec.  m-
 bent segroti qui en castro et guilda, quam  apellantauta uuinto et sexto hujus mens.*
 adsunt "
   * This is also stated in the register of Merton College.
   It This seems to have been  an unnecessary, a-, well as culpable  desertion  of duty by
 the physicians; the disease having never manifested any c^^\V\0^!.^u'
 ver apprehensions might have been entertained on that subject at first:  Bes.des  tht
 filet averted in the Register of Merton College,  that tho,o only s.ckened who were
 present, &c. on the 5lh and  6th of July,  and that no medic;,!  attendants, nor^ vib.tor.
 were  Stacked, Mr. John Stow, in his Chronicle  of  England, (L,.,„1or,  1631) after
 ravine that "there died in Oxford 300 persons,  and in other  places 200 and odd,
 from the  6th of Julv to tbe l«th of August,"  adds, "after which  died not any of thai
 sickness, for one of them infected not another."
    §Thi»  account of U> disease is in  exact conformity with the Uegistrr  of. "* I erf on
 College. 
432
no women were taken away by it, or poor people,  or such that admin?
isteredphysic, or any that came to visit.*  But as the physicians were
ignorant of the causes, so also of the cures of the disease."   He adds,
" many  supposed that the cause of this infection  proceeded  from the
nasty and pestilential  smell of the prisoners when they came out of the
jail, of whom, two  or three being overcome with  it, died a  few days
before the assize began,  as a  notet  written in these times testifieth.
If so be, that was the cause, (he adds) why  then were none destroyed
at the frst appearance of the said prisoners,  which was the 5th of
July, when, as 'tis  generally said,J  none died till  after sentence was
passed, which was the day following ?  Certainly, we cannot to the
contrary but think, that the said smell or stench, was more violent the
first time when the  prisoners appeared,  than when  they had received
air several times before."  Here, however, he introduces the observa-
ti5n of Bacon, Lord Verulam, mentioned at p. 109 of this volume.
He afterwards informs us, that " some thought this Oxford  mortality
was the same that Leonard Fuschius calls  Sudor Anglieus, (sweating
sickness,)  which began first in England, anno 1485, 1st Henry VII."
Sec: but this  Mr.  Wood thinks  "not  likely,  because the  nature of
that disease was almost  quite different from  the other.*'  He adds,
" Some  again have thought,  and do think, that  it was devised by the
Roman catholics,  who used the art magic in the design; and that al-
so, as a certain note|| witnesseth, it sprung " ex artificionis Diaboli-
" cis, et plane papisticis flatibus e Lovaniensi barathro  excitatis, et ad
"nos scelestissime, et clam  emissis."   This notion, however, he re-
jects, as  well  as that of Sanderus, who  (de  Schismate  Angl. lib. iii.)
calls it  " ingens miraculum,"  and a just  judgment on the cruelty of
the judge, for sentencing the book-binder to lose his ears.§
  The most important, and at the same time the most obscure part of
this account, is that  which relates to the circumstances and means con-
nected with the production of this disease.  Stow, after mentioning the
arraignment and condemnation of Jencks, " for his  seditious  tongue,"
says, " At which time there arose amidst the people  such a damp, that
almost all  were smothered; very few escaped that  were not taken at
that instant;—the  jurors died presently," &c.   Annals of England—
imprinted at London, by Ralfe Newberry, 1601.

  * This is also stated  in  the  Register of Merton  College; and Stow also asserts,
(Loc. Citat.) that no woman or child died of the  disease ;  in  which he is supported
by Sir Kichard Baker,  in  his chronicle of the Kings of England, p.  353, and by Cam-
den, in his Annal Reginse, Elizabeth, 1577,  (Ed. Th. Hearnii, 1717,) p. 316,—vol.2.
  f This is mentioned by the author from the entry in the Register of Merton College,
to which he belonged; and this  register, with  which he was  well  acquainted, appears
to have been his only authority for stating, that two or three of the prisoners had died
before tiie assize began, as I cannot find any thing of that sort mentioned by any other
writer.
  t This is stated by Camden,  and I believe,  by  Hollingshed,  to whom I  cannot now
conveniently refer.
  1 The author here alludes to the Register of Merton College, and proceeds to copy
fi-om it the  words placed between inverted commas.
  § Mr. Wood informs us, that after " Rowland Jencks had  suffered the  sentence
passed upon  him, he went to Donay, (in Flanders) and there  became  baker to the
English College of Seculars, and livedt o be a very old man." 
43$
   Camden, (Loc. Chati) after mentioning the bringing up of Jenckss
for judgment, adds, " venenoso et pestilenti halitu, sive fadore incar-
ctratorum,  sive ex solo ita correpti sunt, plerique .omnes qui  ade^
rant ut," &c.   And sir Richard Baker, at the page lately quoted, after
mentioning the same  proceedings against Jencks, adds, " Suddenly
they were surprised with a  pestileniial savour, whether rising from the
noisome smell of the prisoners,  or from  the  damp ground,* is uncer-
tain ; but all that were then present, almost  every one,  within forty
hours died, except women  and children."
   The most probable  meaning of all these accounts would seem to bej
that about the time when sentence was passed on the prisoners, a nox-
ious vapour, in some degree perceptible by  the  senses,  and proceed-
ing either from the prisoners^ or the earth, had been suddenly diffused.
through the hall, and that in consequence thereof, a great part of those
who  were present had been almost  immediately attacked,  and that
many died within a few hours.
   There is, however, no cause of disease with which I am acquainted|
whose effects would  have been such as are here described.   Pestilen-
tial contagion cannot be suspected,  because  that would  have required
contact, and because the symptoms of the disease were not like  those
of the plague, nor was it contagious.  And there is as little reason to
suspect the contagion of typhus or jail fever, (especially at that season
of the year,) there being no instance recorded,  or known, of its pro-
ducing disease so suddenly, nor of that disease when  produced, ter-
minating so speedily  in death.   Nor were the symptoms such as oc-
cur in jail fevers :f  nor does the  contagion of that fever spare women,

   * This expression, and that of Camden, seem to point at marsh effluvia,  which, at
that season of the year,  would  be more  likely to  occasion disease, than typhus con-
tagion, and in a shorter space  of time, and chiefly upon vigorous men ; probably, also,
the situation of the place was suitable  for their production.  The old Shire  Hall, iu
which  sentence was passed on Rowland Jencks, was placed  in the yard of Oxford Cas-
tle, (once deemed impregnable,)  which stood on  the west side of the town, at  a small
distance from the river Ids, whose banks, especially at that time, were low.  The pri-
son was also within the castle, at about 200 yards distance from the hall, and- consisted of
a multangular tower, called St.  George's,  (on the west side  of the castle,) together
with an adjoining church, which also  bore the  name ot St George, and two square
pooms, all connected one with the other, and made the common gaol for the  county,
by a statute in the reign of Henry the 3d.   See Grose's Antiquities of England, vol iv.
p. 182-3: also, King's Vestiges of Oxford Castle, p. 28.  In  the appendix to Thoma9
Hearne"s Preface to Gulielmi Neubrigensis Historia, 8cc.  p 88, is a print representing
 the catsle of Oxford, and on the other side of the  river is a mount, at the foot of which,
 are the ruins of an  old building,  which are thus described in a note to the plate : viz—
 " Reliquise domtxs in qufi. assizoe olium  tene  bantor,  donee ob pestem subitaneam, ad
alium civitatis locum regnante t'Aizabetha transferre placuit."  But though I think marsh
 miasmata a more probable cause of the disease in  question than typhus contagion, I  am
 far from believing that they would have produced effects such as are said  to have occur-
 red at this black assize.
   f In  addition to, and confirmation of the account of the symptoms of this disease, as
 stated  by Mr Wood, from the Register of Merton  College, 1 will here subjoin that
 wiiich  was  given to  Mr. Bernard Gilpin, who after founding a grammar  school at
 Houghton le Spring, in  Durham, educated several young men there,  and afterwards
 ■maintained them at the  University of Oxford, which brought him into a correspondence
 with their college tutors,  one of whom  wrote  a letter in  Latin, giving an account of
 jhe disease in question of which an extract translated,  has brcn preserved in  "The Life
 of Bernard Gilpin, by  William Gilpin, M.  A." 2nd edition, Ixmdon,  1763, p. 120.
 The  translated account of this disease is in these words, viz.—" Those who are seized
 with it are in  the utmost torment; their bowels  are burnt  up ; they call earnestly for 
334
 children, and poor people, as the cause of this disease is stated to have
 done,  (but on the contrary:)—nor do  the stoutest and  most robust
 soonest perish by it, as the Register of Merton College declares to
 have happened in this disease.  (" Et ut quisque fortissimus, ita citis-
 sime moritur.")
   Whether the facts connected with the production and nature of this
 disease have been misrepresented, or,  whether it proceeded from a
 cause which has ceased to operate in later times, I leave  for the deci-
 sion of others.
 \  The sickness  which I have mentioned  at  p.  1 LO, as  occurring at
 Exeter, almost nine years after, viz. in 1586, appears to have been the
 true jail distemper,  according to the account given of it by Hollings-
 head, vol. ii. p. 1547, where he says,  "At the assizes kept at the citie
 of Exeter, the 14th  daie of March, in the eight and twentieth year of
 her  majestie's reigne, before Sir Edmund Anderson, Knight, Lord
 Chief  Justice of the  Common Pleas, and  Serjeant Floredaie, one of
the Barons of the Exchequer, Justices  of  the Assize in the county of
 Devon and Exon, there happened a very sudden and strange sickness,
first among the prisoners in the jail  of the castle of Exon,  and then
 dispersed (ppon their triall) amongst sundrie other persons."—" This
sickness was very sharp for the  time,  and few  escaped which at the
first were infected therewith.  It  was contagious and  infectious,  but
not so  violent as  commonlie the pestilence is; neither doth there ap-
peare anie outwarde  bleer or sore."—" The origin and  cause  thereof,
diverse men are of diverse judgments.  Some did impute it, and were
of the mind that it proceeded from the contagion of a gaole, which,
by reason of the close aire and filthie stinke, the prisoners newly come
 out of a fresh aire into the  same, are,  in a short time,  for the most
 part, infected therewith; and this is commonlie called gaole sickness,
 and  many  die thereof."  He then proceeds to relate the case of thirty-
 eight Portuguese seamen,  who had  been some time before taken at
 sea, coming with fish from  Newfoundland,  and " cast into the deep pit
and stinking dungeon" of the " gaole of the castle of Exon;" and " had
no change of apparell," but being left to lie " upon the ground, with-
out succour or reliefe, were soon  infected;"  (probably by the conta-
 gion previously existing in this dungeon,) " and all, for the most part,
 were sicke, and some of them died, and some of them was (were) dis-
 tracted ; and this sickness verie soon after dispersed itselfe among all
the residue of the prisoners in the  gaole,  of which disease many of
 them died,  but all brought  to great extremities, and verie hardlie es-

drink ; they cannot liear the touch of clothes; they intreat the standers by to throw cold
 water upon them; sometimes they are quite mad  ; rise upon their keepers; run naked
Oiit of houses ; and often endeavour to put an end to their lives  The physicians are
confounded, declaring they have%net with nothing similar, either in their reading or prac-
tice.  Yet  many of them  give this distemper a name, though they have done nothing to
shew that they  are at all  acquainted with its nature.  The greater part of them lam
told, have  now left the town, either out of fear for themselves, or, conscious that they
can do no  good  This dreadful distemper is  now generally attributed to  some jail
infection, brought into court at the assizes : for it is remarkable, that the first infected
■were those only who had been there.  Few women or old men have died. God be
thanked, the rage of this pestilence  is now much  abated,  It is still among us, in some
degree,  but its eftects appear every day weaker." 
435
caped.  These men, when they were brought before the foresaid jus-
tices for their triall, manic of them were so weake and sicke, that they
were not able to go nor stand, but were carried from the gaole to the
place of judgment, some upon hand-barrows, and some between men
leading them, 8cc.  He adds, that these miserable men were brought
in at  "one  end  of the hall,  near  to the judge's seat," where their
wretched  condition excited  general  commiseration, and  particularly
that of the chief justice,  " who, upon this occasion, tooke a better or-
der for keeping all prisoners thenceforth in the gaole," &c.  He adds,
"And howsoever  the  matter fell out, and  by what occasion it hap-
pened, an infection followed upon manie, and a great number of such
as were there in the court,  and especially such  as  were nearest  to
them,  were soonest  infected.  And albeit the infection was not then
perceived, because everie- man  departed,  as he thouglit, in as good
health as he came thither; yet, the same by little and little, so crept
into such upon whom the infection was seizoned, that after a few daies,
and at their homecoming to their own houses, they felt the violence of
this pestilent sickness, wherein more died that were infected, than es-
caped."   He then gives the  names of some of the principal persons
who were thus cut off; among whom were  Serjeant Floridaie, one of
the judges; three knights;  and several esquires and justices of the
peace; and many constables, reeves, tythingmen, See.  In  this case,
the disease  appears  to have been propagated by those who  were first
attacked, so that "it was dispersed  throughout all the whole  shire."
And, on this subject the author makes an important, and I believe just
observation, concerning the time which the infection remained dormant
in the system : viz.—" It resteth for the most part, fourteene daies
and upwards, by  a secret infection, before  it breake out into his force
and violence."  All this is  very unlike the disease from which the
black assize at Oxford obtained that appellation.
   I am next,  according to the promise made at p. Ill pf this volume,
 to enter upon an examination of the facts relating to the supposed pro-
 pagation  of typhus or jail fever,  at the Spring sessions of 1750, in
 the Old Bailey,  by contagion from Newgate.
   I have already mentioned  that Sir John  Pringle's  Observations  on
 " Hospital and Jayl  Fevers," were published (probably written also,)
 immediately after, and to take advantage  of the sickness which then
occurred.  In his dedication of that publication to Dr. Mead, he says,
 " Whilst I was revising  the  notes I had made on the Diseases most
 incident to an Army, the jayl distemper having broke out in  such a
manner,  as to alarm  the town, I  thought I could not*comply more
 seasonably  with your  desire of  having them published, than by com-
 municating at present, that  part of my observations  which  related to
 this disease."  He  says afterwards, that he the  more willingly em-
 braces this occasion of writing, "as at this  time every body is inclined
 to  listen  to the  subject" &c; adding,  "lam certain, that however
 rarely our jayls produce such visible noxious effects, they are often
 one of the more insidious sources of slow and malignant fevers, which
 generally prevail  in large and crowded cities.   Thus, in the late case
 of infection:—from the quantity of the contagious  matter,  the close-
 ness of the air, and crowds of people to render its  corruption more 
                                  436

 quick,  a distemper arose so suddenly,  and was so  violent, genera!,
 and fatal, that every body now refers  it to its true cause ;  whereas,  if
 the number of malefactors had  been fewer,  the multitude less, and
 the air freer,  so few would have been seized, and that with fevers of a
 slow and less alarming kind,  that  the cause might have been intirely
 overlooked."
   By thus  confidently  representing  the  Old  Bailey sickness  as the
 product of jail infection, Sir John Pringle enviously secured a  very
 general attention to his publication, and gave it unusual importance at
 that time.   But I think too highly of his  probity, to magine that he
 would, from such considerations, intentionally mislead the public ; and,
 therefore, I am the more surprised, that he should have thus assum-
 ed to  know, and decide upon, " the true cause" of this disease, and
 upon  " the  quantity of contagious matter" supposed to  produce it,
 without having seen any  one of the persons who  had been  attacked by
.the  disease; and without having,  in the  smallest degree,  ascertained
 the existence even of a single atom of contagious matter, at that time,
 in Newgate.
   But, though Sir John Pringle, in this his first  publication,  confined
 himself to general, and gratuitous  assumptions, respecting this trans-
 action, he afterwards, in  his work on  the  Diseases of the Army,  first
 published in 1752,  gave a statement of what he considered  as the prin-
 cipal facts relating to it; and, as this statement seems to be  the founda-
 tion of almost all that has been since written, and  believed by others on
 this subject, I shall here subjoin it, from the  seventh edition of that
 work, which  contains, I  believe, his latest additions  and  alterations;
 introducing, in the form of notes, such corrections and explanations as
 seem necessary.  The statement is at p. 330, and seq. in these words,,
 viz.—" In the year 1750, on the 11th of May,* the sessions began at
 the Old Bailey,  and  continued for some  days; in which time, there
were more  criminals tried, and a greater multitude present in the
 court,  than usual.   The  hall in the  O'W. "Bailey, was a room of only
 about 30 feet square.f   Now, whether the air  was most tainted from
 the bar, by some of the prisoners, then ill of the jail distemper, or, by

  * The sessions began, as is proved by all the diurnal,  and monthly publications of that
time, on the 25th of April, old style, and ended on the 30th.  Sir John Pringle intended
 here to designate the time according to.the  new style,  which was afterwards established
 bylaw, as is evident, by his having annexed the letters N. S. to the  11th of May, in
his account given m the first edition of .his volume on the  Diseases of the Army.  Bi.«
even  this left him in an  error of five days.  The  Universal Magazine for April, 1750,
contains the following passage :—"Wednesday, the 25th, the sessions began at the Old
Bailey; when 23 prisoners were tried ;" &c. audit added, that on "Thursday," the
26th, ten persons were  tried ; and among them ' Captain  Edward Clark, for shooting
Captain Thomas Innes, in a duel, in Hyde Park," March the 12th. These gentlemen
 were captains  in the royal  navy, and Captain Clark's trial exciting great curiositv,
produced a very crowded court, and lasted  a grt..t  part of the day ;  so that only nme
other prisoners  were tried.  And it was on this day, the 26th, as will be seen presently,
that the cause  of the disease, whatever it may have been, was applied to the persons
who afterwards sickened, and who appear to have been all then present,  and only then.
There was, indeed, so far as I can discover, no trial during the sessions of that month,
which excited any great curiosity,  or occasioned any crowd; nor will Sir John Pringle's
reasonings or description^ apply to any other day.
  + According to the  measurement  of Mr. Dance, Clerk of the Works to the. city
of London, this hall was 40 feet in length,  and 31 feet in breadth. 
437
the general uncleanliness of such persons, is uncertain ;*  but it is pro-
bable that both causes concurred.   And, we may easily conceive, how
much the air might have been vitiated by the foul steams of the Bail-
dock,  and of the two  rooms opening  into the court, in which the pri-
soners were the whole  day crowded together, till they were brought
out to be tried.f   It appeared,  afterwards, that those places had not
been cleaned for some years.  The poisonous quality of the air was ag-
gravated by the heat and closeness of the court, and by the perspirable
matter of a number of people, of all sorts, penned up  for the most
part of the day, without  breathing the free air, or receiving any refresh-
ment.!  The bench consisted of six persons,  whereof four died, to-
gether with two or three of the counsel,  one of the under-sheriffs,
several of  the Middlesex Jury, and others present, to the amount  of
above forty; without making allowance for those of a lower rank, whose
death  may not have been heard of;  and without including any that did
not sicken within a fortnight after the sessions.
  " It was said,\\ that  this fever, in the beginning, had an inflamma-
tory appearance, but that  after large evacuations the pulse sunk, and
was not to be raised by blisters,  nor cordials; and the patients soon be-
came delirious.   Some  had petechia, and all that were seized with the
fever died, excepting two or three at most.   Some escaped without a
fever, by a looseness coming  on, and which was  easily cured.   How


  * This question, of all others, ought not to have been left, and much less represented,
as being in  a state of uncertainty ; since all  our reasonings and conclusions will almost
exclusively depend upon it.   Sir John Pringle  certainly had no good reason to  suppose
that any person  in Newgate was  " then ill of the  jail distemper,  and much less any oj
the prisoners at the  bar; and his language is therefore fallacious.  In regard to  "the
general uncleanliness of such persons," I shall indeed wonder if any one,  after reading
this volume, can  believe it to have  been  capable of producing the disease under con-
sideration,                                          i
  fin a note to this passage, Sir John Pringle mentions his having heard, that about
100 prisoners were tried at  these sessions, and he supposes that they " were all kept"
in "the bail-dock, and the two rooms  opening into the court,"—"as  long as the court
sat,"—which is, I believe, an error : for though  care is taken, that a sufficient  num-
ber of prisoners shall'always be  in readiness for trial,  the whole jiumber is not, accor-
ding to my information, brought up at  once,  when it is known that they cannot all  be
tried in one day.  Sir John  Pringle seems also to  have formed erroneous  ideas of the
situation of the' bail-dock, &c.  It will be  seen by the plan of the Sessions House,  or
Justice Hall,  in the Old Bailey, between pages 438 and 439, that the  bail-dock  is pla-
ced without, and in front of the  house, and is a kind of vaulted cell or dungeon, below
the surface of the court yard, where  the prisoners are kept,  until called successively
iuto court, a few minutes  before their respective trials are expected  to commence.
And while in the bail-dock,  they must  be too far removed, and too much  separated
from the hall, to infect the court, even if they were all labouring under jail fever.   In
regard to the  " two rooms opening into the court," and which he supposes to have been
crowded with prisoners, they must have been merely partitions within the bail-dock,
to separate the men  from the  women.
  $ The heat and closeness of the court, with the quantity of perspirable  matter from
those who were  " penned up in" it, for a few hours, will  bear  no sort of comparison
with the sjtate of  the Black  Hole at Calcutta, where we have seen  that nothing  like
contagion, or a regular, and much less a mortal fever was produced.
  || This, and other expressions, demonstrate that Sir John Pringle did  not attend a
single person labouring under this fever;—for, if he had done so, it would not have
been necessary for him to recur to hearsay; and he would certainly have given us a
distinct account of the symptoms, especially as all those who  did attend in this sickness,
had strangely neglected this duty; so that we have nothing but loose hearsays on a point
of gre at interest and importance. 
                                   438


 far this sickness spread among the nurses, and other attendants on the
 sick, is not known."*
   Sir John Pringle  has mentioned in a note, that the persons  on  the
 bench of the judges were, " The lord mayor, three of the judges, one
 of the aldermen, and the recorder.   Of these (he adds) died Sir  Sa-
 muel  Pennant, Lord  Mayor; Sir Thomas Abney, and Baron Clark,
 Judges; and Sir Daniel Lambert, Alderman.   It was remarkable that
 the lord chief justice, and the recorder, who sat on the lord  mayor's
 right hand, escaped, whilst he himself, with the  rest  of the bench on
 his left, were seized with the  infection;  that the Middlesex Jury, on the
 left side of the court lost many, whilst  the  London Jury opposite to
 them received jio harm; and that  of the  whole multitude, but one or
 two, or at most, a  small number of  those  who  were on the Lord
 Mayor's right hand, were taken ill.   Some, unacquainted with the dan-
 gerous nature of putrid effluvia, have ascribed both this circumstance,
and the sickness in  general, to a cold taken by  opening a window, by
by which a stream of air was directed to the side of the court on the
Lord  Mayor's left  hand.f   But it is to be observed, that the  window


  * I am sorry to observe, that there is an appearance of disingenuousness in this expres-
sion. The author, in his first edition, had said, " This sickness, as far as appears, spread
no farther; which was perhaps owing to the season, and to the weather,  at  that time
cold, from northerly winds."  A circumstance, however, which would  have  favored its
spreading, had the disease been a jail fever.   In the 5th edition,  (printed in 1765,) the
author says,  "This sickness, as far as was known,  spread  no farther; there being at
that time no disposition in the air, nor other circumstances to propagate the infection."
Here it is manifest, that he was convinced  no  person had taken the disease from any of
those who were first   attacked,  and that  he  was anxious to  obviate  the  infer-
ence suggested  by that  circumstance, that the disease  was not the jail fever, by saying
what he could not have known, that there was then  " no disposition in  the air" &c.
when, in fact, the unusual coldness of the season, was suited " to propagate the infection."
Whether Sir John Pringle was convinced of the insufficiency of  these allegations, to  ex-
plain why the disease had not been commwucatedhy any of the sick,  1 know not; but he
afterwards thought proper,  in bis 7th edition,  printed in 1774,  to suppress these allega-
tions, and represent it as being uncertain, whether the disease had, or  had not, been com-
municated by a contagious quality,  or rather as  being uncertain how far it had been
"spread &c.; affording room for a belief that it  had  in fact been  spread among the
nurses," &c-  though the extent  of its spreading was  unknown.   Twenty four years
had then elapsed,  and  with the  dispositions which  were  manifested by Sir John
Pringle on this subject, it may be safely inferred,  that he  had never in  all that time
been able to gain any information, rendering it probable that the fever under considera-
tion, had been propagated in a single instance by contagion.  For a single well-ascertain-
ed fact of this nature, would have answered his purpose, by proving that  the disease was
ajail fever, and have rendered unnecessary all his other laborious and ineffectual endea-
vors to attain this object.
  •j- In the Gentleman's Magazine for May, 1750, (p. 235,) the following paragraph rela-
ting to this subject may be found, viz :—" As there was no  uncommon sickness among
the prisoners  that came to the bar,  or in Newgate, some attentive observers do not sup-
 pose it to be a case of infection.  But that the court being so much heated by the crowds
 which came to hear the extraordinary trials of Captain Clark  and others, and there being
 a very cold piercing East Wind to  attack the  sweating persons, when they came out  of
 court, and many of them dining in public,  and drinking  perhaps a glass extraordinary,
 to comfort them after fatigue, a fatal fever might ensue."  The writer of this paragraph,
 though  he properly ascribes the fever to a piercing  cold East wind, seems not to have
been sufficiently informed of a most  important fact, connected with the place and manner
in which this wind was applied, so as to produce disease :—I mean the opening of a large
 window in front, and on the left hand of the court, at the North-West corner of the build-
 ing, one of the three distinguished by the letters N, N,  N,  in the annexed plan.   This
 was done in consequence of'the great heat and want of air, produced by the crowded state
 of the hall, during Captain  Clark's trial.  It appears, that before this expedient was re-
 sorted to, the court, as well as the audience, had been greatly incommoded and overheat 
Ij Plan of the. O/sUJazley.as it existed previously to its destruction during the riots in 7?#o.
\fopied exactiv  From, the- origvnalJh-awiru/ in the vofscfswn of'treorqeDttneeEsq.Architect
 or (ZerkoFthe Works.to the City oFLondon.by whom this Copy  was given to the -dulhor.
 A3 The-divisions  -within, the Cburt'-Ifall are marked according to its present stale; T>ui>
 the-^uthor- has been, informed- by J/'Dunce thai these do not di/Fer. or.  at least, not ma
 terudly. from those- which existed hithe- Former J3 uilding. 
 
   EXPLANATION of the PLAN of the  OLD BAILEY.

 a  Covered passage, by which the prisoners are brought from Newgate
       to the Old Bailey.
 b  Bail Dock, in which the Prisoners are kept till they are called into
       Court.
 c  Small Door, (under the Window)  by which Prisoners enter the
       Court from the Bail-Dock, pr eparatory to their trial.
 d  Place where they stand bc/ire they go into the Prisoners box.
 e  Box for Prisoners under trial.
f  Bench for the Lord Mayor, Judges and Aldermen.
g  Places of retirement from that Bench,  taken from the corners of
       the room.  They are about seven feet high, and that on the right
       of the Court is left open at top.
 h  Boxes for the Sheriffs.
i  Bench for the Counsel.
k  Table for Do.
 I  Spaces serving as passages.
m  Box for the Middlesex Jury.
n Box occasionally used for the London Jury.
o  Boxes or Seats for Officers, Clerks, Sfc. of the Court.
p  Box for Law-Students, c$c.
q  Box for the Witnesses.
r  Standing place for persons who attend to prosecute or give evidence.
s  Columns.
t  Doors opening into different parts of the Court.
u  Windows, of which the  three facing the Judges are large Sash-
       Windows.
x Passage outside of the   Court, over  which are the Galleries for
       Strangers who come to hear the Trials. 
 
439
was at the furthest end of the room from the bench, though the judges
suft'eted most.  Nor could the kind of fever, nor the mortality attend-
ing it, be  attributed to a cold;  it  is therefore probable, that the air
from  the window, directed the putrid streams to that part of the court
above-mentioned. . Indeed, it must be granted, that septic particles
passing into the blood, become  more active and fatal, if the  mfected
person catches cold, or,  by any accident suffers a stoppage of perspi-
ration, or  of any of the other discharges of excrementitious and noxious
matter.
   Before I  particularly notice the latter part of the preceding note, I
think it proper to introduce some other testimonies on this subject.
   In  Foster's Reports and Cases on Crown Law, (printed at  Oxford,
 1762, folio,) I find, at p.  72, the following statements, viz :—
   " At the  Old Bailey sessions  in April,-1750, one Mr. Clark was
brought to  his trial;  and, it  being a case  of great expectation, the
court, and all the passages to  it were extremely crowded, &c.
   " Many people who were in court at this time, were sensibly affected
with a very noisome smell; and, it appeared soon afterwards, upon an
enquiry ordered by the Court of Aldermen,* that the whole prison of
Newgate, and all the passages leading thence  into  the court, were in
a very filthy condition, and had long been so.
   " What made these circumstances to be at all attended to, was, that
within a week, or ten days at most, after the session, many people who
were present at Mr. Clark's trial, were seized with a fever of the ma-
lignant kind;  and few who were  seized recovered.
   " The  symptoms were much  alike in all the patients; and, in less
than  six weeks time, the distemper entirely ceased.
   " It ought to be remembered, that at the  time this disaster  happen-
ed, there ivas no sickness in the gaol more than is common in such
places; this circumstance, which disiinguisheth  this from  most of
 the cases of the like kind which  we have heard of, suggesteth a very
proper caution:—Not to presume too far upon the  health of the
gaol,  barely  because the gaol fever is not  among the prisoners."
   In  addition  to the preceding statement,  it will be proper for me to
introduce the testimony of the Rev.  Stephen Hales, D.  D  and F. R.
 S.  whose character as a  divine,  and philosopher, needs no encomium
from  me.  He  attended as  a witness to  Captain Clark's character
upon  the trial in  question;  and,  in the second part of his Treatise on
Ventilators, (printed  in  1750,) at p.  161,  after quoting a considera-

ed ; and, upon the opening of the window, a stream of cold air forcibly rushed in, and pas-
sed straight forward alungthat side of the  hall which was nearest to the  street, and on the
left hand of the Lord Mayor.  And the mischief done,  or sickness produced, appears to
have been confined to those whe were placed in the direction of this sir- am of cold air ;
which, therefore, contained and conveyed the morbid influence, whatever it was, that <,cca-
sioned the fever.  This important conclusion, my readers will, I hope, bear in mind, till 1
can resume this topic.
  • This mention of the Court of Aldermen made me wish to have the books of that
court examined ; and a gentleman, who by his office, Lad access to them, nMigingly look-
ed them over for the whole time betv.een 1743, and 1770, without being able to find any
entry respecting this subject, or tbe health of tht-prisoners, except some orders forth*
paymentof money, for putting up and working a ventilator at Newga e, which wasdonr
in consequence of the sickness in question, under the direction oft' : Rev. Dr. Hales and
Sir John Pringle. 
440
 ble part of Sir John Pringle's  account of it, he adds, " As the most-
 putrid vapours are the most subtile and volatile,  so I observed them
 to  be in the court,  at  the Old  Bailey, May the  11th, (erroneously
 adopting  Sir  John Pringle's date) 1750, when  I  was obliged to  be
 there, and found the smell of the air in the gallery on the right side
 of the court,  sensibly more offensive than  below,  when I was called
 down among  the crowd  to  give evidence.   And  accordingly, those
 who were situated highest in the court,  as the Lord Mayor, Judges,
 Middlesex Jury, and those in the gallery on the left hand  of the
 court, were chiefly infected with the fatal contagion ; on which (left)
 side a wide sash-window facing the Judges was open ; at which an
 Easterly wind entered, which might blow  down the most venomoua
 vapour which  was near  the ceili?ig,*  and condense, in some degree,
 and check  the subtile infectious vapour,  heated  by a crowded court
 for many hours, from  ascending so  fast from among those  on the
 bench, and in the left hand gallery: whereas,  on the right  hand,
 where no window was  open, the same  heat might cause the  enven-
 omed  vapour to  ascend quicker to  the lofty ceiling;  as it  is well
 known such vapours constantly do in rooms full of crowded  assem-
 blies."
   Assisted by these statements and explanations,  I will now proceed
 to overthrow the baseless  fabrics,  to erect which so much labour  and
 ingenuity have been wasted.
   Those who  ascribed the fever in question to jail  infection, must have
 supposed, and ought to  have proved, either that the prisoners by whom
 the contagion was said to have been diffused in the court,  were then
 actually labouring under jail fever, and capable of generating its con-
 tagion, or, that this contagion existed so copiously in the place whence
 they had been brought into the court,  (Newgate) as to infect their
 clothes sufficiently to enable them to infect others  at the distance of 25
 feet, which seems to  have been the space between the Lord Mayor's
 seat, and the box allotted to the prisoners on  trial.  (See the plan.)  But
 it is not known that any of the prisoners who were  brought into court
 had any sort of febrile indisposition, nor is it known that any  case of
 jail fever then  existed, or had recently existed, even in Newgate.   In-
 deed, the contrary seems to have been generally admitted and  believ-
 ed, and with great reason;  because, after so many persons  were  at-
 tacked with fever, in consequence of their attendance at the Old Bai-
 ley, on the 26th of April, so much attention was excited and directed
 to the  state of Newgate,  that if  any thing resembling  jail fever  had
 been  found in a single  case, it  would have been reported and made
 known; instead of which, we only are told that upon an examination,

   • It is truly wonderful that Dr Hales, who, on other occasions,  and particularly at p.
 156, has justly observed, that the " cooler heavier external  air," by rushing into a warm
 room, displaces, and forces upwards the lighter, should here employ so much ingenuity
 to deceive himself, and reconcile his own facts with Sir John Pringle's suppositions.  Lei
 any one pour quicksilver into a tube containing spirit of wine, and see whether the former,
 when it enters at the top, will remain uppermost, and press down tiie latter.  His reason-
 ing concerning what happened on  the right side* of the court, is equally fallacious.   He
-oays the air on that side, and especially in the gallery, was "sensibly more offensive ;"
 and, therefore the " infectious vapour" ought to have been there most abundant  ; and yet
 all the mischief was done on the opposite side. 
441
it was found that the prison,  " and the passages leading thence !nt6 the
court,  wrere in a filthy condition."  It has been asserted, however, that
though there was then no case  of jail fever in Newgate, there might
be such a remnant or accumulation of febrile contagion formerly ge-
nerated there, as to contaminate the clothes of the prisoners, and ena-
ble them to infect the court, without being themselv es made sick by
that concentrated  infection, which, even  when diluted  and diffused,
was still powerful enough to cause the deaths of persons at a conside-
rable distance;  and such  assertions have  been  adopted  and repeated
under the sanction even of ccrcat medical authorities :  and the better
to account for this wonderful immunity in these distributors of death,
it has been pretended, that persons might gradually acquire the habit
of  bearing  unharmed the impressions of that contagion, which has
proved so destructive to others;  and, therefore, that we are not to
conclude, that  febrile  contagion did not exist in  a very concentrated
and virulent form in Newgate, from the circumstance of its not having
occasioned sickness to any person who  was confined therein.  In my
judgment, however, these assertions and reasonings, as  applied to the
contagion of typhus fever,  have no foundation in truth.  All our ex-
perience proves, that the longer persons are exposed to the action of
this contagion,  the more, certainly, will they be attacked by the fever:
that the escapes of medical men are entirely owing to their remaining
but for a  short space within its reach  at any one time : that persons
who may resist its impressions for a day, are not  likely to resist them.
for a week; and that those who resist them for a week, will rarely con-
tinue to do it for a fortnight:—I mean in places where the contagion m,
not dispersed and rendered innocuous  by frequent  changes of the at-
mosphere.  But even if the assertions which  I am now controverting
were true, they would not answer the purpose for  which they were em-
ployed, in regard to the events of the  Old Bailey sessions.  Sir John
Pringle, in a note to p. 330, mentions what is indeed generally known,
that " it has been the custom some days before every sessions, to re-
move all the malefactors from oilier gaols into that of Newgate." And
this appears  to  have been done previously to  the  sessions in  April,
 1750;  and as the persons thus removed could not have gradually ac-
quired the supposed habit and pov.-cr of bearing the contagion alleged
to  have been at that time accumulated in Newgate, they must have
been as liable to hs morbid influence,  as those who were said to have
been infected by it at the Old Bailey, and infinitely more so, because
they must have been exposed to it at the source, and in its  most con-
centrated form ; whilst the Iatter-could only have received it at a second
hand, when diffused from the clothes of prisoners, and greatly diluted.
And as none of the persons so brought into Newgate appear to have
been attacked with jail fever, either before or after the sessions,  there
is the strongest reason to believe that no such contagion at that time
existed in Newgate, Sec. consequently that none could  have been car-
ried thence to infect the court at the Old Bailey.
   But if we were to suppose (for  the sake of argument^ that the jail
fever did at that time prevail in Newgate, and  to as great an extent as
it was ever known to have done, there would still be good reason  to
                                  56 
445
 conclude that it did not occasion the fever  which was consequent upon
 Capt. Clark's trial.
   In a note to p.  438, I found sufficient ground  for concluding, that
 whatever the cause  of that fever might be, it must  have been  con-
 tained in and applied by the stream  of cold  air which entered by the
 open window, and reached the persons who, being placed in that par-
 ticular direction,  were afterwards exclusively attacked  with the dis-
 ease.  This was also the avowed opinion of Sir John  Pringle  and Dr.
 Hales.   But if we suppose the jail infection  to have been brought uito
 court by Capt.  Clark, (a strange supposition considering his rank in
 life,  and the cleanly decency at least, with which  he must have been
 clothed) that contagion would have  been much more likely to operate
 previously to the opening of the window, when, as there was little or
 no circulation of  air,  it would have been less diluted;  but if it had
 operated at that tune,  its operation would  not have been directed and
 limited  to those particular persons on  whom the cold easterly wind
 afterwards blew, but to those  who  were nearest  to him  on all sides;
 and we may  therefore presume, that the fever in question was not oc-
 casioned by any application of jail infection, previous  to  the opening
 of the window,  and  certainly it could not have been produced by  that
 cause after the admission of such a  strong current of air, as must by
 its quantity  and  coldness  have so  much diluted, elevated, and dis-
 persed the contagion,  as to render it harmless, even if,  in addition to
 Captain Clark, scores of prisoners had been in court.*
   Another insuperable objection to the supposed production of this
 fever by contagion arises from the space between  the bench on which
 the judges were seated, (where the cause of the disease proved mor-
 tal to four out of six then present) and the box wherein the Prisoners
 are placed when under trial, and which is the  nearest approach they are
 ever  allowed to make  towards that  bench.   This  distance, as  I have
 already mentioned, and as will  appear by the  engraved  plan of the  hall,
 is about twenty-five  feet; and  we are warranted by all the experience
 of modern times in believing, that the contagion of jail or typhus fever,
 from  a person actually under the disease in its worst form, will not pro-
 duce  fever in other persons at  the distance of three yards, in  a room
 of moderate dimensions, where the air was not previously infected.f

  * Had there been any contagion in Newgate capable of infecting the court at the Old
 Bailey, we might have justly expected that it would have  done so on the  first dav,
 when  more than twice as  many prisoners were tried,  and when no window appears ta
 ha>e been opened, to  dilute and disperse the infection.   It is  not, however, pretended
 that the jail infection operated at any time during the sessions, excepting the day when
a stream  of cold air  was admitted,  sufficient of itself to produce the fever, without
 any aid from contagion, and  sufficient also to render contagion harmless, even if it had
been present.
  •J- Dr. Haygarth, in his letter to  Dr. Percival, on the  Prevention of infectious fevers
(Bath, 1801,) says, page 8,  " In 1777, I began to ascertain, by clinical observations,
according to what law the variolous infection, and in 1780, according to wl>at law the
febrile infection is propagated.  1 found that the  pernicious effects of the variolous mi-
asm were limited to a very narrow sphere.   In the open air, and  in moderate cases,
I discovered that the infectious distance does not exceed half a yard.  Hence it is pro-
bable,  that even when the distemper is malignant, the  infectious influence extends but
a few yards from the poison.  I soon, also, discovered that the contagion of.fevers was
confined to a much narrower sp/iere." 
443
   With this knowledge of the very limited action of the contagion  of
 jail or typhus fever, when present, and with so many valid reasons for
 believing  that none was present,  at the sessions, the 26th of April,
 1750, we  are certainly bound to  ascribe the fever which was a  conse-
 quence of that session, to some other cause; and none presents itself
 so obviously, and with so many probabilities, as that which Sir J. Pringle
 thought proper to reject; I mean the sudden admission of a continued
 stream of cold air, impelled forcibly  by the  external wind,  upon  per-
 sons, who had previously been  greatly overheated,  and  were  conse-
 quently in that state which renders a sudden and copious application
 of cold, either  externally, as on  that  occasion,  or internally by large
 draughts of spring or iced water, in very hot weather, or by the eating
 of iced creams, &c. in particular circumstances, so often productive of
 a mortal disease.   Even  Dr. Hales was aware  of danger from a free
 admission of fresh  air by ventilation, as may be seen  at p. 144, 153,
 and 155 of the work lately quoted, and at the last of these passages,
 after representing " it as a matter of great importance  to  vise means
 to change the air in crowded rooms, he adds,  that this must be done
 by a constant ge;i tie succession of fresh air;" which " must not be let
 in at open full windows, especially in cold weather;" and this injunc-
 tion he repeats in other places.  Almos; all the circumstances which
 are known to render the application of  cold hurtful, seem to have co-
 operated at the Old Bailey, during  Capt. Clark's trial, particularly the
 length of  time hi which its  application was continued; its being ap-
 plied by a wind, or current of air;  its being a transition or sudden and
 considerable change from heat to cold;  and its being applied partially
 to a particular part  of the body, vv hile the rest was kept in  greater
 warmth than usual: we know but Uttle of the causes which might have
 assisted to produce  debility on that occasion, and thus to  render the
 impressions  from  cold  more injurious;  excepting that of fasting,
 which, from  the duration of the trial, must have been unusually  pro-
 longed ; nor are we acquainted with what might have  happened after
 the court had adjourned, to increase the morbid influence of the cold,

  In a report made by the committee of the  dispensary at Newcastle, published in Dr.
 Clark's collection of papers respecting fpver wards, (Newcastle, 1802)  the  following
 paragraph occurs, at page 12, viz  " The most malignant fever does not render the at-
 mosphere infectious farther than a few feet from the patient, or from the contagion preserv-
 ed in clothes, furniture, &c. and daily observation confirms, that a person must remain a
 considerable  time within the sphere of infection to receive iff for physicians and surgeons,
 who  avoid the current of the patient's breath, and  the effluvia arising from his body
 within the bed-curtains,  do not receive the contagion in their ordinary v sits ; and they
 never convey it to others ; the infectious  effluvia, received in their apparel, being spee-
 dily rendered  mnoxious by being diluted  with pure air."  In a report, also, from  the
 institution for the cure and prevention of contagious fever in the metropolis, May "tih,
 1805, it is stated, that ♦' the house occupied for the purposes of the institution stands in
 the midst of a  row, in contact with dwelling houses  on both sides; that 420 pati-
 ents"  (with  typhus fever) " have been received into it," &c " yet the neighbourhood
 has continued altogether free from the disease," he  After which the following obs t-
 vation is added, viz.  " Were not the general prejudice  on this subject strong, this
 fact, indeed, might have been clearly anticipated. For if, as we have learnt from  ex-
perience, contagions, diluted by the free  admission of air,  are not communicated from
 room  to room  in a house  nor even from  bed to bed in the wards  of an hospital, it
 scarcely required a positive experiment to prove, that houses even Hi conta'f, wcra
 not liable to infect each other." 
                              444

 which had been already applied.  We know enough, however, to make
 it probable, in the highest degree, that this was the cause ot the fever
 which ensued, and proved mortal to so many persons.   Sir John Prin-
 gle has, indeed, delivered an opposite opinion, but on grounds  which.
 in my judgment, have little solidity; he observes, ui the note lately
 quoted, that the  window which admitted the cold air, " was at the
 farthest end of the room from the bench, though the judges suffered
 most;" it should, however, be remembered, that this window was
 much higher than the heads of any of those who were on the left hand
 side of the court,  and, consequently, that the stream of cold  air passed
 harmlessly over those who were nearest to the window, and, gradually
 descending by its superior  gravity, went uninterruptedly, and with full
 force, to the judges,  on that side) who being most elevated, were most
 exposed to its impressions, though ,farthest JYoni- the window ; a cir-
 cumstance which Sir John Pringle did not think of any importance,
 though 'immediately after, he  stated it as  probable \hat the air from
 the window directed tlte putrid streams to that part of the court where
 the judges were  seated"   Certainly, if the current from the window
 was sufficient to convey the supposed putrid or infectious matters to
 the judges, it must have been sufficient also to communicate the effects
 of its own diminished temperature or coldness.
   In regard to bis other ground, viz. that neither " the kind of fever,
 nor the mortality attending it," could  " be attributed  to  a cold;"  it
may be answered that they are much less  attributable to jail infection.
 Unfortunately, we know  but little  of the " kind of fever" then pro-
 duced; a circumstance for which Sir John Pringle himself is  blame-
 able:  for, though he  appears never to have seen a  case of it, he
might  easily have procured, from  other  physicians,  a sufficient ac-
 count of its symptoms, (which Mr. Foster states to have been much
 alike in all the patients,) and have  enabled us to judge how far they
were similar to those  which  he has  described  as  belonging  to jail
 fever.   But without doing  this, he  admits that " it was said that this
 fever in the beginning had an inflammatory appearance,"  which is ex-
 actly that of a fever from cold, and the very  reverse of a jail fever.. In
 Opposition, however,  to this  admission, he  adds, " that after large
 evacuations the pulse sunk, and was not to be raised again by blisters,
nor cordials,  and  the patients soon became delirious."   It will not,  I
presume,  be expected, that I should undertake to account for particu-
lar effects, loosely stated on the ground  of hearsay, without any com-
munication of other facts and circumstances,  which, if known, might
 probably remove all difficulty and obscurity respecting them.  I need,
therefore,  only observe, that I do not consider it as necessary, that
fevers produced by the sudden application of cold, should, in  all cir-
 cumstances,  ages, and constitutions, bear large  (probably excessive)
 evacuations,  without a sinking of the pulse, or without subsequent
delirium.  And in regard to petechia,  which were reported to have
been observedin some few cases, I need only refer to p. 97 of the Ap-
pendix  to Sir John Pringle's work, where he notices, " the undeter-
mined  meaning of the word  Petechias;"  adding, its " ambiguity  is
such, that I must regret my having at all used  the term."  The au-
thor had before said,  in the  preceding page, that ev^n these spots 
445
 which he had called  petechia, though sometimes  accompanying the
 jail fever, had no "title to characterise that disorder."
   Sir John Pringle also mentions that some escaped without a fever, by
 a u looseness coming on, which was easily cured."   This fact I con-
 sider as eminently indicative  of morbid affection from   the  applica-
 tion  of  cold,  which  is  often  observed   to take that course; and by
 doing so, to obviate  the occurrence of fever, and other worse conse-
 quences : but I  have never known such an  escape from typhus fever.—■
 Cm the contrary, I believe that where  a sufficient dose of that conta-
 gion has been imbibed, the supervention of  diarrhoea from any cause,
 would render its operation  in producing fever, more s/ieedy  and cer-
 tain,  by inducing debility.
   It is much to be regretted,  that neither Sir John Pringle, nor any
 other writer  within my  knowledge, has  stated the precise  interval
 between the trial of Captain Clark, and the commencement of fever in
 any one of the persons then  present.  He only mentions that none were
 taken into his account who did not sicken within the  first fortnight after
 the sessions.  With this  latitude,  there might have been barely time
 for the  production of fever by jail  infection.   But, though  this was
 the longest interval, they might, for any  thing which he says to the
 contrary, have all sickened  within half the time, and that,  in my  judg-
 ment, would have afforded the most decisive proof of a different fe-
 brile cause; and this probably was the fact, at  least in some  of the cases;
 though  the extract which I have given from Foster's Reports,  &c. is
 almost as vague on this point,  as Sir John Pringle's statement;  for  il
 only  asserts,  " that within a week,  or ten  days  at most, after the ses
 sion,  the persons in question were  seized with a fever," £cc*
   In regard to the mortality from this fever, which Sir John  Pringle
 thinks too^great for  a fever from cold;  he surely ought to  have re-
 collected, that this  objection would apply with greater force to his sup-
 position, that the fever had originated from contagion ;  for the most
 concentrated or virulent jail infection ever known in this  country, did
 not,  so far as I  can recollect, produce a fourth part so  many deaths
 among an equal number of sick; and it therefore  must be incredible,

  * We are left in equal uncertainty concerning the time which the disease had subsisted
 even in a single case, before its fatal termination. We are only informed by the Lon-
 don, Gentleman's, and Universal Magazines, for May,  1750,  of the  days  on which
 most of the persons died, with intimations of their having been at the preceding Old
 Bailey sessions.  1'he London Magazine mentions Sir Daniel Lambert,  and one or two
 others, as having died on the 13th of May, and other deaths  as occurring on  nearly
 all the succeeding days, until the 21st. The Obituary of the Gentleman's  Magazine
 states,  "Sir Daniel  Lambert, knight  and alderman," to haveVIied on the  13th, "of
 a violent fever,," which certainly is  not a description of typhus.
  \)r.  Adams (misled by Sir John Pringle,  in regard to the commencement  of the
 sessions,) states in his Inquiry into  the Laws of Epidemics, (p. 12 and  13) that on the
 11th of May, 1750, the prisoners  at the Old Bailey were sufficiently in health to attend
 their trials ; yet, from the effluvia they  brought with  them  on the 13th,  died one magis-
 trate,  on the 14th the undersherifF, on  the 17th one judge," &c.  Here Dr. Adams mani-
 festly believed, and  intended that  others should believe, that the effluvia supposed to
 have been thus brought into court on  the  11th, had not only produced a violent dis-
 ease, but that this disease had also proved fatal, all in the  space of 48 hours from the time
of its communication.   A monstrous error: it being probable, that jail infection never
produced  disease and death in so few weeks as the number of days in which the doctor
supposes all this to have happened. 
446
that such  unexampled mischief should  have been occasioned, where
the febrile contagion, supposing it to have existed, was too weak to pro-
duce disease, even  in those who were said to have brought it into
court, or in Newgate, whence it was said to have been derived.  And,
though  the mortality in question was greater than I should have ex-
pected,  from a  fever produced by the sudden application of cold, yet,
so many things are  capable of increasing and aggravating the morbid
effects of  that cause, particularly by inducing local and mortal inflam-
mation in some  important organ or viscus, that it is much less surpris-
ing that a fever so produced should occasion an unprecedented mor-
tality than it would have been,  if so many deaths had resulted from a
jail or typhus fever.
  I have not insisted on the non-communication of the disease by any
of those persons  who sickened  after being at Captain Clark's trial,
because mat  fact, though it increases the probabilities, does not af-
ford any decisive  evidence  that the fever was not a typhus,  as most
of il.e sick were above the ordinary class,  and may  be supposed to
have occupied apartments so large, that the propagation of the fever
was not a necessary consequence.
APPENDIX.
No.  V.
  The author,  at*^>. 119, intimated an intention of inserting in this
Appendix certain extracts from the " Memoires sur les Hospitaux
de Paris, par M. Tenon," respecting the  Hotel Dieu of Paris; but
the editor finds it  necessary  to refer those to whom these  extracts
might have proved interesting, to M. Tenon's original work,  particu-
larly to the preface, and to  pages  135,  138,  141, 163, 165,  194,
197, 198, 199,  207, 208, 209, 223, and^287. 
APPENDIX.
No.  VI.
  The author, at p. 151, has referred his readers to this Appendix,
" for Proofs" of the " Exemption of the inhabitants of (or adjoining
to)  Peat Bogs from  Intermitting Fevers."   The  same  necessity
which compelled the  editor to omit what was  intended to  constitute
the preceding  Appendix,  (i.  e. the unusual  number of pages to
which tbe volume has already extended) has determined him to refer
the reader to Dr. Jameson's Mineralogy of the Scottish Isles,  vol. 2,
p, 127;  and to the Essay on Peat, by the Rev. Dr. Walker,  Professor
of Natural History, in the University of Edinburgh,—published in
the Transactions of the Highland Society  of Scotland, vol. 2, p. 23.
The author had moreover intended to place in this Appendix certain
MS. communications, stating the  non-occurrence  of marsh fevers at
Strabane, and some other places in Ireland, adjoining to Peat Bogs,
except in persons who had previously been exposed to marsh miasms,
by  residing in other  situations.   In  such persons, particularly one
from  the state of Maryland, intermitting fever is  stated  to have oc-
curred some months after leaving America, and to have proved very
ebstinate.
APPENDIX,
NO. VII.
Having explained the purpose of this Appendix at pages 203 and
204, and meaning to leave no doubt subsisting in the mind of any per-
son qualified to decide on the credibility of Dr. Chisholm's account of
the supposed generation of a new Pestilential Fever on board the ship
Hankey, on the Coast of Africa, I beg leave to premise a short, but
faithful statement of the transactions which arc  supposed to have been
connected with that monstrous production, founded principally upon 
448
the African Memoranda of that very intelligent and meritorious offi-
cer, Captain Beaver, of the Royal  Navy;*  and upon authentic docu-
ments, published in Wadstrom's Essay on Colonization.
   Several gentlemen having associated for the establishment of a  co-
lony at  the island  of Bulama, near the mouth of Rio Grande, on  the
Coast of Africa, and obtained the approbation of government, a num-
ber  of colonists and labourers were engaged,  and embarked  in two
chartered vessels, viz. the Calypso, of 298 tons, and the Hankey, of
260 tons, besides a sloop of 34 tons, purchased by the association;  all
of which, with sufficient stock  of provisions and  stores, sailed from
Spithead, on the 12th of April* 1792:'the Calypso having  onboard
149  setders, or colonists, consisting of men, women, and children;  the
Hankey 120; and the sloop 6 ; making in the whole 275.  These ves-
sels were, however, separated in a few days, by a storm, and the Ca-
lypso having touched, on the 3rd of May, at Teiieriffe, and on the 12th
at Goree, proceeded to Bulama, and on the 25th of that month anchor-
ed  in a harbour, at the western extremity of the island, where the  go-
vernor of the new colony, Mr. Dalrymplc, determined to wait for  the
arrival of the Hankey, on board of which was the investment for pur-
chasing the  island, and  trading with the natives.   But in Jjie mean
time, he imprudently landed, with some others, to explore the"*'island;
While, as Captain  Bearer informs us, (at page 46 of his African Me-
moranda,) several of the colonists erected small huts and tents on the
shore;  parties wandered wherever they pleased in  the day, and  re-
turned to the ship, or not, as they thought proper,  in the evening.   In
short, nothing," adds he, " could be more  irregular, or improper than
their conduct.  In this disorderly state, they were on the 3rd of June
surprised and attacked by a party of Bijugas, a warlike tribe of Afri-
cans, inhabiting the neighbouring island of Canabac, (to whom Bulama
then belonged)  who killed five  men and one woman, wounded four
men, and carried off four women and three  children.  This disaster,
which had resulted  from a mistaken notion in the natives, that  the
colonists had come to dispossess them by force of their territory, caus-
ed so much  alarm among those who had escaped,  that they re-em-
barked  immediately, and sailed on  the 5th  for Bissao, a Portuguese
settlement on the coast, at a small distance.   But on their way thither,
finding the Hankey was just arrived in the Bi;uga channels, they joined
the latter ship, and on the 8th of June, both ships, with the sloop, pro-
ceeded to the road of Bissao, where they anchored.   By this time, as
Captain Beaver  informs us, \p. 58.  " the Calypso  had many persons
on board ill ol fever, though none had yet died of it;" besides which,
he adds, " nothing was heard but mutual reproaches from the people
of the Calypso.   The colonists accused the members of the council hi
that ship, of a want of attention to  their comfort and accommodation:
(those in the Hankey having fared better than themselves, by procuring
supplies of fresh  provisions  at  Teneriffe and St. Jago.)  They were
tired out with the length  of the  voyage; irritated by the loss of their

  * At p. 94 of his Letter to Dr.  Haygarth, Dr. Chisholm, after mentioning Captain
Beaver's publication, describes it as " a most complete  and circumtantial narrative of
-the whole of their proceedings;" (those of the Hankey and the Bulama colonists,) ami
as executed " with a candour and naivete, which stamps it with the seal of truth." • 
449
inends, in the recent attack of the natives, and the disappointment of.
their hopes.  On the junction of the ships,  these discontents were
speedily communicated to the colonists on board the Hankey:  Captain
Weaver,  who had made his passage in that ship, says, that he had " left
her on the 5th ot June, a quiet clean, healthy, and orderly ship;"  but
at his return, on the 7th, he found her « a noisv, dirty, disorderly ship ;
the colonists dissatisfied and dispirited."
   During their stay at Bissao, Captain Beaver mentions the fever to
have appeared on board the Hankey; and that on the 21st of June it
"still continued in both ships, but onlv one  person had yet fallen a
victim to it in the Calypso, and none "in the Hankey."  '(Page 60.)
Soon after the arrival of the ships at that settlement, agents were sent
to the island of Canabac for the purpose of ransoming  the women and
children taken prisoners at  Bulama, which was accomplished on  the
19th of June;  and the willingness of the Bijugas to sell the latter island
having been ascertained, the ships quitted Bissao on the 21st of June,
and anchored on the 27th in a fine harbour, in the  East Channel,  be-
tween Bulama and the Biafara shore, opposite to the spot on which the
settlement was subsequently fixed;  having previously disoatched Cap-
tain Beaver with Mr. Dobbin to Canabac, where  they speedily con-
eluded a treaty, by which the island of Bulama was purchased for 473
bars, worth  from  120 to 140 pounds sterling.   In the mean time, how-
ever, the discontents had increased among the colonists; " the major
part of whom," Captain Beaver describes (in  a letter addressed to  the
Trustees of the Bulama Association in London, dated from Bulama, the
22d of November, 1792, and printed at page 300 of the second part of
Wadstrom's Essay on Colonization,) as being" drunken, lazy, dishonest,
and impatient;"  and the setting in  of the  rainy season, which began
on the 4th of June, with the prospect of great fatigues and privations
to be undergone during that season, had  probably contributed not a
little thereto.  In  this state of mind, a very considerable number of
them resolved to abandon  the colony, notwithstanding the success of
the negotiation with the Bijugas.  Accordingly, sixteen ol them sepa-
rated almost immediately;  and others, to the number of 147, (among
whom were the governor, Mr. Dalrymple, and the lieutenant-governor,
Mr. Young,) sailed from the Bulama in the Calypso,  on  the  19th of
July, for Sierra Leone, and  thence to London, where  they arrived in
the middle of November, excepting about 40 who died from sickness.
The state of both ships, in regard to health on the day of the Calypso's
departure from Bulama, is  thus mentioned by Captain Beaver,  at  p.
80 of African Memoranda;—-" 19th of July.   The fever had hitherto
continued in both ships; the  Calypso having buried  three who had
died of it since we had left Bissao, and sailed with many sick;  The
Hankey had buried three also, and had  now two colonists, and three of
the ship's company labouring under that disorder."
  Upon the departure of the Calypso,  witli governor Dalrymple, &c.
the remaining colonists, consisting of 48 men,  13 women, and 25 chil-
dren, elected captain Beaver to be governor,  and his conduct, amidst
the numerous difficulties and  distresses by which he  was continually
surrounded, until compelled to abandon the island on the 29th of No-
                               57 
450
vember, in the following year, appears to have been  in all  respects
highly commendable.   The first and principal undertaking of the new
colonists, was that of building a block-house for their protection and
accommodation, upon the summit of a hill near the harbour, which
was  then " covered with a thick forest."  See p. 93.  But, having no
sort  of accommodation  on shore, they were constrained to live on
board  the Hankey; and the better  to defend  themselves from the
rains,  Sec. they erected a covering to the ship's deck.  Their onlj
shelter, on the island, was "a little  tool-house,"  and as the heavy
rains made it impossible to dress their victuals on shore, the working
people were  landed on the island at day-light every morning, and
brought on board to breakfast, at 8 o'clock; carried back to their work
at nine; brought on board to dine at noon; again relanded at 2, P. M.
to resume their labours; and, finally, brought on board to sleep at sun-
set.   In this manner they continued to work through the rainy season,
(which ended about the 15th of October,) and afterwards until the be-
ginning of November; when the  time being expired  for which the
Hankey had been chartered, it became necessary to land the colonists
with all their stores, to  enable the ship to prepare for her departure,
although the block-house could not  be  finished  until the month of
February.
   On the 23d of November, the Hankey sailed from Bulama, having on
board sixteen of the colonists; viz. 7  men, 4 women,  and 5  children,
besides her crew. At this time the colony had sustained a loss, subse-
quently to the Calypso's departure, of 48 persons by death, of whom
23 are stated to have died of fever ; one by " fever and flux," an 14 by
other specified diseases,hurts, and accidents.  On the 26th of Novem-
ber, the Hankey anchored at Bissao, and  sailed thence for England on
the 3d of December, but in the night of the 4th she grounded on a sand
bank near the island of Warang, which  made it necessary to send  a
part of her crew in the pinance (an open boat) to Bissao for assist-
ance ; and these men, after hard rowing for two days  and nights, re-
turned with  a schooner and long boat; tnd with their help  the ship
was again made to float :  but on this day " all  the people who came
from Bissao in the pinance were taken ill."  On the 13th the Hankey
was brought  back to Bissao, to refit,  but finally sailed thence on the
21st of December, and anchored in St. Francis's Bay, at St. Jago, on
the 26th of that month ; where I shall leave her at present, that I may
enter upon an inquiry into the causes and nature  of the fever which
had been so prevalent, while she remained at  Bulama;—an inquiry
which, as marsh  fevers alone  have hitherto been found to  prevail in
that part of Africa, nothing but Dr. Chisholm's  confident,  though un-
warrantable statements, could have made  necessary.
   It has been already mentioned that the  Calypso had arrived at Bula-
ma fourteen days before she rejoined the Hankey  in the Bijuga chan-
nels in which interval, the colonists (tired of their confinement on ship-
board, and  believing they had  now reached the land of promise had
wandered about  that island in  the most unrestrained  and imprudent
manner, sometimes sleeping on shore, and otherwise exposing them- 
451
selves  most incautiously to the action of marsh miasmata,* until they
were  surprised, and partly cut off, by the Bijugas.  Those who have
lived  between the tropics, or who have read of the numerous instan-
ces of mortal fevers which have been there produced  by sleeping a
single night  on shore, will not be surprized that after such conduct, it
should have  been found, as is mentioned by Capt. Beaver, that on the
8th of June " the Calypso had many persons ill of fever :"  nor thai this
fever should have  been,  as will be incontestably proved, the  common
marsh, intermitting  or remitting fever of the.coas*,  and that the same
fever should have appeared in the Hankey  some time after her arrival
at Bissao ;  a place  where this " coast fever" is known  to prevail in
the rainy seasons, (which had then recently  begun) and where during


  • Dr. Chisholm, at p. 103 of hisletter to D. Haygarth, says, " In every instance of great
mortality on the coast of Guinea, and in many other countries of the old and new continents
within the tropics, (and there are many dreadfut ones given by  Dr. Lind and others J
the cause has evidently been marsh miasmata, or an " inland impure atmosphere, loaded
v* ith stinking sulphureous  mists."  Yet, in direct opposition to this assertion, he immedi-
ately after, endeavors to maintain that the mortality on hoard the Calypso and Hankey
did not result from this cause,  but from one which certainly never did produce " great
moitality'1 between the tropics ;  1 mean febrile contagion ; and for this purpose, he alle-
ges that Bulama, " is every where surrounded by sea, is no where marshy,  gradually ri-
ses to a moderate elevation immediately from its shores, is blessed with abundance of
running water, and with a soil rich and prolific, affording ample pasturage to innumerable
wild animals."  Had  it however suited  Dr. Chisholm's purpose,  1 am persuaded that,
even supposing this description to be accurate,  (whieh 1 do not  believe) he would,  not-
\\ ithstanding, have readily discovered sufficient sources  of marsh miasms at Bulama.  Its
being surrounded  by sea is no obstacle to their production ; witness the islands of St.
Thomas,  Batavia, St. Lucia, St. Domingo,  and scoies of others, which are extremely un-
healthy ; and in regard to its " rich and prolific " soil,  Bulama, in this respect,  only re-
sembles the country  along the banks of  the Guadalquiver, in Andalusia, the Terra di
Lovoro, near Naples, and other- places already mentioned, as being eminently produc-
tive  of marsh fevers.  Governor Dalrymple, and the council, in their joint letter to the
trusteesof the Bulama association, say, "the island, we learn from the gentlemen  who
have explored it, has extensive savannahs, of a deep black movidP  See YVadstrom's Es-
say on Colonization, 2d part, p.  144.  And governor  Dalrymple, in a separate letter,
quoted in the preceding page, says,  "the north end of the island, is one continued savan-
nah, covered with long grass, with a few trees interspersed, but without any rocks or
stones."   He adds," the soil of this plain is deep and rich"  Now, it is utterly impossible,
that such a soil, in  such circumstances, should not be greatly productive of  morbific ex-
halations,  in that climate, whenever (by showers or otherwise)  there is sufficient mois-
ture for their extrication, and besides these savannahs, it is incredible that the  shores of
such an island, and especially its harbours, should not iu a multitude of places be fitted to
produce and give out marsh effluvia  copiously :  there not being,  so far ast can discover,
one situation in that part of  Africa where a ship can anchor  near  the shore  and remain
even for a  week, during the rainy season, without some ol" her crew being soon after at-
tacked by marsh fever. Such, however,  was Dr. Chisholm's anxiety to  persuade others
that in this respect, Bulama differed from every part of the coist, that (at p. 118 of vol.
i. of his Essay) he has introduced a quotation from the "Voyage de Chevalier des i. rchais
(en  Guinee and isles voisines)" which, besides its being otherwise of little importance,
relates entirely to the islands in the river of Sierra Leone, and not in the smallest degree
to Bulama, which is in the Rio Grande,  and distant more than 200 miles   lie nuiki-s a
similar mistake by quoting Dr. Lind,  who has not  once mentioned the islands in Rio
Grande.  I may add that Dr. Chisholm's anxiety on this subject has also led him to ad-
duce the testimony of Mr Paiba, (which admitting it to be correct as fir as his  know-
ledge extended, amounts to very little) though in many other parts of his writings Or.
Chisholm earnestly endeavors to impeach Mr. Paiba's veracity, and as I think, with  vnry
little reason ;  for though his communications to Dr. Smith,  were not all correct, in re-
gard to dates and numbers, (he relating them from memory only, and after an interval of
tour years) his statements in other  respects have been generally confirmed by other evi-
dence, and he has no where  made such groundless  misrepresentations, as those of Dr.
 Chisholm, nor indeed any which manifest an intention to mislead. 
452
her stay of 14 days, it may be presumed that the drunken, dissipated,
and vicious characters mentioned  by Captain Beaver,  as being a ma-
jority of  the colonists, would have freely indulged their dissolute pro-
pensities,* in aid of the morbid influence of mash miasms ; but though
these vessels afterwards proceeded to  the  harbour, adjoining to the
spot destined  for the  settlement at Bulama; yet by reason of the in-
tended departure of the adventurers, very little work was done on shore
during this interval;  and the fever,  being void  of contagion, did not
spread in the ships ;  as only five persons were ill of  it on board the
Hankey, when the Calypso quitted Bulama on the 19th July.  After
this time, however, all the remaining colonists, able to work, were con-
stantly employed in laborious occupations on shore, for 9 hours  daily,
and were often caught, as is mentioned  by Capt. Beaver, in very heavy
showers of rain, than which few  things can be more dangerous in that
climate;  and they must also have been greatly exposed to the marsh
miasmata constantly emitted in that rainy and sickly  season.  These
causes, joined to their general despondency, and various hardships, pro-
duced, as might well be expected, such an increase of sickness,  that,
as Captain Beaver mentions at p. 137, "every person  employed  about
the block-house was  ill and unable to work" on the 17th of  Septem-
ber.
   Dr. Chisholm has, in various places,  stated his  opinions of the
causes of this fever, though with some variety, and often with no little
obscurity: that statement, however, which seems to have obtained his
last correction, may be found in his letter to Dr. Haygarth, in which,
at p.  103, after asking, "what were the causes of  this fever and mor-
tality," he says, " all the causes  which generate infectious  or  pesti-
lential fever, is the obvious answer."   Now, though this answer may
satisfy some  of those who believe that  there are such  causes, it is far
from satisfying me, who (for  many reasons already stated)  have no
such belief;  especially, as though assuming the presence of all these
supposed causes,  he has omitted to designate, and establish the exis-
tence of any one of them.  He has, indeed,  attempted to prove that
the fever in question was infectious, and for this purpose (at p. 99 of
the letter just quoted) has availed himself of a passage in captain Bea-
ver's African Memoranda, (p. 54)  where  the  latter,  describing the
transactions of the Hankey and Calypso, after their rejunction on the
7th of June, says, "the  fever from  which  the Hankey was still free,
had already  made its  appeai'ance  in the former ship; and,  instead of
separating the infected from the well,  and taking any steps to prevent
the spreading of that  dangerous disease,  by prohibiting any  unneces-
sary intercourse between the two ships, the whole time, since the ar-
rival of the Calypso,  had been taken up in the constant interchange of
visits: nay, the affected themselves,  the very persons who had the fe-

   * Wadstrom, page 511, gives the following extract of a letter from Charles Drake,
 Esq. " We left the remains of several of our  people at Balnma ;  butl know of none
whose decease might not be accounted for, by their being addicted to drink rum."
   Id. page 113, Lieut, governor Young, in his " Return of the deaths of the Bulama Ad-
 venturers," states that, " oi the nine persons who died at Bulama, not one contracted his
fever there, but all of them at Bissao, except those who brought their disease from Eng-
land.  Of the remaining number, many caught the fever at Sierra Leone, through intem-
 perance," &c. 
453
•ver on  them at the  time,  had been  actually  on board the  Hankey,''
and the  consequence was, that many days did  not elapse before tho
fever  made its  appearance in that ship also."   That  captain  Beaver,
when  he wrote this passage, (which probably was about the time when
the transactions happened,!) did suppose the fever in question to have
been communicated  from the  Calypso to the Hankey, is evident.  He
seems, however,  to have thought so, from an erroneous notion (which
has prevailed, in  a great degree, even among medical men, and  which
captain Beaver might well have adopted) that  all fevers were  conta-
gious, and that,  as a matter of course, such a  communication of fe-
ver must have resulted  from the intercourse just described.  But there
is good reason to believe,  that he  did not long  retain this notion, but
was soon convinced, by personal observation,  that contagion had no
influence in spreading  the fever, (especially  as, even on the 19th of
July,  only two of the Hankey's crew,  and  three colonists, had any
fever,) or occasioning the mortality which resulted from it; for he does
not afterwards (according to my best recollection and belief,) even hint
at the operation or existence  of any such cause;  but wholly  omits it,
in  the various parts of his journal  and official letters,  in which he
endeavours to  account  for the  sickness  and deaths,  either of the co-
lonists or of the  Hankey's crew ;\  nor did he, when he afterwards be-

  * This fact indicates, what will soon be proved, that the fever in question must have
been a mild marsh fever, probably an intermittent, for under such contagious fevers as
Dr. Chisholm supposes the Hankey to have  drought to Granada, patients do not  pass
their time in going from one ship to another,  to make or return visits.
  ■fCapt. Beaver, at p. v. of his preface, says, "most of the  circumstances preceding
the 19th of July were written by myself, as the circumstances occurred;" and he profess-
es generally to have published his journal just as he wrote it, in order to  exhibit the
impressions on his mind,  at the  moment when each part was written.
  £ To establish the truth of this  allegation, the following proofs will suffice, viz. in a
letter  from Capt Beaver to the Bulama trustees, dated November 22d,  179'2,  (see
African Memoranda, p.  292) he writes, " t/ie great mortality must certainly be attri-
 buted  to the great labour and fatigue attendant on those who first attempted to settle
 a colony, and to the  necessity we were reduced to of working in the rains,  in order to
 have a fort to defend, and a house to cover us.  With  little strength, we found it ne-
 cessary to work from morn to night, except when the rains poured like torrents, and hy
these  we were often caught when  going in the boats either on board,  or ou shore."
 Afterwards, he observes, (African Memorada, p. 495,) "had we carried out the frame
 and materials necessary for the  erection of a  large house,  it might have been finished,
 in at most one month ; but "asaWthe timber, which I built with, wasi growing at the
 time of our arrival, it was February  in the following year, before 1  had a room to put
 my head in.  The being exposed during the  whole of that  time to either the  rains or
 the sun must certainly  have been a great cause of our mortality."  He had before ob-
 served, (African Memoranda,  p. 367) that the mortality of the colonists at Bulama,
 " though  in some measure certainly to be attributed to the climate, was much more
 to the adventitious circumstances  which have been already noticed; and 1  am inclin-
 ed (adds he) to think that, independent of  its having really been the most unhealthy
 season of the year,  independent of our hard  labour, and  great exposure during that
 inclement season, much of  our very great mortality  may be  attributed to the uncom-
 mon depression of spirits which our situation produced, on the minds of most of our
 colonists.;  and I verily  believe  that I should have died too, if I had ever suffered  my
 mind  to he so subdued.   But how far this despondency may  have contributed to our mor-
 tality, must be left to the decision  of physicians."  Upon this passage, Dr. Chisholm
 (at p.  105 of his letter) says, "Were I to hazard an opinion, I should be inclined to say
 that it contributed  as a powerful predisposing cause to the action of infection, which
 had already accumulated in their bodies,  like the electric fluid in  the Leyden phial,
 and required only  this excitement to destroy at  a single discharge." But surely Dr.
 Chisholm,  before  he ventured upon this extravagant and most inapplicable compari-
 son, before he assumed this excessive accumulation of some undescribed febrile contagion, 
454
came governor of the  colony,  (if it may be so called)  adopt,  in the
smallest degree, any of those measures, for  " separating the infected
from  the well," and for  "preventing  the spreading"  of  the  fever,
which he had  at first supposed to be of high importance;  and  which
he certainly would not have neglected, with so much humanity and vi-
gilance as he has manifested on aVJ occasions,  had he  still retained his
former opinion.  Capt. Beaver was, in truth,  so far from  believing Dr.
Chisholm's allegations respecting  the Hankey, that he has,  on various
occasions, given those  allegations  the  most  decisive  contradiction:
witness among others, tiie  following passage, at p. 305  of his African
Memoranda, viz. "the mortality which took place in the island of Bu-
lama, and on board the  Hankey, after her departure from it,  was in this
country called  the  plague,  or Bulama fever,  by those  who were inim-
ical to the success  of our enterprise; and such serious representations
were made on  the  subject,  as produced  an order from the privy coun-
cil to  sink that ship, though on further  inquiry it  was  not carried into

should at least have proved the existence of a few particles of it, either in the Calypso
and  Hankey or upon the island of Bulama.  In  regard  to the former,  Dr. Chif-holm
has admitted  (what might otherwise he readily  proved) that when these ships sailed,
and during the voyage out, the crews and settlers were  all healthy," and that " no sus-
picion  whatever can be entertained of the existence of latent infection among them."
See his Essay on the malignant pestilential fever,  &c vol.  1. p.  103, et seq.  It follows,
therefore, that if the fever in question  was produced by contagion, generated  in either
of these ships, it must have been after her arrival on the coast of Africa,  and  that the
guilty ship must have  been  the  Ctdypso, since,  according to Dr.  Chisholm's last new
opinion  (adopted to take advantage of Captain Beaver's error) the infection was commu-
nicated from her to  the Hankeff.  But I have already,  in different places, adduced so
many facts decisively proving that filth, crowding, and all the other causes supposed to
be capable of generating febrile contagion, do not produce that  effect, when in cold or
temperate climates, and in  circuinstances which ought to lender those  causes highly
prolific, if they were capable of such  generation, that I shall not be here expected to
enter upon a particular refutation of Dr. Chisholm's- unsupported and  most improbable
suppositions, respecting the Calypso and  Hankey; especially as it has been  already
proved that the high temperature between the tropics,  is so  unfavourable, I need not
say to the generation, but to the existence, of febrile contagion, that even when it hap-
pens to be brought into that temperature  it cannot subsist, much less propagate itself.
Dr.  Chisholm's inconsistencies on this subject are truly ridiculous.  In his Essay, at p.
95 of vol. 1. he asserts,  that " the state of the  atmosphere  between the tropics does
not seem to admit the generation of a /ugh degree of  infection," and at  p.  189 of his
letter to Dr. Haygarth he says, "one universally  admitted fact,  I mean in the West In-
dies, incontestably proves that heat and filth do not render shipping " the most dan.
gerous of all human habitations."  The fact (adds he) is  this, that the  shipping frequen-
ting the different ports of the  West India islands before  1793, were almost uniformly
and remarkably healthy." Yet, in the  very same letter, he  twice adopts and repeats
what he had previously declared  in his letter to  Dr  E. H. Smith, that  "a fever (on
board the Hankey)proceeding originally,  perhaps, from the inclemency of the season,
and the circumstances of the situation of the adventurers,  had become, by confinement,
filth, consequent impurity of air, and depression of spirits, a true  jail fever,  or fever
of infection heightenedto almost pestilential violence," A jail firver between the tro-
pics ! ! ! and a jail fever heightened to almost pestilential violence,"  in an atmosphere
which  he had before mentioned as not admitting " the generation of a high degree of
infection ! /"—And least these contradictions should be thought  too few,  he tells us,
at p. 217 and  218 of the very same letter to Haygarth, that (instead of jail fever) the
disease imported hy the Hankey to Grenada was a " nova pestis,  a peculiar, original fo-
reign  pestilence, recently generated, and utterly  unknown  before,9 8cc. ( see p. 201 of
this volume J Had he told us that  the supposed causes of  this new plague,  had generated
Elephants at  Bulama, I should have thought the talc  less improbable, because  these
animals have  been frequently seen on that island, while neither plague nor pestilential
fever ever was nor as I believe ever will be. 
455
 effect;  and the ship was restored to the owners, after their having sus-
 tained very considerable less, by the industry with which certain inte-
 rested people  kept  up the report of the malignity of the distemper,
 which it was said that ship brought home, and for which there was
 not  the  shadow of a foundation."  Again, in a note to p. 192, after
 noticing the report of the pestilential fever or plague, supposed to have
 been carried by the Hankey " from Bulama to Grenada," captain Bea-
 ver  adds, "this report was for a considerable time believed;  the Han-
 key was sent to Stangate Creek to perform quarantine, and orders were
 given for sinking the ship and. cargo;  however, on  examination,  the
falsehood and  malignity of this report Hieing proved, this order was
 oonfined to the Bulama baggage only."
   In addition to these facts I shall  now adduce the most decisive evi-
 dence, to prove  that  the  fever which prevailed in the  Calypso and
 Hankey, and  among the  adventurers  to  Bulama, was the  common
 marsh fever of the  western  coast of Africa;  and for this purpose I
 shall first quote the testimony of Lieutenant-Governor Young, who, in
 his  " return"  of the deaths  of the Bulama adventurers, and in allu-
 sion to  the fever, which produced  so many of them, observes con-
 cerning it,  that " the coast fever is of the intermitting kind and  not
 infectious" [See  Wadstrom, page  313.]  This gentleman's com-
 petency to form  a judgment on the subject will scarcely be  doubted,
 after reading the following character of him by Capt. Beaver, at p. 82
 of African Memoranda :  " Young, next to the governor in the council,
 was  a man in  mind and information inferior to none  I have  ever had
 the  happiness  to know.  I respected, I loved him: and never  was in
 his company without  leaving it both wiser and better, from his know-
 ledge and  virtues :"  and he  must have had very sufficient opportuni-
 ties of observing  the intermitting nature of the  fever, and its non-in-
 fectious quality, both  at Bulama and on his passage in the Calypso to
 England, during which about forty  of the persons on board are stated
 to have died, mostly  of this disorder.  Mr. Paiba's testimony on  this
 subject, as communicated to Dr. E.  H. Smith, and published in the
 New-York Medical  Repository,  vol.  1,  p. 463,  is in these words:
 " Concerning the sickness which carried off the colonists, both at Bu-
 lama and Sierre Leone,  and on the home passage of the Calypso, it
 may be  remarked,  once for all, that it was by no means of one kind,
 as the readers  of Dr. Chisholm would be led to suppose.  Few, if any,
 escaped, altogether, some had regular intermittent fever,  (which is
 the  fever  of the coast,) of various  continuance, from a week to seve-
 ral months; others had a  violent fever, which terminated favourably
 or fatally,  in one, two, three, four,  five, or six days ;  or which linger-
 ed out after its first  violence as many weeks ;*  some had  diarrhoea,


   ' The " violent fever" here mentioned may, in many cases, hive been a marsh fever,
 aggravated by some other of the well knowu causes of fever, such as being caught by
 heavy rains,  drunkenness,  fatiguing exercise, or labour in the sin, &c. and in a few it
 may have been produced by these latter causes only, though it seems difficult tu believe
 that any person, who had been evnn but a few weeks on the islai.d, could hive, so far es-
 caped the influence of marsh miasms, as that a fever in him should not, in som^ decree
 have resulted from their  influence. 
456
ilid dysentery;  and others fell martyrs to the indiscreet use of opium*
and spirits, as preservatives."
  But-to render superfluous all other evidence on this subject,  I will
here adduce that of Dr. Winterbottom,  who, by appointment of the
Sierra Leone company, was physician to that colony, when the Calyp-
so arrived there, with Governor Dalrymple, and the discontentd  colo-
nists from Bulama;  and consequently had abundant opportunity of be-
coming well acquainted with the fever which prevailed among them,
and which was  supposed to have  been communicated from that shi/i
to the Hankey,f and undoubtedly  the testimony of a physician so im-
partial,  and so respectable by  his character, and his general as well  as
professional knowledge will be deemed conclusive on this subject.   It
was  given at p. 16  of the 2d  volume  of his account  of the native
Africans,  where he says,  " the fever which carried off so many of the
settlers  at Bulama, precisely resembled the endemial remittent fever of
Sierra Leone,  a  sketch  of which, at some  future  opportunity, may
perhaps be laid before the  public ;  but the fever  described, by Dr.
Chisholm" (meaning the malignant pestilential fever,  so called  by
him,  and supposed to have been brought by the Hankey to Grenada)
" differs so essentially from that which occurred at Sierra Leone, that
it cannot  be  recognized  as the same  disease."  Afterwards, in the
same page,  Dr. Winterbottom corrects  one of Dr. Chisholm's errors
in regard  to the Hankey,  by stating that she " had no communication
whatever with Sierra Leone;  adding, " the other vessel, the Calypso*
after leaving Bulama, called for refreshment at Sierra Leone, where
she remained about six  weeks,  during which time upwards of fort ij
of the crew and passengers  died of the remittent fever, though un-
attended with any appearance of peculiar malignity."   Against such
testimony, the  unsupported assertions and suppositions  of Dr.  Chis-
holm, who never was on  the coast of Africa, nor personally acquaint-
ed with any of the facts in question, must be  of no value.
  1 might here, therefore, dismiss this part of my discussion, did not
a regard  for truth compel me to notice  Capt. Beaver's account  of  his
own fever, in order to expose and correct  a very important, and  seem»
ingly a  very culpable, misrepresentation, which Dr. Chisholm  has
made concerning it.  This  account may be found at  p. 161  of  his
African Memoranda  in these words : " The letter which  I  wrote to
the  trustees  by the Hankey was, I  think, dated Nov. 23,  1792.  It
was written  during that and the two preceding days, in those intervals
when I  had the full  possession of my  senses, ahd was able to apply
myself  for a short  time to writing, for  long I could not; and each of
the first two of those days, as well as for several before, I was delirious,
generally from about 10 A, M.till 2 or 3 P. M. and this was the case in" al-
most all the severe attacks of the fever which 1 afterwards had.   This
was owing to the excessive heat between those hours; for I invariably
got   better as the sun declined,  and never  experienced the violent
raging of the fever till the sun had again acquired power on the follow-


  f Though the fever was not communicated  by one ship to the other, it was manifest-
ly the same in boll?, and derived from one common source—marsh effluvja. 
457
iftg day.'*  Page 161, African  Memoranda.  See likewise his othei»
description, at page  173—4, and at page 114—121 ;* from all which
his disorder appears  to have been one of those marsh, or intermitting
fevers, the paroxysms of which are often accompanied by  delirium,
at least between  the  tropics; and it could not, therefore, possess any
contagious property, even  in Dr. Chisholm's opinion, as delivered in
various parts of his writings; and particularly in the first volume of his
Essay, Sec. p. 299, in these words, viz. "The true uncombined yellow
remitting fever, deriving  its origin  from the miasmata of  marshes,
and the various exhalations from putrid vegetable sub^fcnees, confined
humidity, and stagnant water, is not contagious ;  nor can it be proved
to be so in any instance, of Torrid Zone at least."  But in direct op-
position to this opinion, he makes the following unaccountable state-
ment, at p.  102  of his  letter to Dr. Haygarth, viz.  " The fever"  (at
 Bulama) "appears to have been direfully contagious ; for in one in-
stance, particularly, three persons who were  near his" (captain Bea-
 ver's) " bed,  during his own  illness, from which he almost miracu"
 lously recovered, received the  infection from his person, and died soon
 after."   And for proofs in support of this allegation, Dr. Chisholm
 refers to pages 171 and 172 of the African Memoranda, where indeed,
 mention is made of captain Beaver's illness, and of the deaths of three
 persons in two succeeding days, but without any fact, or circumstance,
 indicative of the existence of  any  thing like contagion, or of any con-
 nexion between captain Beaver's disorder and the deaths in question.
 The only passages relating to  this  allegation, which occur in the pages
 referred to by Dr. Chisholm,  are the following, viz.
    "Thursday,  December 13, 1792.  "Very ill; delirious part of the
 day.   In the  evening,  after having somewhat recovered my deranged
 senses,  sent for Messrs. Fielder and Hood, the only  subscribers  able
 to move; made my will,  and  gave them  advice how to act in case of
 my death."
    " Friday,  14.   Died of a fever,  and were buried, both Mr. and Mrs\
  Freeman.  This couple  I married  on the 4th  of last month.  They
  were both taken ill, about ten minutes after the ceremony was  per-
  formed,  and have  been so ever since.   They both died this morning,
  within ten minutes of each other,  and  were both buried in the same
  grave.   Myself a great deal better  in the morning, but delirious great
  part of the afternoon."
     "Saturday,  15th.   Died and was buried this evening.  Mr. Fielder.
  This is  the  man who, two  days ago, made  my  will,  and  whom I
  thought likely to be my successor.  He was young and brave—fit to

    • Capt. Beaver, at p. 354, states himself to have " had seven separate attacks of the
   fever;" a circumstance which even if most of them should be considered merely as re-
   lapses, must render it very unlike Dr- Chisholm's malignant pestilential fever, which he
   represents as derived from the same source, or contagion,  as that which he supposes to
   have produced  the fever of Captain Beaver ; for the doctor asserts, that, " by a general
   law of the peculiar contagion"  of his pestilential fever,  " those once attacked and  recov-
   ered are exempted from being affected by it."  See letter to Dr. Haygarth, p. 180. My
   readers  will not, 1 hope, conclude  from the mention which I sometimes make of this
   supposed " malignant pestilential fever," that 1 believe such a fever to hr.ve ever existed,
   or that the fever so called was any thing else than a modification, or variety, at most, of
   the common non-contagious yellow fever.
58 
458
draw a lion's tooth."  These being the only deaths to which Dr. Chis-
holm's reierence can be applied, or  extended,  we must necessarily
conclude that these were the three persons in his contemplation, when,.
to prove that captain Beaver's  fever was direfully contagious, he ven-
tured to assert, that in one particular  instance, (leavuig us to suppose
many others probable,) three persons,  who  had been near captain
Beaver's bed,  &c. received the infection from  his person, and died
soon  after."   Now, from the  antecedent parts of captain Beaver's
journal, it appears that the fever, under which he laboured on the 13th
of December4*792,'had only commenced on the 9th of that month,
34 days afterMr. and Mrs. Freeman were attacked with that  fever
which occasioned, and lasted until their deaths.   It is true, indeed, thai
captain Beaver had been attacked by fever some weeks before, but this
was not until  five days after the illness of Mr. and Mrs. Freeman had
commenced,  i. e. until the  9th of November; and as previous to that
day, captain Beaver had been well for about six weeks,  Dr. Chisholm
could not,  with any degree of truth,  pretend that they had  received
febrile infection from his person, and died  soon  after; especially  as
their deaths only happened after forty days; a protraction of disease,
which I am persuaded Dr. Chisholm has never mentioned, as occur-
ring in his malignant pestilential fever.
  In regard to Mr. Fielder, no mention is made in the pages referred
to by Dr. Chisholm;  nor, so far as I can recollect, in any other, of the
disorder which caused his death;  nor arc we entitled from any  thing
within my knowledge, to  conclude that he died of fever.   But if this
did cause  his  death,  it could  not  have been produced by contagion
from  captain Beaver's person, at the time of making his will; because
even if his Beaver's) fever had been contagious, we have the strong-
est reason  to believe,  that no febrile contagion has ever produced dis-
ease and death within forty-eight hours from the time of its being re-
ceived.  There is, therefore,  nothing which I can discover to excus'e,
and much  less to justify, Dr. Chisholm in the serious liberty which
he appears to have taken with the truth, on  this interesting subject; a
liberty which  is the more extraordinary, because as the facts which
have  been so  strangely misrepresented, were  distinctly  and perma-
nently stated in print, there appears to have been no room for any mis-
take; and, unfortunately for Dr. Chisholm, the impression^ resulting
from  this incident will not be weakened by others,  which must hereaf-
ter fall under our notice.
  After this digression, it will be proper for us to return  to  those
events which more immediately relate to the crew of the Hankey,  of
whom it has been already mentioned that three were ill of fever,  when
the Calypso sailed on the 19th of July.  But  during the subsequent
part of the rainy season, they remained comparatively healthy; proba-
bly because they were much less exposed than the  settlers to the
causes ol fever  on shore.  For if the fever had been contagious,  as
Dr. Chisholm pretends, the seamer, by remainmg constantly on board
with  the  sick, would probably have been infected  sooner,  and  in
greater numbers, than the colonists  who  were labouring on shore.
But when  the Hankey began to prepare for her return to Europe, and
,her captain, (as is stated in captain Beaver's Journal, p. 135,) "want- 
459
jng ballast,  and being unable to procure any of 'stone, determined to
ballast her with wood;"--"all the men he could spare" were sent "on
shore to cut it;" which is notoriously  a most dangerous employment
between the tropics.  It is also mentioned, in captain Beaver's journal,
under the date of October 31, that " all this day, by permission of cap-
tain Cox, the Hankey's crew have been stowing away our goods in  the
store-room" on shore.  And they are stated to have been employed in
this service on the three following days.  Again captain Beaver states,
" 4th,°.f November.—Four of the sailors came on shore to cut logs for
«*;" Le  the settlers,—see p.  159.   And besides  these, they were
sent upon another dangerous employment, that of watering the ship;
by all which they must in that situation have imbibed marsh miasms,
sufficient to  account for their subsequent sickness, aided  by other ma-
nifest causes.  After  leaving Bulama  on the 23d of November,  the
Hankey went  to the unwholesome settlement at Bissao, and remained
there for a week, during which, it may be presumed, that the sailors
run into their customary irregularities; and with these, added to the
other causes of disease, it cannot be thought extraordinary, that " three
of the crew were taken ill of fever," on the 3d of December, when the
ship sailed from Bissao.  Her getting aground,  and the other  events
which followed  until  she reached St.  Jago, have been already men-
tioned.  On this subject, captain Beaver has made the following  ob-
servations, at p. 192 of African  Memoranda, viz.—"When the Han-
key left Bulama, not  one of her  crew had been  buried, although so
many of the colonists had;  however,  a  few days afterwards she  be-
came very sickly: and this  was  most likely increased by the extraor-
dinary labour, consequent on the ship's running a-ground on the  4th
of December, in the Bijuga channel;  in which situation she remain-
ed until the 9th; and the hoat haying been sent about 90 miles to Bissao
for assistance, I find  noted  in the Hankey's Log-Book, on the day of
her return, which was the 8th, " all the people which came from Bis-
sao in the pinnace taken ill." He  adds, " this was, in all probability,
owing to their great fatigue, and exposure to the sun in the day,  and
the dews in the night."   Here  it  will be observed, that though  Dr.
Chisholm would have us believe  that all  the sickness and mortality
which occurred on board the Hankey about this, as well as at other
times, were produjeed by that "direful" contrgim, which'was ima-
gined by him, Captain Beaver had entirely discarded all belief of it,
and  has ascribed events  to  their usual and natural causes,  upon this,
as well as former occasions.
  I have already mentioned the Hankey's arrival  in  the  Bay of St.
Francis,  at St. Jago, on the 26th of December,  whence she removed,
and came to anchor at Port Praya, in the same  island, on the 4th of
January,  1793; having then lost by deaths, subsequently to her de-
parture from Bulama, eight of her crew, with  five men,  three  wo-
men, and two children, colonists, who had  been taken on board,  I
belieye,  all in a sickly condition.*

  •Mr. Paiba  states, that all the colonists who embarked at Bulama, to return in the
Ilatrtcey, excepting himself, Mrs  Paiba, and another woman, were unwell; as might in-
deed be supposed  from preceding events. That " before the Hankey put to sea, all
tke bedding of the sick was thrown overboard, or destroyed ; and the ship was washed 
4G0
  When the Hankey had been  a week  at Port" Praya, the Charon,
ship of war,  Commodore Dodd, arrived there from England, an event
which was made the foundation of a most extraordinary misrepresen-
tation  by  Dr. Chisholm,  in his first publication, respecting what he
called the "Malignant Pestilential  Fever,"  "from Boullam"  See.
The following is Dr.  Chisholm's statement, (p. 87) viz.—
  " With much difficulty they  (the  Hankey's people,) arrived at  St.
Jago,  where they fortunately found the Charon and Scorpion,  ships of
war.*   Captain Dodd, of the former,  humanely rendered them every
service in his power; and on leaving them, put two men of each ship
on board  the Hankey.   With this aid, they proceeded to the West
Indies; a voyage to England  being impracticable in their wretched
state.   On the third day after leaving St.  Jago,  the men they procur-
ed from the ships of war,  were seized with the fever, which had  car-
ried  off three fourths of those on board the Hankey, at Boullam;  and
having no assistance,  two of the four died: the remaining two were
put on shore  here, in ttye most wretched state possible.  Captain Dodd,
on bis arrival at Barbadoes, from the  coast of Africa, was ordered by
Admiral Gardner to convoy the  homeward-bound  fleet of merchant-
men.   In the execution of his orders, he came to Grenada on  the
27th  of May, and  hearing of the mischief which the Hankey  had
been the cause of, mentioned that several of the Charon's and Scor-
pion's people were sent on board the Hankey  at  St. Jago, to repair
her rigging,  &c.; that  from  this circumstance, and the communica-i
tion  which his barge's  crew had with that ship,  the pestilence  was,
brought on board  both ships: and that  of the Charon's crew thirty
died;  and of the Scorpion's crew about  fifteen. The  Hankey arriv-
ed at the  Port of St.  George,  on the  19th of February, in the most
distressed situation ; and for a  few  days lay in the  bay,  but was after-
wards brought into the  Carenage."
   By the publication of such apparently decisive, though fictitious, in-
stances and proofs  of a most powerful and destructive contagion, on
board the Hankey, joined to others  of equal value, which were stated
by Dr. Chisholm to have  occurred after her arrival at Grenada, we
cannot wonder that many persons  were so far misled,  as to believe in
the  generation and  importation of a new and " direfully" contagious
fever by that ship; for  at first the Hankey, and not the Calypso,  was
represented   as the parent of this monstrous  and dreadful  produc-
tion.  Fortunately for the cause of truth, the falsehoods regarding the
Charon and  Scorpion, were detected, and laudably exposed by Dr.
Trotter, who happened to be then surgeon to the Vengeance, ship of
the  line, one of Admiral  Gardner's squadron, under whose protection

from stem  to stern, both above and below, with salt water, and then with vinegar and
 water, and tbe purification was completed, by thoroughly fumigating her with tar,  pitch,
 and  gun-powder; and that this purification was repeated at Bissao;  and he ascribes the
 eight deaths, which occurred subsequently to the ship's getting a-ground, principally to
 the terror,  confusion, great fatigue, &c. occasioned by that event. See New York Medi-
 cal Repository, vol 1, p. 4GG.

  * The Charon did not arrive until  the 13th  of January, a week after the Hankey's
 arrival : and Scorpion only entered l\X Praya on the 24th, one day after the Charon
 had left it. 
461
die homevvard-bouiid West India summer  fleet (of 1793) was then
returning to England.  He informs us, at p. 327 of the first vol. of his
Medicina Nautica, that on the 22d  of August, a ship, one of the fleet,
y- lost her fore-mast in a  squall of wind, and received other damage,
when the Admiral made the signal for the Vengeance to take her in
tow.  The ship proved to be the Hankey from Grenada and Bulama.
Captain Thompson sent carpenters on board, with the necessary stores
to assist in repairing her losses : they remained for three or four days,
but no sickness followed, Sec.  Dr. Trotter afterwards mentions, how
from this, and other circumstances, he was induced to make inquiries
concerning Dr. Chisholm's account of the consequences of the Hankey's
intercourse with the Charon and Scorpion, particularly from Captain
Dodd, who " had his broad petulant" in the former ship, and of Mr.
Smithers, who was her surgeon: from them, says Dr. Trotter, I have
copied the following narrative of their transactions with the Hankey,
viz.—
   " When the squadron, under  Commodore Dodd, came to St. Jago8
in  1793, the  Hankey lay there, in great distress for want of hands,
having buried above one hundred persons,* men, women, and children,
from the time she had been at Bulama. The fever was now overcome;
Mr. Smithers saw two men who had lately recovered.  He prescribed
tp the master, who was ill of a venereal complaint, and for which he
left him some mercurials,  with directions how to use them;  at the
same time he left a quantity of bark.   The Charon and Scorpion sent
two men each to  assist  in navigating her to the West Indies.  The,
Hankey at this port was cleansed, washed with vinegar, and fumigated.
No fever appeared in either of the men of war in consequence of this
communication; they arrived at Grenada in perfect health," Etc. Dr.
Trotter adds, " It is probable from these facts, that the Hankey did
not import the infection that produced the Grenada fever."—It is also
doubtful, how the effects left in  the Hankey, could produce the fever,
for the bedding was thrown away, and what clothing remained had been
aired, and probably had scarcely been in  contact with the body after
being sick.  Mr. Smithers was  examined before the (lieutenant) go-
vernor pf Grenada on the the subject, and gave his opinion decidedly,
that the  Hankey did not communicate this fever to the colonists."
   From this statement, and other proofs, it has been unquestionably as-
pertained, that every part of Dr. Chisholm's  account, which asserts the
 communication of any disease  from the Hankey to the Charon and
 Scorpion, was a mischievous falsehood, fabricated without the smallest
foundation,  or  particle  of  truth; since the latter ship did not lose a
 single man during her whole voyage, and the Charon lost only four,
 from causes described by Dr. Trotter, and wholly  foreign  to the Han-
 key.  Indeed, two of these four did not belong  f o the Charon, and one
 of them was  a black prisoner, sent to England to be tried  for murder.
 But what is Dr. Chisholm's apology, what his atonement, for having
 asserted and published these falsehoods?  Why, truly, in  the  preface
 to his, second edition> after noticing Dr. Trotter's publipation on this

   * This  number is stated generally, and prphably from imperfect recollection. Tie
 deaths amounted to sixty, and no more;  of these nine were seamen. 
462
 subject, he says, p. xxii.  " On further inquiry, 1 find 1 have been in-
 correct* in my statement  of the circumstances of the  interview (an
 interview between  ships!) which the Charon iiad with the Hankey at
 St. Jago;" and then, as if not willing to retract on the evidence of Com-
 modore Dodd and Mr. Smithers, or without seeming to do it spontane-
 ously from other evidence, (which we are to suppose an anxious regard
 for truth had induced him  to procure)  he mentions his  having been
 " politely favoured" " with the perusal of a Log-book, kept" by " a
 lieutenant of the Charon, during the voyage in question;" in which he
 says, " I found that no sickness took place on board that ship in  con-
 sequence of the interview."  And the.i he adds, (perhaps as a compli-
 ment to Commodore  Dodd and Mr. Smithers,) that " a Log-book is
 unquestionable evidence, and, therefore, I have suppressed what I have
 advanced on this affair," (a great favour truly'. )  " on  the authority
 of the late  Mr, Home:" adding, " but why Mr. Home  should men-
 tion this as a fact communicated to him by Commodore Dodd, I can
 assign no reason;" nor indeed  can any other person, as I believe.  But
 before we employ  our time  in assigning reasons or motives for  sup-
 posed events, it is always best to inquire whether they have really hap-
pened.   The  question seems to be,—Whether, in truth, Mr. Home
 did inform Dr. Chisholm that  Commodore Dodd had told  him these
 falsehoods ? This being a question of no small importance; the affir-
 mative is not to be assumed with  Dr. Chisholm's seeming levity and
 unconcern.  For the assumption is  nothing less than fixing upon the
 character (as  I believe unblemished) of  a gentleman now dead, and
 unable  to justify himself, the stigma of having invented and propa-
 gated the most groundness (and in no small degree injurious) false-
 hoods ;t for no person will believe that Commodore Dodd, without
 any discoverable motive, should have invented  and  reported what he
 manifested so much readiness in contradicting, and  in authorizing Dr.
 Trotter to contradict,  and what every man on board the Charon and
 Scorpion, as well as himself, knew to be false.
   Had  Dr. Chisholm  in stating these untruths, named his  authority,
 as he ought to have done, and had the person named admitted  him-
 self to have been the informer,. Dr. Chisholm's veracity would not  have
 been impeached, whatever might have been thought of his discretion,
 in publishing such reports.   But instead of this, he ventured to assert
 as from, or, within his own knowledge,  that Commodore,  or Captain
 Dodd, on coming to Grenada,  and hearing of the mischief caused by
 the Hankey, had "  mentioned" the falsehoods in question ;  and by this
 unqualified assertion, he had made himself responsible for its truth, and
 liable to be  considered as  its  author.  I do not mean to decide that
 Mr. Home  did not give Dr.  Chisholm such information,  as he pre-

  * When the principal facts in a statement are true, and the lesser circumstances, or
 incidents only,  are imperfectly or erroneously stated,  the author  of such a relation may
 describe himself as having betj 1  •' incorrect;"  but when all the parts for which a state-
 ment was made, are completely unfounded,  and without any  intermixture of  truth,
 other and stronger terms can alone be  proper.  1 should not have made this observation,
 if Dr. Chisholm had «ol so often, and  with very little reason, applied  the harshest and
 most offensive language to others in his writings.
  •J- Mr. Home, I believe, lost his life by the hands of assassins; ahd I will not co-opcratc
 in subbing his reputation, when he is no longer able to defend it. 
4G3
 ^nds ; but on a question of this nature,  I feel it to be my duty to con-
 sider and weigh probabilities;  and,  in  doing this, I recollect that Dr.
 ^nisholm is, at best,  an interested  witness, and, therefore, cannot be
 received  as  one, on this  subject;  that  his own  character is  in  jeo-
 pardy; that when making  his  groundless statement, he, in a  note to
 tiie very page which contains it, has mentioned Mr. Home, as giving
 mm  ^formation respecting  Captain Coxc's refusal to destroy the ef-
 tects of the  Bulama  adventurers,  unless  indemnified; but  has no*
 even hinted at Mr.  Home as  having  mentioned the other supposed
 tacts, vyhich  had  just before  employed  his thoughts   and  his pen;
 and which,  therefore,  it would have been most natural and proper for
 him  to have done, if they  really had been  stated on that gentleman's
 authority.   And  I recollect  also, that while I  have  no reason to sus-
 pect  Mr.  Home of having ever, either wilfully or incautiously propa-
 gated untruths, Dr.  Chisholm appears  to have  done  this  in but too
 many instances ;*  and,  therefore, the balance  of probabilities,  in my

   * Some of these instances have been  already mentioned, and others will  soon fall un-
 der our notice.  But in the mean time, there is one  so analogous to the matter in discus-
 won, that 1 cannot avoid noticing it here, especially as it proves, that instead of becomin-
 more: cautious and attentive to facts, as an atonement for the untruths published respect-
 ing the Charon and Scorpion ; Dr. Chisholm,  subsequently to his retraction of them, did
 not scruple to assert, and publish others equally void of truth, and for  the same mischiev-
 ous purpose ol proving his Nova Pestis to be direfully contagious.
   1 he following are his own words, at p. 32th, of vol. ii. of his Essay, viz :—« When
 visited this island, (St. Thomas's) in Novemher, 1796, an accident famished me with ah
 opportunity of informing myself relative to the history of the malignant pestilential fever
 as it appeared there in 1793 4,5, and at that time.  The history was indeed a melancholy,
 but it was also an iusti-uctive one  An eminent merchant, M. C. G. Flicker, with whom
 I had been acquainted at St. Croix,  requested me to visit a valuable voung German gentle-
 man of this house, of the naineo; Schmaler,  who had arrived from "Hamburgh only about
 ten days before, and at this time  unhappily  laboured under a fatal attack of this most
 dreadful malady  In Mr.Flicker's house,  the indignant pestilential fever  had very
 frequently made its appjpunce during and since 179J,  and except in one mstauce, the
 captain of a Hamburg ship, alwa> s  fatally.  No means, at least r.oue sufricirnt for the era-
 dication of the infection, had beL-n  <p>. ployed on the death of the unfortunate sick, conse-
 quently the chambers, which we     ccessively occupied by strangers  from  Europe, be-
came a never-failing seminiuin ..;' the pestilential contagion.  V very few day.s alter his
 arrival, Mr. Schmaler felt its influence," &c.   This misrepresentation, to call it by the
 mildest name, being made known to I F. F.ckanl, Ksq. Danish vice-consul, at  Philadel-
 phia, that gentleman wrote a letter to Dr  Mease of that city, in which after giving a co-
 py of it, he adds the following observations, viz.
  " Dr. Chisholm, no doubt alludes, in the above  paragraph to Mr. C  G. Fleicker, who
 resided at St.'l'homas's, but who had not, at the period of Dr. Chisholm's visit any regular
 establishment in the island, but acted as  an assistant to ui\ nouse, of which Mr Schmaler
 was clerk.  There being a greatintiraacy between Mr. F'eicker and myself, he often in
 my absence, was authorised to superintend my  concerns, and this was the case at the time
 Mr. Schmaler died.  I was, however, at home when he arrived from Europe, and return-
ed soon after his death.
  «' More young men had died in my house,  from 179> to 17 »6, and even later, than per-
 haps in any otherin town ;  because more had  come  out to me from F.uropo than to oth>
er merchants.  Their deaths, however,  could not have been  occasioned by the contagion
remaining in the chambers or the house, as Dr Chisholm supposes;  for the cases  took
place at remote periods, in  diT-rent houses-;  I having clnnged my dwelling iu 1795__
Neither could their deaths  havi  ,ic»iV occasioned by  i he contagion remaining in the bed-
ding, for the beds and bedding of those who died of a putrid feverin my house were never
used again. Further, according to  the best of my recollection, two persons were never ill
of the  fever at any time, in the  same chamber,-in «ither of my houses; in  both of
which  I had  tour or five rooms  appropriated for  clerks :  besides many persons slept
in  those chambers without any  inconvenience   If  Dr; Chisholm's account were cor-
rect, my house mast have  bien  a lazaretto, for  those suppnscd   pestiferous ch.im- 
164
judgment,  is very Unfavourable to  him.  And in any event, u writer
who will adopt, and give his utmost sanction to  unfounded reports,
when they  happen to suit his own purpose,  must not expect that evert
his facts, when be  happens to  state  them, will be  believed, without
other authority than his own.
   It  will be recollected, that the  testimony of Commodore Dodd and
Mr. Smithers, did not  extend to any transactions on  board the  Han-
key,  subsequently  to her leaving St. Jago,  and, therefore, a part of
Dr. Chisholm's statement  was left uncontradicted  by tliem, though
since proved to have been false by the Hankey's Log-book. The part in
question is as follows,  viz :—That  " on the third  day  after leaving St,
Jago, the men procured from  the ships of war were seized with the
fever, which  (as  he pretends) had carried off three-fourths of  those
on board the Hankey,  at Boullam, and  having no  assistance,  two of
the four died : the  remaining two (he adds) were put on shore here,
(at Grenada) in the most wretched state  possible."  The object of
this part of Dr. Chisholm's mis-statement, like that of the  former, is
to prove the existence of this  " direful" contagion on board the Han-
key :  but it seems to be as completely  destitute of truth as the other.
The  Log-book,  indeed, mentions that Samuel  Hodge,  one  of the
seamen sent from the  Charon,  on the 23d of January, died on the 4th
of February; but Mr. Pabia,  a passenger in the Hankey, says  this
man " was unwell when  he came on board,"—though " able  at that
time to do duty ;"—-" that he grew more and more unwell as they pro-
 ceeded."  That " Captain  Coxe, who was still  unwell when the Han-
 key left St. Jago, recovered his health,  before they  reached the West

 hers were almost always occupied ; and I can  assure him, that commonly  a whole
 year,  and  sometimes a longer  period, passed without any one of my family being
 sick of fi-ver   It is, moreover,  incorrect, that  all  ihose/pofsons died  who had heen
 sick of the pestilential  fever during, and since 1793, exeBJjPthe Hamburgh  captain ;
 and also, • that after the two first  years of the introduction of this fever, the inhab-
 itants,  without exception,  whether Creoles  or foreigners, equally suffered.'  The
 truth is, that many Europeans and Vmerieans recovered, both before and after the time
 of Dr. Chisholm's visit to St. Thomas's, and the fever never spread to the inhabitants at
 large, but was confined to persons recently arrived from Northern climates, and to those
 on hoard the vessels in the harbour ; nor was there any apprehension of -flentagion, ex-
 cept among the shipping.  I never heard of a single instance of any person who had resi-
 ded for some years in the island being afflicted with the malignant fever.   A residence of
 nearly twenty years iu the island  enables me to speak positively as  to this fact.
    " I have  not the honour of Dr. Chisholm's personal acquaintance, but as he was so
 polite as to visit Mr. Schmaler in my absence, 1 feel myself obliged to him, and I am sony
 I have been under the necessity of correcting his mistatements.  He mentions  Mr. Jen-
  nings and Dr. Tucker as his acquaintances at St. Thomas's, and to these gentlemen, as
  well as to Mr.  F'leicker, I refer for corroboration of any part of my statement if re-
  quired.
                           Iam,&co.
                                                CSigned,) J. F. Eckaiidi
    Philadelphia, Feb. 1,1804.
    This letter has now been published seven years, (in the 1st vol. of the  2nd  Hexade of
  the New York Medical Repository, (p 337) of which work Dr. Chisholm appears to be
  an attentive reader,) but he has carefully avoided all notice of it,  not pretending  (so far as
  I can discover,) to have been misled by even a dead pei-son ; though his letter to Dr. Hay-
   garth must have afforded him a most inviting and suitable opportunity for giving, if it hqd
   been possible, some satisfactory explanation concerning these his gross  misrepresentations1. 
465
Indies,  (though he afterwards had a return of his disorder,)* and all
the others were perfectly well,  notwithstanding  the hard  duty they
had  to perform,) and continued so."  See New York Medical Re-
pository,  vol. 1, p. 469.
  For these latter untruths,  Dr. Chisholm has never,  so far as 1 can
discover, pretended to have had Mr. Home's, or any other person's
authority; and, though Dr.  Trotter's publication  ought to  have con-
vinced him that they were,  at least,  very improbable,  he confidently
re-published them as matter of fact, in  his second edition; and has
not, in any subsequent publication, either retracted, or apologized for
them, though the truth  had been  forced  upon his notice by the Han-
key's Log-Book.
  After a passage of 19 days, the Hankey arrived at Barbadoes, and
there,  Mr.  Paiba states that, during a  great part of two days, her
captain, passengers,  and crew,  communicated freely with the inhabi-
tants, without causing disease in any of them : they did the same af-
terwards at  St.  Vincent's; and  anchored at Grenada on the 19th of
February, according to  Log-book time, but  in ordinary language, in
the afternoon of the 18th.  The next day, several paragraphs appear-
ed in the St. George's Gazette, mentioning the Hankey's arrival " from
the  island  of Bulama,  on the  coast of Africa;" and "that  she and
another vessel  had carried out to  that settlement upwards  of 300 ad-
venturers, of whom one-third had  not survived her departure from the
settlement," &c. In addition to these exaggerations, it was asserted, as
" from good authority, that of the whole number the two ships car-
ried out, only  ten were living when she (the Hankey)  took  her de-
parture."
   It is not wonderful that such gross mis-statements should have creat-
ed apprehensions of  danger  from supposed contagion  in the Hankey,
among the inhabitants of St. George's, and have also excited and given
a bias to Dr. Chisholm's industry on this subject.  It happened,  also,
that  a state of  weather  then existed, and had existed some weeks be-
fore, at Grenada, very  unlike that of other years, and better suited for
a copious production of marsh  miasmata.  This fact  appears from an
account which Dr. Chisholm has himself published, in the-introduc-

  * This appears to have been an intermittent, of which Captain Coxe is stated to have
had  several returns, as commonly happens to those who have been much exposed to
marsh miasms   Mr. Paiba  states distinctly, that while the Hankey  was at St. Jago,
 there was no sickness on  board of her, but " debility,  and  slight intermittents ;" that
 " her crew and passengers  mixed without suspicion, and with perfect freedom with the
 inhabitants of Port Praya, and received them on board, where they had a  number of en-
 tertainment,  of which the governor of the island and several of the principal people
 partook," without so much as a suspicion of any sickness " being excited by it."  He adds
 "Indeed no sickness prevailed at St Jago during the Hankey's stay, excepting the com-
 mon  ague and  fever  of the  place" That during the ten days which the  Charon re-
 mained at Port Praya, it was the commodore's " custom to send his  barge every morn-
 ing to the Hankey, for Mr.and Mrs. Paiba, who usually spent the day with him, and re-
 turned  in the  evening.—That Captain Coxe was several times on board the Charon ;
 and both Mr. Smithers and his mate visited the Hankey, and two of the Charon's seamen
  were employed great part of one day about the Hankey's rigging.  And finally, that Com-
  modore Dodd had so little apprehension that any person belonging to the Hankey would
  be liable to infect others, that he gave Mr and Mrs Paiba a letter of recommendation to
  a gentleman at Grenada ; and in  consequence of  it, they were invited to reside, and did
  reside at this g* ntlcman's plantation, while they remained on the, island. See New-York
  Medical Repository, vol. p. 468-470.
                                   59 
46G
 tion to his Essay, of " the changes  which took place in cacb month of
 the years  1784, 1785, 1786, and 1793," and from  his " table of the
 highest, lowest, and  medium height of the thermometer during that
 time;" "from all which it results that in  1793, the months of January
 and February  were generally rainy, which he notices as " an uncom-
 mon circumstance ; and that the heat in those months was uncommon-
 ly great ; the thermometer,  at noon, rising to 88, and 89",  and which
 is 3 and 4 degrees  higher than it was during the same months in any
 of the preceding years; and seven degrees higher than in 1785.   And
 in the three following months there appears to have been such  an in-
 termixture, or alternation  of showers and of hot sunshine, as com-
 monly renders  marsh fevers prevalent in places liable to them.
   Dr. James Clarke, also,  in his treatise of the yellow fever, which
 prevailed in the same, and following years, in the neighbouring island
 of Dominica, says, p. 49, " from tiie month of January to the 15th of
 June,  (1793) when this fever first broke out, the weather was extreme-
 ly calm,  and much  hotter than usual in this and the neighbouring is-
 lands.   There  was little rain  (he adds) till the 15th of October," at
 which time  " this fever became less  violent here;  and  about the be-
 ginning of November it ceased altogether."   In the next page he ob-
 serves, that in June, July, August, and September,  Fahrenheit's ther-
 mometer "generally rose to 88° or 90° and sometimes to 92 degrees,
 between the hours of  two and four o'clock, P. M."   Again, at p. 51,
 he says, " the  heat for some months before, and during the continu-
 ance of this  fever in the island, especially in the night time, was al-
 most insupportable."
   Whether the very early  appearance of the yellow fever in most of
 the West Indian islands, in 1793, resulted from this unusual state of
 the weather alone, or whether there was a co-operation of other causes
 which  were either unknown, or unnoticed, I leave for the considera-
 tion of others, and content  myself with again  expressing  my belief,
 that we are not  yet acquainted with all the causes which assist either in
 the production of marsh miasmata, or in rendering their morbid influ-
 ence more powerful than usual.   But we know particularly from what
 happened at Charleston, in 1732, (seep. 245 and 319,) and at other
 places  to be hereafter  mentioned, that the occurrence of yellow fever,
 as an epidemic, may be accelerated  several months by particular con-
 ditions of the atmosphere:  ami as Grenada is situated several degrees
 southward  of Dominica, and must therefore have sooner felt the in-
 fluence of the sun in  its approaches to the northern tropic, we shall
 not be  surprized that the fever became prevalent soonest at the former
 of these islands.
   In regard to the supposed communication of febrile, or pestilential
 contagion,  from the Hankey, subsequently to her arrival at  Grenada,
 Dr. Chisholm asserts, in the first volume of his Essay, (p. 121,) thai
" a Capt. Remington, an intimate acquaintance of Capt. Coxe, was the
first person who visited the Hankey after her arrival in St.  George's
Bay.   This person  (says Dr. Chisholm,) went on board of her in the
evening after she anchored, and remained three days, at the end of
which time he left St. Georges, and proceeded in a drogher, or coast-
ing vessel,  to Grenville Bay, where his ship, the Adventure, lay.   He 
467
was seized with malignant  pestilential fever  on the passage; and the
violence of the symptoms increased so rapidly as on the third day to
put an end to his existence."  In regard to this transaction, Mr. Paiba
not only contradicts Dr. Chisholm concerning the time of Capt. Rem-
ington's visit to the Hankey, (which it seems now difficult to  ascertain)
but he asserts  that this  Captain " had been  all day and night coming
from Grenville Bay, and had been wet through."  " That he slept on
board hi his clothes, and went in an open boat* the next day,  back to
his ship; enough (adds he,) to kill any one in  that climate." See Me-
dical Repository, vol. i. p. 471.  On this point, Dr. Chisholm, in his
2d edition,  (p. 122,) says, "That this person had fatigued himself, and
had even  slept in wet clothes,  might have  happened; but does this
prove any thing further than a greater predisposition of his body to be
acted on by infection?"  Yes,  if true, it proves that Capt. Remington
had been exposed to causes sufficient to produce a mortal fever, with-
out any infection, as thousands have experienced; especially in that
climate.  Dr. Chisholm, however, objects to  Mr. Paiba's statement,
because it was made after he had seen Dr. Chisholm's Essay.   But
would the Dr. have us believe that truth is not admissible, if brought
forward to correct particular misrepresentations?   On this  subject,
however, Dr. Chisholm has referred us to " Dr. John Stuart,  an emi-
nent practitioner, who  attended him (Remington i  at  Grenville, when
he arrived there."  And as I have the pleasure of knowing Dr. Stuart
(who, satisfied with the produce of  his estate,  has since relinquished
his profession and title) and entertain great  respect for his  character,
as well as the utmost reliance on his candour and veracity, I  shall most
readily admit every thing stated as matter of  fact by that gentleman,
only regretting that his statement on this subject is not more compre-
hensive.
   It is  contained in the New-York Evening Post, of Tuesday, Novem-
ber 26, 1805, in a letter to Dr. Hosack, to which Dr. Chisholm has
referred in his  printed letter to Dr. Haygarth} and in it  Dr. Stuart
mentions his going,  in the month of March, 1793,t on board the ship
Adventure, then lying in Grenville harbour, to visit the  carpenter, who
was under his care, and then adds, " While there, Captain Remington
arrived from St. George's  by sea:  he had come round in a drogher,
and had had heavy squalls, with rain in his passage to windward.  He
then complained  of  being feverish, and seemed low spirited;   he had
heat of skin, his  pulse full, and under 100; head-ache, pain in his back

   ♦ The droghers, at Grenada, are not properly open boats; but the  space they afford,
as a protection from rain, under the deck or half deck, is so very close, hot, and confined,
if my recollection be accurate, that most people rather than avail themselves of it for
any length of time, would probably allow themselves to get wet.
   + Unfortunately, Dr.  Stuart has not mentioned the day of the month when this hap-
 pened ;  but he has mentioned enough to prove, that Dr.  Chisholm must have erred con-
 siderably in regard to the time when Capt. Itemington went on board the Hankey.  For
if it had been, as he asserts, upon the evening of her arrival at St. (ieo rge's, this would
have been on the 18th of February, and supposing him  to  have remained on board 3 days,
 and not one night only, as Mr Paiba asserts, he must,  notwithstanding, have set out on
 his return to Grenville Bay, upon the 21st of February,  and supposing him to have em-
 ployed two other days in making the passage, though  it  is commonly done in less than
 one, still he would have reached his ship not in March, as Dr. Stuart mentions him to
 have done, but on the 23d of February. 
468
and limbs, and over his whole body.  These symptoms I imputed to
cold caught in his passage up, and accordingly took eight ounces of
blood from him, which unexpectedly neitner exhibited the buffy coats
nor the coagulum, any degree of contraction,  nor consequent separa-
tion of serum.  He took an emetic of ipecacuanha in the evening, and
a dose of Glauber's salts the following morning.  During three days
I continued to visit him, his pulse did not exceed 100, nor was the heat
of skin considerable; he took occasionally small doses of antimonial
wine, with the addition of laudanum at bed time, and made free use of
tepid drinks.  At the end  of that  time, I was under the  necessity of
putting him in charge of a neighbouring practitioner, having a call to
the other side of the island.   On leaving him,  J certainly  did not  en-
tertain any idea of his being in danger ; I was, however, forcibly struck
with, and coald not well account for, an uncommon degree of despon-
dency of mind that was then present, and it was not possible to remove
the impression  that he was to die; nor was I the less surprised, on
going to Grenville some days after, to be told  of his death, and more
especially to hear of that event having been preceded by haemorrhage
from his nose, stomach, mouth, and urinary bladder.  On this occasion,
while in conversation with some gentlemen on  the fate of this unfortu-
nate man, I could help noticing the malignancy of the case, and the  dif-
ference in the train of symptoms, from what  I had ever witnessed to
take place in the worst case of our  endemic fever.  But a few minutes
had elapsed "when a  gentleman arrived  from  St. George's;  I had no
sooner mentioned Capt. R.'s death to him,  and my  surprise thereat,
when he instantly replied, it was none to him, for that Capt. R. had eat
and  slept on board the  Hankey, during several days that he was in
town."
  It my readers will compare this account with that given by Dr. Chis-
holm, they will, I presume, be forcibly impressed by the important  de-
viations from the truth which occur in the latter, and by the  evidence
which it affords of his inexcusable carelessness  about facts which might
have been so easily ascertained, if  he either did not know, and was at
all solicitous for the truth.  It uppears from Dr. Stuart's statement of
Capt. Remington's case, that, instead of that  " violence of the symp-
toms," and that rapid increase of their violence,  which,  " on  the third
day, put an end to his existence," .'as Dr. Chisholm asserts) the symp-
toms were all so very moderate, that when Dr.  Stuart left his patient, at
the end of three days, he was not even suspected to be in any danger,
and, according to the best information which I have  been able to pro-
cure, Capt. Remington did not die until the 8th day of his illness.*
  In regard to the cause of Capt. Remington's fever, Dr. Stuart's  ac-
count of it  accords, in my judgment, much  better with that of Mr.
Paiba than  of Dr. Chisholm. Whether Capt. Remington got wet in
going to St. George's, or returning thence to  Grenville harbour, or
both, Dr Stuart avowedly, and with reason, considered his disorder as
proceeding from cold.  And though he appears to have been surprised

    i he edi'or remembers distinctly to have heard Dr. Stuart mention, that it was on
Sunday that he fi.st prescribed for  captain Remington, tint he took leave  of him on
Wednesday ;  that his death happened on the following Sunday.
\ 
469
at its fatal termination,  I cannot persuade myself that it is so unusual
in that climate for fevers  produced  by such a cause,  to  end in dea'.h,
and  even with haemorrhage from different parts, as fairly to authorize
a belief that some more malignant cause must have co-operated;  and,
perhaps, if Dr. Stuart had never heard of the groundless reports  con-
cerning the Hankey, he might not have suspected any such co-opera-
tion: though after all that appears to have been  told him of that ship,
his doing so was, I think,  very natural.  But  as my readers will soon
be convinced, if they are not so already, that no infection was, or could
have been communicated from the Hankey, and  as Capt. Remington's
fever manifested no contagious property, even in the narrow space of
a ship's  cabin, and when  as there was no  suspicion of infection, no
precaution would have been used to guard  against it,  we have, I think,
the strongest presumptive, as well as negative evidence, that it did not
proceed  from, or  possess  any contagious  influence.  Indeed, if the
Hankey had abounded in contagion, it must have been  altogether in-
credible  that it could have produced disease  so speedily;  and if the
getting wet, and  sleeping in wet clothes should not be deemed a suffi-
cient cause for  the disease and death of Capt. Remington, another,
and that  infinitely more probable, in my opinion, than a new pestilence,
naturally presents itself to  those who recollect,  that besides the influ-
ence of marsh miasmata in the bay and carenage at St.  George's, his
own ship lay in  Grenville bay or  harbour, which Dr. Chisholm (at p.
290 of his letter to Dr. Haygarth) has particularly designated as one
of the  places  which,  in  an uncommon  degree,  expose  ships lying
therein " to the malignant influence of marsh miasmata."
   Dr. Chisholm tells us (Essay, p» 122,) that "the crew of the Defi-
ance, of Blythe Port, near Newcastle,  were the  next  who suffered by
visiting this ship ;  the Hankey)  the mate, boatswain, and four sailors,
went on board tiie day  after her arrival ;*  the mate remained either on

   * Dr. Chisholm apparently was anxious to lose no time.   He made captain Reming-
ton go on board the Hankey the  very evening of her arrival; though  Mr. Paiba  says it
was nearly a month after, which it might have been, consistently with Dr. Stuart's state-
ment ; and consistently with that statement, he could  not have gone on board in much
less  than a week : and, therefore, if the people of the Defiance went on board the day
after the Hankey's  arrival, and were immediately seized with the fever, they, and not
eaptain Remington,  must have  been  the first " who suffered."  And, as they are said
to have all died in three days, excepting the mate, whose disorder was slight, and, there-
fore of no long duration ; and it is not pretended  that any other of the crew took the fever
 from tliem ; it ought, according to this account, to have ceased entirely  on hoard the De-
fiance, before the end of February.  Hut by another  statement, at p« 202 of the same
volume, we are told that "about the end of March, 1793, the Herberts, Captain Brown,
sailed from the Port of St. George,  Grenada, for Glasgow.  In working the ship out of
the harbour, (continues Dr. Chisholm,) Captain Brown was obliged to send five of his
ms-n  onboard the  Defiance, of  Blythe  Port, to fasten a warping line.  At this time,
 (the end of March) the malignant pestilential fever raged on board the Defiance." It
 always rages in Dr. Chisholms accounts.   He adds, " The next day after the Herberts
 sailed, the five men were seized with the disease,  and three of them died."  Here the
 Doctor's favorite number, three, h applied to the men who died, and not the day or days
 on which the termination happened.  Now,  what are  we to  believe amidst these contra-
 dictions ?  Did this fever rage on board the Defiance, about the 20th of February, ac-
 cording to the first statement, or, about the end of March, according to the second ? In
 regard to the latter story, nothing less than  Dr. Chisholm's credulity could produce it
 belief  If five men  were sent in a boat along side the Defiance, with a warping-line, the
 endot that line might  easily have been thrown on board of the Defiance, and fastened
 by one of her crew, and is often, and as ought to have been done, where a pestilential 
470
deck, or in the cabin, but the rest went below,  and staid all night there.
All of them were immediately  seized with the fever,  and died in three
days."  Here Dr. Chisholm seems to have been either totally regard-
less of truth, or completely infatuated, if he believed this account to be
true.  What, y?x/<? persons immediately seized with a contagious fever I
Did any species of contagion ever produce disease immediately?  The
plague itself does not act with  such celerity.  Moreover, these  five
persons all died exactly " in three days."   Did ever contagion act with
such  deadly and exact uniformity ? Differences of  age,  constitution,
susceptibility, 8cc. were, it seems, completely inefficient.   And here I
cannot help noticing Dr. Chisholm's singular predilection for the exact
term of three days.   The four  seamen obtained by  the Hankey from
the ships of war at St. Jago, are  stated to have been all seized "on the
third day" after she sailed, " with the fever," which probably neither
of them ever had; and Captain Remington is  made to die  of it on the
third day,  though Dr. Stuart  did not  then believe  him to  be in any
danger;  and again, the  five men from the  Defiance,  are all  repre-
sented as having died in  three  days, and a sixth,  (the mate) as  having
only escaped with a lighter disease, because, by remaining on deck or
in the cabin, he was " less exposed to  the virulence  of the infection."
All this,  however, rests  upon  Dr. Chisholm's unsupported  authority,
the value of which, I must leave others to estimate, having no means,
except those furnished by Dr. Chisholm, even to ascertain whether
the ship Defiance ever existed.
   After this, Dr. Chisholm  tells us, (p. 123) that" The crew of the
ship Baillies, from the same imprudent civility, or curiosity, were the
next who  suffered."*  " These (he adds) communicated  the infec-


fever was  raging ; and, at most, if this was not done, it could only have been necessary
for one man to jump on board, for a single minute. No stay could have been allowed, as
the men must, at that time, have been  wanted immediately on board their own ship.  To
suppose, in such circumstances,  that  they could u/lhave been infected, and that this in-
fection should have operated so as to  produce disease in them all the very next day, is
completely inadmissible, because no contagion yet known, is capable  of being transmit-
ted so far, and in so short a space ; and also of producing disease  within  24 horn's after
being transmitted ; and, therefore, if five men belonging to the Herberts, were attacked
by the supposed malignant pestilential fever, they must  have previously been  exposed
to the causes which had produced it in others, independently of any communication with
the Defiance.
  * It is here remarkable, that Dr. Chisholm makes nomention of  the nature, or extent
of the suffering supposed to have been thus brought  upon the crew of the Baillies.  He
might have told us, at least, how many had been attacked by the supposed new fever, on
board that ship ; and I certainly regret that he did not.  He gives  us,  indeed, four sup-
posed cases of that fever, which fell under the management of his partner,  Mr. Camp-
bell, at a time when Dr. Chisholm himself was under salivation for hepatitis, and proba-
bly before he had seen any case of this fever.  One of these without date, but said to have
been the first which occurred in  Mr.  Campbell's practice, was that of the carpenter of
the ship Charlotte,  of London, which is not mentioned by Dr Chisholm  as having had
any communication with the Hankey : and the second is the case of "John," a  sailor on
board the Baillies.  And this was probably the first  case  of fever which occurred on
board that ship; for, as the partnership of Chisholm and Campbell appears to have had
her sick, it is not likely that any other practitioner was employed.  Mr. Campbell first
saw John on the 21st of March, 1793, on which day he first resolved to make trial of
mercury, and this in John's fever ; being, as he says, "fully satisfied that this disease was
the malignant fever, which prevailed  at  that time."  Now, if Dr. Chisholm's account of
the commencement of this fever was correct, how could the malignant  fever be then
prevalent ? Captain Remington had  sickened some time in March,  and for any thing 
471
    tion  to the ships nearest to them, and  it gradually spread from those
    nearest the mouth of the Carenage,  where the Hankey for some time
    lay, to those at the bottom of it; not one escaping, in succession, what-
    ever means the captain  took to prevent it."  An effect which, if cor-
    rectly stated, is much more like that of marsh miasms than of contagion.
    .^ This statement, however,  is too general for a  particular examina-
    tion,  and being, like the former,  without any support, I can  have no
    reliance on  its accuracy.   That a violent marsh or yellow fever did at
    that time, or soon after, prevail among the shipping at the Carenage,
    at Grenada, (as it had often done there,  and in the like situations, long
    before the supposed generation of Dr.  Chisholm's new pestilence,) I
    believe;  and  I also believe,  that  this fever (which, as  usual, began
    among the seamen) soon after appeared in some of the inhabitants on
    shore, but not as Dr. Chisholm supposes from contagion.   We have
    seen that the Calypso, who is  supposed by Dr. Chisholm, to have  in-
   fected  the Hankey, and whose  fever consequently  must have been
    the same, was not suspected at Sierra Leone to have communicated
    any disease there, nor to have had any other than a marsh fever on
    board.  And we have seen that she returned thence to England, after
    suffering a mortality,  greater in proportion to her stay in Africa, than
    that of the Hankey ; and it never was even suspected, that either her
    crew, or her surviving passengers, with all their bedding and effects,
    and those of the  dead also,  (though landed  and dispersed  in Great
    Britain) had introduced any  sort of contagion, there being fortunately
    no person here, to excite groundless  alarms, by inventing and propa-
»   gating falsehoods as in Grenada.   In regard to the Hankey, we have
    every reason to believe that no other than marsh fevers, or fevers from
    cold, fatigue, intemperance,  and other similar causes,  and had occur-
    red on board of her during the whole voyage.   It appears, moreover,

    that appears to the contrary,  subsequently to John ;  and also at a  remote part of the
    island.  The Baillies is stated by Dr Chisholm to have been the second ship which com-
    municated and suffered by communication with the Hankey; and, from his second state-
    ment, quoted in the preceding note, she appears to have been the first.  But supposing
    the  Defiance to have been the first, the sickening of a part of her crew alone, could not
    justify Mr. Campbell in stating this to have been a prevalent fever, nor that it was  one
    in which he was "well convinced the  common mode of practice was by no means success-
    ful."  To have acquired this conviction, he ought to have had a considerable number of
    cases, or have  known that many cases of this new disease had occurred to others, and
    terminated unfavourably under "the common mode of  practice  in fever."   But such
    cases could not have happened, according to Dr. Chisholm's statement, from a commu-
    nication with the Hankey ; and it therefore seems probable, that what Mr. Paiba has
    asserted in the New-York Medical Repository,  vol. 1, p.  47, may be true, viz that this
   "sickness was universally known to be in the town ofSt. George, when captain Rem-
   ington visited the ship,"   the Hackney.   And Mr. Campbell's first case, that of the
   carpenter of the Charlotte, before mentioned, seems to  prove that at least in this in-
   stance, the supposed new fever was not derived from the Hankey.  Mr. Campbell men-
   tions a second case  on  board the Charlotte, that of Mr. Taylor, the mate, but without
   any date ; and he also mentions a second case on board the Baillies, that of "Stephen"
   which occurred on the lUth of April: and these are the only ones mentioned to have  oc-
    curred on board that ship, either by Mr Campbell  or Dr. Chisholm.  It seems remark-
   able, also, that Mr, Campbell does not even hint so much as a suspicion, that either of his
   patients had  communicated with, or derived his fever from the Hankey; and to me it
   seems probable, that cases of this supposed new fever had appeared at St. George's before
   the Hankey, though not much noticed, as indeed they were not likely to be, while sparo-
   dic, and few in number. 
472
 that she was three times cleansed and fumigated, viz.  at Bulama, Bis-
 sao,  and  St.  Jago;  and  at the latter of these places, (at  least)  she
 must  have been free from  any contagion;  for otherwise,'her  un-
 restrained intercourse with the inhabitants, would have excited disease
 in some of them ; which it did not, nor in any person  on  board  the
 Charon or Scorpion, nor in the four sailors obtained from those ships
"by Captain Coxe;  who,  during the  subsequent part of the  voyage,
 could not have  escaped it, if any had existed, capable  of  producing
 such wonderful  effects as Dr. Chisholm has supposed, in Grenada.
   It appears certain, that  every body  on board the Hankey was well,
 when she arrived at  Grenada,  and continued so during her stay there,
 and also during the  whole of her voyage to England,  which is proba-
 bly more than could be said of any other ship then at Grenada; so  that
 even if it were  ascertained that an importation of febrile infection  had
 then taken place, every other ship ought to have been suspected of it
 before the Hankey,  coming,  as  she did, from a place where  there is
 good  reason to believe no contagious fever  had  ever  existed.   Dr.
 Chisholm, indeed,  does  not  pretend  that  the infection  supposed to
 have been derived from the Hankey, had emanated from any person
 actually on board when she arrived at Grenada, but from the baggage
 and effects of the deceased colonists: to this, however, there are in-
 superable objections,  some of which  will be stated in the  subjoined
 note ;* besides others, arising  from the fact of its having been found


  * It appeal's from Mr. Smither's account, that  the hagsjage and effects in question
 consisted of clothing, which " had been aired," and probably never in " contact with the
 body of any person," after  that person became " sick ;" though as  there was no conta-
 gious sickness among the colonists,  that circumstance seems to be of but little impor-
 tance.
  In regard to the  bedding, Mr Smithers confirms Mr  Paiba's assertion, that it was
 thrown away at Bulama.  But whatever the effects brought  from Bulama  may have
 been,  they were carefully preserved by Captain Coxe, and " delivered vp" at Stangute
 Creek, on the 18th of October,  1793, as is proved bj the Hankey's Log Book,  (though
 Dr Chisholm has asserted, without any foundation, that they were thrown overboard at
 Grenville Bay ;) and therefore,  it will be easy for me to place Dr. Chisholm  in a  most
 embarrassing dilemma   Assuming,  as he does, that the Bulama bairgage was the ve-
 hicle, receptacle,  avfomitcs, whence the Hankey's supposed contagion issued,  he must
 necessarily to elude, eithei th,.t this  contagion was most powerful at first, and  that it dai-
 ly became weaker and weaker, by constant evaporation, and diffusion through  the atmos-
 phere; or, he must conclude, according to the common opinion in regard to fomites, that,
 like vermin, it possessed the power of multiplying itself, and of becoming daily  more pow-
 erful aud destructive.  Should he adopt  the first of these conclusions, it will  he necessa-
 ry, though impossible, for him to explain how this baggage  could retain enough of conta-
 gion, to produce such wonderful and'unexainpled effects at  Grenade, though  when in its
 stronger and more accumulated state, it was too weak to excite disease  in Mr  Smithers
 or his mate, or any other person at St Jago, or in any of the seamen  during the passage
 thence ;  and if he  should prefer the latter conclusion,  it  will be equally necessary, and
 equally impossible for him to explain, why, if this supposed contagion had become so virulent
 aud powerful, as is pretended, at Grenada, it should, with  its power of farther multiplying
 and increasing itself, have been found perfectly inert, and harmless,  during the passage ».o
 England from Grenada, not only to the six scam'en received hv Captain Coxe from the com-
 modore a t that island, (on the 18th of J uly,) hut alsoto tht carpenters  sent on board the Han-
 key, from the Vengeance ship of war, (on the 22d of August,) and v. ho remained three or
 four days on board ? The contagion, by this time, ought certainly to have become "direful-
 hj" active; and the carpenters, as well as the six seamen I: ti ly mentioned, must havt; been
 much  more exposed to it, and for. a much longer lime, thaii any of those, who according
 to Dr. Chisholm, so suddenly became its victims at Grenada.  And, ou either  supposition 
473
 that such effects are absolutely incapable of exciting Dr. Chisholm's
 supposed malignant (or any other) fever, after having  been  used by
 hundreds ill, and dead of it.  He,  as is  well  known, and his  adher-
 ents at Philadelphia,  insist most strongly, that the yellow fever which
 prevailed as an epidemic in  that city, in  1793,  had been  imported
 from  the West Indies, and that  it was truly the malignant pestilential
fever, supposed to have  been  derived  from  the  Hankey;  and it  is
 solely upon this identity, that they found their assertions and belief of
 its being contagious.   It is also  known, that during the prevalence of
 this fever in that year, an hospital .was opened at Bush-Hill, near Phila-
 delphia, and appropriated exclusively to the reception of patients ill of
 it;  who, in great numbers, were placed under the care of M. Deveze,
 as was mentioned by me,  at p, 258.   And it is also  well known,.that
 when the fever had ceased, as usual, at the approach of winter, all the
 bedding, blankets, clothes,  and other effects, which  had been  used
 by the sick,  were  sold to the Agents of the French government,  and
 employed for then*  sick  soldiers and seamen, without having  been
 washed, fumigated,  or even aired, and without its having been  ever
 suspected that any disease was  produced by  these  effects.   See Dr.
 Valentin's Traite de la Fievre  Jaune, &c. p. 92 and 93*
   Those who are acquainted with the town and neighbourhood of St.
 George, in  Grenada, will readily believe, that it is  much more likely


 it is incumbent on him to shew how, with this amazing activity at Grenada, Mr. Paiba and
 his family were able to land there, with all their eftects, including a quantity; of goods, which
 with the Bulama baggage, made  the whole of the Hankey's lading, and which were stored
 at the house of Mr- Napier, in St George's, without even the suspicion of having infected
 any person ?                         4
   To account for the wonderful escape of Mr. and Mrs.  Paiba and their servant, from
 that supposed  infection, which is said to have rendered the slightest communication with
 the Hankey so deadly to others, Dr. Chisholm asks, vol,  1, p. 131, " What connexion
 had  Mr. Patbu and his family with the packages of clothes and bedding, from which em-
 anated the infectious aura,  productive of almost" (he might have omitted the   aost,)
 " unexampled mischief ?" To this inapt question, I answer,  that their connexion, during
 nearly  three months, which they lived on  board the Hankey,  after her departure from
 Bulama, must undoubtedly have been much greater with the packages iu question, than
 Captain Remington's or any of the seamen, whom curiosity or  civility brought for a
 short time from Other ships, and who may be presumed never to have even  seen them ;
 and, it is difficult to conceive, how those packages, even if they had  been infected, could
 have done the mischief supposed.  It is not pretended that they were opened, or even
 removed by Captain Coxe ; who, faithful to las trust, and convinced of their innocency,
 had determined to carry them to Kngland, and could, therefore, have no motive to open
 or shew them to any one.  In short, there never was, in my opinion, a more inconsistent,
 improbable, and incredible tale, imagined^ titan this, which is, I believe, now sufficiently
 refuted.

  • * The following are Dr. Valentin's words,  viz :—" Le vetemens, les fonroituvos  des
 lits, qui avaient servia des personnes inftctees, ou mortes de la fievre jaune, et qui ont
 passe a d'autres, sans avoir meme ete aeres, laves, on parfunies, ne la leur ont pas trans-
 mise.  On en a eu un exemple frappant, dansles fouroitures qui ont etc Mi.dus, de Fhos-
 pital de Bush-Hill, immediatement apies 1'epidemie dei 1793, parle eomilo de Saute de
 Philadelphie, aux \gens de la Republiqe Franchise, pour les militaire* malades cumme
 I'a rapporte" man ami Deveze auquel iIs ont ete confies."  liuleeii, thousands of | roors
 might  be adduced of the  innocency of clothing, &c.  after haviug been used  iu North
 America,  by persons labouring under that very fever, whicli Dr. Chisholm  suppo^s to
 have been imported to  Grenada by the Hankey, and afterwards transported to different
 parts of the Continent, Spain,  he.  And, therefore, all  his assertions of the emanation
 of contagion from  th-j Bulama  baggage,  must be unworthy of a moment's  considera-
 tion.
                                      60 
474
t© produce violent marsh or yellow fevers, than  Bulama, where the
greatest heat felt by the colonists, appears not to have exceeded 84 de-
grees ; and nothing but the aggravated and fallacious reports spread
upon the Hankey's arrival, could ever have  suggested the idea ot
looking to the latter of these islands as the source of what Dr. Chis-
holm mistook for a new pestilence.  Dr. Lind  mentions, at p. 180 of
his work on the Diseases of Hot Climates, that a " malignant  sick-
ness in the islands of Grenada and the Grenadines, proved very fatal
to the English, who, upon the peace, in 1763, first went over to settle
there."  In a work, printed at Paris, in 1805, under the title of Obser-
vations  sur la  Fievre  Jaune,  Sec.  par J. B. Le Blond, Medicin Natu-
raliste, 8cc.  (who formerly practised physic in Grenada,) the author
mentions the yellow fever as having occurred frequently at that island,
and with great mortality to strangers; adding, that " its malignity was
shocking, in consequence of the unhealthy exhalations from the port
and  town of St. George.   (See Medical Repository, vol. 10, p. 73.)
And Dr. John Hunter, at p. 3Q7 of his work on  the  Diseases of the
Army, says, "The town of St. George lies low,  and there is marshy
gromid in the  neighbourhood ;  the troops, in such situations, have al-
ways been unhealthy," &.c.  These accounts are, however, too gene-
ral ;  and therefore, I will add, from my  own recollection, that this town
is situated at the foot  of,a steep and lofty hill;  (Mount Cardigan) and
on both sides of a ridge descending from its summit towards, and into
the sea,  and forming  what is called the Carenage, or harbour, at the
bottom of a capacious bay.  This Carenage is a long inlet or arm of
the sea,  m which vessels are land-locked, (except a small opening at
the south-west, whence the wind rarely, if ever blows,) and are moored
close to the wharfs; and here, both the atmosphere and water are  com-
monly stagnant, in a considerable degree: the shore on this side of the
rk! :^e or town, is remarkably low,  and  crowded with houses and other
buildings, reaching close to the wharfs;  most of  them small, built of
wood,  and filled with  low and profligate inhabitants.  And in addition
to all these circumstances, obviously favourable to the production of
yellow fever, there is a large offensive marsh  at the east end of the
Carenage, over which marsh, the wind commonly  blew upon this
inlet, and the  greatest part of the town, during the months in which
the supposed new fever became prevalent.   But I would not have it
understood, that those only were  attacked with the fever who  lived
within the reach of marsh miasms.  Mankind exercise their locomo-
tive powers; and when these miasms are not brought to their habita-
tions, they often go on business, or pleasure, to situations in which this
cause  of disease abounds.   In  this way, persons  commonly residing
or stationed on Richmond Hill, and Mount Cardigan, were sometimes
attacked by the fever, though much less frequently, and with less vio-
lence, than others.  Dr. Chisholm considered these attacks as the ef-
fect  and  proof of contagion; but the late Dr. J. Hunter had, nearly ten
years before,  thought more justly on this subject; for,  at the page
lately quoted, after mentioning the salubrity of these elevations, he ad-
ded, " But in order that troops may enjoy the full benefit of such situa-
tions, care should be taken that they be not permitted to go  down to
the low grounds, for if they are, they  will infallibly carry fevers up 
475
with them."   Dr. Lind had,  indeed, previously convinced himself of
this truth ;  for, at p. 217 of his work on the Diseases oi Hot Climates,
he observes, "that in several places, mentioned as a secure refuge
from sickness," (by marsh effluvia,) " there  are instances of persons
being seized with the diseases of the adjacent country.- The yellow fe-
ver  has been known to  seize persons in the garrison of Monk's Hill,
in Antigua! But inferences (he adds) drawn from a few uncommon
cases,  have no force against observation  and experience.'.'—" unless
the garrison of Monk's Hill had been apprised of the danger of sleep-
ing in unwholesome places, and had cautiously avoided sleeping out of
the garrison, the question cannot be fully determined, whether persons
who never slept out of  Monk's Hill,  were attacked with the  diseases
of the adjacent country ? It is my opinion, they seldom or never would.
  " I mentioned the affair to a person who had resided long at English
Harbour, in Antigua, and he informed me, that he had known some
of the  garrison on  Monk's Hill to  have had the yellow fever.  I de-
sired he would endeavour to recollect the circumstances of their being
taken ill, and whether they had slept any nights preceding their illness
in the low grounds, or in  English Harbour.  It immediately occurred
to him, that when he was seized with the  yellow fever,  there  were at
the same time, two officers belonging to the  garrison at  Monk's Hill,
labouring under it, who had both been seized with it early in a morning,
after sleeping the two  preceding nights at English Harbour.  Upon
beginning to cons'der the great danger of sleeping in unhealthy places,
(with which he was before entirely  unacquainted,) he recollected that
most of the people in Monk's Hill, who had been seized with this fe-
ver,  were taken ill after sleeping on the low  grounds; it being a com-
mon custom among the  officers of that garrison, to sleep in the house
at English Harbour where  they  had  dined and  supped."   I need
hardly mention  that English Harbour  notoriously  abounds in marsh
miasmata.  The application of these facts will be obvious.
  Dr.  Chisholm has laboured, as the foundation of his whole super-
structure, to create an  essential difference between his  supposed new
fever or pestilence, and the yellow  fever,  which had  previously .exist-
ed in the West Indies and North America; and for this purpose has
employed the most strained, though  unavailing efforts to identify it
with the true plague ; and  he concludes  a chapter on this subject by
declaring,  (vol.  1,  p. 322,^ that "We must consider the  fever  of
Grenada, in  the years 1793,  1794, and  1795, as truly pestilential,
and  differing from the  plague, strictly so called, only in not always
exhibiting those symptoms that are said to be peculiar to that malady."
Surely, when Dr. Chisholm committed himself so unfortunately, he
could not have recollected that the plague had never existed between
the tropics. My readers, I presume, will not expect that I should em-
ploy their time, or my own, so unprofitably as I must do, if I were se-
riously to refute a conclusion so extravagant, after the   facts  recently
stated  in my chapter on the plague.   Indeed, Dr. Chisholm has not
appeared  to  be satisfied with  his own opinion on this subject, for,
without disclaiming, he has strangely  deviated  from it in several in-
stances; sometimes representing  his supposed new malignant fever,
as resulting from " the united action of pestilential contagion, and the 
476
miasmata of marshes, and other direct causes of the yellow remitting.
fever," &c. See vol. 1, p. 208.  And at other times, after laying aside
his pestilential contagion, he substitutes that of typhus or jail fever, and
represents this as having  caused  not only his  supposed new fever  at
Grenada, and in other parts of America, but also that typhus which
prevailed among the troops  under General White, at  Cork,* and af-
terwards in the passage thence to  Barbadoes,  in  1796,  as I  have men-
tioned at p.  344; thus deriving from one cause,  two fevers, as diffe-
rent from each  other  as any within my knowledge.   Dr.  Chisholm
seems, however, as little disposed to adhere to his jail  infection, as to
that of the true plague; for, in his letter to Dr. Haygarth, which is
the most  recent publication of his sentiments on this subject, we find
these words,  at pages  117,  118, viz :—
  " To conclude,  let  the unbiassed reader now  become umpire, and
decide whether,  or  not, a ' nova pestis, a peculiar, original, foreign
'pestilence, recently generated, and utterly  unknown  before, endued
'with a new and distinct character, possessing new powers  of devas-
1 tation, and  capable of propagating  itself by contagion throughout
ithe world,' was introduced by the Hankey, on the \9th of February,
1793,  into Grenada."  He adds, " The  demonstration of  my senses,
and the clearest  perception of my mind, assure  me it was a nova pes-
tis,  to which the observation of Thucydides  is  truly  applicable ;  for
never before had so dreadful a pestilence occurred in the West Indies,
nor such a destruction of the human race been recorded."
  Here it is remarkable, that though  Dr. Chisholm declares the Gre-
nada fever of 1793,  to  have been a new, peculiar, original pestilence,
never known until the 19th of February, 1693 ; yet in.the very next
page, he makes  it a very old disease, by asserting, that if it be compar-
ed with the plague of Athens, as described by Thucydides, " we shall
find that  they bear a strict affinity to  each  other, in their  causes :.nd
symptoms ;" and  that " they  seem, indeed, to have been the same
disease, the same destructive monster."   But though  Dr.  Chisholm
excites our astonishment,  and tries the extent of our credulity, by his
accounts;—first  of the miraculous creation of a  new and terrible pes-
tilence ;  and then of the almost as miraculous revival of one, which
had been  for many  ages extinct,  or unknown, he has  kindly relieved
us from these awful impressions,  by stating  in a letter to Dr. David
son. dated Demerarv,  August 10, J800,  that a fever then prevailed in
that colony, whose " features were almost without exception, precisely
those of  the malignant pestilential fever  of Grenada,  of 1793 and
1794;"—" fully as fatal, as rapid, and as insidious  "  and that this
direful fever originated in  a ship,  which had  " arrived about the be-
ginning of July, or end  of June, from Liverpool, after touching at
Surinam."—" The filth on board, (he adds  occasioned by  a cargo  of
horses, and the extreme neglect of the officers and crew, beggars all
description."   (See Medical Repository, vol. 5, p. 229.)   Here we
have Dr.  Chisholm's new pestilence, stript by his own hand of  ever).
thing miraculous and wonderful, with which he  had previously cloth-
ed it, as  proceeding from Africa and the Hankey ;  and we are told

     * «iee Dr. Chisholm's Essay, &c. vol. 1, p. 203, et seq. 
477
that it was produced by a common vessel, making a common passage.
from Liverpool to the  West Indies,  and with nothing more extraordi-
nary than a cargo of horses ; of which,  thousands of cargoes have at
different  times, been brought  to  the West Indies,  particularly from
New England,  as closely stowed at least, and probably with sailors as
neglectful, as those of  the Liverpool ship, and all, as 1 believe, without
any suspicion of having ever  generated  a contagious fever. Indeed, the
only  peculiarities which belong to a ship  with horses, are those which
occur in stables on shore, and which are not found or supposed to pro-
duce any morbid effect, much less to have  ever generated any species
of pestilence,  or pestilential fever.  Dr. Chisholm mentions in  the
same letter, that at the request of Drs. Dunkin and Lloyd, m Sta-
broek,  and of Dr.  Ord, on the Eastern  Coast of Dcmerary, he had
visited a  few of the sick  with this fever, and that he had "no hesita-
tion  in pronouncing it a fever of infection."  No person will,  I  be-
lieve, suspect  Dr.  Chisholm of any  great disposition  to hesitate in
pronouncing; though I have good reason to believe that the gentle-
men whom he mentions as having called for his intervention, did hesi-
tate ;*  and that they were very far  from adopting  the  decision pro-
nounced so readily; having  been  long  acquainted with theirs* of
them,  and having had opportunities of conversing with him on this to-
 pic,  several  years after the date of Dr.  Chisholm's letter.   But I am
 entering unnecessarily into a refutation of Dr.  Chisholm's inconsistent,
 extravagant, and incredible  notions, which only  need to be stated,  and
 contrasted,  in order to their  being properly estimated.
    Here, then,  I might have desisted from  any farther observations on-
 this  subject, if Dr. Chisholm's supposition of novelty m the fever of
 1793,  at Grenada, had not been  countenanced,  and in a great degree
 adopted, by Dr.  Stuart, whose opinions  I  consider  as justly intitled to
 a respectful  attention.  This gentleman, in  his  letter to Dr. Hosack,
 lately mentioned, has stated his  reasons  for believing, that the fever in
 question " was  specifically  distinct from every form of the indigenous
 bilious remittent," which he had ever before observed.  These reasons
are.
   1st _« Because it appeared at a season of the year which I had al-
ways found healthy, during 19 years I had resided in the colony.'   But
this, as I have already observed, can decide nothing.  The occurrence
of vellow fever, principally depends upon the temperature, and other
conditions of the atmosphere, and if these conditions take place before
the usual time, (as was the case, according to Dr. Chisholm s state-
ment, in  1793,) the fever will be also precocious.   It has been already
mentioned, particularly at p. 245, that Ac yellow  fever, which rarely

  • In the month of February, 1805, the editor passed two nights as the guest ot Dr.
or Mr. Onl,  (formerly surgeon to  the 39th regiment,)  wheo  going from  Demerarj.to
D.sbice and  returning thence ; and * as. each time, distinctlytold by him  that he  ad
neve- seen any f-ver)n that colony, or on that coast,  which he bebeved  to ha e h -en
TowJoZ  T\i editor has also hea.-d a similar opinion from Mr. Dunk.n, lately Gar-
rison Su%eon at Demerarv, and now Deputy-Inspector of Army Hospitals, when con-
ve^ng with  him on this subject.  Indeed this gentleman's very aerurat .and judicious
reto.r concerning the prevailing fevers of Dmerary, (see Chisholm's r.ssay, he. yo.
2nd   '>03  &c 'Wiews, that his ideas and  reasonings were too well founded for hmi
toh:.%.■■• ver adopted opinions like those of Dr. Chisholm, in regard to the existence. T
eontagious fever, in that part of America. 
478
prevails at Charleston before the  month ol August, became very ge-
neral and  mortal there, in the month  of May, 1732.  A like precocity
happened at La Vera Cruz,  in 1802, when, according to a statement
by the " Consulado" of that place, a mortal sickness, with a black vomit-
ing, began there in April, and raged with extraordinary violence until
October, causing the deaths  of fifteen hundred seamen, and strangers
from the interior  and  higher country.  See  Medical Repository, vol.
10, p. 296.
   2ndly.—" Because it did not particularly appear in those situations,
where bilious remitting fever usually prevailed, during the unhealthy
season of the year."  This being a general statement, I can only an-
swer it generally, by reminding my readers of what has been already
noticed, in different places, that the most violent forms of marsh fever,
accompanied with black vomit, Sec.  commonly require for their pro-
duction, the co-operation of all, or some of the circumstances or pecu-
liarities of a large sea port, or commercial town, accessible to ships or
vessels.   And, therefore, yellow fever, strictly so called, often does not
appear in some marshy situations, which  are very liable to bilious re-^
mittents.
   3rdly.—" Because there was an evident difference in the  character
and type of the two diseases; there was a greater despondency of mind
in this fever; the eyes were more muddy and inflamed, there was com-
monly a deep-seated pain in the eye sockets, the motion of the eye balls
was  attended with uneasiness; the  pain in the back and  limbs was
greater than in the bilious  fever; the vomiting was not  of so violent
and straining a nature, nor was there such evacuations ol bilious mat-
ter.*   The  black vomit generally occurred at an early period; the
yellowness was of a dingy  hue, not of the real icteric tinge, accom-
panying cases of bilious  fever.   The delirium was, in many instances,
of a  peculiar nature, and much resembling a state  of intoxication; hse-
morrhage was  more frequent, particularly by urine, and from the sto-
mach and intestines."
   This statement, in my apprehension, relates chiefly to the plus vel
minus of particular symptoms, and presents nothing new, or characte-
ristic of a new  disease :  nothing,  at least, of any importance, which had
not been noticed  and described by Towne, Warren, Lining, Moultrie,
Hume, Hillary, Mosely, and others, as occurring  in the yellow fever,
long before the year 1793.  Indeed, the differences here  alleged, as
distinguishing  the supposed  new fever, seem to depend solely upon an
increased violence, or aggravation in the usual symptoms; and, there-
fore, never could, according  to my conceptions, alter the nature or kind
of a disease, or create even a new species of it.
   I  have already, in various  places, adduced numerous, as well as high
authorities, to  prove that marsh fevers are  liable  to all the variations
noticed by Dr. Stuart, and  therefore  I cannot persuade myself that they
afford any ground for considering the fever of 1793 as a new disease.
Perhaps  Dr. Stuart had not sufficiently attended to this fact.  He men-

   " Dr Chisholm asserts, vol 1, p.^ 174, that " the vomiting was, for the most part, por-
raceous; but towards the faial crisis, always black,  aud resembling coffee badly boiled."
It may b • hoped, that he does not  consider this as  a new symptom, or as the mark of a
 new disease. 
479
Dons, in his letter to Dr. Hosack, that he had for nineteen years exer-
cised his profession at a considerable distance from St. George's, and
that his ordinary  residence during that time was four miles from  even
the small port of Grenville; consequently his patients must have been
in a great degree  separated from those circumstances, or causes, which
have been mentioned as modifying and aggravating marsh fevers, into
that particular form which is called yellow fever; and as this fever had
not for many years prevailed with so much violence and exasperation,
even in the  large sea-port towns of the West Indies  as it did in 1793,
Dr. Stuart  might well have been strongly impressed by this aggrava-
tion of its symptoms, beyond any thing which he was accustomed to
see; and believing as he did the extravagant reports which were cir-
culated respecting the Hankey, he might naturally have been persuaded
that the fever in  question was a new disease.
   This fever, at Grenada, appears in most cases, and especially those
of seamen, (who  were the greatest sufferers by it) to have resembled
that variety or modification of the disease, to which the French applied
the name of  Mal de  Siam, more than a century ago; ahd in which
from a scorbutic  taint (as I have supposed, at p. 237) or  some other
cause, haemorrhages, black vomitings, and  petechias, were predomi-
nant symptoms;  occasioned, undoubtedly, by what has been called a
dissolved state of the blood; which seems to occur  fat least in some
degree) before death,  in  all the more viqlent forms of yellow fever.
And, by attending to this fact, we shall find no difficulty  in accounting
for the early appearance of black vomiting, in the fever of 1793, as
mentioned by Dr. Stuart, nor for the dingy hue which, from extrava-
sations of blood, was given to the " icteric tinge" of  the skin;  nor for
the more frequent occurrence of haemorrhage from the urinary  blad-
der, stomach, and intestines.   Nor can we be at any Toss in explaining
why the stomach, in that gangrenous state, which frequently attends
the worst cases of the disease, should be less irritable, and less capable
of violent strainings to vomit, than it is when less injured, as in the or-
dinary bilious fever;  nor why the least violent strainings should pro-
duce the smallest ejections of bile;  nor why exudations  of blood into
that viscus, should change the colour of the matters  ejected, as they had
done  a century before.   In regard  to the 4th, 5th, and 6th, reasons
mentioned by Dr. Stuart, viz. the fever's not having ever to his know-
ledge terminated  " within a few weeks in an intermittent;" (as happens
sometimes to  bilious  remittents;)  its producing a greater degree of
weakness;  and its not admitting, at least with benefit, of an early, bold,
and free administration of the bark, I must observe, that, to my under-*
standing, they do not oppose any obstacle to the belief of  this disease
having been the yellow fever; which seldom changes to an intermit-
tent ; alvvaysfproduces exn-eme debility;  and, in its inflammatory stage,
before the appearance of a remission, is, I believe, always aggravated
by taking the bark.
   As Dr. Stuart's reasons,  for thinking the  fever in  question to have
been a new  disease,  were stated with candour  and precision; and as
they have been quoted and adopted by Dr. Chisholm, (at p. 24 of his
letter to Dr. Haygarth,) I have chosen to answer them  in preference
to those which Dr. Chisholm has described with greater prolixity, and 
480
with a manifest effort to make this fever resemble the  plague.   His
descriptions appear, also, to have been adapted, almost exclusively, to
the worst  cases;  though he admits,  that in many persons the fever
was mild, and thought to resemble the ordinary bilious remittent  But
the worst cases were best suited to his purpose  of creating a distinction
between these fevers;* he  has, however,  not  only failed to establish
any such distinction, but has even mentioned  facts which prove  that
the fever of 1793 could only have been a marsh fever.   The following
are some of these facts,  viz.  (like  all  other marsh fevers it most  rea-
dily and generally attacked  strangers  from  cold or  temperate climates,
and with the most fatal consequences;  sparing  all others in different
degrees  according to  their susceptibilities, as explained by  me, be-
tween pages  177 and  197.   At p.  140 of the first volume of his Essay,
Dr. Chisholm has given,  in regard to this  disease,  what he calls a
" scale of its violence,  or the gradation it observed  with respect to the
different classes of inhabitants;" which  accords entirely with  what I
have repeatedly  mentioned  of the  effects of marsh  fever, upon  similar
descriptions of persons, in other situations.   The highest place in this
scale, is occupied by " sailors, more especially the robust and young;
those least accustomed to the climate,  and those  most given  to drink-
ing new  rum."   The  next,  by  " soldiers, more  especially  recruits
lately from  Europe,  and the most intemperate."   After these come
" white males in general lately arrived, more especially young  men


  * Dr. Chisholm seems principally to rest the supposed novelty of the fever under con-
sideration,  and its character, upon  a sort of  petechias,  or effforescense, resembling
patches of red or livid spots ;" (vol.  1. p. 58) upon a " dinginess, or peculiar mixture of
livid and a dirty yellow^ (mentioned by Dr. Stuart)  which he (Chisholm)  whimsical-
ly ascribes to (a nonenity) " the action of the matter of infection ;" (vol. 1, p. 76) and
upon the frequency  and profusion of htemorrhages ;  (p.  166)  but all these symptoms
obviously result from a dissolved state of the blood, which as well as the  symptoms them-
selves, have been  long noticed  by almost every writer  on the  yellow  fever.  Dr.
Moseley  (p.  456) observes of  it, that,  in  " the  last  stage,"  " the  interior sur-
faces of  the body are all oozing out blood, into their cavities ;  every  excretion is cor-
rupted blood;" "and internal hemorrhage becomes general."  Hillary says (p  151)
' in the latter stage of this fever, the  blood is so attenuated, and dissolved, that we fre-
quently see it flowing not only out of the nose and mouth, but from the eyes, and even
through the very pores of the skin."   He mentions, also, " livid spots  in many parts of
the body," and that they are multiplied  after death.  Dr. Moselev's description of
Capt  Mawhood's case, which occurred before  the Hankey existed, affords all tlfe worst
symptoms of the worst cases of the supposed new fever of 1793.  It  was not, indeed,
accompanied by Dr. Chisholm's " dinginess, &c," which I have mentioned (at the bot-
tom of p.  47)  as someties occurring in the disease,  and which Dr.  David Grant, in
describing  the yellow fever of Jamaica, calls " a livid hue tinged yellow."  It is remark-
able, however, that though so much importance is now attached to this symptom, Or.
Chisholm,  in the first  Edition of his Essay, did not mention or even  allude to it; but
contented himself with stating, as  " a principal  distinction," between the supposed new
fever, and the bilious remittent, that in the former, " the  yellow suffusion, seldom hap-
pened ; in  the latter always." Seep. I'28 of his first edition.  The "dinginess" seem-,
only to have been noticed by Dr.  Chisholm, after his return to the West Indies in 1796,
when, according to his representation, the  malignant  pestilential fever had  ceased  to
prevail there, and the common yellow fever had taken its place.
  I may here observe, that the fever of 179,3, at Grenada, did  not differ half so much
from the common yellow fever, as it did from the fever which occurred in the  Haukey,
anil among the colonists at Buluuia ; aud it must be very absurd to derive the formei
from the latter, as its  parent, and at the  same tiinw pretend that the supposed new
lever, with its  smaller variations from the com non yellow fever, could not have oris":
^atqd from the causes by which it (the yellow fe*er) is produced- 
*
                                4Sl

from Europe."   The  places of other  descriptions of persons, will
be  readily understood  by what I formerly stated of their respective
susceptibilities, in regard to  marsh miasms:  always recollecting that
females are less susceptible than  males,  children less than adults, and
negroes least of all.   The greater liability, or predisposition to the dis-
ease in seamen, than in any other description of strangers, Dr. Chis-
holm ascribes  with  reason, to their  "violent exercise in t*,e sun,  the
immoderate  use of  undiluted rum;  bathing in a state of intoxication,
and often when violently heated;  and the sleeping on deck during the
night."   (Vol. i, p.  124.)  Indeed, these causes alone will often pro-
duce yellow fever.  Dr. Chisholm has,  however,  suggested another,
(p.  302,)  as perhaps rendering " tiie disease infinitely more  fatal" to
them, than to " any other class of men,"  viz.—a scorbutic taint, which
I formerly mentioned,  as  likely to have  occasioned that variety of the
disease called by the French mal de  Siam.  In regard to the military,
at Grenada, he says, "that nearly one half of the 45th regiment" were
jn the barrack  near  the carenage, and that " all* the officers and men
were successively seized with the disease; but it  proved fatal only to
the recruits  who  had lately joined."  Vol. i. p.  132.  The  case  was
similar  in the  ordnance  department;  of those  who had become sea-
soned, in some degree, to the climate, only five died out of 56; but of
recruits  just arrived,  21 died out of 26; and this with all the advan-
tage of Dr. -Chisholm's skill, two months after he had discovered the
wonderful benefits of mercurial salivation, in this fever.   See vol.  i.
p. 133.
  After these  instances of the frequency and violence with Which per-
sons newly arrived from northern climes were attacked by the disease,
(as always happens  with marsh fevers exclusively) he proceeds to the
other extreme, and  mentions fi.eld negroes, as being the most exempt
from it;  though that mixed race called people of colour, seem to have
enjoyed  this exemption in a very high degree; for Dr. Chisholm  tells
us,  that  " the inhabitants of the district of Montserrat," (and a part of
St. George's, adjoining the carenage) are almost all free people of co-
lour ; and among them the disease never appeared, affecting their  own
persons ; many of the  sick, (he adds) from the shipping, were accom-
modated in their houses;  but  a peculiarity of  temperament  saved
them generally."   Vol. i. p. 128.   This peculiarity of temperament
might,  indeed, well save them from the morbid effects of marsh mi-
asms, as it has always been found to do, when they had not lost it, by
long residence in a cold climate; but negroes  and people of colour,

  * Tt is difficult to understand what quantity, or proportion, Dr. Chisholm means by
 "all."  He says, at p.  134, vol  1, of his Essay,  that " about the middle of June, tho
disease broke out in the 67th regiment, and among the artifices  and  labourers on
Richmond Hill" " all  were  successively seized  with it; but it fell heavier on the offi-
 eeh than the men;  several of the former, being young men lately arrived from Eu-
 rope. He adds,  that " of  about 300 men,  at that time the strength of the 57th regi-
 ment only about sixty  were seized with the symptoms of infection and of that number
 only 'three died." Here we find that all signified only  one-fifth part, and that  the dis-
 ease proved fatal only to one in twenty. Did Dr. Chisholm form his description of the
 disease from its  general appearance on Richmond Hill ?   Or did he conclude thedis*
 ease to be direfuUy contagious, because only 60 out of 300 men took it, and doubtless, by-
 going down the hill, and within the reach of marsh miasmata?
                                    61 
482
have no peculiarity which will protect them from the morbid effects of
pestilential and typhus  contagions;  on the  contrary, they are,  as has
been proved, the first and greatest  sufferers by these contagions, i.nd
this single fact would alone orerphrow Dr. Chisholm's  whole  sys-
tem.*
  In regard to the termination of this epklemic, Dr. Chisholm states,
 (vol.  1, p. 136)  that " from about the middle of  September,  till the
month of February, of the  year  1794, the  disease  seemed to have dis-
appeared every where in Grenada."  Why a contagion, with such ir-
resistible power, should have become extinct when there was no want
of persons susceptible of it, he  has not  explained; but, in looking
over his account of the weather we find, in vol. 1, p. 90, the  follow-
ing statement, viz.  " September, the greatest part of  this month re-
markably rainy,  attended  frequently with most  vivid lightning and
tremendous  thunder, and  violent  squalls."   Of October, he  says,
M much rain fell in this  month also," "but not in the violence of the
last."   He adds of November, " five days excepted,  the whole of this
month was uncommonly rainy  " " a great deal of thunder and light-
ning."  " December was also very rainy."  That these excessive and
long continued rains ^assisted by the salutary effect of  violent squalls,
thunder, 8cc.)  should have put a  stop  to the  fever, by diluting the
marsh miasms, and  washing away the  materials necessary for  their
production,  will, I am persuaded, be thought highly probable, by
those  who may have  attended  to  the  facts mentioned in the former
parts of this work.   Concerning its return, in Februaiy, 1794, as the
Hankey did not then return, it  might  have been expected that Dr.
 Chisholm would have found some difficulty in giving a  suitable expla-
nation, but having  before  luckily sent the contagion to Philadelphia
 by some unknown vessel,  and from some place, respecting  which
there  are very contradictory accounts, he  contrives to have it brought
back to Grenada, by the way  of Martinico, where, after it had  been
deposited by  one vessel, it was taken up by another and left at Gre-
nada.   But unluckily, though he was then at Grenada, Dr. Chisholm
is unable even to  hint at her name, or the name of her  captain ;  a sort
of  inability  which (considering how much greater difficulties he had
previously surmounted)  I  should not have expected; especially as he
 says the sick belonging to  this vessel, and by whom  Grenada was the
 second time  infected, were placed  under  his " charge ;" and that he
 " had no doubt respecting the  identity  of the disease."  Really,  I
 should have believed that the books of  himself and his partner, must
 have contained  the names  at least of the vessels,  to which patients of
 that description belonged ; as they  certainly did not bestow medicines


  * At p. 302, of Ids first volume, is the following passage, " why,  however it" (i. e. Ihe
 vim-- <>f his supposed contago i " should operate with most violence on Europeans just
 arrived, and who had never ente-ed the Tori-id Zone before, is a singidarity 1 do not
 pr- tend to explair.'   Tha abstinence from explanation, though unusual in Dr. Chisholm
 was, I think, discreet on the  present occasion.  Certainly, if his supposed contagion had
 existed, a,! manifested this wonderful predilection for Europeans, at their  first entering
 the TortM Zone, it would hav.- been a singularity never observed in anv other contagion ;
 and t.Urfor- well calculated <o discourage him from any attempt to explain. The singu-
 larity, however, and the contagion, were but creatures of his own imagination 
483
 and attendance gratuitously.  I should have,  moreover, expected, as
 Dr. Chisholm had no doubt of the identity of their disease, with that
 which had  recently done so much mischief, that its re-introduction
 would have been deemed by him  a matter  of high importance, and
 that instead of such unexampled negligence,  he would have spared no
 pains to collect and preserve all possible information on the subject.
   I have stated, in a note,  at p. 260, that Dr. Chisholm's adherents in
 Philadelphia, convinced that they could not otherwise establish any
 distinction between  what they represented as his  Grenada fever, and
 the marsh bilious fever of that countiy, had assumed contagion as
forming its distinguismg character ;  and Dr. Cliisholm has followed
 their example, doubtless for the same reason.  At p. 200, vol. 1, he
 says, " the  most remarkable di'jtinction  between the malignant pesti-
 lential fever, and the yellow remitting,  is contagion;"  this  assertion he
 repeats at the next page, and then very properly endeavours to prove
 the existence of this contagion; but here he unfortunately  adduces for
 his first and principal proofs of it, the absurd story concerning the ship
 Herberts, lately noticed; and his equally absurd notion " that much
 of the melancholy fate of the army collected at the Cove of Cork, uri-
 der major-general White,  about the end of the year 1795, for St.
 Domingo, is to be attributed to  the infection of the malignant pesti-
 lential fever."  Thus making yellow fever the parent of typhus.  These
 being evidently, in  his own estimation, his best proofs and instances
 of the contagion,  which is supposed to distinguish the fever of 1793,
 I shall not be expected to notice the others, after all that I have before
 written on this subject.
   Dr. Stuart,  in  his letter to Dr.  Hosack, mentions of this  fever,
 that "its contagious nature appeared from many instances of men in
 1793-1794, gomg to St. Geoi'ge's on business, and being attacked  a
 few days after their ret&rn to the country, with fever; to  several of
 whom it proved fatal."  This, however, is only what commonly hap-
 pens to persons, exposing themselves to the influence of marsh mias-
 mata ; and what has been often described, as happening to persons going
 into towns where the common yellow  fever prevailed, long  before the
 Hankey existed ; which yellow fever, Dr.  Stuart  (as  well as Dr.
 Chisholm)  believes never to have been contagious.   Dr. Stuart, in-
 deed, with laudable  candor ', makes this addition to what has been just
 quoted from his letter, viz. "but I must observe that I  met with no
 instance in  the country, of the disease being communicated to others,
 either visitors or attendants.  It is true that every attention was paid to
 keep the chamber of the sick well aired, their linen frequently shifted,
 and when a fatal issue took place, every article of wearing apparel and
 bedding was commonly destroyer."    This destruction,  however, was
 probably of no use, as it only took p>ace in fatal cases, and not invariably
 even in these, as I  conclude from the expression " commonly ,•" and
 as the cases which were not fatal, would have equally infected the un-
 destroyed clothes and bedding, from  which no harm resulted.   The
 airing of the  sick apartments  might,  indeed,  have  been effectual,
 against typhus; but not against any such virulent and powerful conta-
 gion as tf e  Hankey is  supposed to have imported.  This part of Dr.
 Stuart's statement is confirmed by Dr.  James Clark,  in regard to the 
434
fever which began at Dominica, in June, 1793, and which Drs. Stuaitt
anu  Chisholm suppose to have been the same with that of Grenada,
and  derived from the same source.  Dr.'  Clark's  statement  on this
point I have already quoted at p.  296, and  I may add that as no pre-
cautions were  there employed to  hinder the operation of contagion, I
am persuaded that if none had been used at Grenada, the fever would
have proved equally incommunicable.   Dr. Clark says, (p. 61)  "that
the common remittent fever, dysentery, and other bilious complaints,
had begun to shew themselves previous to  the appearance of the yel-
low  fever" in 1793;  a plain indication of the prevalent influence of
marsh miasms.   The same author, at p. 22,  makes the following ob-
servations concerning the supposed new  fever, viz. " I have been in-
formed that it has been considered, by some, as an imported and very
infectious disease;  but in this island it did  not appear to be either  im-
ported or infectious.   The very  few instances which seemed to indi-
cate* contagion,  I think, may  be accounted for on other principles.
Some inhabitants, who had been accustomed to breathe a cool healthy
air,  in high situations in the'country, were sometimes attacked after a
visit to town in the same manner as new  comers from Europe  and
America, who never had been in the West Indies before; the reason
of which will be enquired into hereafter.  Those who had resided long
in town,  or  near t/ie sea side, were not attacked with it.  The physi-
cians and surgeons who visited the sick, and  the nurses who attended
them constantly, were not infected ; nor did there occur a  single in-
stance,  of one of them being  seized with  this fever for these three
years,  that I have remained in the island, since it broke out: although
no prophylactic, or precaution of any sort whatever,  was made use
of to counteract or avoid contagion.   I am, therefore, of opinion, that
this terrible disease was not  imported into this or  any  other  of these
islands, or  into  America;  but  that it was  produced from  natural
causes."*  Of  Dr. Clark,  Dr. Chisholm  has stated, at p.  258 of his
2d volume, that he was " a physician of great eminence, whose prac-
tice for five and twenty years, in the West Indies, furnished a most
ample field for  observation and  experience ;" and it appears that he
was not singular in believing that the fever in question  was  not conta-
gious.  For Dr. Chisholm states, (vol.  2,  p.  254^ that  "Dr. Fillan,"
who " has been an eminent practitioner in Dominica, for near twenty
 years," " imagined he could perceive nothing contagious or infectious
 about.it,  i. e. the new fever:" this negative exercise of the  imagina-
tion, however,  is at least unusual; persons having much oftener  ima-
 gined they could perceive what does exist, than the reverse.  It ap-
 pears,  indeed,  that it was not  Dr. Fillan who thus exercised  his  ima-
 gination, but Dr.  Chisholm,  who thought it most convenient  to repre-
 sent Dr.  Fillan as having only imagined, when in fact he had  asserted,
 that he  could perceive nothing contagious,   8cc.  for he immediately
 subjoins the following sentence, viz. " on questioning the doctor close-

   * Dr Roberts, Physician to the forces, who was at Grenada during the great mortality
 there in 1796, and who, probably, saw more than 1000 cases of the supposed malignant pes-
 tilential lever, declares that he could discover no sufficient reason for considering  it as a
 disease d fferent from the common  yellow fever of  the  West Indies, with which he was
 Well acquainted ; having been born at Antigua. 
                                 485

ty on this subject, I perceived that no conclusive or well-founded rea*
soning  could be  adduced  in  support of this assertion."   That  Dr..
Chisholm should not think  any reasoning conclusive or well-founded,
which had induced another person to imagine he could not perceive
that contagion, which has  so long occupied and  bewildered  his own
imagination, I can  readily believe; and  though I cannot applaud the
candour of his statement, I am glad that it contains less of misrepresen-
tation than many of those which I have found it necessary to controvert.
But though  Dr.  Chisholm could not, by " closely questioning," hin-
der  Dr. Fillan from asserting his inability to discover any appearance
of contagion in the supposed new fever,  he  seems, from his  own ac-
count,  to have been a little more successful  with Dr.  Fillan's " assis-
tant."  For the latter, (who is styled, by Dr. Chisholm, an " eminent
practitioner") after declaring that he had neglected to make any " in-
quiry so as to establish the source of the disease in any instances,"  is
said to  have  readily " acknowledged, that had an investigation been in-
stituted, with  the care and  attention  the subject merited, he had rea-
son" (where did he get this reason)  " to think that contagion  might
have been detected,  as the cause of  the disease, in every  instance."
If Dr.  Chisholm has not misrepresented this  (probably young) gen-
tleman's language, it may be well that his complaisance, or his imagi-
nation, did not carry him farther.*
   But after  all this, Dr. Chisholm, who has repeatedly stated his sup-
posed new fever, or its contagion, to have been carried from Grenada
to Dominica, (though without  designating any mode,  or vehicle, or
person, by whom this mischief was perpetrated,) tells us, at p. 256 of
his 2nd vol. that  " the  first appearance  of the disease  (at Dominica)
was in a ship, called the Providence of London.  She arrived (he adds)
about the 8th or 9th of  June, and the first case of fever appeared about
the  13th: many of the crew were attacked immediately after, and died.
The fever appeared in the neighbouring  ships, and spread so  rapidly,
that^about the 20th, scarce any were free from  it."  And this, Dr.
Chisholm (whose intellectual and perceptive faculties appear inacessi-
ble  to  all ideas, which  do not  accord with  his supposed contagion,)
considers as a proof, that the disease was communicated from the sick
to the well, and from one ship to another, in succession ; and all in the
space of one week.  A monstrous supposition! utterly incompatible
with every thing known of the different kinds of contagion; among

  ♦ As an illustration of the truth of this remark,  I will here mention a statement made
by Dr. Chisholm (at p. 257, of vol. 2d.) on the information, as he alleges, of Dr. Fillan's
assistant. It relates to a Dr. Wilson at Dominica, who resided about 12 miles from
town, and who three days after returning to the country from town, where he had visited
 persons labouring under the prevailing fever, was astonished to perceive a number of
 carbuncles, spreading round his neck, and towards his face and breast. The progress of
 these was so great, as to threaten  a mortification.  In this distress, he sent an express for
 Dr. Johnson.  Dr.  Fillan's assistant  "who  immediately visited him. By the time he
-arrived a mortification had actually taken place, and Dr. Wilson died a few hours after,
 whilst endeavouring to examine the state of his neck in a looking glass.  The description
 of the sores on this patient's neck, says Dr. Cliisholm, left no room to doubt they were
pestilential carbuncles."  Thus has Dr. Chisholm's heated,  distempered imagination,
 created the true plague at Dominica ;  and that it might not be created in vain, he imme-
 diate! v adds that " an immense number of the inhabitants were seized and many died."
 Is it possible that he can  have believed and wished to make others believe, that these
 persons died of the true plague ? 
486
which, there is scarcely one, that could have so soon produced disease,
even  in two persons successively.  When ships are placed wi .iii the
reach of those miasms, or local causes of disease,  which, a.  < . rtain
times, commonly produce the yellow or other marsh fevers, in .he har-
bours of the West Indies, their crews being acted upon, nearly at the
same time, by the morbid exhalations, many persons will naturally fall
sick almost  simultaneously: and nothing but such a cause, could have
produced the effects just mentioned, as having occurred at Dominica.
But how Dr. Chisholm expected to reconcile the first appearance of the
disease, in a London ship, just arrived at Dominica, with his assertion
of its  having been derived from Grenada, I am unable to conceive.
   Believing that it would be not only superfluous, but tiresome to my
readers, as well as to myself, if I were to carry this refutation any far-
ther ;  and presuming, that I have sufficiently demonstrated the fallacy
of all  those statements and arguments, by which Dr. Chisholm has la-
boured to prove the fever in question to have been  derived from the
Hankey;  and that there is no good reason for considering it as specifi-
cally  different from the common yellow, and other marsh fevers, which
have been proved to be void of contagion, I shall here dismiss the sub-
ject;  adding only a few observations,  to justify the uncourteous and
disobliging expressions which I have been sometimes forced to employ,
in regard to Dr. CJiisholm.  Had this gentleman contented  himself
with stating fairly and correctly, the facts and reasonings which occa-
sioned,  and were by him thought  capable of supporting  his  most
extraordinary opinions, I should have left the public to judge of their
sufficiency,  and have gladly avoided  every  appearance  of  controversy
with him.   But instead of doing that, which would have most benefited
the cause of truth, and the interests of mankind, Dr. Chisholm, with
great perseverance, and very little temperance or moderation, has la-
boured  to propagate and maintain these  opinions, by assertions as
positive as they were unwarranted; and by -statements of pretended
facts, which were destitute of any foundation in truth, and at the same
time of such decisive import, that a belief of them, must  necessarily
produce an  adoption of the opinions intended to be thus maintained;
which opinions, I sincerely believe to be not only erroneous, but likely
to obstruct the  progress of medical science; perplex and frustrate all
endeavours to elucidate the important subject of contagion;  and, more-
over, to produce all  those mischievons consequences which I  have
mentioned at p. 332—336.  Under this conviction, I have thought it
my duty,  to endeavour, at least,  to rescue and vindicate  the  truth?
from  those fallacious arguments, and confident misrepresentations, with
which it has been surroonded and obscured, by Dr. Chisholm;  and for
this purpose, to contradict, and confute the untruths advanced, (I will
not say fabricated,) by him;  and demonstrate the little  reliance which
(either from his extreme want of caution, or excessive anxiety to over-
come his opponents,) ought to be placed on his supposed facts and
representations, in regard to the origin and nature of the fever of 1793.

  * Dr Chisholm, at p. 219 of his 1st vol. has declared, that " the cause of truth is
paramount to all other considerations;" and has assigned this as his motive, and justifica-
tion, for contradicting Dr Hush;  professing, at the same time, to entertain  the highest
opinion of "the humanity, the genius, and the professional skill of that gentleman." 
•  487
For such contradictions and confutations, I have found it necessary to
employ adequate terms;  but 1 have  done it  reluctantly, and have in-
variably preferred the least offensive, as far as I  could  do so, with-
out weakening my conclusions,  or leaving my ideas imperfectly ex-
pressed.
  This explanation  I have thought  due to my own character, rather
than to  Dr. Chisholm.   For,  whilst endeavouring to spare his feel-
ings, I have bebeved that very few  writers  were less entitled to in-
dulgence and tenderness in this respect: because, with a few excep-
tions, he seems to have exercised neither towards those by whom his
statements and opinions are controverted.   His Letter to Dr. Haygarth
abounds in offensive, arrogant, and  injurious language, particularly at
p. 75, where he designates the most respected and meritorious physi-
cians of New-York and • Philadelphia, as " pertinacious theorists."—
" Disturbers and destroyers  of society:"—Kind as deserving  " to  be
execrated  by their  fellow citizens:" and  this, only because they had
controverted his opinions, respecting the fever of  1793.   And again',
at p. 159, he has generally accused  all  who  deny the supposed conta-
gion of that fever, of ' a predetermination to break down the barriers,
which alone can secure mankind against the calamities," arising from
" infection and contagion," " universally  diffused, and universally
 destructive of the human race"  He had previously, in his preface to
 the 2nd edition of his Essay, plainly intimated, that the " Medical Staff"
 of the  army, under Sir Ralph Abercrombie, in  the West Indies, were
 chargeable, in  a great degree, with the deaths of 13,437 soldiers; and,
 at p. 243  of that volume, he has accused them of a species of " con-
 duct, which led to the pernicious, indolent, and unscientific habit, of pre-
 scribing for the name of a disease:"—" prevented the investigation of the
 principles on which practice, in any particular distemper, should be
 founded;"—"  which tended to the  discredit of a mode of treatment of
 the epidemic,  from which alone,  success  could  be expected:" and
 which was,  "  in short, the paramount cause  of the mortality which
 has disgraced  the annals of the West India Medical  Staff of the  day."*
 The foundation of  these outrageous accusations, and the delinquency
 to which they relate, is nothing more than a belief or pretence, in Dr.
 Chisholm, that the medical officers of the army in question, did  not
 sufficiently adopt and persevere in the practice recommended by him<
 of giving or applying mercury to excite salivation, in the yellow fev r;
 a practice,  of which I have delivered my opinion, at p. 73—78; and I
 will here observe,  as one of the physicians to that  army, that there was
 nothing in Dr. Chisholm's situation, which could make it our duty, or
 even warrant us, to persevere unsuccessfully, in the trial of his strange
 and unpromising innovation.f  He had only been known  as  a  practi-

   * The mortality with which the medical officers of Sir Ralph Ahercrombie's army are
 here reproached, was  certainly great, and  ever to be deplored ; but it  did  not, in any
 instance, extend to 21  out of 26 patients, as happened to persons under Dr. Chisholm's
 •arc. after \\\& pretended Aimw-ry of an almost certain remedy.
   + It is remarkable, that while Dr. Chisholm brings such heavy accusations against the
  medical office rs of the army,  for  not having sufficiently employed mercury to cure the
  yellow fever, Dr Cillespie, who was then in charge of the nav.d hospital at  Fort Royal,
  in M JitiiNCo, declares * that many of these gentlemen fell victims totheir implicit faith
  in mercurial mediuines which had been lately supposed so efficacious in  epidemics, of a 
488
tioner at Grenada; and when there, could not have  pretended to  an
equality with several others, in public estimation.   Nor did I find that
his boasted success at that island, from the use of mercury in tiie yel-
low fever, had been known there, until his printed accounts of it had
arrived  from  Europe,  nor that  it was  believed when  thus made
known.  I feel, however,  no resentment against  Dr. Chisholm, for
the obloquy which he has thus attempted unjustly to throw upon me
among others, though I sincerely .regret, that his acknowledged talents
ana industry, were not more judiciously and beneficially employed.

similar nature to those which then reigned."  Meaning the Grenada fever, and Dr. Chis-
holm'saccountof it.  See Observations on the Diseases," &c. " of his majesty's Squad*
ron, on the Leeward Island station," &c,p. 1%
APPENDIX.
NO. VIII.
9
  At pages 204 and 205,  I have explained the subject and motives
of this appendix; and the following is Dr. Blane's  statement, (therein
mentioned,^ to the American and Prussian ministers; viz.
  "On the 16th of May, 1793,  the Thetis and Hussar frigates, cap-
tured two French armed ships from Guadaloupe, on the coast of Ame-
rica.  One of these had the yellow fever on board, and out of fourteen
men sent from  the  Hussar to take care of her, nine died of this fever
before she reached Halifax, on the 28th of the same  month, and the five
others were sent to the hospital, sick of the same distemper.  Part of
the prisoners were removed on board of the Hussar, and  though care
was taken to select those seemingly in perfect health, the disease spread
rapidly in that  ship, so that near one third of the whole crew was more
or lAs affected by it.
  " This fact carries a conviction of the reality of infection, as irresisti-
ble as volumes of argument; and, it further affords  matter of important
and instructive information, by proving that the infection may be con-
veyed by the person or clothes of men in health."
  Numerous facts and considerations most of which have been already
mentioned,  having induced me to  think it impossible, that the  yellow 
                               489

lever should have in this instance manifested properties, which it had
been found not to possess in a multitude of others, I was solicitous to
investigate the circumstances of this transaction, as minutely as possi-
ble, in order to ascertain the truth,  on*a point which I have long con-
sidered as of high importance to mankind; and I therefore applied to
the commissioners of the transport  department, for permission to in-
spect the medical journals of the surgeons of his majesty's ships Thetis
and Hussar, for the year 1795, and the correspondence of the surgeons
of those ships with the sick and wounded board, for the same period,
and was very soon honoured by a letter from Sir Rupert George, Mr.
Serle, and Dr. Harness, dated 14th October, 1807, and  informing me
that " the journals were ready for my inspection, but that there did not
appear to have been any letters received from the surgeons of  those
ships during that period."  1 lost no time in availing myself of this per-
niission; but as the journals in question did not afford all  the desired
information, I  extended  my researches to the navy office;  after which,
I thought it my duty, fairly to communicate the results of my inquiries
to Dr. Blane;  and having done so,  he thought it proper  to write the
following letter to Dr. Wilson, now physician to the Plymouth hospital,
and formerly surgeon to the Hussar frigate,  viz :
                                       "London, Nov.  17,  1807.
       " Sir,
   "You may  possibly have seen, in some of my writings,  that I have
adduced as a proof of the infectious nature  of the  yellow fever,  that it
spread from the Raison, French prize, to the Hussar frigate, in May,
1795.   Ti^ere is, in my opinion, sufficient proof of this fact from other
quarters, but as you were then  surgeon of the Hussar, and as I find by
my notes, that it was partly on your testimouy that I built, I take the
liberty of putting some questions to you on this subject.  What leads
to this  is, that Dr. Bancroft, a respectable  medical gentleman of this
place, who has paid much attention to the subject of infection, but who
is of a different opinion from me on this point, means to controvert my
statements of  that case, and founds  his proofs chiefly on your journal,
which he has not only  inspected, but has copied it for the months of
M'iy and June, 1795, and has very candidly called on me,  and shown
it me.  There  is certainly nothing in that part of your journal  which
can be construed  into a proof, that the ship's company of the Hussar
had the same fever with the prisoners.   But the composition of it bears
marks of very  great haste;  and no  description of the symptoms is
given, except  a reference to the case of Mr. Backhouse, who  Was not
taken ill till a month after the battle, and whose symptoms have nothing
characteristic  of the yellow fever.  I am sure, however, from my notes,
that either in some other parts of your journal, or in those accompany-
ing remarks,  enjoined  by the  form of the  journal,  or  in  your  letters
from the  hospital, there must have  been some further testimony from
you on this subject.  The purpose of tins letter, therefore, is to request
you to consult your memory, and your p^peivs, regarding it.  You will
certainly  recollect, whether or not, the men of the  Hussar, either on
board, or at the hospital, were affected' with a fever  attended with yel-
lowness of the skin, and coffee-coloured vomiting, and in what num-
bers; also, whether onlv tbe prisoners apparently in health, or both the
                                 62 
490
 sick  and healthy, were brought on board of your ship? If you should
 be able to give any satisfactory information, cither for, or against, these
 facts, I should hold myself extremely obliged to you, and I am sure so
 would Dr. Bancroft, in order th'at neither of us may be led into error,
 in so material a point.  There is a reference in your journal, to some
 letter you wrote from the hospital, but as Dr. Bancroft could not find it,
 it has, no doubt, been mislaid at the office ; but it would be a great sa-
 tisfaction to us, if you should have kept a copy of it.   In short, if you
 will have the  kindness to send all the information on this affair, which
 your memory, or written documents, can supply, and your time will af-
 ford, you will greatly oblige
                   Sir, your most obedient,
                       and very humble  servant,
                                                  GIL.  BLANE.
     " Dr. Wilson, Plymouth Hospital.
   " P. S.  I ought to have mentioned that  Dr. Bancroft has also in-
 spected the muster-books of the  Hussar, at the navy office, and finds
 the prisoners  in sickness as well as health were brought on board the
 Hussar,  contrary to what I have  stated in my letter to the American
 and Prussian ministers,  which you may probably have seen in print."
   To this letter the following answer was returned, viz:
               " Royal Navy Hospital, Plymouth, Nov. 22,  1807.
     " Dear Sir,
   " I am much afraid I have lost the journal of the sick kept by me, at
 the time the yellow fever prevailed on board the Hussar; I have, hovy-
 ever, found a copy of the letter, which I transmitted to the sick and hurt
 board, on that occasion.   I have, agreeably to your wishes, transcribed
 the greatest  part  of  it, and herewith enclose  it for your perusal ;  if
plain matter of fact can have any weight, you will there find sufficient
 to establish fully your observations on the  contagious nature of that dis-
 ease.  Should any  other testimony be wanting, by a reference to capt.
 Beresford, who then commanded the Hussar,  and now commands the
 Theseus, further particulars may be obtained.
   " Mr. Backhouse was subject to frequent attacks of chronic rheuma-
 tism ; was, in consequence, sent to the hospital at Halifax;—first, on
 the 27th of June,  1794—and again  in November following.  Many
 were afterwards, at different periods, sent for the same complaint, and
 particularly two on the 28th of May ;—one on the first, and another on
 the 17th of June, 1795.*  Their treatment  being  nearly the same as
 that of Mr. B. a reference, in order to  avoid repetition, was in conse-
 quence always made to his case.   This, I trust, will  explain, why no
 symptoms, in  common with yellow fever, could be found in the  cases
 alluded to, or any thing  that could lead one to believe, the Hussar's
 ship's company to have the same fever with the prisoners.

  * This accords with Dr. Wilson's Journal;  but in his subsequent letter to Dr. Blanc,
he admits, that the entry relating to the 17th of June, could not have been correct; "as
from the 6th of that montli, to the 4th'.)f July following,  we  (the Hussur) had no com-
 munication whatever with the hospital."  Il must consequently follow, that the entry in
 his journal of another name, as  sent to the hospital, the 20th Junej  must also be incor-
rect. 
491
  " I  do not recollect the number of prisoners received on board the
Hussar: I only remember,  that the sick were not removed from  the
Raison ;  that  they remained  in the prize  until her arrival in port,
and that  it  was  only  those in health that  were  permitted to  come
on  board  of us; the names of the sick, as well  of those  in  health,
were, as is customary in such  cases,  indiscriminately  entered  on  the
books of the Hussar.*
  " The  number of the Hussar's  ship's company affected with  the
disease, appears to have  been 98.   The number of deaths on board
the Raison, between the 16th and 28th of May, were (was)   .   .   9
   The  number of deaths at the  hospital, between the 28th of May
and 6th of June   .    ...............6|


                                                               "Total 15
   " The  above will, I believe, be found  a correct statement.
                                   " I  am, dear Sir, &c.
                                                             « J. Wilson.
   " To Dr. Blane."

  * The only way in which I can reconcile this with the opposite testimony, is by suppo-
 sing, what appears in other respects probable, that there were no sick on board La liai-
 son.   I found, by  the books at the JVavy Office, that" head money" had been paid to the
 captors for 116 prisoners, as having been  on board the  liaison, at the commencement of
 the action ,• and itappears from the master-book of  the Hussar, that she received the same
 full number of 116 men on board, from La Raison, on the 16th of May, and that every one
 of these men were delivered from the Hussar to tiie Security, prison ship,  at Halifax,  on
 the 28th of May ; consequently none  had been killed in, or died subsequently to the en-
 gagement of the 16th of that month.   Their names  are all stated in the book at full
 length ;  and under them is a certificate, signed hy  John Beresford, captain, and Francis
 Prior, declaring " to the Commissioners for Victualling his majesty's >iavy," " that the
 before-mentioned prisoners, beginning  with the name of A L. Le Sau, and ending  with
 thatot Anthony Pigr.on, were actimUy victualled  at two-thirds  allowance, the number of
 days as specified  by the several entries and discharges."  These entries and discharges
 include all the days'from the 10th  to the '28th of May ;  and aginst the names is a column,
 for tliem when  mustered, and  in  this column the  23d of May  is  written against
 each  name, or the  letters Do. under that date.  I inquired particularly of the gen-
 tleman  at  the   office,  whether it might not be possible that  these letters should
 he  i.ffised to the names of some of the  prisoners who had nmai ed on  board the
 liaison, and was answered in the negative ,-  with an assurance, that every man against
 whose name those letters  were written, must have been actually on board ; and that if
 any man had been sick, so as not to receive his allowance, or absent from the Hussar for
 a single day, it  would have been  noted in the column,  or " checked," as they express it:
 and in confirmation of this, 1 was shewn sineral instances of such checking, iu the books.
 It  is to be recollected, that the " two-t/urds''' is the full allowance to prisoners in health ;
 and it would have been fraudulent to make a false entry in this respect : and, moreover,
 it is highly probable, that they must have been in health, because at Halifax they were all
 sent,  nut  to the hospiiul, hut the prison ship ; and none were sent thence to the hospital
 until three days after ; and even at that time, it does not appear that a:iy one sent was i!l
 of fever.  Chat they would have been sent earlier from the prison-ship to the hospital, if
 they  had been ill  sooner, is manifest, because  two of the I'revoyante'screw were sent
 from  the prison ship to the hospital, one the '29th of May, and another  on the 3i>lh, as
 appears by the hospital books, and being all prisoners made  at one time,  aud in the same
 circumstances ; the men belonging to the Kaison, if any  had been jV/on those days, would
 have  naturally been sent at the same time.
    + Dr. Wilson  has stated and  admitted,  several times, what the books of the hospi-
 tal at Halifax prove, that the  whole number of men  belonging  to the Hussar, who
 were sent to this hospital, in May and June,  1795,  amounted only to 12; and, in  his
 Letter to Dr- Blane, of December 20th, 1807, he declares, that six  of these were sent
 back  to him, on  the 6th  of June, and that they all  recovered.  He  also states, that
 two of the remaining six, were cases of rheumatism, in the  persons of David Sullivan
 ai»d Nicholas Martial, who, hy Dr.  Wilson's Journal,  arc stated to have been pat ou 
492
   The following  is a copy of the transcript, mentioned in the preced-
 ing lettt;. of u ibt greatest" part of Mr. Wilson's Letter " to the Sick
 and Hurt Board," viz.—
   " On the 16th  of May, 1795,  his  Majesty's ships  Thetis and Hus-
 sar, cruizing off the Cape of Virginia, fell  in with five French armed
 ships, two of them, after  a severe action of about an hour and a half,
 struck; they had  sailed some time before from Guadaloupe, where the
 yellow fever had prevailed, and had carried oft' numbers of the French;
 unfortunately for  us, La Raison,  the  ship we took  possession of,  had
 suffered greatly from this disease;  several of her crew having died on
 the passage, and at this time many were found  confined to their beds,
 in a state of the greatest  debility*  Capt.  Beresford, in order to pre-
 vent, if possible, the Hussar's ship's company being infected, ordered
 all the prisoners who had  the least appearance of disease, to remain
 where they were,  and those only  who appeared  to be  in a perfect state
 of health were allowed to  come on board of us.   Frequent communi-
 cation was, however, found  unavoidable; and, notwithstanding  every
 precaution was taken, I  was  extremely sorry to find, that before vvc
 reached Halifax, we  began to experience the sad  effects of the con-
 tagious nature of this disease.   And of fourteen fine, young, healthy
 seamen, with officers, &c. ordered to conduct the prize into port, five
 only survived their arrival ;f  and four of those in so debilitated a state,
 as to render it necessary to send  them without loss of time to the hos-
 pital, together with  six others, that had  been affected with  the same
 complaint on  board the  Hussar.   The  disease now began to assume
 so serious an appearance,  that it was deemed proper  to send them on
shore the  moment they complained, where few  survived longer  than
three or four  days.\

 the sick list of the Hussar; one on the 1st, and the other on the 4th, of May: and
 they continued sick, and  were sent to the hospital at Halifax, on the 28th of that  month,
arid entered as cases of -fevar in  the hospital books. But as neither of them died,  the
 deaths in the hospital could only have been four,  and not six, as is here stated.  It is
 moreover to he remarked, that though these two men are stated to  have been constantly
on the sick list in Muy,  Dr Wilson, in contradiction to his own Journal, asserts, in his
Letter to Dr Blane, of (he 20th of December, 1807, " that for some time previous to the
 action of the 16th of May, 1795, there had not been a man on the Hussar's sick list."
  * In the preceding note, 1 have stated documents aud reasons, which make it impassi-
ble for me, at least,  to believe (hat this can be correct ; and this impossibility will be in-
 creased, bj facts to be adduced hereafter.
  t Facts are hei e equivocally, or obscurely stated;—-nine only of the I Inssar's crew died
    oard the Raison.  We are no where informed, how  many  officers were put on
 hoard that  ship, in addition to the 14 seamen.  But it appears that no person of that des-
 cription, either died, or sickened, by going on that service.
  $ Dr. Wilson here admits what may be otherwise -ufficiently proved, that ten of the
 Huzzar's crew went to the naval hospital, at Halifax,  ill of the  supposed yellow fever  ;
none of them, however, as appears by  h's own Journal,  was sent until after two days
illness  Of  these ten men,  he states in his letter to Dr. Blane, of the 20th December,
 1807, that he received back six,  oi> the 6th day of June, and that they all recovered.  It
appears alsoj by the books of the naval hospital, at  Halifax, and by a letter to the com-
missioners of Sick and hurt seamen, written by Mr. Haliburton, surgeon to that hospital,
and dated the 25th of June, 1795, that at the date of this letter, only three persons had
died  there, of the supposed yellow fever ; and, in fact, no more than four did die, in the
Ibfio'e, o  that fever, at Halifax ; and this fourth man appears, by the books of the hospital
to have relapsed, and died on the 30th of June.  With  a knowledge of these facts, I have
t'fijt no little astonishment, at finding that Dr. Wilson  had permitted himself to assure 
493
  *l The idea of an infectious disease, which had in so short  a time
proved fatal to so many seamen, alarmed the inhabitants of Halifax and
its  vicinity to such a degree, that they  made application  to  Captain
Roddam Home, commanding his majesty's ship Africa, and then senior
officer in port, to order the  Hussar, officers, and ship's  company, to-
gether with those yet alive at the hospital, to be  removed to the oppo-
site uninhabited shore: the  request was immediately complied with.
Tents were erected for their accommodation; and on the  morning of
the 6th  of June, 1795, at day-light, the  Hussar was  anchored  at  the
place pointed out for that purpose.   The following is an extract from
the Physical Journal kept by me, during the time the sick were under
my care; the symptoms of those taken  ill when on shore, were  ob-
served to be the same as in those first taken ill on board  the  Hussar
and Raison.
   " On the commencement of the disease, the patients were, in general,
costive, and complained of  great lassitude, giddiness, sickness at  sto-
mach, frequent sighing, cold chills, succeeded by a burning heat all over
the body, and affecting the whole of the prima via; a hot dry skin; pain
and oppression about the procordia; pain in the head, back, and loins;
pulse rather quick and full, with a  considerable throbbing of the tem-
poral arteries;  a constant vomiting of at first a yellow, and afterwards,
of  a very dark-coloured bilious  matter; eyes  red, full,  and  heavy;
thirst great;  tongue much  furred;  teeth  incrusted with-'a dark-co-
loured gummy substance;  a yellow suffusion of the skin ;  great pros-
tration of strength;  restlessness;  delirium, Sec. Sec*  The above were

the Commissioners of Sick and Hurt Seamen, that from the very serious nature of the
disorder, it had been deemed proper to send them, the sick, on shore the moment tfiey^
complained,•" and that there (on shore) "few survived longer than three  or four days."
Nine of the ten persons in question were sent on shore on the 28th of May; and exactly
four weeks after, three only of the ten had died. Few, is generally understood, at  most,
to mean the smaller number; but here, more than two-thirds had^ survived, not merely
three or four days, but as many weeks.  In making this computation,  I have taken facts
most favourably  for Dr. Wilson—because, in addition to the ten persons here mentioned,
nine seamen belonging to the Thetis, who were sent  on hoard the liaison, to supply the
place of the  Huzzar's men,  when sick or dead, had also been sent to the naval hospital
with the same fever, where they all recovered; and these, I should suppose, ought also
to  have been taken into Dr. Wilson's consideration,  when he thouglit  proper to state
that few had survived longer than three or four days.
   • Many circumstances convince me, that it is proper to receive this genera!  account of
the symptoms of the supposed yellow fever with great caution.  Indeed, the imagina-
tions of some persons at Halifax, appear, on  that occasion, as at Grenada, in regard t»the
Hankey, to have acquired a morbid activity and bias   Even Mr. Halliburton,  tbe supe-
rior medical officer of the navy on that station, has, 1 think, clearly manifested this, in his
 letter to  the Commissioners of Sick and  Hurt Seamen, though written on the 25th of
 June,  when all apprehensions of danger had subsided, and sober common sense might
 have'been expected  to regain its proper ascendency.  Among other instances of the
 effect of his excessive alarm, he states the following, viz—" I went on board the I luzzar
 with Captain Beresford, had all hands turned up, spoke to the men of the absolute ne-
 cessity of their not concealing their complaints, if they had any; that their safety depended
 0n an early application.  Six of them came forward,  with  evident symptoms ol the ap-
 nroachintr malady, and although at work, I recommended it to Capt. Beresford to send
 them instantly to the suspected tents,-  and  in the evening when I visited them, Hound
 three of them very ill, with quick pulse, vomiting,  Ike." How much of the illness mthese
 thri'e men  depended upon their imaginations, or the  imagination of  Mr. Halliburton, I
 know not ;  but if the symptoms  of yellow fever had been so evident in  the six men, as
 i,e states  we might expect  that he would have found more than three  of them very III
  , hat evening  And, I w ill add, moreover, roy belief, that if a distempered imagination, or 
494
the symptoms, as they in general occurred in succession.   But, Gen-
tlemen, previous to my submitting to your consideration  the mode of
treatment adopted on this occasion, permit me to make a few observa-
tions.
  " On the first appearance of acute diseases, in general, the evacua-
tion  of the alimentary  canal, becomes a primary object;  and in no
complaint, whatever, is this maxim to be attended to, more than in the
disease at present under consideration. In its early stages, I have often
experienced the good  effect  of emetics and cathartics; but when the
former were too often repeated, they were found to be productive of
the most serious evils;  that they not only increased the irritable state
of the stomach, but also, that of the  hepatic system; and that in con-
sequence, a train of such disagreeahle symptoms obtained, as frequent-
ly baffled every effort of either medicine or art to get the better of.
  " On the first attack of the disease, the patient, if of a full habit of
body, was bled, head shaved, a blister applied to the breast, and an eme-
tic, consisting of 2 or 3 grains of tartarized antimony, given;  but in
order to avoid the bad consequences  above alluded to, the  emetic
was  seldom,  if ever,  repeated;  nor was any  liquor  allowed to be
drank  during its operation.  A considerable quantity of bilious mat-
ter was, in general, thrown up; the  spasm on the extreme  vessels, in
some measure, removed,  and a stool or two frequently procured.  In
cases where this last circumstance did not take place, injections were
had recourse to, and often without effect; calomel, however,  from 10
to 20 grains, seldom  failed in procuring some free passages.   Could
the stomach have borne a  sufficient  quantity of the kali tartarizat, or.
any other neutral salt, I am fully of opinion every purpose would have
been equally well answered.   The pain and oppression about the prae-
cordia, and laborious respiration, were much relieved by the bleeding
and blister; and in cases where the vomiting was very severe and pain-
ful, saline medicines, combined with camphor, aether, and opium, af-
forded relief:  saline draughts (with opium,) in a state of effervescence,
were also of infinite service; and those with whom the vomiting, to-
gether  with the burning heat of the prima via,  continued, by taking
three or four grains of nitre, with a few drops of laudanum, in a wine
glass of cold water, or lemonade, every hour,  although ejected almost
as soon as drank, yet,  by persevering in its use for eight or ten hours,
found  the irritation at the stomach, in some measure, removed, and
the  febrile action considerably  abated.  Purgatives, whenever they
could, with any prospect of effect be given, were administered, and
several passages, if possible, daily insured.  When, however, the vio-
lent heat, and morbid action could  not, by these means,  be subdued,
much  benefit was  derived from the cold affusion.  The  manner in
which I used it was as follows: The patient was stripped perfectly na-
ked, and if violent,  held, whilst  sea water from a bucket, was poured

something else, had not overpowered Mr.  Halliburton's  sober judgment, he never
would have thus mentioned evident symptoms of an approaching yellow fever in men
who were quietly at work, and seemingly had no suspicion of being unwell, until fright-
ened into a belief of their being so.  Other physicians often find it difficult to ascertain
whether a fever will prove to be a yellow fever, even sometime after its actual commence-
ment. 
495
on his head, and all over his body, until, If delirious, he came a little
rational,, which was, in general, in the course often or fifteen minutes,
(if not delirious, not so long ;) the affusion was then discontinued, the
patient rubbed dry, with coarse flannel cloths, and put to bed.  Sleep,
and a gentle diaphoresis, usually followed, and the patient awoke in the
course of a few hours, apparently much refreshed,  and free from ei-
ther fever or delirium.   On a return of these complaints, the same re-
medy was again, or again, if necessary, had recourse to, and invariably
with the same effect.   Tonics, consisting of bark, wine, Sec.  &c. with a
proper nourishing diet, soon perfected the cure; and, I have great sa-
tisfaction in adding, that  of those who were  under my  care on shore,
amounting in number to 83,1 did not lose a single patient.
                                                       «J. W."
  The preceding  communications from Dr. Wilson, afforded me but
little information, which was either new  or satisfactory.  In the hope,
however,  of obtaining more,  I stated,  in a letter to Dr. Blane, several
new difficulties and objections, which had occurred to my mind on the
subject, together with fourteen questions, which I thought it probable
Dr. Wilson might be able to answer from  memory, (if no written evi-
dence should be in his possession,)  and which I conceived likely, and
necessary, to ascertain the symptoms and  nature of the disease, and
supply the want of important facts, which  had been  omitted in all the
former  accounts.   These questions, together with my letter, were
transmitted by Dr. Blane to Dr. Wilson, who, in consequence thereof,
wrote an answer, dated December 20, 1807, explaining some contra-
dictions which I had mentioned,  between bis journal and the books of
the naval hospital  at Halifax, and recapitulating his former statements,
but without answering any one of my questions,  which his memory,
as he declared, did not enable him to do.  He moreover intimated, that
he thought it " hard  to be thus called upon, at this distant period of
time, for further proofs of accuracy  and fidelity."  Haying thus failed
in my endeavour to procure full information  on this subject, nothing re-
mained for me, but to employ, as well as I was able, the little which had
been afforded: and as this did not, in any degree,  weaken the reasons
which had, from the first, made it difficult for me to believe the disease
in question to have been the yellow  fever,  I shall  state those  reasons,
after having premised the following additional facts and explanations,
viz:                                                   .
   It appears, from official documents, as well as from the information
which was given  to  me verbally,  on the 26th of October, 1807,  by
Mr. Sawers, who was surgeon  to the Thetis,  in  1795, that in conse-
quence of the sickness and deaths of most of the men sent by the
Hussar on board  the Raison,  a number of seamen belonging to the
Thetis* were also sent on board that ship, to assist in navigating her to
Halifax.  And in Mr. Sawers' " Medical Journal of his majesty's ship
Thetis, from the  13th  of October,  1793, to the  14th of October,
 1795,"  the names and ages of nine of these men are  stated, and against
them, the several days,  from May 27th, to June  11th, on which they

  ♦ Mr- Sawers was not able to recollect the exact number, nor the times when sent on
board La Raison. He thought, however, that they might amount to 15 or 16; 
•  496
were sent to the Naval  Hospital, at Halifax; and to these name's and
dates, the following explanation is annexed,  viz:
  " These men were sent into  Halifax in a French prize vessel.   We
afterwards learned she  had been employed a great part of the war as a
prison ship, atCiuadaloupe, and had been very sickly, and a number of
men had died on board of her.*   When they began  to move her stores,
upon her arrival in Halifax harbour,  the  men began to complain, at
different times, of pains in their heads, attended with rigors and shi-
verings, and  great  lassitude,  loss of strength, with violent retchings;
the matter brought up from the stomach, 1 was told,  had the appear-
ance of contaminated  bile.\   A 'number  of men from his majesty's
ship  Hussar,  were also on board this  vessel, several of whom died;
and it was remarked, that  they were either very yellow some time be-
fore death,  or turned  yellow  soon after it.  In  short, from what I
could learn  from the prize-master,} and other people on  board, it must
haVe been the yellow fever.
  " I  had not an opportunity  of attending those men  myself,  as  they
were sent to the hospital,  agreeably to the dates, immediately upon
their complaining.   They were accommodated in the out apartments
of the hospital, and in tents erected in the fields.   I  went frequently
and saw them.   The method  of treatment was as follows : strong ca-
lomel, or other active purgatives, were given in  the beginning,  and
repeated, whenever an inclination  to vomit came on,  and after the ir-
ritability of the stomach was  subdued; bark, serpentaria, decoctions
of chamomile, and  other tonics,  were given freely, with plenty  of
wine, and nourishment; ar; also, ripe fruits.   In some cases,  sluicing
with  cold water, was administered, with good effects.  They all  re-
covered, which I suppose  was owing to early  assistance  being given at
the hospital."
  In conversation, Mr. Sawers told me that the  disorder of the nine
men  belonging to the Thetis  was slight, that they were able to  walk
about, but looked sallow, and had been taken to the hospital rather as a
precaution, than from  any  urgency of sickness.   That the Prevoyante
had remained three or four months at Guadaloupe, after coming there
from France,  and had  lost some men during  that interval, by the yel-
low fever; but that she was in good condition, and her crew very healthy,
at the time  of her capture; and that they gave no disorder to the  The-

  * This expression leaves it uncertain, whether the writer meant that these men had
died on board  the Raison, during her passage from Caudaloupe, or whilst she was em-
ployed as a prison ship ; hut the latter 'terns to have been the fact.
  f This comparison does not give me any better idea of the " matter"
  i It appears, by this reference to the prize-master, that no medical assistant could
have been sent on board La Uaison, notwithstandingthe great number of her own sick that,
as is pretended, were left on board, and the additional sickness and deaths of the men be-
longing to the Hussar : and if it had not been for the little information  here given by Mr.
Sawers, we should have had none whatever, respecting the sickness of the nine men be-
longing to the Hussar, who died before her arrival at Halifax.   And even at this time, af-
ter all my researches and inquiries, I am utterly ignorant how  soon any one of them was
attacked after being sent on  hoard ; what other symptoms, excepting turning yellow, ap-
peared in any of them ; how long the illneSs lasted, nor when any of them died, [fit had
been wished to compel  a belief of their having all died of yellow fever, by  withholding
every thing requisiie to form any judgment whatever, this extraordinary omission would
have been very natural. 
497
tis} which  ship did not send one man to the hospital after her arrival
at Halifax,  excepting the nine who were on board La Raison.   It ap-
pears, however, by official documents, that two of the crew  of the
Prevoyante, notwithstanding her good and healthy condition, died on
the passage to Halifax, viz:—one, a French seaman, on  the 25th of
May,—and one black seaman, on the 26th; whilst none  died  of the
Raison's crew, though represented as being then in a most sickly and
deplorable condition.  And it is moreover in proof, that after their ar-
rival at Halifax, the sickness and mortality were much greater among
the crew of the Prevoyante, than among that of La Raison.
  But as Dr. Wilson has given an  account of his proceedings with
the 83 sick, of the Hussar's crew, it will be proper  to give a like  ac-
count, in regard to such of the crews of the French ships Prevoyante
and Raison, as sickened before the  7th of July,  after they had been
transferred, on the 28th of May, to  the prison  ship, Security,  at Ha-
lifax.   It appears, from the books of the Naval  Hospital there, that on
the 31st of May,  eight of the crew of La  Raison, were sent from the
prison ship to the hospital ; three of whom died before  the 25th  of
June,  and one on the 9th of July; and these were all the deaths from
the crew  of that ship.   The  other four remained in hospital  four
months ; and it seems probable, that the whole number of eight, had
either  hectical, or  chronic, affections; because Mr. Halliburton,  in
his letter of the 25th of June, to the  Commissioners of Sick and Hurt,
giving an account of the sick French prisoners, says,  " One  or two
hectic patients have died, but none with this fever:" meaning the sup-
posed  yellow fever:—an observation which applies  equally  to  the
crews of the Prevoyante, and makes a detail in regard to  them unne-
cessary.   It seems  probable, however, that after the crews of these
ships had been transferred to the prison ship, they were exposed to the
contagion of typhus, which is, indeed, no uncommon event, in such
situations,)  though Mr.  Halliburton, and Dr. Wilson, imagined it to
be the contagion of  yellow fever.
  Mr, Halliburton, in the letter just mentioned, after  giving'an  ac-
count of his, and  Dr. Wilson's proceedings,  in regard to the Hus-
sar's men, supposed to be labouring under yellow fever,  adds, " the
disease now began  to make its appearance on  board  the  prison-ship,
and as they were much crowded, I represented to Captain  Home, now
senior officer, that the same precautionary measures should be adopt-
ed, which were pursued respecting the Hussar; that the sick must be
separated from the  sound  and  healthy, and that all with suspicious
symptoms should  likewise be removed.   In consequence  of which, a
place was hired about six miles from the town,  by water, called Kava-
nagh's island, and all the sick, to the number of 31, were  towed there,
in a boat by themselves, that they might have no communication with
the ship's boats that towed them.  Ten or  a dozen of them were very
ill, and many* of  them were afterwards seized with  it, who had the

  * It appears, by this expression that the disease did not actually o.cur  in all who had
 the first symptoms upon them ; and  this circumstance  ought, perhaps, to h-sseu the
 regret which we must otherwise have felt, at Mr. Halliburton's not having made us as
 wi»e as himself, in regard to the nature of these " first symptom*
                                63 
498
first symptoms upon them, when removed, but we have not as yet lost
 one of them ;  and by pursuing Dr.  Rush's mode ol treating the Phi-
 ladelphia fever by bleeding,  See." " has proved very successful, and
 highly pleasing and satisfactory."
   It appears by the books of the hospital,  transmitted by Mr. Halli-
 burton, to the sick and hurt office, that this "removal of sick prisoners
 took place on the 15th of June;  and that  they  consisted of 17 men,
 who had belonged to the Prevoyante, and of  14 who had belonged  to
 the Raison ; and  certainly there never was a more harmless yellow fe-
 ver, excepting that of the men under Dr.  Wilson, nor one more ac-
 commodating; for, except one man, who, besides the fever, seems to
 have had some lingering chronical disorder, they are all stated to have
 been ill, exactly fifteen days;  so that  as they had been all towed  to
the island in one boat, they might all be towed back in another. There
is, however, one important fact  connected  with this transaction, and
which seems to have been hitherto quite overlooked ;  and this is, that,
among the 17 supposed /yellow-fever patients from the Prevoyante, six
were, blacks, (negroes,)  whose names are  distinctly  entered;  and of
 the 14 from La Raison,  three were also  blacks, though there were on-
ly ten  of  that description among  her crew.  Now  the  idea  of nine
 blacks, coming directly from the West  Indies, where they might have
bid defiance to the yellow fever, even when most prevalent as an epi-
demic, and taking that  disease at Nova Scotia, a place where, like
Great Britain,  from its moderate temperature, the  yellow fever never
did, nor ever will occur, (at least without a great alteration of its cli-
mate,) must  appear as ridiculous and absurd as  any  thing which  can
be imagined ; at least to those who may have read the preceding parts
of this volume, or who  shall have otherwise acquired competent infor-
mation on the subject.  This single fact, in my judgment, would suf-
 fice to  prove,  indisputably,  that  the disease in question, could  not
have been the yellow  fever ;  because the notorious insusceptibility of
 negroes,  coming directly from a hot climate to a cold one, would ne-
 cessarily, according to  the principles formerly  stated,  and  the uni-
 form experience of more than a century,  have been encreased, not
 diminished;  but, on  the  other  hand, their  susceptibility  of disease,
 from typhus contagion,  by such a transition from heat to cold, would
 have been augmented, as has been repeatedly observed:  and this may
 explain why so great a proportion of negroes took the (typhus1 fever
 at Halifax.  Dr.  Blane,  in his letter to Baron Jacobi, asserts, what he
 has indeed repeatedly mentioned in his other writings, that the yellow
 fever " has never been known to  appear, except either in tropical  cli-
 mates, or in those  seasons in the more temperate climates,  in which
 the atmospheric  heat has, for some length of time,  been equal to the
 tropical heat, that is, at, or above 80°  of  Fahrenheit's thermometer.
 This i he adds) is a fact  incontrovertibly established by observation;
 for  there is no instance  either in North America,  or Europe, of the
 yellow fever appearing, except  at these degrees of heat, nor of  its
 surviving after it had fallen to a lower degree of temperature."  Now,
 if Dr. Blane, before  he  allowed  himself to adopt  and give his sanc-
 tion to this story, of a communication of the  yellow fever, by the
, crew  of  La Raison, to  those of the Hussar, &c.  had exercised his 
"   499
good sense, in reflecting upon the  Usual and probable temperature of
the atmosphere on the coast of New England and Nova Scotia,  at that
early season of the year, he must  have been convinced that it never
could have there attained, and much less have been " for some length
of time," at, or above 80° of Fahrenheit's thermometer.  Mr. Sawers
told  me, on the 26th of  October,  1807, that on the passage to Hali-
fax,  after the capture of  the Frevoyante and Raison,  they had encoun-
tered a gale of wind from the north-west,  which rendered the air cool,
as it must have done on that coast,  where this is the coldest wind; and,
indeed, it appears by the length of the passage,  v12  days) notwith-
standing the  aid  of  the  gulf stream, that the winds must  have been
generally from the north, and the temperate, probably,  was  during
that time much oftener below than above 60°: and it is well known that
even in  South Carolina,  except from a rare concurrence of circum-
stances, the yellow fever does not prevail  before the month of July or
August; who, then, will believe, that  in the frigid climate of Nova
Scotia, it should have attacked so many persons, about the end of May
and beginning of June ? and this though it never did before, nor since,
appear there, even in the hottest months of the summer.*
  Whatever the cause of the fever may have been, it certainljTwas not
derived from, nor first applied  to, the crew of the  Raison; for no one
of them appears to have  had it, until near the middle of June; where-
as, it is stated in the abstract of Dr. Wilson's Medical Journal, authen-
ticated by his own signature, that three of the Hussar's men (viz. W.
Atterly, John Lopez, and Jonas Ireland were attacked with it, in that
ship, on the 25th May, and two others on the 26th; and, notwithstand-
ing all that has been strangely asserted to the contrary, the crew of La
Raison, if any faith  can be placed in official documents,  were  less
sickly, and had less mortality  among them, than  those of  either the
Hussar or the Prevoyante.
  It would be to me a very unpleasant undertaking, were I to enter
upon a critical examination of Dr. Wilson's general account of the ag-
gregate symptoms of his supposed yellow fever patients; an account'
so indiscriminating and  deficient that no  body can  discover from it,
whether the ordinary progress of the fever lasted a week or a month;
or even whether it was continued, remittent, or intermittent; and though
some of the 14 questions forwarded to Dr. Wilson were especially, and
pointedly directed to  these important circumstances, I  obtained no
answer to them.  Whether Dr. Wilson was  unwilling or unable to

  * Dr. Trotter, in the first volume of his Medicini Nautica, has introduced the following
  atement, at page 357, viz—
  "December 3d—most of the ships which have returned  this season, (the Autumn of
1796,) from the West Indies, have been sufferers from the yellow fever; yet the dis'euses
in all of them, uniformly dissappeared as they increased their  latitude : at 32" North,
no fresh attacks were known." " The Dsedelus frigate, that arrived at Portsmouth in
October, left the islands with this fever on board; so large a number of men and officers
were affected, that captain Countess thought it expedient to push for Halifax, to land his
sick ; but before he reached that port, the disease had taken a favourable turn, ami was
soon extirpated." If this effect was  produced  on the coast of America, in the hottest
part of the Summer, how can it seem credible, that,  in the month of May, and with cold
northerly winds, the yellow fever should have  made so many "fresh attacks," as were
supposed in the Huzzar,  so much beyond the 32d degree  of North latitude, and even at
Halifax itself. 
000
 remember,  is best known to himself; there is, however, one of his
 symptoms,  which I cannot overlook, as the description of it seems to
 have been intended to obviate all doubt of the fever's having been  the
 true yellow fever: and this is " a constant vomiting of,  at first, a yel-
 low, and afterwards of a very dark-coloured bilious matter?'   At that
 time, the black  vomit, so called, was thought by  many persons, and
 probably by Dr. Wilson, to consist in a great degree of condensed or
 dark bile, and this description seemed to have been intended to induce
 a belief that black vomiting was a common symptom among  his  pa-
 tients.   But that I might not fall into a mistake on  this particular, one
 of my  questions was directed immediately to it: as another was to the
 number  or  proportion  of the  sick who became  yellow ;*  but  these
 questions, like all the others, were left completely unanswered, and, as
 I must think uncandidly ; because it is incredible that Dr. Wilson should
 not, at least, have known his own meaning  in regard to the " very dark-
 coloured bilious .matter" vomited by his patients;  and it was, I think,
 his duty  to remove all doubt concerning it.   Certainly, if what is com-
 monlv  understood by black vomiting had occurred, in even one of his
 83 patients, there is the  strongest reason to believe that no more than
 82 of them  would have recovered.   And his unexampled  success, if
 there were no other reasons to disbelieve the existence of yellow fever
 am mg his patients, would render it absolutely incredible.  Some gen-
 tlemen, indeed,  from whom I should have  expected more discernment,
 have strangely  imagined that  the  recovery  of every individual of 83
 patients,  under  Dr. Wilson, might be ascribed to  a superiority in his
 treatment of them, without suspecting that the disease was not the true
 yellow fever; and Dr. Wilson seems to have derived credit and promo-
 tion from this mistake; which, however, is not likely to subsist;  experi-
 ence having, I  believe sufficiently proved,  that in cases of the  true
 yellow fever, recoveries have not oftener resulted from this, than from
 other modes of treating that disease:  and it will,  I think, have been
 fortunate, if no  mischief has been done, by an imitation of that part of
his practice, which consisted in the giving  of antimonial emetics*

  * 1 have  already several times remarked, that yellowness of skin is not a characteristic
symptom of the yellow fever, nor a rare occurrence in typhus; but, on the contrary, that
in some circumstanoes and situations, (particularly one mentioned by Dr. Lind) it has so
frequently accompanied the latter fever, as to have procured for it the name of yellow
fever. Dr. Mane  has, also, mentioned a similar occurrence on board the Royal Oak,
where a ship-fever,  introduced by six men  who came from England in the Anson, and
 which extended to thirtv others, was attended with yellowness of " the eyes and skin," in
all that were affected by it, though the disease was very  mild in most of the cases.  See
his work  on the diseases of seamen, p 148 and p. 352-
  • 1 have mentioned the danger of giving  emetics in yellow fever, at p. 67, &c. and this
dang«r is multiplied  in a ten-fold degree, by preferring antimonials.  The following is Dr.
Moseley's observation, respecting the effects of emetic tartar, or tartarised Antimony, em-
ployed by Dr. Wilson, to the ext-nt of three grains, viz.  " How often have I seen and la-
mented the effects of emetic tartar, given to remove the supposed cause of the  treache-
rous symptom of vomiting !  Even in slight degrees of fever, in the West Indies, in young
plethoi-ic subject.:, newly arrived, the stomach has been some times destroyed by iu la-
stead of removing the irritating sickness in this (yellow) fever, or exciting a diaphoresis, a
spasm has been produced in the stomach ; incessant vomiting ; inflammation ; the vessels
of the thorax am! Iiead have been stifled with blood, and the patient has vomited away his
life." See his valuable work on topical diseases, 8tc p. 435 of the Third Edition. 
601
  That the fever which spread among the crew of the Hussar, and in
the Security, prison ship, could have been no other than a typhus, I am
convinced.  It was, indeed, so unusually mild, and devoid of mortality,
that we can only account for so many recoveries, even under that fever,
by the known effects of a warm temperature (which  would  have taken
place at Halifax in June) in first moderating, and soon after producing
a cessation of it.
  Whence the  infection of this fever was derived I cannot be expected
to explain, destitute as I am of all information respecting the commu-
nications  which the Hussar may have had with infected persons, or
things.  Mr. Sawers told  me, what indeed must be otherwise highly
credible,  that  ships of war on the Halifax  station, were  sometimes
known to get the  contagion of typhus, by pressing seamen, and emi-
grants, out  of merchant vessels going from Great Britain and Ireland
to the United  States,  &c.  many of the  latter being often taken  from
the lower classes of society, among whom that fever is but too  com-
mon.
   In regard to  the fever  which  produced so much mortality among
the men sent by the Hussar, on board the Raison, and of which we
know nothing,  except that  some of them became yellow, either before
or  after death, it would be presumptuous in me, without more informa-
tion, to offer any thing but (a very probable) conjecture, that it was oc-
casioned by the foul air or morbid effluvia, contained in her hold, or
in  some other part which these men had rummaged, in search of rum,
or wine, or other  things which their appetites, or cupidity, might dis-
pose them to plunder, and which, in a prize,  they might expect  to
find, perhaps, concealed.  In numerous instances,  fevers  resembling
the yellow fever, and  even more generally and speedily mortal, have
been  manifestly  produced by  exhalations  from the  foul  ballast, and
other decomposing matters, retained in the ships ;*  and the fact  stated
in  Mr. Sawers's  Medical Journal, as  lately noticed, in regard to the
men belonging to the Thetis, who were sent on board the  Raison, viz.
that " when they began to move her stores, upon her arrival in Halifax
 harbour, the men began to complain, at different times, of pains in-their
 heads, attended with rigors and shiverings, and great lassitude, loss of

   • For decisive instances of such fevers, produced by these causes, see the  New-York
 Medical Repository, vol. i- p. 394, vol. ii. p. 327, vol. iv. pages 2, 3,243, 245, and 353 ; vol.
 vi. p  15'J ; vol. vii. pages 86, 87, and 88 ; and vol. viii. p. 71. The first instance in the
 4th vol. of this Repository relates to a yellow fever produced by the foul atmosphere of
 the hold of the  America frigate, General  Green, which was fatal to twenty  persons,
 and decidedly not contagious; though some of the crew fell sick on board, several weeks
 after she had been cleansed and  freed from the noxious matters producing the  noxious
 atmosphere; a circumstance, for which it then seemed difficult to account, but which,
 from what I have mentioned in a former part of this work, concerning the time that mi-
 asmata often remain inactive, may now be readily explained.  See also, for similar in-
 stances, Trotter-'s Medicina Nautica,  vol. ii. p 97, &c.  Dr Gillispie's volume,  page 19
 20 21 and 61; and Valentin's work on yellow fever, from p. 121 to 129.  I could easily
 multiply these quotations, but I will finish with one from Dr Mane, on the diseases of sea-
 men p 609 viz.  " With regard to the effect of putrid exhalations, I need only menUon
 that at the time of the battle of the 12th of April 1782, there was not a sickly  ship ui our
 fleet hut many of the officers and men who were sent to take care of the French prizes,
 were seized with the yellow fever ; and it was observed, that when at any time the holds
 of these ships, which were full  of putrid matter were stirred,  there was an evident in-
 crease of these fevers soon after." 
502
strength, with violent retchings, 8cc. seems to prove the existence of a
noxious atmospherer or rather of matters capable of emitting noxious
effluvia when disturbed; and  this might well be expected  in a ship
which had been long employed as a prison ship, and afterwards sent,
probably without being cleaned, to obtain a cargo in the United States,
for France.   That this fever, or that which afterwards occurred at
Halifax, could not have resulted from contagion in the Raison,  must
be evident; because if that had been the case, as it  must have  been
applied  to her own crew several weeks before, and for a much longer
time than it was to those of the Hussar and Prevoyante, the former
would not have been among the last and least sufferers by it.  Here I
will close this appendix, and, with it, this volume.
/ 
J '
^4 www mmmw m®*m®v
         BY
  JOHN B. DAVIDGE, A.M. M.D.

\ 
 
NOTES.
                            ft .     —!.

                             Page 40.
The matter of black vomit is, notwithstanding the reports of the ex-
aminations of bodies dead of the yellow fever, sometimes met with in
the gall-bladder, common duct leading  to the duodenum,  and  in the
duodenum, in considerable quantities,  as well as  in the stomach.  I
have had occasion to observe this fact, and have also been informed by
respectable authority, in which the utmost confidence may be placed,
both as to dignity of character, and acuteness to observe, that such is
the fact.  To Dr. Wm. Donaldson, a physician of great circumspec-
tion in  observation,  and extensive professional knowledge,  I am in-
debted on this head.
  That the matter of black vomit is  the result of morbid secretion,
appears to be the opinion of some of the best informed in  this  city,
Baltimore.  The hemorrhage occasionally met with is, perhaps, inci-
dental.  That the liver is the  organ chiefly concerned in the  secretion
of this matter, I  am  strongly  inclined to believe, from its presence  in
the gall-bladder, and its existence  in cases where there has been no
effusion of blood, at least, observable.

                             Page 93.
I have  taught, from my Chair as Professor, for several years  past, the
doctrine, which  I am much gratified to find advocated by the able pen
of Bancroft, that putrid animal matter, simply as such, is never pro-
ductive of fever. -  And although in certain habits, sickness at stomach
and faintness may  occur from the effluvia of putrid animal bodies, yet
in regard to th^production of regular fever, of whatever type  or genus,
they are wholly innocuous.
  The  genius of our learned author has shed much important light on
the subject of Typhus, arising from collections of healthy persons in
ships, hospitals, or jails.   He properly  and judiciously rejects all such
speculations, and places the affair in its proper attitude.  There is no fever
that can with propriety be attributed to any such collections of healthy
persons. If disease, febrile disease, take place among persons crowded
                               64 
506
together in ships, or jails, or hospitals, we must look for its cause to
some other source, than the recrementitious materials thrown off from
the bodies; the cause is from without.   When  persons die under the
circumstances above suggested, it is somewhat as when they die from
carbonic acid gas; they are killed negatively.   In other words, they
die for want of pure, repirable air;  not from any poisonous operation
of the  ffluvia.   These effluvia, I hold to be, equally with those from
putrid dead animal bodies, unproductive of a febrile disease.

                            Page  122.
In the Introduction, I have taken the liberty to prefix to this volume,
the reader will have perceived that I have called the attention of the
medical philosopher.to the important, yet simple fact, that no feverous
disease arises from, or with propriety can be referred to, more than some
one simple cause, however aided that cause may be by circumstances
incidentally disposing the body to be acted on.   And that if the yellow
fever be derived from marsh miasmata, as is proved by the ingenious
and learned author of the present work, and is well known to be a fact,
by every man conversant with the subject, it is  altogether unphiloso-
phick, if not absurd, to ascribe it to a  poison generated in the body.
All communicable diseases, so far as our researches extend, have their
origin universally from poisons generated in the living body. How con-
tagious diseases came first into  operation, whether  from  climate and
conditions of life, or original poisons created by Deity, as  the various
principles of animal and vegetable lives are, I am not prepared to an-
swer. Much  learning and talent have been displayed on both sides.
   No disease, that has its origin from a poison or cause not formed by
the morbid action  of living vessels, is communicable or contagious.
 And if the yellow fever be, a thing occurring daily, imported  from one
 country to ..nother, it must be in the original materials, and not by dis-
 eased bodies, or infected clothes.  I  touched on thi*^ subject in my
 Sketches, published in 1798.

                             Page 312.
 In the year 1797 I was, by a particular combination of circumstances,
 led Into a discussion on the nature and  origin of the yellow fever.  Mat-
 ters took such a course, that I  deemed it proper, in the beginning of
  1798, to collect and arrange into  form  the scattered and fugitive re-
 marks,  that,  during the  discussion, I had occasionally given to the. 
507
public, and to publish them  in a more serious and formal manner, as?
the result of my most mature deliberations and judgment.
  In this small Treatise, I assumed it, as an ascertained medical axiom,
that no marsh disease is a communicable disease; that the yellow fever \
is a marsh  disease; that as  such it cannot be communicated by any ;
intercourse of persons; that its diffusion is co-extensive with, and at.
tributable to the marsh effluvium; and that no disease whatever is de-
rivable from  more sources  than one:  every  simple effect being the
production of a simple cause.
  Sir Gilbert Blane, although he  has  altogether failed in establishing
his  favourite  hypothesis,  furnishes an important argument for us to be-
lieve that the yellow fever is not found beyond the influence and opera-
lion of the  marsh effluvia.   So well assured is he of this valuable and
pertinent fact, that he delivers it as his serious and professional opinion,
" the few cases that occurred in the Hussar, after her arrival at Hali-
fax, are to  be ascribed to the inhalation of poison in the warmer lati-
tudes," (not to the contagion emitted from the diseased bodies on board
of ships); " and ventured to assure the Ministers of Russia and Prussia,
that their countries had  nothing to fear  from the importation of this
pestilential epidemic."
  No point in medical history is better ascertained, or more strongly
estabUshed, than that all  diseases known tb be contagious, are certainly
more communicable in the colder than in the warmer latitudes.   Nor
can a stronger  or  more  conclusive argument against  the contagious
nature of the yellow fever  be brought  forward than the well-settled
fact; it does  not communicate in the  more cold and humid  regions.
It is well known, and wholly beyond controversy, that all poisons, ani-
mal secretions, are more condensed,  and, in proportion to their state
of concentration, more  active, in  the  colder than in the  warmer lati-
tudes.  This holds true  in regard to the small-pox, measles, chicken-
pox, mumps, &c.  &c. and every other contagious disease which acts
through the  medium of the atmosphere.  Contagions  that act by im-
mediate contact, as canine madness, siphilis, and perhaps the plague,
act equally in the  colder or warmer regions.  I am writing at present
on diseases that communicate at smaller or greater distances, without
contact.  But to return  to the facts of  Sir Gilbert,
   " It has never," says Sir Gilbert Blane, " shewn itself, in the fisrt
instance, but in a sea-port town, and never in the interior of the coun'
 try, whether island or continent." 
508
    In scientific disquisition there is nothing less entitled to considera-
  tion, or  more  unphilosophic, than dogmatical gratuitous  assertion.
  That the  yellow fever has never, in the first instance, shewn itself but
  in a sea-port town, is wholly gratuitous, and in direct opposition to facts
  from the most  respectable authorities.  From authorities, which, as
  they are not professional, and had no particular prepossession to sus-
  tain, must be viewed as the more valuable and disinterested.
    To aver that to be an uniform, or even a general fact, which has been
  the object of our personal observation only, is to proceed very far on the
  principle of  the begged question.  For although personal observation
  affords respectable ground on which  our  author is  to repose  his opi-
  nions, it is proper to take into account the consideration that our indivi-
  dual experience does not embrace in its range the whole field of facts, and
 may not be laid under those circumstances, as to country and climate,
 demanded by the subject in discussion.  That the  first appearance in
 the interior of the country, in any one instance, of the yellow fever, was
 not the experience of Sir Gilbert, is  a thing very probable.   But from
 such personal negative  observation there can be no positive induction
 that the fever never shews itself, in the first instance, but in a sea-port
 town.  The conclusion is  far more than commensurate with  the pre-
 mise, and  such as  to furnish  ample reason to question the  ground
 upon which it is made.
   That the  yellow  fever does not shew  itself, except in a  sea-port
 town, involves a full consideration of all the circumstances of its origin.
 We are led by the position to an examination of all those sources from
 which it may possibly derive its existence: and also of the various tes-
 timonies as to facts.   It must be shewn, that the original cause; what-
 ever it may be, cannot have place but in a sea-port town.   The disease
 must have derived  its origin from  some  definite cause, and under
 given circumstances. What can this  cause be, and what are those cir-
 cumstances ?
   If the cause be human effluvia, it is difficult to conceive the circum-
 stances, in a sea-port town, under which such  effluvia  can efficiently
 act, that could not have place in a town in the interior of the country.
 whether island or continent.  I am apprized of the operation of no
 cause or causes productive of disease, contagious  or not contagious,
exclusively the production of a sea-port  town.   Whether human efflu-
via, or marsh effluvia, or  any vegetable poison, be the subject pre- 
                              509

scnted to mind, I am still at a loss to conceive why, occasionally, «uch
effluvia or poison might not be furnished, under given circumstances,
in an inland as well as a sea-port town.
  That  the yellow fever does  not shew itself, in the first instance, ex-
cept in a sea-port town, is, a priori, indefensible, and, I am convinced,
in contravention of well-established facts.
  Dr. Miller, of New York, in his excellent  Essay on the Yellow
Fever, repeats a communication,  highly important and valuable, by
Mr. Andrew  Ellicott, a gentleman of character, both as regards ability
to observe, and integrity to  communicate such matter, as his enlight-
ened mind might deem worthy of communication and public notice.
  " The village  of Galliopolis," says this judicious observer, " is  a
few miles below the great Kanhaway, on  the west side of the  Ohio
river, and situated on a high  bank.  It is  inhabited by a number of
miserable French families.  Many of the inhabitants, this season, fell
victims to the yellow fever.   The mortal cases were generally attended
with the  black  vomiting.  This disorder certainly originated in the
town, and in all probability  from the filthiness of the inhabitants, added
to an unusual quantity of animal and vegetable  putrefaction in a num-
ber of small ponds and marshes within the village."
  " The  fever could not  have been taken there from the Atlantic
States, as m*y boat was the  first that descended the river after the fall
of the waters in the spring.  Neither could it have been  taken  from
New Orleans, as there is no communication at that season of the year,
up  the river, from the latter to the former of those places.   Moreover,
the distance is so great, that a boat would not have time to ascend the
river after the disorder appeared that year in New Orleans before the
winter could  set in."
  " General  St. Clair," continues  Miller, " who had the advantage of
a medical education, and is,  moreover, a gentleman "of a  discriminat-
ing mind and distinguished  talents, has assured me, that he is well
convinced the yellow  fever is an endemic complaint,  in  a large por-
tion of our south-western  country, where  he  resided as governor a
number of years."
   Here are two  interesting facts;  one communicated, in a public do-
cument, by a gentleman who cannot be supposed to be at all involved
in  the professional question of contagion; the other by a gentleman
who was educated under  the old doctrine of contagion.  Until  1797, 
510
when a fugitive communication  or two appeared  in  llie  Baltimore
newspapers, from  my pen, I find nothing but the idea of contagion
in any American writer, and it must be presumed that the preposses-
sion and habits of thought with  general St. Clair, were  in  favour of
contagion.  The circumstances of  his observations  must have  been
very decisive in character,  for him  to embrace new sentiments, and
abandon altogether the doctrines he  had received in his early years.
   With the former of these gentlemen,  Mr. Ellicott, there could have
been no conceivable reason, or interest, for him to misrepresent a plain
fact.  He could have had no professional prejudice to overcome; no
affair of party to support.   In short, there could be nothing to give to
his narrative a false or disingenuous colouring, or to hU mind a dis-
honest obliquity.  He is not only positive as to the fact, but, by a plain
and conclusive course of reasoning,  shows that the disease must have
derived its origin from  the circumstances of the village.
  In addition to the above,  we are furnished with a fact or two by Dr.
Watkins, a man of distinguished  talents and acute observation; and
whose decision is the more valuable, inasmuch as he was educated in
Edinburgh, under the doctrine of contagion, and is to be  presumed
not to be wholly free from prejudices in favour of the  system of con-
tagion.
  " There  is a village," says the Doctor,  " called New-Design, about
fifteen miles from the Mississippi,  and twenty from  St. Louis, con-
taining about forty  houses, and two hundred souls.  It is  on high
ground, but surrounded by ponds.  In 1797, the yellow fever carried
off fifty-seven  of the inhabitants,  or more than a  fourth.   No person
had arrived at that village from any part of the country where this fe-
ver had prevailed,  for more than  twelve months preceding.  Our in-
formant resided in the village at the  time, and, having seen the disease
in Philadelphia, Jhe declares it to be  the same that prevailed at New-
Design.  He also mentions an Indian v illage depopulated by the same
disease, two or three years before."—Med. Rep. vol. iv. p. 74.
   In corroboration of the above communication, Dr. Watkins, during
a stay of a  few days in Baltimore, visited several cases of yellow fever
with  me, and gave  the assurances  that he had seen,  in the western
country, perhaps alluding to the instances already quoted, a disease
accompanied by all the circumstances  and phenomena that  were pre
sent in the yellow fever we were then visiting. 
511
  2dly.   " No part of the population of the towns whfere it has broke
out has been affected,  but such as had some communication with the
shipping, directly or indirectly."
  What  sir Gilbert intends to convey by the term indirectly, it is diffi-
cult to conceive,  since no one  fact on the page of faithful medical re-
cord is  more  uniformly true,  than  that no persons residing remote
from the sources of marsh effluvia,  have ever received the disease by
way of contagion from other persons, who have  contracted the fever
by being in the more  immediate vicinity of such sources.
  Why  those who  may be in the neighbourhood of the shipping, will
have the disease, is obvious.  The shipping is along the wharves, and
the wharves are,  for the most part, constructed  in, and sometimes of
the alluvious soil, the  very materials  to which the origin of the fever is
justly referred.   That certain  persons, of highly susceptible  habits,
residing  at sites remote from the shipping, may be affected, is not only
possible, but probable.  It may be readily conceived,  and there is re-
spectable record to support the opinion, that by certain currents of
air, the poison evolved by the  wharves or ponds, or alluvion, may be
carried to great distances, and  applied to those highly  sensitive habits,
and produce the disease, while the general  population would remain
healthy.   What given quantity of the poison is  adequate to the pro-
duction of the. disease, is not ascertained-;  and were it,  the great varie-
ties of susceptibility remains to be settled.   Before a medical philoso-
pher permits himself to admit the existence of contagion, he should be
well satisfied that no marsh effluvia are present;  since few, or no men
are so sceptical at the present,  as  not to concede that  this fever does,
in the general, have its origin in poison thrown off by alluvious earth.
   Sir Gilbert Blane constantly speaks of this fever, as being present
with the shipping.   He does not surely mean that it  arises  from the
ships, or the sea-air, or the sea-water.   It must be ascribed to some-
thing contained in  the ships.  What can this something be ? If it be
animal  matter—animal matter is  found remote from ships, in all its
possible conditions. If it be vegetable matter—vegetable matter, under
all its changes and revolutions, is met with in places distant from  ship-
ping or  wharves.  If animal and  vegetable matter, mixed  and  com-
bined, the same mixture and combination  are  discovered  in ponds
and lakes, and alluvious soils  in the interior of the country, whether^
rsland or continent.  If the reference be to multitudes collected  togc- 
512
ther, and living filthily, the same conditions of life are to be met with
on land, in places to which ships can have no access, and under the
same latitudes.
  '* In the year 1798," says sir Gilbert, " I wrote a letter to Mr. Rufus
King, minister from the United States of America to the British court;
and in  the year 1801,  another to Baron Jacobs, minister from Russia,
for the information of their respective governments.   In these letters I
laid particular stress on what occurred regarding a French ship, taken
in battle on the coast of America, in  May,  1795, on board of which,
this fever, or its infection,  was  found, and was communicated to the
seamen of the British ship  Hussar, by the men in health,  who  were
shifted into her from the prize.  It is evident, that if it could be proved
that this fever  is communicable  from one ship to another at sea, such a
proof of the reality of contagion would be of the nature of an experi-
mentum crucis, there being no possibility of land exhalations to ac-
count for it; such I then considered, and still consider the facts of this
case to be; they  were, however, so strongly and so  speciously con-
tested  by Dr.  Bancroft,  as  greatly to frustrate the  impressive effect
which my statement was calculated to produce.   The reader will be
able  to judge of the  validity of his objections from  an annotation at
the end of this work.  I feel to  myself that I was so  far from making
too much advantage of these  facts, that I might  and ought  to  have
availed myself of them still more.  I  might have adduced them as a
very striking  illustration of the incompatibility of the  disease with a
certain temperate degree of atmospheric heat, for the range into, cool
and pure air, in proceeding to Halifax, did in a very short time, first
deprive it of its malignity,  and  then of  its infectious nature, so as en-
tirely to extinguish it.   The few that were seized after arriving at Ha-
lifax, might have  imbibed the poison, in the warm latitudes  through
which they passed.  It was on the strength of such facts as these, that
in my conferences with the members of the  British parliament, and in
my correspondence with those of Russia and Prussia, I ventured to
assure them that in none of those countries was there any thing to fear
from the importation of this pestilential epidemic, which in the end of
the last century, and in the  beginning of this had so afflicted the West
Indies,  North America, and  Spain, as  to  excite  a  general alanfi
throughout Europe." 
513
  u There is another useful remark which I did wrong in omitting in
my statement of fourteen men sent from the Hussar to navigate the
prize, nine died before reaching Halifax, a passage of twelve days; the*
other five were sent to the  Hospital, where some of them  probably
died."                           •
  In the two paragraphs, just quoted, Sir Gilbert Blane has given what
he terms the experimentum  crucis.   From them  I expect to derive
such proof as will be satisfactory to all, in any  degree acquainted with
the nature of the subject, that there is not in the circumstances detail-
ed, the slightest evidence in favour of the hypothesis of contagion.
  " It is evident," says Sir Gilbert, " that if it could be proved that this
fever is incommunicable from one ship to another at sea,  such a proof'
of the  reality of contagion, would be of the nature of an experimen-
tum crucis, there being  no possibility of land exhalations to account
for it."
  It has never before been suggested  by any writer', that the yellow
fever, as to  its origin or cause, is attributable  to land exhalations.  I
was not aware that land,  as land, evolved any exhalations  to which any
fever could be legitimately traced.  It is only contended that the yellow
fever is properly ascribable to a certain condition of vegetables, whether
on land or on board of ship.  Arfd, notwithstanding the authority of Sir
Gilbert, I am still disposed confidently to believe, that putrid coffee, or
cabbages, or potatoes, or flax-seed, &c.  &c. would be  the same, in na-
ture and effect on board of ship, as on  the land.  The profession, no
doubt, will be amused, if not instructed, to hear from such high and
respectable authority, that the yellow fever is derived from land exha-
lations; or that it is  necessary for putrid vegetable matter or foul water
tp be on land, to emit the noxious  poison from which this fever draws
its origin.
   Hitherto it has been  presumed,  and really I thought the opinion
rational and modest, that vegetable or  animal substances, in a given state
of putrefaction and quantity, would,  other circumstances  being  equal,.
produce the same effects at sea as in harbour.   But it appears that the
common sense of the world, acting upon the  experience of all ages,
has been wrong; place and vehicle are every  thing !
   Perhaps, however, Sir Gilbert, or those  who conceive  his facts and
arguments to be decisive, can furnish the rationale, why a foul ship, a*
                                 6-5 
5U
the French prize is acknowledged to be, lying along-side of a clean
ship, at sea, could not, as readily and certainly, by poisonous exhalations
evolved from her foul materials, produce disease in the seamen of the
healthy ship  as in harbour.
  To my understanding the proxiritity and relative position of the ships,
the exhalations and presence  of healthy excitable bodies, the inter-
course between the ships, would result in the same on the ocean as at the
wharf.
  Sir Gilbert says nothing of the relative position of the ships while en-
gaged in battle, or after the French struck her colours to the English
ship; not whether they fought in contact, in grappled relation; nothing
as to the course of the wind, whether from  the foul French ship to the
healthy British seamen, nor whether the French ship was boarded after
the fight, hy way of taking possession  of her, by the  British seamen;
nor whether the very seamen who took possession, in part, at least, were
not those, who after the ships set sail for Halifax, became diseased.
  An inquiry into the above is of primary importance to me:  but  to
Sir Gilbert  and his admirers it may not be so necessary.  They are
satisfied that no land exhalations were present.
  As the facts now stand stated, there is no more evidence or probability
of contagion, than if I were, with a company of armed men, to approach
a wharf, or any other source of foul alluvious ground,  engage in battle
prove victorious, take possession  of the unhealthy district,  and, after
the delay of some hours, necessarily  consumed in making arrange-
ments, within the range of the miasmata,, again continue on to my des-
tined position, taking with me  a few healthy prisoners, there would be,
that my company would be diseased by the healthy men taken, and not
by the poisonous exhalations which had been inhaled during the con-
test, and the delay in the neighbourhood of the alluvious ground.   And
were I to give publicity to the opinion, that the company attacking, most
certainly took the disease from the healthy men, and not from'the foul
district, my ignorance, I believe, would meet with little else, from men
of science, than pity or contempt.
   The cases are parallel as far as  regards every thing that can be con-
ceived to be efficient in the production of the disease.
   To know how very foul the  French ship was, we have only to admit
the evidence of Sir Gilbert, " that of the fourteen men  that were put
6n board the prize to navigate her into Halifax, in the course of twelve 
515
days nine died, and the remaining five were sent diseased to the Hos-
pital, where probably some died."
  Certainly no ship could be more foul; but yet, not a word is said of
the medical men, nurses, or patients in the hospital.  Was the disease
communicated to them?  No.  Did  the purity of the air of the Hos-
pital check the  contagion ?. A contagion can act at sea, in  the purest
air, but cannot be propagated in a Hospital!  Had a few of the citizens
of Halifax paid a visit to  the foul prize, they, in all probability, would .
not have found the air of such purity, as to have kept them  in safety.
  Can credulity itself admit that  a contagion which, on board of ship,
is so virulent, as not to permit a solitary man, out of fourteen, to es-
cape, and  yet to become weak and  innocuous the instant it is placed
within the walls of an Hospital!
   In regard to the British ship, the Hussar, we are told that the sea-
men were infected by the healthy taken from the prize ship.  Sir Gil-
bert does not enter into particulars;  he does not say all her seamen.
Yet the phrase, the " healthy men from on board the prize communi-
cated to the seaman of the Hussar," does, by liberal interpretation, mean
the whole.   Or  Sir Gilbert may mean that the healthy men from the
prize, communicated the fever to the men of the Hussar who had beep
on board the prize.
   That he does not mean the whole of the men of the Hussar is cer-
tain, from what follows.  " The  few that were seized after arriving at
Halifax, might have imbibed the poison in the warmer latitudes through
which they passed."  And if the few who were seized after arriving at
Halifax, imbibed the poison while  passing through  the warmer lati-
tudes, what certainty is there  that the few or many  that were seized
before her arrival at Halifax, did not derive the poison from the same
source—the  warmer latitudes.  Or from a source far more probable,
the exhalations of the prize while engaged in battle with her, and sub-
sequently during the stay in her neighbourhood.  The marsh effluvia
will evolve its effects in morbid phenomena, after the lapse of eighteen
or twenty days, or indeed several months.  I write from personal ob-
servation and knowledge.  See Bancroft, p. 81.
   " There have occurred, since the period  alluded  to, facts equally
conclusive, regarding the communication of the disease from one ship
to another.  It  will be enough to specify one or two.  A French ship
 of war, the Palinurus, lying at  Martinique, severely affected with the 
£16
jfeMow fever, was ordered on a cruise, to  try the effect of sea-air oa"
the disorder.  She fell in with and captured the Carnation, a merchant
ship, on her passage from England, part  of tiie crew of which were
seized with the fever while at sea.   Another French ship of war, in
which this fever prevailed, both at St. Domingo, and on her passage
to Brest, made prize of a merchant ship from the Mediterranean, off
Cape Finisterre, and having, without shifting the persons, sent a party
of their own seamen to navigate her, the crew of the prize caught the
fever,  and almost all died of it.   The men having been  seized on
board of their own ship, makes it a stronger case than the other, in
which this circumstance is not mentioned; had they been taken ill oh
'board the capturing  ship, it might have been said, that it was from the
exhalations of the hold or stores."
   In the affair of the Palinurus, the narratiye, as far as it goes, amounts
to but little.  It is not stated, whether the men were  changed  from
Che  merchant to the foul ship.  It is only affirmed, that the Palinurus
captured a merchant ship from England, and that a part of the  crew
were seized with  the fever while at sea.  It may fairly be presumed
that the healthy men were translated to the French ship, for Sir Gil-
bert appears at this stage  of his argument, to be quite sensible of the
possibility, perhaps  certainty, of the disease being communicated by
the  " exhalations  of the hold and  stores."  And had the capturing
ship sent her men on board the merchant ship, he would have been
careful to take advantage of the fact.  The case of the  Palinurus,
therefore, might, with no  loss to  the argument, have been omitted in
this catalogue of imaginary  facts,  It is altogether without bearing on
the  subject.
   The second  case carries with it, at first view, some speciousness
and plausibility.   It however, conveys us to the old ground, and we
have again to inquire, at what distance did the merchant ship remain,
ftfter capture, and while she kept with  the ship of war, affording facili-
ties for the removal of the men from the ship of war, together with the
 body and bed-clothes to her own cabin ?   With the men, provision
for their support until they could arrive at Brest, was, doubtless, con-
veyed from one ship to the other.   This provision, possibly, might be
 vegetable, and this vegetable matter not in the sweetest and soundest
 eondition.  Might I propound the question,—Was this disease at first
 produced, and afterwards kept up, by this provision ? On land, nothing 
517
more usually gives  origin to  fever, than  putrid  cabbages,  pola*
toes, &c.
  Without the least  violence to probability, or even fact, it  may be
admitted, that the two ships lay in convenient relation to each other,
side by side, or at a short distance.   The  two ships, under such cir-
cumstances, would of necessity be involved in the same exhalations,
which, Sir Gilbert acknowledged, in the other ship, to pour out from
the hold and stores very copiously.  Twenty minutes  may be, equally
with twenty days, sufficient time for the poison to make its impression.
From the great mortality the  poison  must  have been active and con-
centrated.
  All that is said  derives probability  and strength from the fact that
the capturing was  the foul ship.  Hence  there could be no possible
reason why the two ships  should keep at a distance.
  It is not said that, on the  arrival  of the ship carrying  those, almost
all of whom died on their way to Brest, the disease was communicated
to any persons of the  town or hospital.
   Neither Sir Gilbert, nor any of his  admirers, will tell us that the air
of a city or  hospital,  is better suited to put a stop to a contagious dis-
ease than the pure air of the ocean.  While on board of ship, as in the
affair at Halifax, the disease  operated;  but when the men were  re-
moved to the hospital, it ceased.  Nothing can be more clear and con-
clusive, than that the poison was in the ship, and not in the persons.
   Such are the facts  which have afforded cause of great triumph to a
writer,  in a late number of the Medical Recorder; a book deservedly
of extensive circulation, in favour of the opinion, that the yellow fever
is a contagious disease.  Facts, from  which my mind, were they insu-
lated,  and the only known facts in relation to the fever, would deduce
the opposite  conclusion,  or surrender its privilege of  thinking and
reasoning.  The assertions of sir Gilbert Blane, and the pretty  and im-
passioned declamations of his friends,  being Is id aside, there is nothing,
as I hope, the reader perceives, in his facts, to induce even a careless
inquirer to believe otherwise, than that the yellow fever is of the marsh
progeny, and incommunicable.   Dr. Bancroft had great reason,  in-
deed,  to contest the subject, and weaken the confidence of any Boards
fei the  opinions and conclusions of sir Gilbert.. 
518
                            Page 337.
 It is gratifying to the cultivators of science, and highly beneficial
 in the promotion of patient and successful research, to see such abili-
 ties and professional knowledge, as possessed by Armstrong and Ban-
 croft,  blending their  powers and influence in recommending the im-
 portant, and I apprehend defensible  doctrine,  that the typhus fever is
 a contagious disease,  and referrible to a generick poison  alone, in the
 same manner as small-pox, canine madness, Etc. Sec.
   While  I refer the  reader to the work of Armstrong,  for the facts
 and the arguments, he will excuse me,  if I quote a sentence or two
 from his valuable pages.  His opinions are so pertinent,  and so natu-
 rally constitute a part  of my present subject, I  cannot avoid doing my-
 self the pleasure of recording them.
   At page 7, says Armstrong, " It strikes mc, that to call any species
 of fever typhus, which has not the contagious essence, capable of pro-
 ducing an unequivocal typhus, is equally incorrect in logic as in lan-
 guage. In this essay, therefore, the word typhus shall be limited to
 the peculiar disease,  which is allowed to originate from a specific con-
 tagion, and which, doubtless, has the power of  producing  an affec-
 tion of its  own nature, in individuals exposed to its influence."
   The typhus is not,  so far as my observations have extended, a dis-
 ease of Maryland,  perhaps not of America;  at any rate,  not south of
 the New-England  states.  And since, as Armstrong and Bancroft,
 and most other enlightened physicians,  admit contagion as essential to
 typhus, (I here refer  to the typhus of Britain and Ireland) it  must be
 highly absurd to speak of the typhoid condition of diseases, in regard
 to those diseases that are not admitted to be  contagious in any stage.
 For surely, no disease can be said  to be like another, that is  deficient
 in an essential quality.  Hence it appears, how unphilosophic the lan-
guage is, that -states the low and collapsed condition of  the  body, in
 remittent  bilious fever,  synocha of the winter, or pneumonia, to be
 typhoid.  Those diseases are wholly distinct from typhus, in all their
 stages, cause, and sensible phenomena. 
519
                            Page 369.

In my nosology, I have considered the  plague as  a species  of
typhus.   More extensive reading, and the consultation of the more
modern and enlightened authorities, have, however, satisfied me that
I was not correct.  The plague, upon the authority of  those who ap-
pear to  have had the best opportunity to  observe it, is an exanthemar-
tous or eruptive disease, and as distinct in nature and character froqi
typhus, as from small-pox, or measles;  it is a disease sui generis*
.THE ENB, 
 
INDEX.
                               A.

Abeksethy, Mr. quoted for a case of black vomiting without yellow
  fever, p. 26, n.
Adams, Dr. quoted in regard to variolous and vaccine infections, 91, n.
  His  opinion that febrile  contagion may be generated by crowding,
  contested, 338. His mistake respecting the Old Bailey session, 1750,
  445, n.
Agathias,  quoted respecting the plague in Justinian's reign, 392, n,
Aip.e, J. J. Job. his deputation to Cayenne, 104.
Akenside, Dr. his opinion of Dysentery, 354.
Appendix, No I. On the nature of the black vomit, and the condition
  of the stomach, &c. in yellow fever, 415.
         , No. II. Proving that putrid  animal effluvia do not cause
  fever, 420.
________, No. III. Proving that the crowding in the black hole at
  Calcutta, did not produce fever, 425.
________, No. IV. Facts respecting the  black assize at  Oxford, and
  the spring sessions at the Old Bailey, 1750, 430.
--------, No. V. Hotel Dieu, at Paris, 446.
--------, No. VI. Salubrity of Peat bogs, 447.                  •
________, No. VII. Confutation of Dr. Chisholm's account of a « Ma-
  lignant pestilential fever" supposed to be brought to Grenada by the
  ship Hankey, 447.
________t No. VIII.  Controverts the alleged communication of yellow
  fever from the French prize, La Raison, to the crew of his majesty's
  ship, Hussar ,488.
Anjula, Dr. his account of the yellow fever in Andalusia, 307.
Armesto,  Dr. Rodriquez, his account of the yeljow fever at Cadiz, 30,6.
                                 66 
522
                               B.

Bacon, Lord Chancellor, his opinion concerning human putrefaction
  and jail infection, 93.
Baglivi, quoted respecting the effects of marsh miasmata at and near*
  Rome, 165.
Balfour, Dr. his designation of Dysentery, 353.
Bartholina, Thomas, his account of a marsh fever at Copenhagen, 209.
Batavia, accounts of, 127.
Baussard, Mr. his dissection of a putrid whale, 423.
Baynard, Dr. Edward, quoted respecting the weather during the plague
  of London, 1665, 404, n.
Beaver, Captain Philip, quoted  in Appendix, No. VII. passim.
Berthe, Professor, sent by the French government to enquire concern-
  ing the yellow fever, 44. n.
Black Assizes at Oxford, 110.
■-----------at Exeter,  111.
------■------at Taunton, ibid.
Black hole, at Calcutta, 108.
-----skin diminishes the sun's rays, 193.
----vomit, not peculiar to the  yellow fever, nor a constant symp-
  tom, 39.
Blane^Dr. his opinion of the Black vomiting, 45.
Boghurst, Mr. William, quoted respecting the plague, 410.
Bourgeois, M. mentions a remarkable difference between Creole  and
  African Negroes, 195.
Brocklesby, Dr. mentions the  yellow  suffusion of the skin in marsh
  fever, at the Isle of Wight, 211.
Buce, Mr. William, his account of marsh fever and dysentery, at
  Sheffield, in New England, 355.

                                C.

Caldwell, Dr. asserts the temperature at Philadelphia to be from  four
  to six degrees above  that of  the surrounding country, 191.
Chalmers, Dr. his account of the effects of heat and moist, in South
  Carolina, 187.
Chirac, M. his account of the yellow fever at Rochefort, 297. 
52%
Chisholm's, Dr. observations on his practice of exciting salivation, 74>
   in Appendix, VII.
Clarke, Dr. James, of the influence of the weather in producing yellow
   fever, 149.
------, Dr. John, his acconnt of the violent effects of marsh effluvia at
   North Island, 79.
 Clay in soils, favours the generation of marsh miasms, 85.
 Coxe, the Rev. William asserts that jail fever does not exist in Russia,
   116.
 Cullen, Dr. his definition of yellow fever, 25, of typhus, 337, of dysen-
   tery, 353, of the plague, 376.

                                D.
' Dancer, Dr. his account of the expedition against St. Juan, 195, n.
 Davidge, Dr. his account of the yellow fever at Baltimore, 252.
 Deidier, Dr. rejects the use of mercury in the plague, 411.
 De Roset, Dr. of the yellow fever in North Carolina, 249.
 Desgenettes, Dr.  quoted respecting the plague, 398, &c.
 Devize, M. of the yellow fever at Philadelphia, 257.
 Deimerbroeck, of the plague, 377.
 Du Tertore Pere, of the yellow fever at St. Christopher's, &c. 224.
 Dysentery, when  epidemic is  connected with marsh miasmata, 353.

                                E.
 Eckard, Mr. Danish Vice-Consul at the Philadelphia, corrects some
•   of Dr. Chisholm's gross misrepresentations, 463.
 Epidemic, definition of, 8cc. 29.
 Evagrius, Scholasticus, his account  of tiie plague in the reign of Jus-
    tinian, 372, n.
 Exhumations at Dunkirk, &c. See. 95.
Fellows, Sir James, his letter to the author, 330, n.
Ffirth, Dr. his experiments with the matter of black vomit, 291.
Fontana, L'Abbe, his opinion of the yellow suffusion produced by tlw
  poison of vipers, 51. 
524
Fontana, Nicholas, his account of the morbid effects of marsh mias m$,
   122.
Fordyce, Dr. George, that pure aqueous vapours produce fever,  127,
   8cc. &c.
Forestus, his account of a fever caused by a putrid whale dissected.

                               G,

Gilbert, Medecin au Chef, Sec. 234.
Gilchrist, Dr. Ebenezer, 342.
Gillespie, Dr. of the production of marsh fevers,  125.
Gonzales, Dr. his account of the,yellow fever at Cadiz, 312.
Grainger, Dr. quoted concerning dysentery, 368.
Grant, Dr. (Jamaica) denies the  supposed contagion  of yellow fever,
   244.
Guthrie, Dr. his account of the Russian peasants, 101.

                               H.
Hamilton, Dr. Robert, his account of marsh fevers near Lynn Regis,,
   209.
Haygarth, Dr. 81.
 Heberdeen, Dr. quoted, 31.
 Herring,  Dr. quoted, 405.
 Hodges, Dr. quoted, 403.
 Holwell, Mr. black hole of Calcutta, 425.
 Hosack, Dr. of the  yellow fever,  273.
 Hunter, Dr. John, black vomit, 48.

                                J.
 Jeeferson's, Mr. official declaration,  295,.


                                            «
 Kennedy, Dr. Gilbert, 298.

                                L.

 Lawrence, Mr. his letter on the innocency of exhalations from putrife
   human bodies, 420. 
                             525

l.ind, Dr. James, 26.
Lining, Dr. yellow fever, 260,

                              M.

Morton, Dr. remittent fever formerly prevalent in London, 40.1.

                              N.

$Tooth, Dr. judges  rightly that the yellow fever at Gibraltar was ntft
  contagious, 327.

                              P-
Poupee Desportes, M. on (he yellow fever of St. Domingo, 150.
Plague, definition, Sec. Sec. 369,

                              R-.
Ramsay, Dr. David, 245.

                               S.
Selden and Whitehead, Drs. yellow fe^er in Virginia, 259.
Stomach, its high importance, 40.

                              T.

Typhus, jail, a contagious fever, 337.

                              U.

Ulloa, Don Antonio, his account of Peru, 134.,

                              V.

Vapour, pure aqueous, not a cause of feVer, 13%.

                               Y.

Yellow Fever,  different appellations  of,  25—observations on  its
   generic and specific names,  25 to 29—distinction between sporadic
   and epidemic, 29, 30—symptoms of, 30—parts most affected, 35 - 
                            526

dissections of bodies dead of it,  36—black vomit, 39—affections  of
the skin, 46—diagnosis  of, as disan;..;■• Ashing from the plague and
typhus, 56—treatment, 58—causes of, 122—proved not to be con-
tagious, 332.
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